It is impossible to predict if a person has 6 months to a year to live.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The UK will soon debate an a bill to legalize assisted suicide. Kim Leadbeater (MP) will soon introduce a bill to legalize assisted suicide. The language of the bill has not been released but it is anticipated that the bill will permit a doctor to prescribe lethal poison to a person with six months or a year to live.

An article by Janet Eastham that was published in the Telegraph interviews end-of-life care medical professionals. Eastham reports:

The Telegraph revealed that Ms Leadbeater’s legislation is expected to specify the timeframe within which someone is reasonably expected to die, with prognoses of between six and 12 months being considered.

Eastham then reports:

Prof Katherine Sleeman, Laing Galazka chairman at King’s College London, told The Telegraph: “It is not possible to accurately determine someone’s prognosis as a number of months, say six months or 12 months.

“As a doctor, patients do ask me, ‘How long have I got left?’ and I would never say, ‘Six months or fewer.’ I might say, ‘Your prognosis is probably measured in months, or “long months”.’ That’s as precise as I would be.

“When someone has only a few days, or certainly only a few hours left to live, it can be easier to understand with a higher degree of certainty that they’re likely to die within that time-frame. But when we’re getting into the territory of months, it is very, very difficult.”

Prof Sleeman noted the “arbitrary” nature of a six or 12-month prognosis, something illustrated by the DWP’s data, which “shows that people who were estimated to live for only 12 months ended up living for more than three years”.

Medical professionals told Eastham that a 6 month or 12 month terminal prognosis is arbitrary. Why not four months or eight months. 

Baroness Finlay of Llandaff, a cross-bench peer and former professor of palliative medicine tells Eastham:

“Predicting life expectancy is impossible… I have known people who live well and actively for years after they were thought to have no more than a few weeks to live.”

Eastham interviews Prof Chris Parker, a senior oncologist, who said he had seen one such patient “only this morning” and said:

“Ten years ago, he was told that he had terminal cancer, and he’s now alive and well,”

Parker offered Eastham a warning:

“I have little doubt that some patients would choose assisted suicide if it was legal, because they were told they had less than six months to live, but in truth, if they had not had assisted suicide, would have lived for years and enjoyed a good quality of life, because I’ve seen patients like that.”

The Euthanasia Prevention Coalition recognizes that a six or twelve month prognosis is included in assisted suicide bills to suggest that the law will be limited to people who are actually terminally ill but it is impossible to accurately predict a six month terminal prognosis.

Further to that, once legalized the six or twelve month terminal prognosis becomes discriminatory to people who are not dying but have a chronic condition. 

What begins as a "safeguard" is soon eliminated because it denies unequal access to a legal procedure.

Euthanasia: too easy for people to view death as a solution

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Baroness Finlay of Llandaff, a member of the UK House of Lords and a Professor in palliative care, warned Scotland's government that: 'online content is promoting a “culture of death”'. Llandaff warned Scotland's government that legalizing assisted death could “gradually get eroded”, leading to “almost death in demand”.

Sophie Villegas reported for Holyrood on November 29 Baroness Finlay commenting on Canada's experience with euthanasia:

“It becomes too easy for people to view death as a solution. It's been estimated that it's about 60 hours of clinical time to really process a request properly. Well, I would prefer that you spend 60 hours of clinical time improving people's quality of life… We need to be saying that people's lives are important. We need to help them live as well as possible for as long as possible,” she added.

“It would be wonderful if every doctor, every nurse, was well-motivated. But goodness me, we have seen disasters in this country of people abusing their position, to say the least, and almost clocking into a culture of death, which is dangerous."

Scotland is once again debating the legalization of euthanasia and assisted suicide. The text of legislation has not yet been released. Scotland's parliament last voted on the issue in 2022.

Oregon's assisted suicide law - significant data gaps

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The British Medical Journal Supportive and Palliative Care published a study by Dr Claude Regnard, Ana Worthington and Ilora Finlay, researching the access to the Oregon Death with Dignity Act over the past 25 years. The study analyzed data from the Oregon Death with Dignity reports (1998 to 2022) that are published annually by the Oregon Health Authority.

Link to the study

The study examines the number of deaths, the reported reasons for seeking death, and the application of the law. It uncovers significant problems with the Oregon assisted suicide data.

Assisted suicide rate

Over 25 years, 2,454 individuals have died from an assisted death. In 1998, 24 prescriptions were written for PAS drugs and 16 patients died from ingesting these drugs. On average, the number of PAS drugs prescribed under the legislation increased by 13% each year and the number of patients who died by ingesting these drugs by 16% annually. In 2022, 431 prescriptions were written, and 278 patients died by PAS. The proportion of deaths following ingestion of prescribed drugs compared with the prescriptions written increased slightly, from an average of 58% in the first decade (1998–2007) to 66% in the second decade (2008–2017), following which it has been stable at an average of 67% over the last 5 years.

The study examined the increase in assisted suicide deaths and indicates that the numbers have increased on a nearly steady basis.

End-of-life concerns for participants

In the first decade of legislation of PAS in Oregon, an average of 65% of participants were privately insured. Since 2008, this proportion has reversed; in 2022, 20.5% of those who died by PAS held private health insurance, while the majority (79.5%) had government insurance through Medicare or Medicaid.

The percentage of PAS patients who cited being a burden on family and friends increased during the time period. The number of patients reporting financial concerns about treatment as an end-of-life concern is low, though there is evidence of an increase over the time period (up to 8.4% in 2021). In the first 5 years of PAS, an average of 30% of participants were concerned about being a burden. Since 2017, this concern has been cited by around half of those who die by PAS (46% in 2022).

Patient eligibility and approval process

Eligibility under the DWDA requires that patients have been diagnosed with an illness that will reasonably lead to death within 6 months. Cancer remains the main diagnosis of PAS patients, though the proportion has reduced over the time period from an average of 80% in the first 5 years to 64% in 2022. In 2022, 109 patients (25% of prescription recipients) were granted an exemption from the usual 15-day reflection period on the basis that they were terminal. Since 2010, patients with a range of non-cancer diagnoses have received PAS including non-terminal illnesses such arthritis, arteritis, complications from a fall, hernia, sclerosis, ‘stenosis’ and anorexia nervosa.

Referrals for psychiatric evaluation have declined as a percentage of assisted deaths. In the first 3 years after enactment (1998–2000), a psychiatric assessment was sought in an average of 28% of cases. By 2003 this had dropped to 5%, and in 2022, 1% of patients who died from PAS underwent psychiatric evaluation. Since 2010 there has been a reduction in both the median duration of the physician–patient relationship and the time from the first request to death. In 2010 the median physician–patient duration was 18 weeks, dropping to 5 weeks in 2022. The time from the first request to death had reduced from 9.1 weeks in 2010 to 4.3 weeks in 2022.

Assisted suicide drugs

From 1998 to 2015, the most common drugs used for PAS were barbiturates, with phenobarbital, secobarbital or pentobarbital used alone. It is now standard for drug combinations to be used, with different combinations being used in the last 8 years, although the dose of each constituent drug is not reported: 2015–2022: DDMAP (diazepam, digoxin, morphine sulfate and propranolol); 2018–2022: DDMA (diazepam, digoxin, morphine sulfate and amitriptyline); 2019–2022: DDMA-Ph (DDMA plus phenobarbital). The 2022 report states that the combinations have resulted in longer times from ingestion to death (3 mins to 68 hours; median 52 min), compared with an aggregate range of 1–104 hours, with a median of 30 min over the 25 years. The number of prescriptions per doctor has increased from an average of 1.6/doctor in the first 5 years to 1998, to an average of 2.7/doctor between 2018 to 2022.

Stated complications following the ingestion of PAS drugs have included difficulty in ingesting drugs, regurgitation, seizures, regaining consciousness and ‘other’ complications that are not described. Complications associated with PAS drugs were reported in an average of 11% between 2010 and 2022, with a peak of 14.8% in 2015. In 2022 complications were identified in 6% of patients, though data on complications was missing in 206 patients (74%). Over the last 25 years, nine patients have regained consciousness.

In Oregon in 2022, 46% of patients did not take their prescriptions. Of these, 84 died of other causes. In 101 patients the ingestion status was not known, only that 43 died. In 58 patients the status of death and ingestion was unknown at the time of the report.

Demographics for assisted suicide deaths

Patients’ end-of-life concerns are reported across eight categories, allowing several concerns to be reported. It is unclear whether these are the patients’ direct reports or those reported retrospectively by the clinician. Concerns cited about ‘losing autonomy’ (91%) and ‘less able to enjoy activities making life enjoyable’ (90%) remain dominant across each year. Over time, there has been an increase in the proportion of patients including concern about being a burden on their caregivers and in those expressing financial concerns about their treatment.

The OHA reports reveal a higher uptake of PAS among those with higher educational levels, but income levels are not given. In Belgium, lower education levels are associated with less intense pain and symptom alleviation, but income was not examined. It is possible to have a high education attainment, but be on a low income. Other vulnerabilities are becoming clearer. For example, patients with mental health issues asking for assisted death in the Netherlands were more likely than the general population to be female, single, of lower educational background and with a history of sexual abuse. In Switzerland, although PAS was associated with higher socioeconomic status, PAS was also more common in females and situations indicating vulnerability such as living alone or being divorced. In 2018 an Oregon Health Statistics official acknowledged that they will accept PAS requests if the patient has refused treatment for financial reasons. Although socioeconomic data already exist for some medical conditions in Oregon, these have not been linked to PAS requests.

Recently the cost benefit to individuals and to society of assisted deaths have been discussed in relation to quality-adjusted life years (QALYs). Economic arguments in support of assisted deaths include the avoidance of possible negative quality of life of the patient, and freeing up healthcare resources for others including organs for transplantation. ... A 2019, a US Gallup poll found a quarter of respondents reported they or a family member had been put off treatment for a serious medical condition because of the cost. In 2020, 31.6 million people in the USA (9.7% of the population) had no medical insurance.

There is a dearth of studies linking socioeconomic vulnerability and PAS data. The change in health funding in Oregon is unlikely to be due to a lag in data since the change to state funding started 15 years ago. Detailed studies are needed to explain the marked change in medical funding for PAS patients in Oregon.

Doctor-patient relationship

The very low referral rate for psychiatric evaluation could be the result of an efficient screening process. However, there is evidence that depression and existential issues such as hopelessness can influence a wish to die and are commonly missed by doctors. Loneliness is known to be associated with depression which, in turn, increases the likelihood of a wish to die. Elder abuse, which can be difficult to identify, has become a major public health issue in both the USA and the UK, and in Oregon, elevated rates of non-assisted suicide have been observed in older women. The OHA data show that the duration of the patient–physician relationship is now almost the same as the time from first request to the assisted death. This steady reduction in the physician–patient relationship in Oregon may have made it more difficult to identify treatable factors influencing the wish to die, but there is a lack of recent data on how many Oregon PAS patients have a treatable depression.

Assisted suicide prescriptions

In 2022, 146 Oregon physicians wrote prescriptions, one of whom wrote 51 prescriptions. These doctors represent <0.9% of the 16 621 active medical licensees. There is a lack of data on whether this results in difficulty seeking a prescriber, whether those writing few prescriptions have limited experience of assessing eligibility, and what happens to the nearly half of prescribed PAS drugs that are unused.

Oregon does not provide data on what proportion of PAS deaths take a particularly long time to die. Washington reported that in 2021 31% of patients died within 30 min and 16% took more than 2 hours to die. Although the time was unknown in 17.9%, the Washington reports provide no information on the drugs used and whether they were changed to achieve shorter dying times.

The Oregon OHA reports show that complications affect one in nine patients on average, although Oregon does not include prolonged deaths or patients who regained consciousness in their complication percentages. A peak in the complication rate (14.8%) in 2015 coincides with a switch to drug combinations. However, the true incidence of complications is unknown since in 2022 data on complications were missing in 206/278 (74%) of assisted deaths.

Expansion of assisted suicide in Oregon

Oregon is often given as an example of stable assisted dying legislation. In January 2020 Oregon waived the statutory 15-day waiting period for patients estimated to have a shorter prognosis, resulting in a quarter being granted this exemption in 2022. In 2022, 16 patients (6%) outlived their 6-month prognosis following prescription of PAS drugs, but there is no detail on how many had treatable conditions or had been misdiagnosed. In 2017 the OHA confirmed that incurable terminal illness is when there is an affirmative response to the question ‘should the disease be allowed to take its course, absent further treatment, is the patient likely to die within 6 months?’. Any patient has the right to refuse treatment, but it is concerning that there is a lack of data on why they refused treatment and how they were advised and counselled.

For example, in 2021 anorexia nervosa was one of the diagnoses listed, but without any details of comorbidities, if this was an isolated case, or whether the clinician misjudged the prognosis or misapplied the law. Anorexia nervosa in any young adult with capacity is terminal if it persists, but it can be challenging to determine the point at which treatment cannot succeed.

In 2022 a federal lawsuit brought by an Oregon doctor forced Oregon to allow non-residents to access PAS.

Involvement with palliative care

In 2022, 92% of people requesting PAS were enrolled in hospice care and the mean for 1998–2020 was 90.8%. However, there are no data on what services were provided and the term ‘palliative care’ is not mentioned in any reports, nor the duration of enrolment.

...The lack of information on whether Oregon PAS patients are receiving care from specialist, interdisciplinary palliative care, or a single, non-specialist practitioner makes it difficult to evaluate whether adequate palliative care was received before PAS in Oregon.

Limitations that exist in examining Oregon assisted suicide data

We limited our analysis to descriptive trends. Retrospective analyses for PAS in Oregon are limited to the content of published reports since Oregon destroys all source records 1 year after each annual report, making verification of data impossible. In addition, missing data for some variables (eg, complications) is high and Oregon does not collect data on how or why PAS decisions were made, pre-evaluation or post-mortem review of cases and the details of rejected requests.

We have found no evidence of the completeness or otherwise of the notification process. As there is no prescription monitoring service in Oregon, it is not possible to triangulate data on prescribed lethal drugs, their ingestion and disposal of unused drugs. As physicians are not required to be present when lethal drugs are taken, data provided for the reports depends on information from whoever was present and from provider questionnaires.

Conclusion

Oregon is often cited as a stable example of assisted dying legislation. Despite Oregon producing detailed and regular post-death reports of value, there are considerable gaps in the data across US states. Most importantly, there is no monitoring in any form of the quality of the consultation in which the decision was made to prescribe lethal drugs. Although population mortality follow-back studies have been used to study end-of-life care, these have limitations. Detailed, prospective studies that include socioeconomic and clinical information are essential to understand fully the changes seen in Oregon PAS data.

More articles on the Oregon assisted suicide law.

• Article: Oregon reported 278 assisted suicide deaths in 2022 (Link).
• Article: Death tourism has come to Oregon (Link). 
• Article: Oregon 2021 assisted suicide report (Link).

Large number of Peers speak in opposition to UK assisted suicide bill

Date: Friday 22nd October 2021

Release time: Immediate

Very large number of Peers speak in opposition to Lords assisted suicide bill

In line with convention, the Assisted Dying Bill had its Second Reading in the House of Lords today after over 7 hours and speeches from over 60 Peers opposing the Bill. It is the normal custom for Bills to move to Committee Stage without a division at this stage. It by no means implies the support of the House of Lords.

Given the Bill does not have Government support, it is very unlikely to be given the time in Parliament to be debated in the House of Commons and have any chance of becoming law.

The very large number of Peers who spoke against the Bill signifies that assisted suicide and euthanasia are strongly opposed by a large proportion of the House. The content and the quality of their speeches also demonstrated beyond any doubt that this Bill is unsafe and should not pass into law.

It is clear that many within Parliament robustly oppose this Bill.

Baroness Finlay

Baroness Finlay of Llandaff, officer of the All Party Parliamentary Group for Dying Well and a Professor of Palliative Medicine, said:

“Peers have today demonstrated a powerful opposition to this bill. Many vulnerable people are unaware of the dangers in going down this road, as this bill has hidden dangers, unsafe qualifying criteria, and potentially opens the door to even wider legislation.

“Instead, the focus should be on pressing the Government to do more to ensure good palliative and end-of-life care for everyone, everywhere in this country.”

Baroness Campbell

Baroness Campbell of Surbiton, Founder of Not Dead Yet UK and long-term campaigner on disability equality and human rights, said:

“Passing this law would be a dark day in our nation’s history. It would run counter to our duty to protect those in the most vulnerable situations, and would exacerbate their fears, through insidious pressure, of being regarded as an expendable burden. As has happened elsewhere, the Bill would doubtless be extended.

“No major disability rights group in the UK supports legalising assisted suicide. What they support is immediate and sustained improvement in their care. Now is not the time to abandon them to the desperate temptation of an assisted suicide under the guise of compassion.”

Baroness Grey-Thompson

Baroness Grey-Thompson DBE, Crossbench Life Peer and one of Britain’s greatest Paralympic athletes, said:

“The legal, medical and social implications of the Bill for disabled people are enormous. They need to know that doctors are obliged to do all they can to help everyone to live a good life. The current law keeps unconscious discrimination and social bias towards disabled people in check.”

For additional quotes and interviews, please contact Simon Caldwell on 07730 526847;

Or Alistair Thompson from Care Not Killing on 07970 162225;

Or Ben Furner from Not Dead Yet on 07946 355795.

ENDS

Notes to Editors The All Party Parliamentary Group for Dying Well promotes access to excellent care at end of life and stands against the legalisation of doctor assisted suicide in the UK. For more information visit https://www.dyingwell.co.uk/about/

Suicide is not something to be encouraged or assisted.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Baroness Ilora Finlay

Baroness Ilora Finlay, who is a doctor, a professor of palliative medicine and a British House of Lords cross bench member, wrote an excellent article that was published by The House on May 20. Finlay, who for many years has promoted palliative care and opposed assisted suicide responded to a new push, in the UK, to legalize assisted suicide.

Finlay wrote:

The House of Lords is once again being asked to look at a Private Member’s Bill proposing so-called ‘assisted dying’. Words matter. They can inform or they can mislead. In this case it’s the latter.

Contrary to what the words might suggest, what’s being suggested isn’t that people should be given assistance as they die. That’s what doctors, and especially those of us who specialise in end of life care, do. What's being proposed is something radically different – that doctors should be licensed by law to supply lethal drugs to terminally ill people who appear to them to meet certain broadly-worded conditions. In law that’s assisting suicide and it’s unlawful.

Finlay continues:

Campaigners talk of strict safeguards. But what exactly are those ‘safeguards’? If we go by the previous Private Member Bills, they will be vague stipulations about what ought to happen in a perfect world – that someone seeking ‘assisted dying’ should have, for example, a “settled wish to die” and should be free from pressure. But what would be the minimum steps to ensure that these and other conditions were properly met? If we go by previous bills, none.

Finlay then comments on the role of doctors:

Who would be required to make these life-or-death decisions? The answer is doctors – because the people concerned would be terminally ill. Yes, doctors can diagnose terminal illness and offer an opinion (or best-guess ) on prognosis. But can, or should, overburdened doctors to be required to judge whether there is something in the patient’s life that might be influencing a request – like feelings of being a burden, or subtle pressure being exerted by others? No, they can’t assess it reliably.

Whatever the rights and wrongs of ‘assisted dying’ may be, one thing is clear. It is not part of clinical care. Most doctors who are caring for dying patients don’t want such powers. ...

Finlay then comments on compassion:

It may sound compassionate to embed such practices within health care. But it’s also dangerous. We rightly trust our doctors not to do us harm, even if that means sometimes being refused treatments we think we want. Seriously ill patients often look to their doctors, not just for treatment, but for guidance. They are susceptible to subtle messaging. A doctor who agrees to a request for lethal drugs risks sending the message, however unintended, that in his or her opinion suicide is the patient’s best course of action.

Finlay then states that suicide is not something to be encouraged:

It may sound compassionate to embed such practices within health care. But it’s also dangerous. We rightly trust our doctors not to do us harm, even if that means sometimes being refused treatments we think we want. Seriously ill patients often look to their doctors, not just for treatment, but for guidance. They are susceptible to subtle messaging. A doctor who agrees to a request for lethal drugs risks sending the message, however unintended, that in his or her opinion suicide is the patient’s best course of action.

We are told the numbers would be small, yet other legislatures have shown such deaths increase year on year, often with the law’s boundaries becoming ever slacker, rising rates of suicides and yet their palliative care remains patchy and inadequate. As observed previously – such legislation would change the moral landscape.

Thank you Baroness Finlay for your well reasoned professional article.

Some previous articles by Baroness Finlay:

• The law must protect, doctors must care and euthanasia undermines both (Link). 
• Assisted dying: What can we learn from places where it is legal (Link). 
• Objections to assisted suicide are based on concerns over medical integrity (Link).
  

The law must protect, doctors must care, and euthanasia undermines both

The following article was published by Mercatornet on July 13, 2017

A British palliative care pioneer talks to MercatorNet about the campaign for assisted suicide.

By Carolyn Moynihan

Baroness Ilora Finlay

There is not much you could tell Professor, the Baroness Ilora Finlay about death and dying – outside of a war zone, perhaps. The Welsh doctor and Member of the British House of Lords (since 2001), was the first consultant in palliative medicine in Wales back in 1987 and set up the hospice system there. In 1989 she introduced the Diploma in Palliative Medicine at Cardiff University where she still teaches. She co-chairs Living and Dying Well, a think tank to examine the evidence around euthanasia and assisted suicide.

Over the decades Professor Finlay has cared for thousands of people at the end of their lives, and in opposition to the growing euthanasia movement has become an internationally recognised champion of the need for good palliative care for all those diagnosed with a terminal illness.

In 2005 she served on the House of Lords select committee on the Assisted Dying for the Terminally Ill Bill – an exhaustive inquiry into assisted suicide that resulted in the UK parliament rejected the bill. She was also a prominent opponent of a similar bill introduced in 2014 (that was also rejected).

Recently she visited New Zealand where a private member’s euthanasia bill (not the first of its kind here) is now before parliament. David Seymour’s End of Life Choice Bill would allow terminally ill people with six months to live, or people with a "grievous and irremediable" condition – that is, the chronically ill -- to ask a doctor to help end their lives.

Mental capacity and vulnerability

“It’s very similar to the law in the Netherlands,” she told me during an interview in Auckland. “It could even be wider in its effect.” For one thing the Seymour bill does not have an explicit requirement for mental capacity.

“It only states that the person concerned must ‘have the ability to understand’ the nature and consequences of assisted dying. There’s no requirement to ask whether a person at this moment is thinking straight, whether their judgement is unimpaired.

“This would make people with learning difficulties extremely vulnerable. A person with Down syndrome, for example, could ‘understand’ from what they hear and see around them what euthanasia ‘means’ and say yes to it when they have not really understood at all.”

The latest official reports from The Netherlands show that 1 in 26 of all deaths there come about through euthanasia or physician assisted suicide, with an increase of 15 percent year on year. In the words of one of the original promoters in The Netherlands, euthanasia is becoming “the default mode of dying” there.

The majority of doctors remain opposed

You would expect Britain, where Dame Cicely Saunders founded the hospice movement 50 years ago, to be good at looking after the dying. In The Economist’s Quality of Death Index 2015, the UK ranked first out of 80 countries for palliative care, followed by Australia and New Zealand.

But is the medical profession there standing firm in its opposition to euthanasia?

“All the professional colleges in the UK as well as in most places around the world remain opposed, as do the majority of doctors,” says Professor Finlay. “Even in Oregon, where they changed the law, two-thirds of the doctors don’t want to be involved. I met with the New Zealand Medical Association whose chairman is absolutely clear that this is not a role for doctors.

“And indeed it is not the place of doctors to sit in judgement on who is or is not eligible for assisted dying, and then be part of the process of bringing about the person’s death deliberately with lethal drugs, when what they should be doing is getting on with looking after patients and caring for them, helping them maintain their dignity and keeping them comfortable, irrespective of what has happened to them.”

Being in control is not most people’s priority

One of the cultural forces driving the euthanasia movement is the desire of some people in prosperous countries who have always had “choices” and been in control of their lives, to remain in control to the end.

How much do people who actually are terminally ill care about being in control of everything?

“I’ve looked after thousands of dying people,” says Professor Finlay, “and what they want is to feel better than they do at the moment, to live better during whatever time they have left. It has often struck me that people who were adamant when they were well that they would want euthanasia or assisted suicide, when they are ill suddenly change their minds and are desperate to carry on living. When they face the reality of losing life they want everything done to help them live as fully as possible.

“The demand for euthanasia is coming, by and large, from those who are not in the last stage of illness, whereas those who are in the last stage are actually being looked after very well. People are frightened of things that, with good care, will probably not happen to them: that they might lose their mind, become breathless, that pain will become unbearable.”

The grey wave and the cost factor

There’s another kind of fear behind the “demand”, too – fear of the cost of caring for an ageing society. How are we going to care for all the people living longer lives but needing help?

“That’s a really interesting question. What the research shows is that if you look after people well, if you provide palliative care early, and you help them live as well as possible, their depression is lower, hopelessness is lower, the quality of life is higher – so paradoxically they live longer, but the costs are not higher. Because you are helping people maintain independent living and carrying on.

“If you look at the statistics for Oregon, for example, the peak age group for assisted suicide requests is 65-80, it’s not among the 80-plus year olds. And people in their 80s are generally much fitter today than they were.”

Are we up to this kind of care?

Can we, though, count on having enough professionals who want to do this kind of care, with its extra demand for empathy, understanding and personal skills? Are we cosseted Westerners up to it these days?

“Oh yes, we are completely up to it. There’s no problem about people wanting to go into specialist palliative care at all. It is one of the most competitive fields of medicine in the UK.

“I think, also, that there is an awareness that we need to be putting more into care, helping people make decisions, helping them understand that they can refuse treatment. Nobody is being forced to stay alive, nobody is being forced to suffer, as people campaigning for Euthanasia claim.

“However, there is always a power differential in the doctor-patient relationship, and we do need to train doctors to listen to what people need, to help them plan in advance and to modify their wishes as they go along.”

Fragile families and loneliness

Fear of death and requests for assisted suicide may be partly driven by changes in the family. Small families, distant families, broken families, families burdened by big mortgages so that both spouses have to work full time – these trends mean that someone who needs support because of old age or a degenerative disease will often not be able to find it in their family.

“Loneliness is a big killer. There certainly is evidence that it shortens your life expectancy, and both loneliness and the fear of it is a major problem in society today.”

Whatever the problem, the answer is not suicide, not killing. But how should opponents of euthanasia focus their case? Professor Finlay strongly emphasises the proper role of the law.

Prime focus: the law must protect the whole population

“First, you have to ask those wanting to change the law, does the law we have now not work? Laws have to protect the whole population, not just a few, so if we change the law, will more people be protected? Or will you be removing protection from people? All the evidence I have seen shows that these laws cannot protect everyone. The process becomes quite arbitrary: here is a suicide we will try to prevent; here is one we will assist. But why?

“You can’t be neutral. The law is written in a way that will involve you. People who think, ‘I’ll leave that to someone else to deal with,’ are deluding themselves. I think if you object to euthanasia and assisted suicide you have a duty to say so, to collect your thoughts and express them sensibly.

“This, by the way, has nothing to do with religion. It is not a question of what you believe -- people on both sides have their beliefs. Your arguments have to be based on evidence. Sometimes the evidence used is not very strong – you get stories going around that might or might not be true.

“But here is a story that comes straight from the most recent full report from Holland’s monitoring committees. There were three young women who were each severely psychologically disturbed. And in all three it could be traced back to abuse in childhood or early teens. Yet they were allowed to be euthanased because they were so disturbed.

“I have a real problem with a society that says, we will kill the victim with a lethal injection, but the perpetrator is out there, free.”

Carolyn Moynihan is deputy editor of MercatorNet.

British Psychiatrist approves six dementia patients deaths at Swiss suicide clinics

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Daily Mail news reported that a British Psychiatrist, who had lost his medical license, approved the assisted suicide deaths of six people with dementia.

Sanchez Manning reported that Colin Brewer, who is no longer permitted to practice medicine, told the Daily Mail that he had done mental capacity tests on six people with dementia, before approving their suicide deaths in Switzerland. None of the six people were terminally ill.

Baroness Ilora Finlay

Baroness Ilora Finlay, one of Britain’s most eminent end-of-life doctors and an opponent of legalising assisted suicide, told the Daily Mail:

‘You don’t know how the disease [dementia] might or might not progress. 

‘Some people may be frightened and may be in despair. 

‘But if you assist their suicide you cut their life off by months or years when they may never have gone on to experience more severe forms of the disease.’

Alistair Thompson, a spokesman for the group Care Not Killing, added:

‘A lot of people fear that when there is a care crisis within the NHS there will be more pressure on people who are elderly and frail to think about ending their lives.’

The Daily mail article reported that:

Brewer ran an addiction clinic in London before he was struck off in 2006 by the General Medical Council after a patient for whom he had prescribed drugs died. 

He can see and assess patients offering non-medical services as long as he makes clear that he is not on the medical register.

Yesterday, after speaking to a group, one of the attendees told me that he supported euthanasia for incompetent people. He said that when his mother-in-law was nearing death, she became unaware of her surroundings. He asked me, what was the purpose of her life? and then he said - How much money did it cost the government to care for her?

I responded by saying: 

sadly, your comments tell me that history may repeat itself.

Killing is never the solution to human problems. 
We support caring options, not killing.

Assisted Dying: What can we learn from places where it is legal.

Alex Schadenberg

Executive Director - Euthanasia Prevention Coalition

Baroness Ilora Finlay

Professor Ilora Finlay wrote an excellent article that was published in the Guardian today titled: Assisted Dying: What can the UK learn from places where it is legal.

Last year the British parliament overwhelmingly defeated an assisted suicide bill. Finlay responded to the push to legalize assisted suicide with this article. 

Finlay first analyzes the Oregon experience with assisted suicide. She writes:

In 1997 the US state of Oregon licensed doctors to supply lethal drugs to terminally-ill patients who met certain conditions – that they had less than six months to live, had mental capacity and were acting voluntarily. 

Up to 2013 there was a steady overall upward trend in the numbers of such assisted suicide deaths. But from 2013 there has been a marked upturn. The two years 2014 and 2015 saw an 80% increase in deaths of this nature: there are now more than eight times the number than when the law came into force. 

There are other concerns too. There is “doctor shopping”, whereby people whose doctors won’t participate in assisted dying (and two out of three won’t) seek lethal drugs from other doctors who are willing but have never met them before and know nothing about them beyond case notes. One such doctor issued no less than 27 prescriptions for lethal drugs in 2015 alone. 

Prognosis of terminal illness is fraught with difficulty. The reports from Oregon illustrate this. They show that some people who had been supplied with lethal drugs on the basis of a prognosis of six months or less lived for up to three years before taking them. How long they might otherwise have lived is anybody’s guess.

Baroness Finlay then looks at the experience with assisted dying in the Netherlands.

What of the Netherlands? Their 2002 legislation also permits physician-administered euthanasia – where a doctor injects lethal drugs (coma-inducing drugs plus, often, a paralysing agent to cause death by asphyxia). The Netherlands’ assisted death rate also rose modestly at first before turning sharply upwards. Last year euthanasia or assisted dying accounted for one in 26 of all deaths in the Netherlands: that’s the equivalent of over 20,000 deaths annually in the UK. 

The Dutch official reports also reveal legislative drift. Increasing numbers of people were euthanised last year because of psychiatric illness (56 cases) or dementia (109 cases). In 2015 euthanasia was administered to a young woman suffering from post-traumatic stress disorder and anorexia nervosa who had been sexually abused as a child. Dutch campaigners want to make suicide drugs available to people who aren’t ill at all, just tired of life.

Dutch legislators simply didn’t envisage this in 2001 when they enacted the Termination of Life on Request and Assisted Suicide Act – a title that is at least upfront and honest and avoids the sugar-coated euphemisms (like assisted dying) that are used here to cloak the realities.

Professor Finlay finishes by stating:

... Campaigners in the UK claim they only want Oregon-style physician-assisted dying for the terminally ill. But such criteria are purely arbitrary and contain within themselves the seeds of their own expansion. ... The limited criteria we are seeing look more like an unpacking of assisted dying in an attempt to get it through the door of a skeptical parliament. If we are wise, we will learn from the experience of others rather than from our own mistakes.

A longer version of this article was published by the NHS.

Ilora Finlay is professor of palliative medicine at Cardiff University and has taught end-of-life care internationally. She is a crossbench Peer in the House of Lords; her private member’s Access to Palliative Care Bill is before parliament. She co-chairs the independent think-tank Living and Dying Well.