As MPs and peers we write further to the views expressed by Tanni-Grey Thompson, who argues that the assisted dying bill is unsafe (We must reject this intentional killing bill, 9 September). As the debate on assisted suicide intensifies, there is a real risk that the voice of the most vulnerable in our society is being drowned out. Evidence from around the world shows that many who chose assisted suicide cited feeling a burden on those around them as a reason for proceeding.
In Oregon and Washington, which allow doctor-assisted suicide, many of those who ended their lives felt a burden on family, friends, or caregivers. Washington state’s 2014 Death with Dignity Act report recorded that 59% of those who died under the legislation self-identified as feeling a burden. In Oregon it was 40%. People who feel a burden are among the most vulnerable in society and often need encouragement to live. At a time when assistance to those with disabilities is being cut due to austerity measures, and the lives of those with disabilities are being made much harder as a result, it is surely unthinkable that we would introduce a measure that would make suicide more accessible to them.
End-of-life care in our nation is far from perfect, yet opening the doors to doctor-assisted suicide is not the answer. We need investment in palliative care, not a weakening of the protection for those most vulnerable.
Rob Flello MP, Stephen Timms MP, Joan Ryan MP, Jonathan Reynolds MP, Catherine McKinnell MP, Gavin Shuker MP, Fabian Hamilton MP, Valerie Vaz MP, Siobhain McDonagh MP, Gisela Stuart MP, Mary Glindon MP, Barbara Keeley MP, Tommy McAvoy, Daniel Brennan QC, James Gordon, Maeve Durham, Alan Howarth
• In responding to Tanni Grey-Thompson’s article it is important to note the actual harm from the reality of the status quo: no safeguards at all for those fleeing abroad or enlisting loved ones to help them die. Are these people not worthy of concern (who might or might not have a disability also)? If there is a concern regarding motives to seeking an assisted death, then engagement with healthcare professionals is overwhelmingly a better and safer practice. The current GMC guidance states to limit any information to an “explanation that it is a criminal offence”. Is this really the most receptive environment for a therapeutic relationship? No.
Second, one cannot coherently state assisted dying is too risky when it provides far more safeguards than current practices that allow patients to die. Both the current and former director of public prosecutions say the law now is not fit for purpose, yet we are asked to believe that a change in the law is not necessary.
Third, the Oregon Hospice Association dropped its opposition to assisted dying after seeing first-hand that the fears Tanni Grey-Thompson raises were proven to be unfounded. This is beyond doubt. The debate should not be about what doctors/lawyers/baronesses do or don’t “like”. The debate is about patients and what they think.
Dr Paul Teed
Member, Healthcare Professionals for Assisted Dying
• Both Polly Toynbee (MPs should be brave and at last give us the right to die, 8 September) and your correspondents (Letters, 9 September) ignore the plight of the terminally ill learning disabled, who lack any capacity to consent. Whether that be in the form of an advance directive about termination of treatment, or the “hard conversation” that Atul Gawande in Being Mortal eloquently recommends as a necessary and essential constituent of palliative care, the absence of the human right to a pain-free, peaceful and dignified death for the learning disabled is never mentioned. As a parent of a 59-year-old man on the autism spectrum, I have written a foreword to a soon-to-be-published guide (from the British Institute of Learning Disabilities) to end-of-life care for those on the spectrum. Of course, this guide does not advocate assisted dying – and we are aware too of the dark shadow of the Nazi euthanasia (or murder) programme for the mentally ill and disabled. While I know that the proposed Marris bill – even if passed – will not aid my son when his time comes, a discussion is long overdue between the many charities and care providers on giving the learning disabled among us the human rights of their more fortunate brethren.
Co-founder, National Autistic Society
• I agree with Tanni Grey-Thompson and with Zara Aziz (We need palliative care not assisted dying, Society, 10 September). However, Aziz’s comment about dementia is alarming from a doctor – “I can understand the argument about assisted dying when I see people with dementia.” My observations are that people can live happily with dementia. Instead of being frightened by it we need to understand and learn the message of the Contented Dementia Trust, which is that, with its techniques, wellbeing can be sustained until the end of the person’s life.
• Tanni Grey-Thompson wrote movingly on the position of disabled people. But she should also know that in August a Populus poll of 5,000 found that 86% of people with a disability supported the assisted dying bill.
• Healthcare Professionals for Assisted Dying is unrepresentative of the view of the medical profession as a whole on this subject. Its letter omits to mention that in a recent survey of GPs only one in seven said they would be willing to consider whether a request by a patient for assistance with suicide met the criteria in Mr Marris’s bill. Once again, we have the familiar statement trotted out that patients could trust their doctors under an assisted dying regime. It is that very trust that constitutes one of the dangers. A doctor who agrees to process such a request risks sending the signal, however unintentionally, that in the doctor’s view death is in the patient’s best interests. Whatever views one holds on this difficult and controversial subject, one thing is clear: it is no part of good medicine to be aiding and abetting patients’ suicides.
Conservative, House of Lords
• There are some people for whom there is no hope of cure and who are not helped by even the best palliative care. Such people suffer intolerably from symptoms such as pain, nausea and weakness. Being totally dependent on others for all basic needs, such as feeding and cleaning after using the lavatory, is an unspeakable humiliation. These people deserve the right to choose when to end their lives, peacefully and with dignity. The bill is directed towards these people and none others. The difficulty is identifying which people fall into this category and have made a settled decision. But I hope that the fact that this can be complex will not deter members of parliament from having the courage to support the bill and prevent unnecessary suffering for these people and their loved ones.
• A survey of 10,000 older people by Saga has found that 61% are in favour of assisted dying, while only 17% are against. The remainder expressed no preference. Two-thirds of the older Britons said they thought a Dignitas clinic should be allowed to operate in Britain. They believe that the law should be changed so people can choose to end their lives in Britain by a lethal dose of drugs, even if they’re not terminally ill. This survey is important, as this is the age group probably closest to having to make that decision. It’s strange how the authorities thought it was acceptable for hospital patients to be put on the “Liverpool care pathway”, which denied them food and water to bring about their death. This was sometimes done without consultation with them or their families. However, when people want to make the decision themselves the authorities will not allow it.
• Zara Aziz suggested that towards the end of life most patients “ask to be kept comfortable and symptom-free” with high-quality palliative care. Palliation and the Caring Hospital (Patch) believes hospitals should provide high-quality care for patients and families at the end of life, as they provide for families and babies at the beginning of life. Over 50% of people in the UK die in hospitals, and palliative care is a vital layer of support for patients with advanced illnesses that are not curable.
The problem facing patients in the UK, which Dr Aziz highlights, is that “end-of-life care is patchy across the country”, and hospitals often only have a handful of specialist palliative care nurses and doctors working with ward staff to meet the needs of hundreds of patients that require end-of-life care. This is due to financial constraints, staffing shortages and a failure to prioritise end-of-life care.
In a busy hospital with conflicting pressures, it takes extensive training and skill to recognise when a patient is dying, to ensure patients are comfortable and free of pain in their final days, and to discuss what is happening with patient and family. It’s essential that our hospitals can provide properly funded palliative care, before the UK considers introducing assisted suicide.
Patch is a new charity dedicated to ensuring that patients and their families have access to such skilled palliative care 24/7. We strongly encourage people who are passionate about end-of-life care to contact us at patchscotland.com.
Michael Nairn Chairman, Patch
Dr Pamela Levack Medical director, Patch