Health: A matter of life and death

"MORNING Mr Underwood. What can I do for you today?"

"I'd like to know where you stand on euthanasia, doctor."

"And why do you ask?"

"Well, I saw that Fighting for Dignity on ITV last week and I've decided that if I get something horrible like that poor Annie Lindsell I'd want euthanasia."

"Want being the operative word."

"Eh?"

"The programme was about voluntary euthanasia. That's euthanasia as in "compassion-motivated, deliberate, rapid and painless termination of the life of someone afflicted by an incurable and progressive disease" and voluntary as in "performed at the dying person's request with informed consent."

"That'll do for me."

"Yes, but unfortunately it's not legal."

"Why not?"

"I'm not sure. As a patient, you're quite within your rights to refuse any treatment that would keep you alive - such as someone with kidney failure refusing dialysis - but you have no right to receive a treatment that would have the same effect."

"That's irrational."

"Yes and no. As doctors, we can't just give every patient what they want. We have to make sure the request is clinically and ethically sound. Which is why voluntary euthanasia should only be given to those with incurable and progressive diseases who have had the best palliative care available and still want it."

"So, what are the arguments against it?"

"Well there's the usual `thin end of the wedge' ploy everyone trots out when they don't want to change the status quo. Legalise voluntary euthanasia and doctors will perform mass involuntary genocide on the handicapped, elderly and mentally incompetent. It's a pathetic argument but very effective as a scare tactic."

"Anything else?"

"There's the nasty relative argument. Vulnerable terminally ill patients may be bullied into requesting euthanasia by someone who wants to get their hands on the inheritance."

"They've got a point."

"True, which is why requests for voluntary euthanasia and physician-assisted suicide need to be tightly controlled within a legislative framework. In Oregon, the law allows doctors to prescribe, but not administer, lethal doses of drugs to hasten death. However, the patients for whom the drugs are prescribed must be over 18 years old, assessed as mentally competent and have less than six months to live. There is then a mandatory two-week waiting period between the request and the prescription to allow time for reconsideration."

"And has anyone gone through with it?"

"Yes, an 85-year-old woman with metastatic breast cancer was prescribed a lethal dose of barbiturates, which she took with brandy, and died a peaceful death 30 minutes later."

"How come Oregon's got a Death with Dignity act and we haven't?"

"The people voted for it. It was passed by a narrow margin in 1994, challenged in the federal court and barred from taking effect. Then the federal challenge was overturned, the bill went back to the public who voted it in by a 60:40 majority. It was enacted last November."

"So, what's happening here."

"Although voluntary euthanasia is illegal, a 1994 survey of 200 consultants and 200 GPs found that half of them would practice it if it were legal and a third of them already had."

"And, presumably, they're now all in jail for murder."

"Absolutely not. The NHS would fall to pieces if every doctor who had practised euthanasia was caught, prosecuted and convicted. Most cases don't come to light because of the double effect."

"Which is?"

"An ethical loophole which allows doctors to escape the law by giving drugs to terminally ill patients to relieve pain and distress, but which hasten death as a side effect."

"What's wrong with that?"

"For a start, many doctors admit off the record that often the primary intention of giving the drugs is to hasten death as well as relieve suffering..."

"So, that's murder..."

"In the eyes of the law, yes. But also, because it's done covertly, there's often no evidence that the patient consented to be given a drug that would shorten life."

"Meaning some of it might be involuntary?"

"Who knows. And to compound the fudge, in almost every legal case on record of someone charged with assisting suicide or performing euthanasia in the UK, the case either doesn't make it to trial, or no conviction is made, or a very light sentence is handed out. Laws should either be enforced or you change the law."

"Legislate?"

"Voluntary euthanasia is too important an issue to leave it to politicians, lawyers and the medical establishment. Let the people decide. And if they want it, legislate for it, get it all out in the open and control it.

"Do you think doctors aren't pushing hard for voluntary euthanasia because they know they've got a dignified way out?"

"You decide."