We know not the day and we know not the hour. Death has many terrors, even for the most stoical and the most pious: we don’t know how it will come, either. If I am to die from a drawn-out and painful illness then I hope that I will have to look after me a doctor I can trust to protect me from that particular terror.
I hope I will have a doctor who will help me to decide how much pain or distress I can bear and — if necessary — who will be prepared to give me enough of the right drugs to ease my departure from this world, and even to hasten it. I want my doctor to give me some control over my death or, if necessary, to take it over for me. I know that the people I love most feel the same and I have many friends who are discreetly grateful to courageous doctors who have done this for their dying mothers and fathers or for their friends and lovers.
Yet this extraordinarily compassionate service is a serious crime in this country. Euthanasia is widely regarded with horror. Last week a retired doctor was severely punished by the General Medical Council for planning to help an old friend to die. Michael Irwin was struck off the medical register on Tuesday for obtaining pills to give to Patrick Kneen, who had terminal prostate cancer and was afraid of a painful death.
Irwin prescribed some temazepam for himself, planning to give it to Kneen. But when Irwin arrived at his friend’s bedside Kneen was too ill to take the pills and later died in a coma. So Irwin did not help him to die; he merely intended to. For this he was disgraced; the GMC found him guilty of acting unprofessionally, inappropriately and irresponsibly and told him that he had abused the trust placed in him as a doctor.
That judgment makes no sense at all to me. As I say, I hope that when my time comes I will have a doctor as brave and compassionate as Irwin was. Of course there is a problem with prescribing drugs in a way that is technically dishonest, which Irwin plainly did. He admitted as much. On the other hand both he and his friend were active supporters of euthanasia and were campaigners for a change in the law — Irwin is a former chairman of the Voluntary Euthanasia Society — and both men knew and had publicly expressed their feelings about it. For Irwin to abuse his friend’s trust in this case would have been to have ignored his fears of a painful death when he himself, as a doctor, could offer a way out.
What happened — as always happens in such cases and as happened with the unfortunate Diane Pretty who campaigned unsuccessfully to avoid a terrible death — is that someone else did more or less what Irwin recommended anyway, but without calling it by its name. Someone else mercifully gave Kneen barbiturates for pain and he died. As Irwin said: “That’s what’s called terminal sedation but which I call slow euthanasia. It’s the current hypocrisy in the medical profession.”
I always thought, at least until recently, that hypocrisy had a useful place in human affairs and often in medicine. I used to think that it would be a mistake to legalise “assisted dying” since it could so easily be abused. Yet I’ve also always thought that it is often right and that the law should turn a blind eye whenever possible.
It does happen a great deal, although for obvious reasons it is not easy to know how much. According to one expert, British doctors help more than 18,000 people a year to die. This was the figure suggested by Dr Hazel Biggs, director of medical law at the University of Kent and an authority on euthanasia, when in September last year she gave evidence to a select committee examining Lord Joffe’s private member’s bill on assisted dying for the terminally ill.
Given such large numbers and a couple of nasty recent cases of nurses killing elderly patients more or less to tidy up their wards, I’ve come to think that there is no place for ambiguity in any of this.
Irwin refused to be ambiguous; he refused to be hypocritical, which is of course why he got into trouble. He could have spared himself a lot of bother by keeping quiet. But he chose to speak out and admit what he had in mind and — whatever the other less obvious aspects of this case — we should all be grateful. Physician-assisted suicide, or assisted dying or whatever else you call it, is going to become more and more important as people live longer and longer and as a larger proportion of the population is old or very old. It will be too important to be left to discretion or to benign hypocrisy.
There is another reason, too. The uncomfortable truth is that the temptation to end older people’s lives with or without their consent is going to grow. People already speak casually of hospital bed-blockers, meaning old people who do not really need a bed in an acute ward but have nowhere else to go. I will never forget a chilling Chinese expression I once heard for the old — “the useless mouths”.
An enormous part of National Health Service annual expenditure goes on old people. Department of Health statistics for 2002-3 show that 30.3% of all NHS spending — approaching a third — was spent on people of 75 or older; 46.7% — approaching half the entire NHS budget — was spent on people over 64. These proportions have gone up noticeably since 2000-1 when the corresponding figures were 27% and 41%.
Sooner or later these startling figures may catch the attention of the dwindling proportion of young people who are working to pay for all this. Some older people — I realise I am treading on taboos — may feel that it is not unreasonable at some point to consider, in the Japanese expression, taking a last walk up the snowy mountain.
In view of this I think any decision to do with the hour of our death ought to be returned unequivocally to the patient or to the patient’s chosen representative. For that reason I hope that Joffe’s controversial bill will succeed, although I think it is much too limited.
A more extensive bill would set free all those who want to die to do so with dignity. Also — and it’s a pity that those who passionately oppose euthanasia do not see this — it would, by laying down clear rules and restraints, protect all those who do not want to be pressed into the arms of the grim reaper before their appointed hour.