US Edition On Tuesday, the House of Lords will debate the Coroners and Justice Bill. While this measure, on the face of it, aims to tidy up the law on inquests, it has provided another opportunity for those who wish to relax the prohibition on euthanasia – specifically assisting people who are seriously ill with suicide. This is not something that most doctors want to see happen. At its annual conference recently, the British Medical Association rejected any suggestion that assisted suicide should be legalised, thereby reaffirming the position it adopted three years ago after a brief flirtation with neutrality on the subject.
Undaunted, euthanasia campaigners are now trying another tack. An amendment tabled by Lord Falconer, the former Lord Chancellor, would remove the threat of prosecution from relatives who help seriously ill people to go to Switzerland's notorious suicide facility – the ill-named Dignitas.
We are hearing the usual incantations about "safeguards". In fact, when you look closely at what is being proposed, the safeguards are near to non-existent. Lord Falconer's amendment requires simply that two doctors – any doctors – should be "of the opinion in good faith" that a candidate for assisted suicide is terminally ill and has the mental capacity to make a declaration of intent. Does that sound reassuring? If it does, then think carefully about what it would mean in practice and you may not feel quite so comfortable.
Let us put on one side the serious ethical objections to doctors participating in assisting suicides – objections that only a year or so ago were drawn to the attention of a parliamentary select committee (of which I was a member) by the General Medical Council and by a number of eminent physicians. Let us also for the moment ignore the fact that within the last year or so both the Royal College of Physicians and the Royal College of General Practitioners have consulted with their members and firmly rejected the notion that doctors should be involved in helping to end their patients' lives.
Instead, let us focus on the clinical practicalities of what Lord Falconer and his friends are proposing. We are talking here about what are life or death decisions. To suggest that they can be taken on the basis of an "opinion in good faith" is both cavalier and irresponsible. There is no requirement in Lord Falconer's amendment that the doctors concerned should have examined the patient or should even have seen his or her case notes.
They are not required to have any expertise in diagnosing the terminal illness in question: the two doctors giving "an opinion in good faith" that someone is dying of pancreatic cancer could, for instance, be a dermatologist and a GP. Nor is there any requirement that these two doctors should have experience of establishing mental capacity or that, in cases of doubt, they should seek expert help.
There is no definition, either, of what is a terminal illness. Large numbers of people live with disabling conditions, such as heart disease, Parkinson's disease or multiple sclerosis, which can be considered life-shortening over time – usually over years or even decades. Are they to be considered "terminally ill" and, as such, candidates for state-sanctioned assisted suicide? Or are we talking about people with a prognosis of a few weeks or months, which is how "terminal illness" is defined?
By associating his amendment with the case of Debbie Purdy, the multiple-sclerosis sufferer who has campaigned for immunity from prosecution for her husband, should he accompany her abroad for assisted suicide, Lord Falconer is indicating that he may wish to see a more expansive application of the law.
There is a widespread, but unwarranted, notion among the public that medicine is an exact science. It isn't: mistakes happen in diagnosis and prognosis. The select committee that investigated one of the "assisted dying" Bills brought forward in recent years by Lord Joffe was told by the Royal College of Pathologists that post-mortems regularly reveal "significant errors", including misdiagnosis of terminal illness, in around one in 20 cases. An eminent physician, a palliative care consultant with years of experience of treating terminally ill patients, spoke of the social security forms that doctors complete for patients who are thought to be within six months of dying. "I would not like to count," he told the select committee, "how many of those forms I have signed in my life for patients still living after a year, 18 months or even longer."
The Association of British Neurologists told the same select committee that research showed that around 30 per cent of patients with motor neurone disease have significant cognitive impairment, even though they may appear on the surface to be completely compos mentis and capable of making decisions. A clinical psychologist from the British Psychological Society gave a warning that there was "a significant incidence of moderate to severe depression" at various stages of terminal illness. It was, she continued, hard to detect "because many of the symptoms of depression are confounded by the symptoms of the disease".
Yet despite the uncertainties, Parliament is now being asked to license assisted suicide on the basis of two doctors being "of the opinion in good faith". What, one might ask, is supposed to happen when the candidate for assisted suicide in the Zurich apartment is given the all-clear? Let us suppose that the person concerned changes his mind about committing suicide. What is to stop an unscrupulous relative coercing him into travelling to Switzerland and going though with it? At the moment there is the possibility of a police investigation after the event to ensure that no foul play has been involved. But if Lord Falconer and his backers should have their way, that safeguard will be gone. Relatives would have a "get out of jail free" card – in the form of a permit to assist with suicide.
In truth, far from offering "safeguards", this amendment would introduce new hazards. It would just fast-track assisted suicides. The only people for whom it would make life easier are the relatives. Yes, there are genuine cases of altruistic assistance with suicide: of course there are genuine "loved ones", as they are referred to by the euthanasia lobby. But there is also a darker side to the assisted suicide story – of relatives who want to be rid of a care burden or are anxious to accelerate an inheritance and who can apply pressure, however subtly, to ailing parents or grandparents when they are vulnerable. The law as it stands, with its duty to investigate cases after the event, keeps such abusive cases in check. But, if a loophole is created to license assisted suicide in advance, that would soon change.
It is hardly surprising therefore that most doctors don't want anything to do with this sort of thing. They are only too aware of the vulnerability of their seriously ill patients and of the need for them to be given more, not less, protection by the law.
Lord McColl is a former professor of surgery at Guy's Hospital, London.