Is it time to change the law on assisted dying?

The palliative care profession has also expressed concerns about changing the law to allow assisted dying. Here’s Baroness Ilora Finlay, who is a professor of palliative medicine at Cardiff University and has taught end-of-life care internationally...

Ilora - I think it's very worrying to hear about people who are frightened and who see the situation as hopeless, when actually we need to be redoubling efforts to relieve distress. We need to be looking at new ways of managing things. But shortening life, cutting life off, isn't the answer to managing distress.

James - Some people are experiencing pain even the best palliative care is unable to alleviate though, aren't they? I mean, Jenny says of her memories of her husband's care at their hospice, 'We had amazing palliative care help, but there were things they could not do.'

Ilora - I think, when you look at what has happened in other countries that have changed the law on this, you find that there isn't less pain. In fact, the evidence is that the symptom control of unrelieved symptoms is worse, and I think it becomes dangerously easy to think that death is a shortcut rather than actually saying, 'let's look again, what else should we be doing?' When you look at the data from Canada, it shows that the percentage of people who are accessing palliative care has dropped over time. Euthanasia has become normalised, so they get euthanasia, but they're not getting the palliative care options, and actually we don't even know what the quality of palliative care is overall.

James - Another element of this debate is, if you decide assisted dying should be legal in instances where a person is in severe, seemingly untreatable pain, why draw a distinction between people for whom the prognosis is terminal and for those who aren't? I'm thinking of something like severe depression, for example. Legal lines have to be drawn somewhere, and you are of the opinion that where the current law lies in this country is, on balance, for the best.

Ilora - The difficulty is that you can't predict prognosis. Anyone who pretends that they can say someone has a prognosis of six months, they're just guessing. You can't predict how long someone has to live. Some people die much more quickly, others live remarkably much longer. The other thing is that different diseases and disease conditions change and move on. But yes, you are right, there are people with long term, severe chronic pain, and it may take some years for them to adapt. The person who's been in a terrible accident, lost limbs, it may take a long time for them to find a new way of moving forwards. But what you have to ask yourself is 'what's society's duty to people?' Are we there to support people and help them through? Or are we saying, 'well, you are in despair and we'll give up on you,' basically? Or are we saying that we want to support you? If you look at the instance of suicides and look at Victoria, people thought that when they changed the law, it would decrease the number. Actually, that isn't what's happened. The data shows that their unassisted suicide rate has approximately doubled. So something changes in society, but to see death as an answer to fear really seems a very dangerous route to go down.

James - Is there anything that our listeners should be aware of that's happening in the world of palliative care to help alleviate the concerns of people who either have a terminal illness, or know people who have one, that their death will be as dignified as possible?

Ilora - There's research and there are advances in palliative care, but there are also across the whole of medicine with new treatments and new ways of managing conditions, and some of those have really revolutionised conditions. But the other thing that people need to be aware of is that ending life is not simple. The drugs that are used have not been approved anywhere. People don't actually know how they work. Some of the ones used in euthanasia, in about two thirds of cases, the person's completely paralysed so they can't breathe. They die of asphyxia. This is not straightforward. And the complication rate when the drugs are taken for assisted suicide has been up at 11% in the last 12 years in the data from Oregon. So this isn't straightforward. It isn't taking one little pill and it's all over quickly. It actually can be pretty complicated and pretty awful, and we don't even know how this cocktail of drugs that's used is really working and what they're doing and nobody has researched them properly.

Any change in the law on assisted dying would require new framework and guidance. But what exactly do the statute books say about what medical professionals can and can’t do when someone nears the end of their life? Chris Smith has been spoke to Imogen Goold, a professor of medical law at the University of Oxford...

Imogen - One first principle is that people can never be compelled to have any form of treatment. So, a person who has the capacity to make their own decisions can always simply say, I don't want to take that medication. That may have all sorts of implications for them, one of them might be that they then die. The other strand to that is doctors can never be compelled to give treatment that they consider not to be in someone's interests or that won't have any efficacy, that won't help them. The doctor may take the view that actually there are no treatments left that they think will do anything that will help the person. In those situations they don't have to treat them. These might be treatments that might have kept someone alive for a little bit longer, but they're extremely onerous, they're very burdensome and unpleasant. The doctor might think, well, on balance, this is just not indicated in this case.

Chris - From what you're saying, I could, as a doctor, elect to withdraw support, I could stop giving food and water to a person if I don't think that's in their best interest. But what I couldn't do then is to give them a massive dose of morphine and stop their heart because, it would amount to the same thing, but I would be actively doing something rather than actively not doing something and, although they amount to the same thing, legally that would be different.

Imogen - Yes, absolutely. You absolutely cannot do something that actively has the intention of ending somebody's life.

Chris - But I can not feed them and starve them to death?

Imogen - Yes. That essentially is the nub of part of the euthanasia and assisted dying debate, is that some people take the view that those two things are actually morally equivalent. In fact, it's worse to withdraw treatment from someone and withdraw support from them so that they die over a long period of time, rather than, as they often frame it, the merciful thing of ending their lives more quickly.

Chris - What do you see as the direction of travel? Do you think that we'll still be having this sort of debate in a decade, or do you think that, probably, we will find ourselves in countries like the UK following countries like Switzerland where there are opportunities for people to go down this path if they elect to do so?

Imogen - So I think we've been trying to travel down this path for at least 25 years. There have been measures brought through parliament multiple times to try to push in that direction and they've all obviously failed because it's such a vexed debate. But what we do see at the moment is that the government has undertaken an inquiry and is continuing to undertake the inquiry into assisted dying, so I think there are steps forward towards either resolving the question in favour of changing the law, or drawing a line under the debate and taking a position that it's been thoroughly investigated and the government will take a position. But, which way it will go I think is very difficult to anticipate at this point, precisely because the arguments are quite finely balanced for and against.