The Lord He is God: He made us, not we ourselves
By Liam Gibson | 20 November 2024
Although commonly referred to as the “culture war”, the deep divisions that have emerged in contemporary society are actually the result of a clash between competing concepts of human dignity. Among the numerous areas of dispute, the central role of human dignity can be seen most clearly in the battle over euthanasia, in which both sides make explicit appeals to dignity. Since 2006, the UK’s Voluntary Euthanasia Society has campaigned as Dignity in Dying, whilst the notorious assisted suicide facility based outside Zurich, Switzerland, calls itself Dignitas. On the other hand, those fighting for the inviolability of innocent human life point to “the inherent dignity” and “inalienable rights of all members of the human family” recognised in international law. Despite the mounting evidence that the so-called slippery slope is real, the rapid spread of assisted suicide across a significant portion of the Western world has created the false impression that its legalisation is inevitable. That is why the defeat of the Terminally Ill Adults (End of Life) Bill is so important.
The Bill, introduced on 16 October by Kim Leadbeater, the Labour MP for Spen Valley in Yorkshire, is scheduled to have its Second Reading on 29 November. Its supporters claim that it is “the strongest most robust piece of legislation on this issue in the world”. Even if this claim were true, it would only demonstrate the impossibility of devising an assisted suicide law capable of protecting the vulnerable from coercion and abuse. However, Leadbeater’s legislation is far from robust.
The fragile thread on which the safeguards hang is the opinion of two doctors (the coordinating doctor and the independent doctor) that a patient (who is over 18, resident in England or Wales and registered with a medical practice) has only six months to live. He or she must also be mentally capable of making a clear, settled decision to end their life that is free from coercion or undue pressure. These safeguards are deeply flawed for a series of reasons.
1. The law would allow doctors themselves to raise the issue of assisted suicide with their patients if they deemed it appropriate. Of course, this would indicate that the doctor had already formed the view that the patient met the criteria; otherwise making such a suggestion would be entirely inappropriate. Any subsequent assessment by this doctor would be subject to confirmation bias, the psychological tendency to seek out only the information that supports a presupposed position or idea.
2. Doctors who make such a suggestion, could prompt vulnerable patients to consider ending their lives when they otherwise wouldn’t have. Ironically, this could give rise to precisely the kind of undue influence that the authors of the Bill assure us that doctors will guard against. In Canada, this policy has resulted in vulnerable patients becoming the target of unwanted advice that they should consider Medical Aid in Dying.1
Nor would medical judgment protect patients from emotional manipulation or the undue influence of family members. Evidence from other jurisdictions shows that many people request assisted suicide to avoid becoming a burden on others. In 2023, 43.3 per cent of people in Oregon gave this reason for requesting a lethal prescription. The experience shows that the so-called right to die can quickly give way to the duty to die. Although the coordinating doctor and the independent doctor must be satisfied that a patient is not acting under coercion, it would be naive to assume that medical professionals will always make an accurate assessment of what is a non-medical matter. We know that some women seeking abortion do so under pressure. Those who have spoken about this experience have described how doctors failed to recognise that they were acting under coercion.2
3. An accurate assessment of life expectancy is very difficult and many people outlive a six-month prognosis. Research shows that errors in diagnosis for severe, life-threatening conditions can be as high as 20 per cent.3 The scheme would require doctors to predict the future of their patients with a routine level of accuracy that is simply unrealistic. In 2023, 17 patients (5 per cent of suicides carried out under Oregon’s Death with Dignity Act 1999) outlived their six-month prognosis.4 It is impossible to estimate how many more would have survived longer had they not ended their lives prematurely.
4. Research shows that reliance on a doctor’s impression of a patient’s state of mind is also of questionable value. Studies on the relationship between depression and the wish for a hastened death show that doctors often fail to recognise depression in very ill patients.5 If recognised and treated the desire for death even in terminal illnesses can be alleviated.6 Improvement in depression is generally accompanied by an increased desire for life-sustaining interventions in the elderly and the terminally ill.7 8 9 Depression is significantly overlooked and under-treated in late-stage cancer10 11 and often goes unrecognised in end-of-life care generally.12 13 Doctors tend to consider low mood understandable in such circumstances, especially if a patient is elderly and has a severe physical ailment.14 15 This oversight can lead to treatment not being initiated or advanced.16
The clinical bias affecting the assessment of depression in terminally ill patients was highlighted by research carried out by the University Medical Centre Utrecht in 2005.17 Of 138 patients, 32 had depressed mood. 30 (22 per cent) made an explicit request for euthanasia. The risk of a euthanasia request for patients with depressed mood was 4.1 times higher than that of patients without depressed mood. This correlation was contrary to the researchers’ expectations.
“Our clinical impression was that such requests were well-considered decisions, thoroughly discussed with healthcare workers and family. We thought the patients requesting euthanasia were more accepting [of] their impending death and we therefore expected them to be less depressed. To our surprise, we found that a depressed mood was associated with more requests.”18
5. Once the coordinating doctor has approved a request, the independent doctor assesses the patient. If the independent doctor disagrees with the opinion of the coordinating doctor, then a third opinion can be sought. If this doctor also concludes that the criteria have not been met, then the process is halted. However, there is nothing in the legislation to prevent the process from being repeated as many times as necessary until an independent doctor is found who will agree that the scheme’s conditions have been fulfilled. Once the doctors have agreed, the application can move on to the next stage, which is a review by a High Court judge.
Conscience and the courts
Perhaps the most novel aspect of the proposal is the involvement of the judiciary. The authors of the Bill expect every case to be verified by the courts to ensure adherence to the law. When this idea was proposed in a similar Bill in the House of Lords, it was heavily criticised by a former President of the Family Division of the High Court. Sir James Mumby described the idea as “problematic”, warning that:
“What is proposed is that a judge by court order should facilitate the administration to a patient of a drug intended to bring about the patient’s death. It is difficult to over-emphasise the profound impact of this on what has hitherto been seen to be the proper role and function of a judge.”19
In 2022, there were 13,241 deaths reported under Canada’s Medical Aid in Dying scheme, accounting for 4.1% of total deaths (incidentally, a growth rate of 31.2 per cent on the 2021 figure).20 If this rate were replicated in England and Wales it would result in 23,663 cases of assisted suicide. If the rate in the Netherlands in 2023 (5.4 per cent) were to be seen in England and Wales there would be approximately 31,393 deaths.21
If, as seems likely, judges would have the right to avoid involvement in the scheme, then Parliament would have introduced the principle that a judge can refuse to hear a particular type of case on the basis of individual conscience. It is difficult to say how many judges would withdraw from the process, but the caseload for those who remained would ensure that they would have to rubber stamp requests without any real oversight, if the system was not to break down.
The Bill also provides some conscience protection for doctors who do not wish to be involved in assisted suicide, at least up to a point. If asked by a patient to make the initial assessment, an objecting doctor would be legally compelled to make a referral to someone who will carry out the process. This almost certainly would be a violation of Article 9 of the European Convention on Human Rights. As usual, the promotion of false rights always results in the erosion of genuine rights.
There is no protection for institutions, such as hospices or care homes, to prevent assisted suicide from taking place on their premises.
At present, the provisions of the Bill are limited only to those patients with a terminal illness who have only six months to live. Unfortunately, the definition of terminal illness is so broad that it could include some chronic conditions. In Oregon, health officials have acknowledged that a patient who stops taking insulin, or a similar life-sustaining medication, would be eligible for assisted suicide. This trend has also been seen in Colorado, where a doctor provided lethal prescriptions to three young people with anorexia on the grounds that their malnutrition meant they had less than six months to live. In 2023, nine people in Colorado received assistance in committing suicide for “severe protein-calorie malnutrition.” Before 2021, not one such case was recorded.
But despite the Bill’s broad eligibility criteria, some campaigners are already calling for them to be expanded even further. This has already happened in other countries. When New Zealand passed its End of Life Choice Act in 2019 it required a patient to have a terminal prognosis of six months or less. Supporters of the law are now campaigning to have that condition removed. David Seymour, the MP who sponsored the Act, told reporters:
“The six month limit was a political compromise. …I never supported it. I never wanted it. I didn’t introduce it that way. I had to compromise because if I didn’t get the votes, there’d be no law at all.”22
When the MAiD scheme was introduced in 2016, it too was limited to people thought to have only six months to live. This was removed in 2021 following a challenge in the courts. Also like the Canadian legislation, the Leadbetter Bill has a built-in requirement for a review after five years. This will almost certainly provide the pretext for further expansion, just as it did in Canada.
“I Accuse”
On 16 September, the Prime Minister, Sir Keir Starmer, addressed the Holocaust Educational Trust and pledged to build a Holocaust Memorial and Learning Centre next to the Westminster Parliament. He also guaranteed that a review of the national curriculum would mean that every pupil would have to study the Holocaust. With a shocking lack of self-awareness, it seems that Starmer sees no contradiction between promoting the lessons of the Holocaust while Parliament is poised to introduce the very policy that resulted in the mass murder of hundreds of thousands of vulnerable and disabled Germans.
In 1941, the film Ich kluge an — “I Accuse” — was released in German cinemas. The movie was both well-made and popular. It was also reasonably successful in its mission to persuade the German people that laws preventing the mercy killing of the sick and disabled were cruel and inhumane. The film’s plot revolves around a doctor, who having failed to cure his wife’s multiple sclerosis, gives into her pleading and ends her life. At his trial for murder, he turns on the judges and accuses them of condemning the terminally ill to pain and suffering.
The scene in which she dies in her husband’s arms reflects the sanitised myth of the peaceful death still propagated by the assisted suicide lobby today. The reality is far less serene. In 2021, Dr Joel Zivot, a practising anaesthesiologist and intensive care medicine specialist with more than 26 years’ experience, gave expert testimony to the Canadian Senate regarding the effects of the lethal drugs used in the MAiD scheme. He told them that:
“… when a person dies by lethal injection, they basically drown. Their lungs fill with fluid, and I would describe that the experience of dying under that circumstance is more akin to death by waterboarding, which we recognise to be cruel. …it should be clear to the Canadian public that the kind of death that they will experience as a consequence of MAiD will be something other than the way it is represented. It could be exceedingly painful and more akin to drowning.”
According to Zivot, the muscle relaxants used in MAiD produce an apparent stillness as a consequence of paralysis that is wrongly described as a state of peacefulness. A propofol injection at a dose of 1,000 mg as used in MAiD is likely to cause burning in the lungs and the destruction of tissue observed in autopsies following an injection of pentobarbital or Midazolam in the execution of the death penalty in the USA.
In a subplot to Ich kluge an, a disabled baby is euthanised off-screen to the relief of the child’s parents. When the film was released, the mass extermination of the disabled was well underway. In hospitals and sanatoriums, disabled children and adults were starved, gassed and left to freeze to death. Even after the protests of Bishop von Galen of Munster had officially brought an end to the practice, the killing continued in secret.
At their trial in Nuremberg, the architects of the T4 programme insisted that their actions were motivated by compassion — an argument that failed to convince the tribunal, not least because the leading members of the medical profession were also guilty of the most grotesque abuses seen in the concentration camps. While high-profile physicians like Karl Brandt and Philipp Bouhler were condemned to death, less well-known individuals who were personally responsible for the murder of hundreds of disabled children, only appeared as witnesses. By the time these men came to trial, the Allies had lost interest in the victims of the T4 programme. Regrettably, it was left to be dealt with as a German matter. Most of these unapologetic perpetrators received light sentences and were often released from prison early. Had their victims received justice, then perhaps the cult of assisted suicide would not be so widespread in the world today.
Nine days until the second reading
To understand the impact of the legalisation of assisted suicide on society, we need only look to the consequences in Belgium, the Netherlands, Canada or Australia. Human dignity is no longer seen as an ineliminable value shared by all human beings, but is solely identified with the autonomy of the individual. The leading reason given for requests for assisted suicide under Oregon’s Death with Dignity Act in 2023 was not unbearable suffering but loss of autonomy, cited by 91.6 per cent of people. Once this view of dignity is equated with autonomy, those who lack autonomy through illness or disability are considered as devoid of dignity and would be better off dead. In The Medical Exception: Physicians, Euthanasia and the Dutch Criminal Law, author Jos Welie notes:
“Paradoxically, the jurisprudential ‘legality’ of euthanasia that was fought for by advocates of voluntary euthanasia on the basis of the principle of autonomy and self-determination of patients, actually has increased the paternalistic power of the medical profession above its last limit, above the law.”23
The best chance to defeat the Terminally Ill Adults (End of Life) Bill is when it is debated at its second reading on 29 November. If passed, the Bill would change medical ethics not only in England and Wales but across the UK, Ireland and, through Britain’s cultural influence, cast a dark shadow far beyond. Those in the UK should urge their MPs to oppose it. Everyone who values the sanctity of human life, regardless of where they live, should pray for the defeat of this legislation.
In recent weeks, Voice of the Family has reminded its readers of the wise words of a holy Catholic woman, which are more appropriate than ever in the nine days before the debate:
“To win the most difficult battles, the most powerful weapon is prayer. A Crusade of Rosaries to be said by 29 November would be an excellent initiative, also to make the faithful more aware of the gravity of the situation.”
Please join us in praying for the defeat of this Bill and a renewed respect for the dignity and value of every human being regardless of their disabilities or stage of life.
“Know ye that the Lord He is God: He made us, and not we ourselves. We are His people and the sheep of his pasture.” (Ps 100:3)
Notes
- Euthanasia Prevention Coalition, ”Canadian doctors accused of pushing medically assisted death” 26 July 2024. ↩︎
- See SPUC Pro-Life, “Abortion and coercion: a briefing”, September 2023. ↩︎
- M L Graber, R M Wachter & C K Cassel, “Bringing Diagnosis into Quality and Safety Equations” [2012], JAMA, 308, 12, pp 1211–2. ↩︎
- Oregon Death with Dignity Act 2023 Data Summary, Oregon Health Authority, Public Health Division, Center for Health Statistics, 20 March 2024, p14 Unless otherwise stated all Oregon figures are take from the 2023 Data Summary. ↩︎
- Madelyn Hsiao-Rei Hicks, “Physician-assisted suicide: a review of the literature concerning practical and clinical implications for UK doctors”, [2006], BMC Family Practice, 7, 39. doi:10.1186/1471-2296-7-39. ↩︎
- 1999] Support Care Cancer, 7, 432–6.] Improvement in depression is generally accompanied by an increased desire for life-sustaining interventions in the elderly and the terminally ill. ↩︎
- L Ganzini, et al, “The effect of depression treatment on elderly patients’ preferences for life-sustaining medical therapy,” [1994] Am J Psychiatry, 151,1631–6. ↩︎
- S C Hooper et al, “Major depression and refusal of life-sustaining medical treatment in the elderly.” [1996] Med J Austr, 165, 416–9. ↩︎
- R E Rosenfeld et al, “Factors associated with resuscitation preference of seriously ill patients,” [1996] Arch Intern Med, 156, 1558–64. ↩︎
- S D Passik, et al, “Oncologists’ recognition of depression in their patients with cancer.” [1998] J Clin Oncol, 16:1594–1600. ↩︎
- L Bowers, D A Boyle, “Depression in patients with advanced cancer.” [2003] Clin J Oncol Nursing, 7, 281–8. ↩︎
- R Stiefel et al, “Depression in palliative care: a pragmatic report from the Expert Working Group of the European Association for Palliative Care, [2001] Support Care Cancer, 9, 477-88. ↩︎
- M Lloyd-Williams, “Screening for depression in palliative care patients: a review”, [2001] European J Cancer Care, 10, 31-5. ↩︎
- J H Groenewoud et al, “Psychiatric consultation with regard to requests for euthanasia or physician-assisted suicide”, [2004] Gen Hosp Psychiatry, 26, 323-30. ↩︎
- D E Meier, et al, “Characteristics of patients requesting and receiving physician-assisted death,” [2003] Arch Intern Med, 163, 1537-42. ↩︎
- S H Dinwiddie, “Potential psychodynamic factors in physician-assisted suicide,” [1999] Omega, 40, 101-8. ↩︎
- M L van der Lee, et al, “Euthanasia and depression: a prospective cohort study among terminally ill cancer patients.” [2005] J Clin Oncol, 23, 6607-12. ↩︎
- Ibid, p 6611. ↩︎
- Sir James Munby, “Assisted dying: what role for the judge?”, The Transparency Project, 30 October 2024. ↩︎
- Fourth annual report on Medical Assistance in Dying in Canada 2022. ↩︎
- The Regional Euthanasia Review Committees (RTE) of the Netherlands recorded 9,068 deaths resulting from assisted suicide and euthanasia in 2023; 5.349% of 169,521 total deaths recorded by the Centraal Bureau voor de Statistiek. ↩︎
- Anna Whyte, “Contentious part of euthanasia law could be reconsidered in member’s bill”, The Post, Wellington, New Zealand, 29 August 2024. ↩︎
- Jos M Welie, “The medical exception: physicians, euthanasia and the Dutch criminal law” (1992) 17 J Med & Phil 419, 435. ↩︎