Assisted dying legislation is a solution to a problem that we don’t have.  I'm puzzled why such a bill is a priority for our politicians. It’s just another distraction from those things we should concern ourselves with.

The number of suicides every year in the UK lets you see that people already have the power to control when they die, if they want. Those bereaved will tell you how that feels. People who like the idea of autonomy and control also like the idea of assisted suicide “in principle.”  They are confident and in charge for most of their lives, but they don’t know much about the end of life and they’ve heard bad anecdotes or seen a bad case.

Comfortable with this idea of having a doctor to help you die, they do not really know how horrible and out of control that process can be.  You only have to look at the woman with dementia in the Netherlands who appeared in a well-documented case.  On her death day, she resisted, and she was drugged and held down by family to be killed.  That was judged to be lawful, and the doctor was cleared.  People have assumed that killing yourself is painful and difficult but having it done through a legal process by doctors is easy.  That's clearly a false comparison.   

Some proponents claim that they are looking for legal clarification.  In Scotland this clarification has already been provided.  Assisting suicide is not a crime in Scotland where it is being discussed in the parliament.  Proponents add that if you help someone to die it “could lead to a prosecution.”  To be honest, many things in life “could lead to a prosecution”.  The key question is how many prosecutions there have been and the answer is very, very few.  Only when there is something really dodgy going on.

And what could be dodgy about this process?

There is a danger that this will be a money saving measure.  First for families who see their money being spent on elder care now that the state has moved away from the "cradle to grave" promise, and second for the State, for whom fast tracking people at their most expensive might seem like a solution. The problem is that it won't work for the State, and children will be conflicted and torn apart as they try to agree when the time is right to stop their parents from breathing.  And many of the most expensive patients and parents will not ask for it but continue to ask for treatments that make little difference but are disproportionately expensive.  No one benefits from this bill whether they are voting for it out of fear and ignorance of how to manage their own end of life care, or with an eye to the personal and public cost of an ageing population.

This proposed law changes the fundamental relationship between health professionals and patients. Of course, people should fear a terrible death but with good end of life care death is not terrible. And it is not out of your control if you think about it in advance. Autonomy would be maximised by helping people understand how to make advance directives and take control of their care.  I am astonished at how many middle class, educated, professional people, including lawyers, in recent personal exchanges have not been aware that currently people can refuse treatment. Or ask for it to be stopped. Or how to do that.

If change is needed it is not legal change. We need increased education and support for people to understand and talk about the end of life and how they’d like it to be.  Making sure you have a DNR, and a proxy decision maker (ie giving someone your power of attorney) means that you have as much control as you like.  You’ll still get comfort and care, but not be kept alive in a way you don’t want.  You can say no to antibiotics, resuscitation and ventilation.  You just have to know how to set this up.

A person with depression often wants to die and changes their mind after they have treatment and support.  If they happen to be also ill with a physical problem that should not put them on a fast track to death.  The way the proposed law is framed suggests that some people who are depressed will be looked at by a couple of doctors who might say, "I see your point. It's logical for someone like you and/or as old as you to want to die. And/or if I was you I'd prefer to die". On what basis will they make such a call?  I don't mean to disrespect doctors, but this sort of decision might better be made by a judge with expert witnesses. It's not a "clinical" decision.  It’s a value judgement.

I would be anxious for my loved ones to see a doctor on their own if I thought one of the options was them being killed. I'd feel guilty and unhappy for the rest of my life. If you look at the doctors and nurses in other countries who decide it is an honour and a privilege to do this work you wonder what that has done to their mental health. As a nurse I have helped many people while they were dying, but "helping them to die” is a completely different thing and morally repugnant.

The fact that other countries are doing it should be a dire warning, not an encouragement.  You would see that if you read carefully about what is happening there. When I started looking at this I was on the fence; but now I am deeply troubled.