Assisted Suicide and Unassisted Regicide

A record number of peers wanted to speak in last Friday’s House of Lord’s debate on the Assisted Dying bill, from a wide variety of viewpoints and professions, but to my knowledge none of them had actually administered lethal drugs to a terminal patient, which cannot be said of a 1936 debate in the same chamber on a not dissimilar Voluntary Euthanasia Bill.

Lord Dawson of Pell, the president of the Royal College of Physicians, had gained fame by saving George V’s life in 1928. He opposed the bill’s setting up of legal safeguards within which a dying patient could choose to end their own life. Rather, he thought ‘the guidance of [euthanasia] properly lies within the medical profession itself’. Doctors knew better than legislators.

This was not an opinion he held in the abstract, but that he applied to his patients, including royal ones. Earlier that same year, as George V lay dying of bronchitis, Dawson had issued a famous bulletin that ‘The King’s life is moving peacefully towards its close’. He made sure of it later that evening by administering a lethal dose of cocaine and morphine to the King.

His action was only revealed by the release of his diary in 1986 [subscription requited], as was his reasoning: he timed his patient’s death to ensure it made the morning edition of The Times rather than later evening papers, thinking this was the proper way for the public to be informed of their monarch’s death – he even telephoned his wife so she could ensure The Times was ready for the announcement.

Dawson’s actions would have been roundly condemned in the debate on Friday. Speakers in favour of the bill emphasised patient choice and control, the very option of suicide being available having an empowering and positive effect. Baroness Warwick of Undercliffe quoted the late Baroness David:

‘If I were terminally ill, I believe that I would be the only person with the right to decide how I die and whether I preferred palliative care to assisted dying. It would provide me with an additional option on how to end my life, which I would find tremendously reassuring, whether or not, in the end, I decided to exercise that option’

 Viscount Dawson (he gained the title after George V’s death) barely made reference to such things:

That can only be decided by her doctors, who know the thoughts and feelings of the patient and the realities of her state. This is something which belongs to the wisdom and conscience of the medical profession and not to the realm of law. [Emphasis mine]

Dawson’s diary suggests that he alone made the decision about the King’s death, without consulting the other attending doctors, and that the monarch had no say in the timing, or indeed the act of being ‘assisted’ in his death at all. This is the kind of death no-one in 2014 is arguing for: for all that it might be born of compassion it takes the power from the patient and puts it in the hand of the doctor. From the debate, it seems that the present bill’s purpose is to give power to the patient themselves, that by giving them some measure of control over their death they can confront it more easily.

Some of the debate looked at the doctor-patient relationship. Lord Brennan put it starkly: ‘This Bill dismantles the Hippocratic oath by creating two kinds of doctor: those who will not help you to kill yourself and those who will.’ This division is however preferable to the third option offered by Dawson: the doctor who will kill you, even when you haven’t asked them to.

Lord MacKenzie of Culkein, a former nurse, worried that in practice the ‘authorised health professional’ the bill allows to assist a patient in their death would end up being a nurse rather than a doctor, and that this would damage their relationship with patients:

I do not want nurses to be in a position where in the course of their normal duties a patient might say—it could be said as a joke, but it might be said seriously out of concern by a vulnerable patient—“I hope, nurse, you’re not one of these who assist dying”, or perhaps in the more vernacular, “I hope you’re not one of these who bumps people off”.

So it was at the deathbed of George V. His last word were not, as legend has it, ‘Bugger Bogner!’, but rather a mumbled ‘God damn you’ to his nurse, Sister Catherine Black, as she sedated him for the last time. True to Lord Mackenzie’s fears that the practical care given by nurses would extent to assisted dying, Dawson initially expected Black to administer the fatal dose. She refused, and he had to the deed himself.

Looking over the 1936 debate on voluntary euthanasia, I was shocked by the attitude shown by the proposer of the bill, Lord Ponsonby of Shulbrede, towards the terminally ill. He cited approvingly Captain Oates, who sacrificed himself while injured in an attempt to save the remainder of Captain Scott’s doomed expedition to the South Pole, as an example for patients to follow.

Your Lordships may say the cases I have quoted are those of noble acts of self-sacrifice for others and the cases that come under this Bill will be acts of people who are sparing themselves pain. I think that is a mistaken notion. I think in many of these cases consideration for others will be uppermost in the and of the patient; in fact to go so far as to say that that the consciousness of being a burden, the despairing veiw that you yourself are no longer of any use, the prolonged anxiety of others of which the patient is aware, may be as poignant as the suffering itself.

This is precisely the attitude feared by the opponents of today’s bill. Lord Tebbit made one of the few jokes of the debate while discussing the danger to the frail, ill and elderly:

They—or perhaps I should say, looking round the House, “we”—are a financial drain ... The Bill would provide a route to great savings in public and private expenditure, and to a great pressure on the elderly, the sick and the disabled to do the decent thing and cease to be a burden on others. Those who care for such people are all too familiar with the moments of black despair that prompt those words, “I would be better dead, so that you could get on with your life”.

Happily, Lord Ponsonby’s view was not in evidence in the modern House of Lords. The Earl of Glasgow angrily rejected the idea that such motivations were behind the Assisted Dying bill:

It has nothing to do with coercing vulnerable old people into killing themselves. Yet our opponents ... talk about this being a slippery slope that could lead to the eventual demise of the frail, disabled or mentally ill. No, it does not. No, it is not. The Bill is about personal choice and the alleviation of unnecessary suffering—the choice to decide how, where and, to a small extent, when you want to die.

However, for all that no peer would any longer suggest that terminally ill patients should kill themselves for being a burden to others, the same may not be true of all medical professionals, according to a disturbing story told by Baroness Nicholson of Winterbourne:

I am the visitor beside the bed of a very sick, motionless and almost speechless friend. In comes a doctor who, during a brief two-minute patient record check, comments loudly that this patient would be better off dead. Five minutes later, an agency nurse comes in. I thank her for her work to ease the patient to a more comfortable head position. She answers, “This patient should be dead; we need the bed”. I murmur an objection, fearful that the patient can hear and will feel distressed. The nurse replies, “All these old people taking up NHS space should not be allowed to survive. Those beds are needed for the living”.

If such views are still expressed by some doctors and nurses in private, it is at least progress that this is shocking, and that it is no longer acceptable for someone to claim in public debate that the terminally ill killing themselves to be less of burden to the living is ‘the act of a brave man and of an English gentleman.’

The death of George V is no model of assisted dying, as it was the killing of an unconscious patient by a doctor without the consultation with his colleagues or the patient’s family, never mind with the express instructions of the patient himself. I mention it not as a warning of what assisted dying might become, but rather because both it and that year’s later debate on euthanasia reveal how attitudes have changed.

I have deep misgivings about both the ethics and the practicalities of assisted dying but comparing the two House of Lords debates, separated by 78 years, I am oddly heartened. As a society we have divested ourselves (in public at least) of unpleasant and dangerous attitudes, both the arrogance of the medical profession that they know better than patients and the awful expectation that ‘burdensome’ members of society should sacrifice themselves. I still don’t think we have a society or health service that could handle assisted dying well (if indeed any society can do so) but perhaps we’re getting there.