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.
