Very recently I have had the good fortune of listening to what two distinguished oncologists – doctors who specialise in the treatment of cancer – have to say about the prospect of assisted suicide becoming law in this country.
I met the first, Professor Mark Glaser, the former head of cancer services for Imperial College Healthcare NHS Trust, in the Reform Club in London. It was our second encounter, and he struck me as he did on the previous occasion: as a gentle and genial man with a humility which is remarkable in view of his achievements. This is the oncologist who, after all, was asked to treat Dr Mo Mowlam after she was diagnosed with a brain tumour in the winter of 1996. He cared for her during her time as Secretary of State for Northern Ireland and through the Good Friday Agreement of 1998, and right up to her death in 2005. When Julie Walters played Dr Mowlam in the acclaimed 2010 movie Mo, Professor Glaser was played by Toby Jones, the star of this year’s Mr Bates vs The Post Office.
I asked Professor Glaser about Labour MP Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill which, according to reports, will permit doctor-assisted suicide for patients deemed to have a year or less to live. He contended that this particular restriction, or ‘safeguard’, rested on a flawed premise because no doctor can predict a patient’s time of death until it is almost imminent.
‘I can recall several patients who came to me – some as first opinions or second opinions – with reports that indicated a prognosis of months and they are still being cared for by myself 10 years, 12 years, 15 years or 20 years later,’ he said. ‘To indicate that there is a given cut-off for a given disease is completely and utterly wrong.’
He said: ‘Mo Mowlam didn’t live the six months, the 12 months, or the 15 months which her prognosis and the scientific literature would have said about her case. She lived for eight years and following her exit from politics she had a very productive and useful life.’
He continued: ‘Most of my colleagues and in effect myself thought that she had months to live. That’s what the literature taught me, that’s what science had taught me, this is what my teaching in radiation therapy and a drug that I was working on had taught me. But I realised she was optimistic and she wanted to go on.
‘She said to me, “Mark, will I suffer by the treatment? Will I suffer by the radiotherapy? Will I suffer by the chemotherapy? Will I be agitated? Will I be nauseated? Will I be in pain?” She asked me all these questions, but there I was able to be more confident in the fact that all these symptoms could be managed. I answered in a very quick way, without even thinking: “I will control the nausea, I will control the pain, I will control the side effects apart from loss of hair. You will feel well in your job.”
‘Everything that Dr Mowlam at the time exhibited we were able to get over to such an extent that she was able to play such an immense role leading up to the Good Friday Agreement. This says so much that the symptoms of a disease can be managed – pain, agitation, depression, not being mobile – everything can be alleviated.’
He said the claims by euthanasia activists that a third of patients in the UK died in pain were untrue, adding: ‘This to me sends shudders through my whole being because we have so many agents to relieve pain.’
I contacted the second specialist, Professor Benoit Beuselinck, via email because a trip to KU Leuven, the research university in Belgium, where he is Professor of Oncology, was a little inconvenient. Curious to know how an ‘assisted dying’ law might change the medicine in the UK, I asked him about what it was like to practise in a country where euthanasia was legalised as far back as 2002 – amid strict safeguards, of course. It was strictly for adults with terminal and incurable physical illnesses before it was extended to children and anyone who claimed to suffer unbearably.
In summary, Professor Beuselinck said that euthanasia deaths have incrementally risen every year and lethal injections now account for 3.1 per cent of all annual fatalities. Euthanasia is no longer seen as an exceptional measure, with people increasingly considering euthanasia as ‘the normal way to die, and palliative care as an alternative for those who chose it’.
More than a fifth of euthanasia cases now also involve patients who are not terminally ill but who have neurodegenerative diseases, psychiatric diseases and poly-pathologies (a collection of comparatively minor but permanent ailments which come with old age, like short-sightedness and incontinence).
People seek euthanasia, he said, also because of ‘fear of future suffering, loss of autonomy, the impossibility to pursue some activities, socials problems, such as isolation, the fear to be a burden for others, mental exhaustion and existential suffering’.
‘Even financial problems, such as repetitive medical bills or the high costs of a nursing home, can then become co-factors, which will change a physical suffering from bearable into unbearable,’ he explained.
‘Moreover, the promotors of euthanasia state that each suffering is mostly subjective, and that it is up to the patient to decide how important his suffering is. Any decision of the doctor that would go against the demand of euthanasia is then easily seen as a lack of respect of the patient’s will and autonomy.’
In Belgium, euthanasia was introduced with seemingly strict and unassailable safeguards, limited only to consenting adults who were suffering unbearably from terminal illness. In a short time these safeguards were removed and euthanasia was extended to children, and to people suffering unbearably. Because such suffering is subjective, this part of the law is interpreted extremely liberally. The situation that Professor Beuselinck is describing after 20 years of ‘assisted dying’ is euthanasia for any kind of suffering. Yet Belgium has not reached the foot of the slippery slope. Activists, he explains, are pushing for euthanasia to be granted to ‘elderly people who are tired of living or who consider their life as “fulfilled”, in order to solve the problem of raising health costs and the lack of nurses and other health care workers’.
So it’s now all about money, which brings me back to Professor Glaser.
During our conversation, he imparted the view that assisted suicide ‘will be a disaster for patients in the NHS, but it might be good for the NHS budget … it may save the NHS billions and billions of pounds’.
Following the Belgian experience, end of life care will be worse, Professor Glaser also predicted, as assisted suicide became a financially attractive option to shorten the care of patients believed to be dying.
‘Should the sick have these resources?’ he asked. ‘Should only young and well people have these resources? As an oncologist, as a doctor of such long-standing, [I say] it is not for us as a society to decide who gets the resources of life and death, dying and living.’
He added: ‘There are hundreds of thousands of patients who are written off and they live infinitely longer than their prognosis. In my own practice I have patients with actuarial survival of about a year and they are alive 10 years later.
‘I feel grateful that I didn’t advise them for assisted suicide, that I didn’t advise them for end-of-life care until end-of-life care was needed and then my team and my colleagues gave superb pain control and other control of symptoms.’
So there you have it: the Terminally Ill Adults (End of Life) Bill is dangerous because it will undermines public safety. It threatens most the poor and the most vulnerable – people who are disabled, the sick and the elderly. It sets in train a juggernaut, driven by the toxic mix of ideology and financial profit, which cannot be controlled and will inevitably lead to ever widening categories of victim and the catastrophic diminution of health care services. It must surely be rejected.
Mo Mowlam’s oncologist says claims by euthanasia activists that a third of patients in UK die in pain are “untrue”
