Fit for what?

Euthanasia literally means 'a good death' but it has come to mean the deliberate killing of those deemed 'better off dead' either by society in general, their relatives or doctors.

'Voluntary euthanasia' is now a very real threat in this country, and there is also pressure to put on a legal footing what is already going on - killing disabled and incapacitated people by 'withdrawing medical treatment' - meaning starving and dehydrating them to death.

Those in favour of 'voluntary' euthanasia accept the idea that incurably disabled or terminally ill people are 'right to want to die', while apparently able bodied mentally well people are 'wrong to want to die'. Those who fall into the category of those considered 'right to want to die' who are unable to express a view either way, precisely because of their incapacity are increasingly assumed to be 'better off dead.'

Holland

In Holland, where 'voluntary' euthanasia has been decriminalised since 1984, those who have not consented are also regularly killed.

Dr. Henk Prins killed baby Rianne Kunst, who had spina bifida, because he apparently 'could not bear to see her suffer' (i.e. to save his 'suffering') (1). He killed her by means of a lethal injection and, in a typical attempt to deny the humanity of those with disabilities, Dr. Prins called Rianne 'a sleeping plant'.

A British Medical Journal (2) article considered 'end of life decisions' for mentally-disabled people in Dutch institutions - meaning deliberate decisions to hasten their deaths. It revealed that 44% of these deaths had been hastened with only two people 'expressing a wish to die' - and even pulling out a feeding tube was being interpreted as a 'wish to die.'

In February 1999 a survey of 400 Dutch doctors was reported (3). It found that of 4,500 cases where doctors admitted they intentionally ended life, 900 patients had not explicitly stated that they wanted to die. In 15% of cases doctors admitted a discussion could have taken place, but they had gone ahead with euthanasia because they believed it was in the patient's 'best interests.' In 17% of cases even the doctors admitted that there were alternative treatment options. This seems a low number, but bear in mind that Dutch medical students have been reported as saying: 'We don't need palliative care, because we have euthanasia' (4).

Not surprisingly, vulnerable Dutch people are afraid. It has been reported that 30% of Dutch cancer patients refuse to take their morphine or take lower doses because they are afraid their doctors might try to kill them (5). And a survey found three out of four residents of Dutch old people's homes afraid they would be killed at some point by a doctor - with or without their consent (6).

Britain now

Elderly and vulnerable people have reason to be afraid here too. It was recently reported that the police were investigating 60 cases of elderly people who had died after being deprived of food and water by hospital staff (7). Several cases have been cited in the newspapers, one of which was Alice Murphy, aged 84.

She was admitted to hospital with pain in her arthritic knee. Her son later discovered that she had been taken off solid food and put on a 'Nil by mouth' regime. She died two weeks later. He says 'My mother went into hospital with something wrong with her knee. No one even looked at her knee. She wasn't even X-rayed.'

British Medical Association

In June 1999 the BMA issued a document Withholding or Withdrawing Life-Prolonging Medical Treatment: Guidance for decision making. It favours starving and dehydrating to death patients in PVS, those with Alzheimer's Disease, those who have had a severe stroke, and disabled babies (including those with spina bifida, the disability I have myself). The Guidelines make it quite clear that in the main they are talking about patients who were not dying until the doctor got his hands on them.

In October 1999 the Government issued a Report entitled Making Decisions, on proposals for reform of the law relating to mentally incapacitated adults. The Report seems to start very well, saying: 'The Government wishes to make absolutely clear its complete opposition to euthanasia which is, and will remain, illegal.'

Unfortunately, this is not the clear statement it appears to be, because the definition they use of 'euthanasia' is 'a deliberate intervention undertaken with the express intention of ending a life.' By claiming that only actions and not omissions amount to 'euthanasia' they get away with the suggestion that doctors should be allowed to withdraw food and fluids from patients who are not dying.

The Winterton Bill

Personally, if someone has the 'express intention' of ending my life, how they choose to do it, whether by stabbing me, overdosing me with drugs or starving me to death, is immaterial. I still end up dead, and the murderous intent is identical in each case. Starving to death those who cannot speak for themselves is not 'voluntary' euthanasia, but it is an appalling kind of non-voluntary euthanasia. It is precisely this sort of dispatching of vulnerable patients that Ann Winterton's Medical Treatment (Prevention of Euthanasia) Bill seeks to prevent.

The Bill is very simple in its provisions and although it seems absolutely clear that it seeks only to protect vulnerable people from death by deliberate neglect, the government is not supporting it.

As far as supposedly 'voluntary' euthanasia is concerned, fear of pain and suffering causes many people to think it may be acceptable. The truth is that most physical pain can be controlled in the right environment. The vast majority of requests to be killed stem from severe depression which can and should be treated, rather than from pain.

Hospice doctors estimate that at least 95% of physical pain can be completely and easily relieved while much of the rest can be relieved by non-drug methods. Euthanasia militates against such care being taken to control pain. Interestingly, there are 185 pain clinics in the UK, and only three in the whole of Holland. Similarly there are over 280 hospices in the UK and only six in Holland.

Suicide attempts

Perhaps the most compelling argument against euthanasia I can present, however, is myself. I have suffered a lot of pain in the past and still do now.

Some years ago - about 17 years ago - mental pain, due to several factors including my husband suddenly leaving me, compounded the physical pain so that I began to think I no longer wanted to live. Over time this became a settled wish. It lasted many years and I attempted suicide several times.

Some of the attempts were really 'cries for help' but others were very serious, especially one attempt I remember well. I took a large overdose of pain-killers and cut both wrists with a knife. I then drank almost a whole bottle of Martini, lay down in bed, cuddled my favourite teddy bear and waited to die.

Fortunately for me (at the time I thought most unfortunately) my friend Sue arrived shortly afterwards. She found I was losing consciousness and called 999.

I was taken to hospital and treated against my will. I refused stomach pumping and treatment for my wrists, so they waited until I lost consciousness, then treated me anyway. If someone had asked me then if I truly wanted euthanasia, I know I would have said 'yes' with no hesitation.

If I were Dutch . . .

If I had been in Holland then, I would have satisfied all their criteria for voluntary euthanasia. The fact that these were not the cause of my wish to die would never have been considered. The Dutch rules specify only that these conditions must be present, not that they be the cause of the suicidal desire.

I would have been killed, and thus denied the chance to rediscover my human value - a value which is not compromised by the fact that even now I have severe pain which is not well controlled, the same incurable disability and, sometimes, depression. I would have been killed solely because of the eugenic philosophy that people like me are 'right to want to die' and 'better off dead.'

Euthanasia concerns us all, but right now it is a current reality for those who cannot speak for themselves. It is also a constant and very real threat to those who feel as desperate now as I once did. For their sake and mine (for I would not be writing this now had euthanasia been legal when I wanted to die), I would ask you to remember that a really 'good death' is one which is natural, not contrived.

Far from achieving 'dignity' only in death (we hear so much about 'death with dignity') what incapacitated people, like those facing starvation to death, and suffering people like me really need is the support and encouragement to live with dignity - until the time comes for us to die naturally.

References

1. Scotsman 8/11/95.
2. BMJ 12/7/97.
3. Journal of Medical Ethics 1999:25:16-21 + Guardian 16/2/99.
4. Western Australian Right to Life Association Newsletter, July - August 1999.
5. Lancet, 2/11/91.
6. Oracle, 22/11/92.
7. Times, 7/12/99.

A personal experience of the current reality and future threat of euthanasia for disabled people