– As we age, more of us will face questions over assisted dying
The immunologist Professor Luke O’Neill, author of ‘Never Mind the B#ll*cks, Here’s the Science’, reveals how his father asked for help in ending his life after a stroke, and reflects on how legal euthanasia works around the world
My father asked me to kill him. He was 74, had suffered a stroke at 71 and couldn’t speak properly. He also had paralysis on his left side. He was a widower in a nursing home. We had tried home helps who came in every day, but he was also severely depressed, which made things difficult. He would say to me in his slurred voice: “You work in a lab. You have the chemicals to do it.” He also regularly said, “If I were a horse, you’d shoot me.”
My father, Kevin O’Neill, had a dark sense of humour, so I used to brush these conversations, but I knew he meant it. I would sometimes cry when I left him in his room, his own separate hell.
Should I, out of sympathy and love, have bumped him off? That would have been murder. But what if the law had allowed me to help him die? How would that have worked and would I have had the guts to do it?
Will a time come when euthanasia will be as routine as childbirth, as we head towards a population where the majority are sick and old, with lots of older people actually wanting to die? Or will the discovery of new treatments for diseases and better palliative care make euthanasia unnecessary?
The topic has been widely discussed in the UK again recently, with the Assisted Dying Bill being debated in the House of Lords. We must face this topic head-on.
Active euthanasia is legal in Belgium, the Netherlands, Luxembourg, Colombia and Canada. Assisted suicide is legal in Switzerland, Germany, the Netherlands, the State of Victoria in Australia and the US states of California, Oregon, Washington, Montana, Washington DC, Colorado, Hawaii, Maine, Vermont and New Jersey. It is illegal in all other countries, as is non-voluntary euthanasia (where the patient is unable to give consent).
Although legal in the countries mentioned above, it is only allowed under certain circumstances and requires the approval of two doctors and in some places a counsellor. Treatment or medical support being withdrawn because it is considered futile will also hasten death but is not illegal.
The Lords Select Committee on Medical Ethics defines euthanasia as “a deliberate intervention undertaken with the express intention of ending a life to relieve intractable suffering”. Yet in the Netherlands and Belgium it is defined slightly differently as “termination of life by a doctor at the request of the patient”. It doesn’t necessarily have to involve the relief of suffering, which is an important distinction.
The medical understanding of suffering can be hard to pin down. Does psychological suffering count, and how would that be measured? Perhaps the Dutch and Belgians have simplified the definition for that reason.
A historic case of euthanasia in the UK happened in 1936 when King George V was given a fatal dose of morphine and cocaine to hasten his demise from cardio-respiratory failure. This wasn’t made public until 50 years later. But it suggests that euthanasia might not have been so rare in Britain’s past.
Questions about euthanasia will come up more as the population ages. The debate centres on four issues: the right of people to choose their fate; that helping someone to die is better than leaving them to suffer; that the ethical difference between the commonly practised “pulling of the plug” and active euthanasia is not substantive; and that permitting euthanasia will not necessarily lead to unacceptable consequences. This is the case in the Netherlands and Belgium.
On consent, perhaps the person is not able to make the decision – determining competence is not straightforward. Perhaps they feels that they are a burden on medical services or on their family. How do we know unscrupulous friends or relatives aren’t pressuring them? Do hospital personnel have an economic incentive to encourage consent?
There seems to be a growing acceptance of euthanasia in the UK. In a 2019 survey of 2,500 people, more than 90 per cent believed that assisted euthanasia should be legalised for those suffering from a terminal illness. Eighty-eight per cent believed that it was acceptable for people living with dementia, provided that they consented before losing their mental capacity.
In another survey, 52 per cent would feel more positive towards their MP if they supported assisted dying, compared to 6 per cent who would feel more negative.
So what concerns people, apart from religious beliefs?
Guidelines and safeguards are important. Physicians and counsellors are all involved in assessing people requesting euthanasia in countries where euthanasia is practised. In the US, Canada and Luxembourg, the person must be over 18. In the Netherlands, the age is 12, while in Belgium there is no age limit as long as the person has the capacity for discernment.
In the US, there is no need for unbearable pain or any symptoms. In the Netherlands, Belgium and Luxembourg, patients must have “unbearable physical or mental suffering” with no likelihood of improvement, although the person doesn’t have to be terminally ill.
There is a danger that people with severe long-standing depression might want to have their life ended if they are terminally ill. This might be difficult to evaluate, as many with a terminal illness may also be clinically depressed.
In the US, assisted suicide must involve a 15-day period between two oral requests, and a 48-hour waiting period after a final written request. In Canada it’s 10 days and in Belgium it’s one month. The Netherlands and Luxembourg do not have any waiting period.
Across all places where it is legal, around 75 per cent of people who undergo assisted suicide are suffering from terminal cancer. The next-highest condition on the list is motor neurone disease, at 10–15 per cent. Pain is not that common as a motivating factor, with issues such as loss of autonomy and dignity being more important.
The bottom line is that euthanasia, when properly regulated, can give us hope of a better quality of death. We must also strive for scientific advances in bringing better treatments or palliative care for those who suffer.
When I think about the rights and wrongs of euthanasia, I think about Christian de Duve, a famous Belgian biochemist who won the Nobel Prize in 1974 for the discovery of the lysosome. This is the garbage disposal system for cells: it destroys parts that are old or worn out and can digest a cell whole when it becomes old or damaged. Lysosomes are a bit like a euthanasia machine for the cell.
Christian died by euthanasia in Belgium at the age of 95, suffering from terminal cancer. De Duve wanted to make the decision while he still could and not to be a burden on his family. Christian spent the last month of his life writing to friends and colleagues to tell them of his decision. In an interview published after his death, he said he intended to put off his death until his four children could be with him. He was at peace with his decision, saying, “It would be an exaggeration to say I’m not afraid of death, but I’m not afraid of what comes after, because I’m not a believer.”
The second person on my mind when I think of this topic is my father. During the winter of 1995–6, Dad suffered several bouts of pneumonia, almost dying on one occasion. In January of 1996 his GP asked to see me. He suggested that perhaps he wouldn’t prescribe another course of antibiotics and would see if my Dad could fight the latest bout on his own. I knew what he was saying by the way he looked at me.
My dad died peacefully of pneumonia (or ‘the old man’s friend’ as he used to call it) in his sleep on 20 February 1996, with me sitting beside his bed, holding his hand. Not a bad way to go, Dad.
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