On the issue of palliative care, we know from all the surveys that have been carried out that between two thirds and three quarters of doctors oppose a change in the law; indeed, the BMA and most of the royal colleges, too, oppose it. However, I have always been struck by the fact that opposition is disproportionately high among palliative medicine specialists—for example, at the time of Lord Joffe’s bill in 2006, 95 per cent of palliative medicine specialists were opposed to it. We have to ask ourselves why it is that people who spend all of their time with the kind of folk whom one might regard as coming within the remit of the bill are most opposed.
I think that there are two main reasons for that. First, people who deal with the dying understand the vulnerability of dying and disabled people in a way that other doctors do not. They spend a lot of time with those people; they understand the family dynamics and the subtle pressures that families can put on them; they see their vulnerability and see them making choices often because they have no other choice; and they recognise the need for people to have legal protection.
However, the second reason is that palliative medicine specialists know exactly what to do with all kinds of different symptoms, whether they be physical ones such as pain and nausea, feelings of social exclusion or spiritual problems such as lack of meaning and purpose. Specialists are specifically trained to deal with such things.
Much of the push for this change in the law is coming from the worried well rather than from really sick people. In fact, the percentage of those dying who want euthanasia or assisted suicide is much lower than the percentage in the general population, simply because people change their minds when they see the care that they can have and when they experience good care.
As you will hear, I do not have a Scottish or an English accent; I come from New Zealand, and one of my colleagues in New Zealand looked after the president of the Voluntary Euthanasia Society of New Zealand in his final days. The man was suffering from a terrible cancer, the symptoms of which were very difficult to control, but right up until the very end he did not request euthanasia, even when prompted. He was anxious that, because of who he was, someone might do the deed for him.
Rob George, who is one of the leaders of the Association for Palliative Medicine of Great Britain and Ireland and who speaks on behalf of our movement, says that, in a lifetime of managing 20,000 cases of dying people, he could count on the fingers of his two hands the number who made persistent on-going requests for their lives to be ended or requests to die. In other words, once those people experienced good care, an overwhelmingly vast majority of them wanted assisted living, not assisted dying. They wanted care until they died, not an assisted death.
The question that we are left with, then, is whether we change the law for this very small group of desperate and determined people to allow them to kill themselves. The argument is about a balance of harms. I would argue that we should not, as doing so will simultaneously remove legal protection from a much larger number of vulnerable people.