Why I believe Dame Esther is profoundly wrong on assisted dying
Published by The Daily Mail (22nd December, 2023)
Calls for a change in the law relating to assisted dying rose to a crescendo this week. Yesterday Labour leader Sir Keir Starmer added his voice to that of Dame Esther Rantzen, who on Tuesday revealed that she has joined Dignitas, the Swiss clinic that facilitates suicide.
Dame Esther, who has stage four lung cancer, wants MPs to be given a free vote on assisted dying in Britain, arguing that people should have a choice about ‘how you want to go and when you want to go’.
Starmer backed her stance, saying there were grounds for changing the law and the most appropriate way forward would be ‘a free vote on an issue where there are such divided and strong views’.
Their interventions in one of society’s most emotive debates come as the House of Commons’ health and social care committee concludes a landmark inquiry into this issue and amid growing pressure from campaigners for reform.
Their cause, which preys upon our deepest fears, is promoted as a progressive ideal for civilised countries. Earlier this week, the Mail’s Sarah Vine wrote a heartfelt piece explaining why she has come to support assisted dying, and it is impossible not to be moved by pleas from terminally-ill patients confronting death, such as Dame Esther.
Yet I profoundly disagree with both of them. And I say this as a liberal and an atheist, who would be comfortable requesting euthanasia for myself if medical need arose. So let me explain the reasons for my opposition.
The first is professional. I have investigated assisted death in the Netherlands and Belgium — the two places that pioneered such reforms — and it is clear that society slides inexorably down a slippery slope once the practice is sanctioned.
‘It’s impossible to keep the door open just a bit,’ one Belgian psychiatrist told me, concerned over a case involving a man pressuring his elderly mother to die on grounds of tiredness with life ‘because he wanted her money’.
Both countries have seen the number of assisted deaths soar as eligibility rules were extended to the point that they embraced even children with incurable conditions, teenagers with mental health problems and young adults with anorexia.
After all, if assisted dying is permitted for physical pain, why not for mental agonies? So in Holland, where mercy killings now account for one in 20 deaths, a woman’s life was ended 12 months after her husband’s death due to ‘prolonged grief disorder’.
The Dutch were the first to legislate for assisted dying for patients with ‘continuous, unbearable and incurable suffering’ in 2002. Twelve years later the law permitted even a 47-year-old woman with bad tinnitus to extinguish her life.
Latest data shows that 288 people with dementia were helped to their death last year in Holland — despite the original proviso that patients must be ‘of sound mind’. And 29 couples chose to end their lives together.
One political party is pushing for ‘completed life’ euthanasia — death on demand for anyone aged over 75 — which follows a joint proposal six years ago from the Netherlands’ health and justice ministers to give anyone over 70 years of age the right to receive a poison pill, without the need for medical involvement.
One Dutch ethicist — who sat on an official body reviewing cases —warned nations considering reform to ‘look closely at the Netherlands because this is where your country may be 20 years from now’.
In Belgium, I spoke to a physician nicknamed ‘Dr Death’ who admitted dispatching 140 people — including two friends — and advising on 500 more cases, despite the Hippocratic oath instructing ‘first do no harm’.
Later I held a disturbing discussion with a bright, friendly 23-year-old seeking to die due to mental distress. ‘It won’t hurt so I don’t see the problem,’ she told me, explaining how she saw ‘a monster’ when looking in the mirror.
Yet many experts insist such cases can improve with time, therapy and medication.
Activists claim legalising assisted dying reduces non-assisted suicides, but several places have recorded a rise instead.
We have seen the same downward spiral in Canada after assisted dying was legalised in 2016. In the following years, rules governing eligibility were liberalised and there was a huge rise in cases, despite Prime Minister Justin Trudeau promising otherwise.
Now Canadian law is being extended again to include anyone whose sole issue is mental illness despite a slew of horrifying tales about patients driven to assisted death by poverty, poor healthcare or inadequate social support.
Jaro Kotalik, a Canadian bioethics professor and co-editor of the first full analysis of his country’s disastrous reform, told British MPs that patients are being offered death over treatment or care to cut medical costs.
‘Some patients, particularly the elderly, feeble, frail or those with long-term disabilities, whose quality of life is perceived to be low, are now seen first and foremost as candidates,’ he said.
This leads to my second source of opposition, which is a highly personal one. As the father of a woman with learning disabilities, I am only too aware of how some people are deemed second-class citizens in our society.
False and bigoted assumptions are made frequently about their quality of life. Official studies show prejudice leads to many avoidable deaths of people with autism and learning disabilities — even in the sacred NHS. And patients in both categories suffered disproportionately high death rates in the pandemic, plus the blanket imposition of ‘Do Not Resuscitate’ notices.
Due to a shameful lack of care support, they are too often locked in psychiatric hospitals with their human rights swept aside — a scandal that drags on despite repeated abuse revelations and condemnation of such practices on cost, medical and moral grounds.
One study published this year revealed that eight Dutch people were subjected to euthanasia simply because they felt unable to live with having a learning disability or autism, along with 16 other closely related cases. Many, heartbreakingly, included being lonely as a key cause of unbearable suffering.
‘Is society really OK with sending this message: that there’s no other way to help them and it’s better to be dead?’ asked the study’s co-author Irene Tuffrey-Wijne, professor of intellectual disability and palliative care at Kingston University London.
Similar concerns have emerged in other countries. These — and the threat of legalisation here — only fuel the fears of parents such as myself over my daughter’s future as her mother and I enter our 60s constantly worrying about her care.
‘Anyone who embarks on euthanasia ventures on a slippery slope along which you irrevocably slide towards the indiscriminate killing of defenceless patients,’ warns Bert Keizer, a prominent Dutch euthanasia doctor.
This is chilling. Yet there is an alternative, which leads to my final reason for opposing euthanasia.
In addition to her learning disabilities, my daughter has a life-threatening condition — and so I have witnessed the amazing, compassionate support of hospice and palliative care teams during intensely stressful times.
We should strengthen, not undermine, a branch of medicine pioneered in Britain to deliver the best end-of-life care and unrivalled levels of support for families.
One professor of palliative medicine told the Commons’ health committee of a patient who said he would kill himself within two weeks but was alive 11 years later, underlining how a desire for assisted dying is often triggered by a fear of suffering that can be soothed.
Another palliative specialist from Wales told MPs his experiences of working with terminally ill patients left him feeling it was impossible to avoid ‘subtle’ and even ‘unintentional’ coercion of frail patients who felt like a burden on families.
Behind the debate lie tough questions about the medicalisation of mortality, the failure of care, the breakdown of families and even how we spend such a big slice of our health budget keeping people alive for a few more months in the twilight of their days.
Dame Esther has fuelled another important debate — but let us hope it goes beyond a simplistic discussion of euthanasia to embrace deeper questions over valued lives and decent deaths in a genuinely humane society.