In Britain Fewer Conflicts of Conscience

Abstract

The thoughtful paper by Campbell and colleagues raises questions in a different context from the practice of hospice and palliative care in the United Kingdom. The debate on the issues of euthanasia and, more recently, physician-assisted suicide, has been going on for many years in this country, as it has in the United States. So far, in spite of the strong lobby of the Voluntary Euthanasia Society, there have been no changes in the law in the United Kingdom. Since 1959 I have been challenged to debate these issues on many occasions and am glad to say that the next generation is now able and ready to respond. Both the Association for Palliative Medicine and the National Council for Hospice and Specialist Care Services of the United Kingdom have recently presented written and oral evidence to the House of Lords Select Committee on Medical Ethics. Endorsed by their membership, their representatives have taken the stand that there should be no change in the law to allow anyone to hasten death. The problem of the different attitudes of hospice teams so carefully presented in the paper by Campbell has not arisen so far. I am also informed that in Scotland, where to assist in suicide is not illegal as it is in England, the question rarely if ever arises and practice there is the same, that is, all help is given to bring relief although not a deliberate hastening of death. At times we may have to involve the principle of double effect, knowing that the adequate control of terminal restlessness or pain may lead to a degree of sedation that in itself may hasten death. This is rare and is always fully discussed with both the patient and the family. It was expressed in his summing up in the Dr. John Bodkin Adams case by Judge Devlin as follows: If the first purpose of medicine, the restoration of health, can no longer be achieved, there is still much for a doctor to do, and he is entitled to do all that is proper and necessary to relieve pain and suffering, even if the measures he takes may incidentally shorten life. This is not because there is a special defence for medical men but because no act is murder which does not cause death. We are not dealing here with the philosophical or technical cause, but with the commonsense cause. The cause of death is the illness or the injury, and the proper medical treatment that is administered and that has an incidental effect on determining the exact moment of death is not the cause of death in any sensible use of the term. But ... no doctor, nor any man, no more in the case of the dying than of the healthy, has the right deliberately to cut the thread of life.[1] Hospice and palliative care teams in this country do not meet patients with unmanageable pain and psychological torment imposed by an illness that is not imminently life threatening. Our experience is that the rare requests of this kind are commonly well within the fifteen stipulated in the act (the patient whose story is quoted in the paper only asked for his life to be ended several days before lapsing into coma). This is as true of our home care patients as it is for those within our in-patient unit (and currently we have between 230 and 250 patients being cared for at home and between 50 and 55 in the hospice wards). I think that hospice teams here possibly have more input in relieving distress than some teams seem to have in the United States, where I understand they are still very much at the bidding of the referring physician. Perhaps our longer experience has led to more successful practice (which has been backed up by a recent study from St. Christopher's Hospice [2]), though in no way do we wish to rest on our laurels. From a personal point of view, I would not judge a patient who took his or her own life and we frequently give patients at home supplies of medication to control their symptoms which they could use in this way. …