The report on Lord Joffe’s Assisted Dying for the Terminally Ill bill was released in April. For those of us arguing that Britain is ‘sleepwalking into euthanasia’ the content was less concerning than it might have been – the expected media feeding frenzy never happened because of the Pope, the royal wedding and the election.

'A thorough and balanced report’?

Acknowledging it was frequently divided, and recognising ‘there is insufficient time remaining for the bill to be considered adequately in this session of Parliament’ (it ended the next day) the Lords Select Committee aimed to present ‘a thorough and balanced report on the subject of assisted suicide and voluntary euthanasia’. (In physician assisted suicide – PAS – the doctor prescribes lethal medication which the patient swallows; in euthanasia the doctor administers a lethal injection.)

Did they succeed? Well, yes and no. Yes, in that there is a useful collection of opinion and evidence from the UK and countries where PAS and/or voluntary euthanasia are legal – the Netherlands, Belgium, Switzerland and the US state of Oregon. Yes, in that there is a reasonable description of the two main principled arguments – personal autonomy (self determination) versus the inviolability of life.

Did they succeed in a balanced report? No, in that there is an astonishing repetition throughout of ‘Lord Joffe said’, ‘Lord Joffe accepted’, ‘Lord Joffe agreed’, ‘Lord Joffe promised’. Who is this lethal Lord? A self declared member of the Voluntary Euthanasia Society, he introduced the bill which became the subject for the Committee, but extraordinarily he then sat on that Committee. He seems to have been its main influence and a neutral reader could be forgiven for concluding he had dictated the report.

No, in that the report is inconsistent in its support for the principle of autonomy. Joffe himself accepts that autonomy has in practice to have limits when he discusses palliative care not necessarily being available to all: ‘That is what autonomy is about. It is about choosing between the options available to you rather than the ones you don’t have.’ Precisely. Let autonomy have limits, and let one of those be that PAS and euthanasia are never available as therapeutic options.

Yet elsewhere we must have euthanasia for a minority whose rights will be harmed unless it is legalised. This is even though ‘the number of people who might be regarded as serious about ending their lives, who are not psychiatrically ill and who are unlikely to be deflected from their purpose is very small indeed [emphasis added]’. There are far more people in Britain who would like to go foxhunting, but we have used the law to deny their claimed right. 

Recommendations

Much has been made of the recommendation that the report be debated in the next session of Parliament but chairman Lord Mackay explained this obligation was procedural. Secondly, any new bill introduced should be referred following a formal Second Reading to a Committee of the whole House for detailed examination. More worryingly, several detailed suggestions are made to improve the acceptability of any future bill.

Gretna Green revisited?

Lord Joffe has announced his intention to exclude Scotland as well as Northern Ireland from the bill’s ambit on the (debatable) grounds that the issues are devolved to the Scottish Parliament. Even with residency qualifications, surely legalisation either side of the border would introduce suicide tourism within the UK?

Could this political strategy be related to Liberal Democrat MSP Jeremy Purvis’s consultation on a similar bill of his in Scotland? And could the euthanasia societies be co-ordinating all this?

PAS – euthanasia one step back?

The report suggests the medical profession and legislators might find PAS more acceptable than voluntary euthanasia. The doctors might feel less directly involved, it might conceivably be a safeguard against abuse as the patient has final control, and drawing on the experience of the countries which allow one or other or both, the lesser scope would lead to lesser take up. Would fewer deaths be more palatable politically?

Ethically, PAS is simply euthanasia one step back. However rarely and with whatever good motives, doctors must never become killers.

‘I’ll be back’

Lord Joffe has already promised to reintroduce a bill in the next Parliament. While this Committee could not agree and has sat on the fence by suggesting it is all a matter for society through Parliament, this report marks the end of the phoney war. Those who oppose legalised assisted dying must now wake up and be alert to fight and continue fighting in a debate that could last decades.