Royal College of Physicians re-examine euthanasia

As with all ‘grey area’ topics, having an opinion on euthanasia is tough. This age-old debate has probably been around since the idea of ‘mercy killing’ first entered people’s minds. Recently, the discussion gained strength amongst doctors in Britain.

On January 2019, a poll was conducted by the London-based Royal College of Physicians (RCP). It sought to identify whether British doctors believe that the RCP should be for, against or neutral in terms of euthanasia legalisation. The RCP represents over 35,000 doctors. 43.9% of respondents to the poll voted that the RCP should be against euthanasia legalisation. A further 25% voted to remain neutral. As a result, the RCP introduced an unprecedented threshold. It planned to remain neutral unless either of the ‘for’ or ‘against’ sides achieved over 60% of votes.

This requirement of a ‘super-majority’ attracted a great deal of controversy. Four doctors filed a lawsuit against the RCP arguing that the poll was unlawful. They claimed the poll was deliberately conducted misleadingly to try and change the RCP stance on euthanasia. Following the legal challenge, the RCP has clarified its position and categorically denied cradling support for the legalisation of assisted dying.

This situation is an interesting case. Usually, it is an apolitical stance to be ‘neutral’.  However, the largest euthanasia lobby group in the UK has acknowledged that opposition from medical bodies is one of the major barriers to the legalisation of euthanasia. Therefore, the poll, the lawsuit and the subsequent clarification by the RCP are not trivial affairs.

There are many countries in which euthanasia or assisted suicide is legal. These include Switzerland, Belgium and the Netherlands. Physician-assisted deaths tend to account for only about 0.3 to 0.4% of total deaths. However, the number of euthanasia deaths rises every year.

When legal, euthanasia is always a choice and one would be forced into it. Therefore, legalisation should not affect everyone. However, legalisation sends a message to society. It explicitly says that people have the option of ending their lives prematurely if presented with a terminal illness.

Assisted suicide is an argument about life, which formed before religion did. This is a medical, social, political, economic, and, above all else, philosophical debate. As Bill Bryson remarks in his book A Short History of Nearly Everything: “Life, in short just wants to be.” Animals, plants, trees, bacteria, and algae all just want to live. This is the most beautifully simple fact: that we just want to keep going for as long as we can. Some countries have legalised euthanasia where the patients are terminally ill. In some cases, it does not even require a great presence of physical pain. Unless the patient is suffering physically, I don’t understand how euthanasia is legitimate. After all, we are all terminally ill. The one undeniable fact of life is that it will end. Let us face, and embrace and indeed give space to this inevitable truth of our lives.

One paper noted that the predominant reason behind people choosing euthanasia is not even pain. Rather it is a lack of autonomy, dignity, and an inability to enjoy one’s life. Most people going down this path are not bothered by the physical illness but the mental toll it takes. Euthanasia, therefore, seems to bloom in minds where independence is preferred over dependence and autonomy over solidarity. Opposing euthanasia is, unfortunately, a double battle. First of reminding societies that we must care for our sick and elderly as we do our children. Secondly for the elderly and sick to be reminded that requiring another’s support, or relying on someone else to live, is not a sign of weakness. Life is a full circle and we should embrace it for what it is.

Then comes the concern of legislation being a step on a slippery slope. Once you legalise euthanasia, how do you decide its limits? For example, Belgium allows euthanasia for children. We all know that resilience is a product of age. How is it right to do euthanise children? We build a narrative around our lives, writing our own stories as we figure out what we want in life and what we care about. The legalisation of euthanasia takes away that requirement to wait, to give space to the period of pain and to let it pass. It offers an easy way out, which may not always be wise.

As a society, we are becoming increasingly aware that mental health illnesses are just as real and serious as physical illnesses. This realisation could also have consequences in the future. What will be considered to be a credible case to provide euthanasia in the future? Mental health illnesses can be chronic. No one can guarantee how a person might feel from one month to another.

What is difficult to accept is the hopelessness of the entire process: to think that things are so badly wrong that there is no way out but death. Is it wise to promote a path that appeals to the hopeless? Or should healthcare professionals, government officials, and ordinary people take it upon themselves to collectively build and protect hope within their communities?

As BJ Miller passionately and powerfully discussed in his TED Talk ‘What really matters at the end of life’, what we ought to provide for the terminal ill, those in pain, or those who don’t have long left is comfort and peace. We need to redesign our healthcare system, or at least broaden its remit. It should aim not just to prevent and cure illness, but to seek a more holistic approach to easing life. At least in the UK, with the ‘cradle to grave’ system that our much loved and much envied NHS is, this support is provided in the form of palliative care. It seeks to offer not only relief from physical pain, but emotional burdens as well. As Miller highlights, we as a society= should put measures in place so that people may feel unburdened and unburdening to others. Then people may choose to live, just as life should be.