“On balance, I do not think that the law should change”

by Katherine Sleeman, 26 January 2015

Dr Sleeman is a National Institute for Health Research Clinician Scientist and Honorary Consultant in palliative medicine at the Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, based at Kings College, London.

In January 2015 she participated in a debate in Bristol that ‘Assisted dying should be legalised in England.  She posted her speaking notes on her blog.

My job as a palliative care doctor is to talk to people who are dying, and to their families, about their problems, fears, hopes and wishes. And I have been privileged to have had hundreds if not thousands of these most intimate conversations. Over the next 10 mins I’m going to explain why, on balance, I do not think that the law should change.

I say on balance because this is not a black and white issue. Wherever the line of the law is drawn, there will be some people who feel it is in the wrong place. So, we should consider what laws are for. The answer is to protect society. The conclusion I have come to, after almost 10 years as a palliative care doctor, is that a change the law would be associated with less protection for society, not more.

Autonomy, the right to self govern, forms the basis of almost every argument in favour of assisted dying. You’ll hear ‘it’s my right’, ‘it’s my choice’, ‘my decision’. I’ve read Chris Woodward, and I’ve read Ann McPherson, both of whom were terminally ill and argued passionately for a change in the law. Who wouldn’t be moved by their eloquent arguments, convinced that for them assisted dying is the right decision. But I am also sure, because I work with them every day, that there are people at risk of being harmed by this legislation.

And we should acknowledge there is a huge and intrinsic imbalance in this debate. Proponents of assisted dying are generally informed, educated, autonomous people, often with a platform to shout from. But those people who might be harmed by a change in the law, they are by definition without a voice. They are incapable of standing up in a crowded room and talking passionately about their vulnerability, we will not see collected essays describing their experiences of coercion. Your rights, your choices, and your autonomy are important and I would defend them. But not at the expense of harming some of society’s most vulnerable.

On this subject of vulnerability, the philosopher John Harris has written “those who might be encouraged to die are and remain free to refuse. They are not victims unless they make themselves victims.” This attitude is exactly what I’m worried about. We have to build structures and legislations around the weakest, not the strongest.

How do we protect the vulnerable within assisted dying legislation? The answer which gets no points is ‘with appropriate safeguards’.

Which safeguards are appropriate? How safe is safe enough? What margin of error are we willing to accept? I am simply not convinced that we have yet found the right answers. Is it even possible to draft a law robust enough to avoid harming the vulnerable? I am not alone in worrying that it might not be.

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