Once introduced euthanasia can expand without restriction
Following a wave of protests over the NHS euthanasia programme, the Coalition Government is preparing an investigation.
Some have claimed that hundreds of thousands of vulnerable NHS patients (or as the NHS calls them, ‘customers’) have been killed through the widespread adoption of the Liverpool Care Pathway by cash-strapped NHS Trusts.
The Liverpool Care Pathway sounds very caring and nice, but what it means is that doctors target vulnerable patients and deny them food and water, while increasing the level of opiates administered. This results in few victims surviving for more than 36 hours on the LCP and allows their deaths to be certified as being from natural causes.
There have already been a number of high profile court cases were individuals suffering progressive and terminal conditions have sought to obtain court approval for their suicides to be aided. The courts have quite rightly ruled that current law would make such assistance illegal, although where an individual is aided by a close relative in desperation, subsequent prosecutions have shown some understanding by the courts of the enormous pressures placed on relatives of the terminally ill. That does not extend to medical professionals and certainly does not extend to a deliberate financially motivated programme of killings.
Even more controversial is the fact that victims have been placed on the LCP to meet specific targets and without the relatives and guardians being informed. Underlining the dangers of LCP, there have been a number of cases where relatives become aware and insist that the victim is taken off the LCP, leading to immediate improvement in health and the discharge of the patient. It appears that some patients discharged home in these circumstances are still alive and able to enjoy a normal life, months after being taken off the LCP. It may be that these patients eventually die months or years after being taken off the LCP.
The result is that the position of courts, and the realities for many sick people, is that any doctor playing god, and deciding that a particular patient can be killed, is making an assumption and not acting on known certainties with the approval of the law. This suggests that those doctors who have been placing victims on the LCD without any discussion with relatives have unlawfully killed their victims like any other murderer. It may also conceal doctors who are serial killers, deriving gratification from their unlawful actions.
This is a very difficult area because it does also place at risk doctors who are effectively assisting a suicide or a killing, where the patient or their relatives have asked the doctor to hasten the death of the patient. The doctor would be unable to prove that death without intervention was unavoidable in the immediate future and that heavy pain relief was unavoidable. If food and water are withdrawn, the patient will die even if the illness is minor and recoverable. If heavy pain relief is administered in increasing doses the patient will eventually receive a lethal overdose. Once a formal policy of killing is introduced, it becomes very difficult for a court to decide which killing is gratuitous and for financial motives, and which is the inevitable outcome of a terminally ill patient needing increasingly large doses of drugs to manage pain.
There is also considerable difficulty in framing laws that define an inevitable death and permit assistance in hastening death. The doctor simply does not know when death will occur. It is possible to say that a patient probably only has six months to live, only for them to walk under a bus as they leave the hospital. It is also possible to say that in all probability a patient will die painfully in the next 24 hours, only for the patient to make a recovery which may be temporary or may give years of extra life. It is a little easier to identify an authority for decision of assisted death. If a patient is in full command of his or her mind and wishes to avoid a continuation of a slow and painful death, the law could recognize the individual’s right to make that decision and to absolve others of any form of blame or sanction. If the patient has made a declaration before his or her conditions deteriorates, it is also possible for the individual designate those who must act on their behalf if the patient is no longer competent to request lethal assistance. Legislation could be passed to fully recognize those rights but, until it has been enacted, there is no legal protection for those carrying out the patients wishes.