Select Committee on Assisted Dying for the Terminally Ill Bill Minutes of Evidence

Examination of Witnesses (Questions 1971a - 1979)



  Q1971a  Chairman: Thank you very much for coming to help us this afternoon. I think that, possibly, the name plates we have provided for you do not have your correct titles. I think I am right in saying that both Mr Gilbert and Ms Fiona Randall are qualified medical practitioners?

  Q1971b  Chairman:

Dr Randall: Yes.

  Q1972  Chairman: First of all, I should explain that the evidence that you help us with will be taken down and you will get a chance to look at the transcript to see whether it accords with what you thought you said. In due course, the corrected transcript will be appended to our report and will become public as a document when that report is published. I would invite you, in what order you think appropriate, to give a short introduction of yourselves and your points of view, and then the Members of the Committee will wish to ask you questions about particular matters in your area that they would like further help on. Dr Gilbert?

  Dr Gilbert: My name is Jim Gilbert and, as you say, I am a qualified medical practitioner, consultant and medical director of a palliative care service in Devon since 1992, during which time, as a service, we have looked after approaching 10,000 patients with advanced, incurable, progressive diseases, and, importantly, the families and those close to them. I have served on the Association for Palliative Medicine, which is the Hospice Doctors' National Association Ethics Committee. I have published on end-of-life care and ethics over the years and currently chair the Royal Devon and Exeter Hospital Clinical Ethics Reference Group. For the Association for Palliative Medicine Executive Committee, together with my colleague Dr David Oliver, I conducted a survey of UK palliative care doctors in 2003 regarding attitudes to euthanasia and physician-assisted suicide.

  Q1973  Chairman: You are using the same definition as I am inclined to use: physician-assisted suicide is where the patient himself or herself self-administers the prescription whereas euthanasia is where the doctor acting on a request performs the necessary action to bring the patient's life to an end?

  Dr Gilbert: Exactly. This survey was referred to briefly this morning, and I have a copy, in case you have not got it for the record here, of both the questionnaire and all the responses. We sent out 726 of these to all those on our database of UK practising hospice doctors and it was interesting that we received, despite all the busyness of those individuals, over 600 replies without any prompting over the course of just a few weeks. Briefly, the results of this survey showed over 90 per cent opposition to legislation permitting euthanasia or physician-assisted suicide. Both options were put in the survey. I have got full details of the numerical results and the comments that came with that for the Committee to look at later. It seems to me that with this Bill there is a clear expectation that assisted dying is to be offered in the context of palliative care and that, therefore, the overwhelming opposition of hospice doctors as evidenced by this survey seems an important consideration. I would like to comment briefly on why I think this might be. Firstly, I would certainly not suggest that palliative care can in all circumstances relieve all suffering. I know that has been an important question for the Committee to have answered. Within existing law, doctors do seem confident, however, that physical symptoms can be treated fully in the last few weeks of life, and I know that in previous sessions of this Committee it has been recognised that existential suffering and the fear of dependence may be much more relevant to requests for assisted dying than uncontrolled symptoms. In these circumstances, my belief is that doctors wish to reassure people unequivocally who believe themselves to be a burden and to emphasise the value of their continued living rather than giving them a psychological if not physical push from the bridge by agreeing to help them end their lives. Finally, from me, a word if I may about prognosis and prognosticating—the art of so doing—because it is far from a science. It is clearly envisaged that an important safeguard has been included in this Bill by restricting assistance in dying to people with a short prognosis. Much reassurance seems to have been taken from this restriction. I believe that doctors working in palliative care are uniquely well positioned to see the fallacy of this apparent safeguard. Paul Glare's earlier evidence to this Committee demonstrated great inaccuracies in doctors' honestly estimated prognoses, and given the injustice that will be perceived by those in favour of assisted dying in denying such assistance to those people who deem themselves to be suffering unbearably as a result of chronic rather than terminal illness, there seems good reason to believe that an estimate of a short prognosis will be easily obtainable from a well-intentioned but perhaps misguided pair of doctors willing to stretch a point in order to comply with what they perceive to be patients' wishes. In summary then, from me, palliative care doctors are overwhelmingly opposed to the provisions of this Bill. It seems both unjust and unworkable to me to restrict assisted dying to those with a short prognosis, and the major relevant suffering (existential suffering and the fear of dependence) may lie out-with the remit of health care and the competence of doctors to judge.

  Professor Finnis: I am John Finnis, Professor of Law and Legal Philosophy at the University of Oxford and a Fellow of the British Academy. I have worked quite a lot on moral and even theological matters, but my academic work at Oxford is on public policy and law, in which matters private morality and belief are not the issue but, rather, the interplay between legal principles and social consequences. It is in that capacity that I want to give evidence today. At present, there is a clear principle: never intend to kill the patient; never try to help patients to intentionally kill themselves. That is the law, it is the long-established common morality, it is the ethic of the health care profession and it is Article 2 of the European Convention on Human Rights, and so forth. There is a "bright" line, and though like other laws and principles it is not invariably respected it is not in the least artificial or brittle; it rests on a rational principle that a person's life is the very reality of the person, and whatever your feelings of compassion you cannot intentionally try precisely to eliminate the person's reality and existence without disrespect to the person and their basic equality of worth with others. I think that that principle underlying the clear line is sound and right, though I am not here primarily to ask you to agree with it. Rather I am here to compare the present situation with the situation once any form of euthanasia or legalised assistance in suicide is admitted. In the new situation, any attempt to draw the line is necessarily artificial. The principles on which any attempted line would be based undermine each other and subvert the attempt to hold a line. If autonomy is the principal or main concern, why is the lawful killing restricted to terminal illness and unbearable suffering? If suffering is the principle or concern, why is the lawful killing restricted to terminal illness? Why must the suffering be unbearable if there is real and persistent discomfort? If suffering is unbearable, why should one have to wait for 14 days? If suffering and terminal prognosis are the concern, why is relief restricted to those who are capable of asking for it? Each of those questions is not simply a reason for doubting the rationality of any proposed line alternative to the present principled lines, each of the questions is also a reason why there will be much more abuse and secrecy and underground killing than at present, because each of those questions can and will be asked by any doctor faced with a patient demanding euthanasia or assistance in suicide or with a patient not demanding it but suffering or confronting an early death. Patient autonomy pushes the doctor to accede to requests that do not meet the legal criteria of terminality or suffering. Suffering, or terminality, and medical responsibility each push the doctor to set aside the requirement of voluntariness. All this will cause eternally reinforced and profound changes in medical and professional ethics, so that intentional death-dealing becomes a clinical option and, of course, also a hospital management option and a nursing home option. Now, you as a Committee have been to the Netherlands and read the government-sponsored and government-commissioned reports in 1991, 1996 and 2003 investigating the practice of euthanasia in that country. You may have in mind the figures that can be found in the tables in these reports but they are known to extremely few people in this country, and I would like to put them in evidence publicly today. The latest figures can be found extracted from the reports and set out in scholarly fashion by the Dutch medical practitioner Dr Richard Fenigsen in the journal Issues in Law & Medicine, volume 20, summer of 2004. The two earlier surveys are analysed in depth by Professor John Keown in his Cambridge University Press 2002 book, Euthanasia, Ethics and Public Policy, Chapters 9-13. I will restrict myself generally to the 2001 figures published in 2003, after Keown's book. The population of the United Kingdom is a bit less than four times that in Holland, but the death rate here is a bit more than four times the size, so it is reasonable to multiply the Dutch figures for euthanasia by four to get a sense of the Dutch picture if it were replicated here. Taking the Dutch 2001 figures, based on their own government-sponsored, ministry-commissioned tables, generated by confidential interviews with hundreds of Dutch medical practitioners and questionnaires to many thousands of medical practitioners who had signed death certificates, there would be here in the United Kingdom nearly 15,000 deaths per annum by active, voluntary euthanasia and nearly half of these would be done without the legally required procedures. There would be over 1,000 assisted suicides, at best about half of them in accordance with legal procedures. But then there would also be nearly 4,000 cases of active, involuntary euthanasia; that is, lethal injection without the request of the patient, all totally illegal and uncertified. There would additionally be over 11,000 cases of lethal overdose of painkillers with intent to cause death, and none of these would be certified. These figures are so embarrassing that the authors of the 2001/03 report omitted a line of inquiry they had pursued in their own previous reports, which had revealed in 1991 that over 70 per cent of the deaths caused by lethal overdoses of painkillers with intent to cause death were without the patient's request or knowledge. In other words, there would be, in the United Kingdom, over 30,000 cases per annum of death intentionally and actively caused by physicians, of which only about 7,500 would be in accordance with the law's procedure. Of these 30,000, over 12,000 would be without the patient's knowledge or consent—not to mention at least a dozen cases a year when newborn babies are actively euthanised without the consent or knowledge of their parents out of a total of about 400 euthanised newborns killed by lethal injection. Besides all that, there would be over 70,000 cases where life-sustaining treatment is withheld or withdrawn with the explicit intention to cause death. That is 70,000 plus out of about 110,000 cases where life-sustaining treatment is deliberately withdrawn or withheld where otherwise it might have been given. So we are looking at well over 100,000 cases of active or, so-called, passive euthanasia in the full sense of an intent to bring about death, and of these only about 7,000 or 8,000 are in accordance with the law's requirements—projected future euthanasia law in assistance in dying—while tens, if not scores, of thousands of these are not voluntary. Those are the figures scientifically estimated by the Dutch government's appointed experts simply multiplied by four to get a rough UK figure. The authors gloss over these figures in their soothing commentaries. I can imagine that they may even have glossed over them in their discussions with you, possibly, though their 2003 report repeats the eye-opening assertion that they made in 1996: namely, it is the patient who is now responsible in the Netherlands for avoiding termination of his life; if he does not wish to be killed by his doctor then he must state it clearly orally and in writing, well in advance. So the public policy point I want to make is that none of this is accidental or can reasonably be assumed to be peculiar to Holland. The interplay between patient autonomy, suffering, prognosis, patient embarrassment, medical autonomy and the hidden influence of relatives and carers with their own autonomy and interests, in the context of an officially sanctioned devaluation of human life under conditions of disease, disability and disablement is, inevitably, I should say, a web of forces making it impossible to establish and hold an effective line once the present clear line and principles are abandoned. The violation of the right not to be killed, the right not to be put in vivid fear of being killed and the violation of the right not to be pressed into suicidal decisions would therefore become, I am confident, more widespread and more burdensome—I suspect enormously more burdensome—than the present violation of the autonomy rights of a relatively few that is alleged (I think fallaciously) by supporters of the Bill you are considering.

  Dr Randall: I am a consultant in palliative medicine and I have been since 1982. I have served on the BMA Ethics Committee and I have a Philosophy PhD in health care ethics. More recently I have been involved in working with the Department for Constitutional Affairs on the Mental Capacity Bill; I was asked to attend that from the Association of Palliative Medicine and that has been fascinating and worthwhile. I would like to take two sets of things. The first is about the overall impact on patients of legalising assisted suicide and euthanasia through this sort of Bill, and the second is about the role of doctors in this Bill. The first set of points to do with the overall effect on our patients. I think my overwhelming anxiety about the legalisation of PAS and euthanasia through this Bill is that it will, I think, increase the suffering of the terminally ill and not decrease it. My reasons for thinking that are as follows: that increasingly in recent years I have found that patients perceive they are a burden; that they are valueless because they can no longer do things; that they need care. A lot of their distress, after most physical symptoms have been alleviated, is emotional; that they feel useless and a burden. My worry is that if this Bill were to go through assisted suicide and euthanasia would become a treatment option, so the option would have to be presented to all terminally ill people who were believed to be in the last months of life. So for the rest of their natural life they would be faced with this enduring choice: as to whether they should "go for" assisted suicide and euthanasia on the grounds that they have become a burden to their families because they perceive that they are useless. We live in an environment where autonomy—the ability to make your own choices, be yourself, do your own thing, be independent—is so highly valued now that patients who have lost their independence so easily feel valueless and a burden, and being faced with a constant choice for the last months of your life as to whether you ought to opt for assisted suicide and euthanasia, I think, would be a very distressing condition to put patients in. So many of them would feel all the time: "Should I do this? Is this now too much for my relatives? Is the nursing home eating up my money?" (That is a more minor issue—it should not be an issue but is still often an issue.) So I think that considering that a small minority of patients would be expected to actually choose assisted suicide and euthanasia, the collateral effect on the great majority who would not, in the end, choose it but would be presented constantly with "Ought I to choose it?", I think, would be an increase in suffering because of the agonising choice which they are constantly presented with. Going on from the general effects, I think there are logical consequences of this proposed legislation which would follow which I, as a citizen, feel are undesirable. There are two logical consequences which follow, which I think go on from what John was saying. The first is, if we are saying that the entitlement to assisted suicide and euthanasia—and that is what this Bill is about; it is about giving these people an entitlement if they meet certain criteria to assisted suicide and euthanasia—is thought to be a benefit for those who are terminally ill, logically, it must be extended to others who feel they are suffering unbearably but are not in the last few months of their life, because otherwise it appears very unjust that this apparent benefit can be gained only when it is believed that you are in the last months of your life, and not for instance earlier when you might be in the earlier stages of Huntington's career, the earlier stages of motor neurone disease, or the earlier stages of diseases which may have a very long process of increasing disability. So the entitlement would logically have to be extended outside the terminal period of life because otherwise it is inequitable if you think it is a benefit. That is a logical consequence, so I think it would be followed—not because people are bad and people are nasty but because it logically follows by reason. The other logical consequence that I think is a bad thing for society is if this benefit of an entitlement to assisted suicide and euthanasia for unbearable suffering is to be there for competent patients how are you logically going to deny this to incompetent patients who you believe are suffering because of distress due to Alzheimer's disease? Some Alzheimer's disease patients actually appear very distressed and it is difficult to know what they are feeling, but if people judge that they really were suffering then why should they be denied the benefit, if you think that is what it is, of having their life ended? So, logically, there will be this extension, as John has said has happened in the Netherlands, towards this for the incompetent patient, and that is not because people are nasty people, it is because it would be the way that your thinking would go. So I think the logical consequence of this sort of Bill is extension to non-terminal illness and extension to incompetent patients. Both of those extensions would actually concern me for society overall. The second thing I would like to say is to do with the role of doctors in this Bill. Doctors have a huge role in this Bill. On the one hand you may say they have power and with that goes a tremendous responsibility in this Bill. If we look at the so-called doctor-patient relationship, and what the effect might be on that of legalising assisted suicide by your doctor or euthanasia by your doctor, doctors are really expected not to harm their patients. It is a very strong principle for us. Society normally thinks that intentionally killing another person is a harm. I really think there is a threat to the doctor-patient relationship and the fundamental trust in this if your doctor is expected to be the person who assists you to commit suicide or give you a lethal injection. Quite often, at the end of life, when patients have had what has turned out to be the last injection, relatives erroneously think you have bumped them off and you have not. If this becomes legalised, how many more people are going to think that when you are in care somebody is going to come and end your life? Once that thought gets hold it will be enormously difficult to eradicate it. So my worry is towards the trust in the doctor-patient relationship—it is a big problem. In the country at the moment there is terrific anxiety about doctors misusing their powers in the ability to shorten life—terrific anxiety about this—so I think legalising this manoeuvre towards allowing doctors to give lethal injections is very bad for the confidence of patients and their doctors. Lastly, looking at it from the doctor's point of view: this Bill expects us to decide whether the patient is suffering unbearably. I cannot decide whether a patient is suffering unbearably because only the patient can say that. I cannot be expected to judge what for this particular individual is unbearable suffering. Then, as a doctor, I am expected to judge whether this patient is in the last few months of their life. It is enormously difficult to do that. Paul Glare's evidence I know you have had, of some studies that have been done which show that however hard you try our ability to guess how long someone is going to live is very limited, and yet that is what we are supposed to do in this Bill. After we have made these extremely difficult judgments, one of which, in fact (the judgment of suffering unbearably), I think is impossible, on which is based an extremely serious consequence—the ending of a patient's life—somebody will come after us and will judge whether we did the right thing or not. So we are asked to make judgments that, I think, are extraordinarily difficult and then judged by somebody else, the Commissioner, and if they think our judgment was flawed in any way it goes before the coroner, and then goodness knows what else happens. So I think there may be an enormous reluctance on behalf of doctors to get themselves into that position. I find myself wondering why on earth is the Commission scrutinising this after the patient is dead? Why not before the patient is dead? In summary, I would say I think legalising physician-assisted suicide, euthanasia, by means of this Bill has more adverse consequences for the whole of society than it does benefits. Thank you.

  Ms Wates: My name is Michele Wates, I am an independent researcher and writer and mainly my work has been around the relationship between disability and family life. I am speaking today as a person with a progressive illness. As long as our society has had written laws the central tenant has been to protect people, especially those who may be physically and/or mentally vulnerable, from being intentionally—or for that matter unintentionally—killed. I believe that this law would turn that principle on its head and establish in its place the principle that a person may invite others to kill them. I think this would represent a central shift in the mores of our society. Media attention has been overwhelmingly focused on a small number of exceptional cases of people who are not in a position physically to take their own lives, insisting that they should have a legal right to be assisted in committing suicide. It is extremely important that lawmakers do not overlook the much larger numbers of people who feel that their existence and their right to support would be put at risk in the climate established by any such change in the law. In my opinion the legislation that we currently have is both necessary and adequate to deal with the complexities of individual situations. A relative, a friend or a care-giver who claims to have killed someone on compassionate grounds should be able to satisfy the courts that this is indeed the case and I believe that the law as it stands is flexible enough and that those who administer justice are astute enough to cope with exceptional circumstances, as recent judgments have demonstrated. The proposed legislation draws a line that I find quite disturbing between those who "qualify" to be assisted in killing themselves and those whom society would seek to prevent from committing suicide. Some will be seen as clearly qualifying, in other cases it would, I believe, be unclear as to whether people qualified or not, while others definitely will not be seen as qualifying. Whether or not a person is deemed to qualify will deem how the medical profession is required to respond to their needs. So take the following scenario: imagine that a husband and wife have serious financial problems and lose their home as a result. Both of them become depressed and the husband goes to the doctor to say he is suffering unbearably and feels suicidal. That doctor is bound to seek to help him recover from his depression and should also point him in the right direction to get help with finding somewhere to live. Imagine that the wife is also depressed as a result of the same circumstances that have caused her husband's depression, and she too feels suicidal. She approaches a doctor and a solicitor who is known as a supporter of assisted suicide and informs her that she is suffering unbearably. Because she is also able to show that, unlike her husband, she has a terminal illness, she is not treated for depression but two weeks later is lawfully killed. Her husband, at her request, is not informed until after her death that that is her intention. I think we would do well to be extremely cautious about the language of anti-discrimination practice, choice and human rights of the individual that are frequently used by many of those who support assisted killing. To see where this might lead we need look no further than the example of the Netherlands. "Over the past two decades the Netherlands has moved" (I am quoting now from an article by Marilyn Golden, who is an American author) "from assisted suicide to euthanasia, from euthanasia for the terminally ill to euthanasia for the chronically ill; from euthanasia for physical illness to euthanasia for psychological distress and from voluntary euthanasia to non-voluntary and to involuntary euthanasia. Once the Dutch accepted assisted suicide it was not possible legally or morally to deny more active medical assistance to die—ie euthanasia—to those who could not effect their own death. Nor could they deny assisted suicide or euthanasia to chronically ill who have longer to suffer than the terminally ill, or to those who have psychological pain not associated with physical disease. To do this would be a form of discrimination. Involuntary euthanasia has been justified as necessitated by the need to make decisions for patients not medically competent to choose for themselves." This is quoted from an author called Hendin[1] in 1996 who describes, also, how for a substantial number of people in the Netherlands physicians have ended their lives without consultation with the patients. As a disabled person I have lived for many years with the knowledge that society's view of the value and acceptability of a disabled person's experience may be quite different from my own. A person who wishes to die because they have come to regard their life as valueless and lacking in dignity as a result of disability or illness may find that they have the acquiescent agreement of those around them, including people who may be their medical professionals. It is widely assumed that it is impairment and illness even of themselves rather than the social and physical environment in which impairment and illness are experienced that leads to suffering and loss of human dignity. I know from personal experience that the quality of my life is not determined by the progress of my illness and extent of my impairment so much as by the access that I have at that particular time to assistance, to equipment, to appropriate environments, to accessible transport, etc. I think it is also important to acknowledge the changing social context within which this debate is taking place and to be open about the fact that with an ageing population society has a vested interest in not having to pay to support increasing numbers of people who are disabled and/or sick. It is insufficiently acknowledged that there is at least a perception of competing and conflicting interests in this matter. We should not be naïve about this. Carers and terminally ill and disabled people may have different perceptions and different interests. This is not to make judgments, it is to face facts. The Bill, in effect, I believe, wishes these complexities away, saying merely that the physician should have satisfied himself that the request is made voluntarily. I believe that a pressure on those who find themselves "qualifying" (and that is a term I, personally, find chilling in the terms of the Bill), whether this pressure came from outside themselves or whether the pressure had been internalised, would, in some cases, be an intolerable pressure and that people who did not want to die would feel that it was incumbent upon them to seek death. It is not enough that the Bill says that the physician should have satisfied themselves that the request is made voluntary; the pressures that people are under will in many cases be internalised and, therefore, no longer open to scrutiny. I think it is significant that the Disability Rights Commission in the UK is unanimous in its opposition to the passage of this Bill. So that if we are talking of the recognition of rights that must weigh for a lot. Members of the Committee may also be aware of similar opposition by disabled people in other countries. I think that the proposed legislation would erode that most fundamental principle that human beings value the lives of friend and stranger. One of the most distinctive and heart-warming features of human society is the value placed on another human life and the steps that people will take to reduce suffering and to preserve the life of a fellow human being. To erode that principle, as I believe the proposed legislation would do, is to make the world a bleaker and more dangerous place for all of us.

  Chairman: Thank you very much.

  Q1974  Earl of Arran: I have a question for Dr Gilbert. I will ask this not in an accusatory way but more of a rhetorical way. Would you not accept that in spite of the most expert delivery of palliative care man can offer at the moment, there is still, nevertheless, a small group of people whose intractable distress or unacceptable suffering cannot be alleviated?

  Dr Gilbert: I would accept that. I think, however, my general medical experience would make me also observe that this is by no means confined to palliative care or to people within a few months of the end of their lives. For instance, there are people with arthritis, for instance, who find it unbearable that their lives are restricted by the pain that they have to endure chronically, perhaps, for many, many years. I would not claim for a moment that palliative care has the answer to all that, nor indeed that medicine has the answer to all that. In the end, I think it is inescapable that unbearable suffering lies in the mind of the individual concerned and so no palliative care, nor medicine, can alleviate all suffering.

  Q1975  Earl of Arran: What do you suggest should happen to that small group of people? Surely it must be genuine, unacceptable suffering.

  Dr Gilbert: Absolutely. I would raise no question about the validity or the genuineness of that suffering. What I would expect to do and I would expect other health care professionals and social care professionals to do, and collectively be supported by society in doing, is our utmost to help alleviate that suffering and to continue to help alleviate that suffering and make it plain to people that collectively we will not stop attempting to relieve that suffering as much as we are able to do. However, to eradicate suffering in the human condition seems too big a task for medicine.

  Q1976  Baroness Hayman: I wanted, with some trepidation, to discuss with Professor Finnis the clarity of the line that at present exists. While he explained very clearly how from some viewpoints there is clarity, could I ask him whether he would accept that from a patient's perspective, more than a doctor or a lawyer's perspective, the clarity is perhaps not as focused as he suggests? I am thinking of the patient whose end-of-life circumstances take them on to a life support machine, a patient whose end-of-life circumstances take them on to dependence on medication which, if not taken, will end their life, or the patient who is at home and has a knowledge of pharmacology at its most basic and has the ability to squirrel away, if you like, an appropriate amount of medication, or the patient who can swallow. In all those circumstances, that patient's autonomy is respected by our legal system if they wish to end their own life. Would you accept that for some patients, whose fate is such that they cannot swallow, they are in different circumstances but they may feel that they want exactly the same end in exactly the same context—and let us leave aside whether it is logical to have this end-of-life situation—and they would feel they were very much at the same point on the spectrum as the other patients who have the ability to exercise their autonomy?

  Professor Finnis: Yes. It seems to me not quite adequate to say that the present law respects the autonomy of the person who can commit suicide. It does and it does not. A few years ago in the Bland case some Members of the House of Lords sitting in judgment on it said that the decriminalisation of suicide was to respect autonomy. More recently, when the whole House looked at it again in a judicial capacity, in the Pretty case, they said it is not about a right—autonomy in that sense—it was decriminalised because of the evils of seeking to pursue, by the instruments of the criminal law, these people in their desperate circumstances. I would not myself articulate it as an autonomy.

  Q1977  Baroness Hayman: Perhaps if I articulated it in terms of the right to refuse treatment and the inappropriateness of a doctor administering treatment when there is no consent to it.

  Professor Finnis: That is a second and different scenario, and a very important one. Can I just finish off the point about "I haven't got the same advantage as others in being able to commit suicide"? That is a difference between persons, but the law takes care not to give public support to those who wish to act on an evaluation of their own life which the law cannot safely admit. If I decide to kill myself, I declare myself to have a life not worth living. We all have a very strong interest in that evaluation not being one that we accept. Of course, we commiserate deeply with the person who makes that mistaken evaluation of their own existence but we seek to preserve society from the judgment running wild that, in a certain condition, "You have got nothing left to live for and you would be better off dead, and, of course, we would be better off if you were dead". We have a huge interest in that judgment not being ratified and that is why—

  Q1978  Baroness Hayman: The Miss B judgment did not ratify that.

  Professor Finnis: Which judgment?

  Q1979  Baroness Hayman: Miss B.

  Professor Finnis: In which circumstance?

1   The paragraph as worded appears in Hendin, Herbert, et al .1997. "Physician-assisted suicide and euthanasia in the Netherlands: lessons from the Dutch", JAMA (Journal of the American Medical Association) 1997; 277: 1720-1722 Back

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