Memorandum by The Association of Catholic
Women
INTRODUCTION
1. The Association of Catholic Women is
an organisation of women and men "supporters"; it is
listed in the Catholic Directory, but is independent as an organisation
of the Catholic Bishops' Conference of England and Wales.
2. The membership of the Association numbers
more than 1,000. The coincidence of the consultation period with
the summer holiday period has made it impossible to undertake
a consultation exercise amongst the membership at large. This
response represents the corporate view of the Association's Steering
Committee.
3. Many of the Association's members have
experienced the work of hospices, both in the United Kingdom and
abroad; through this experience we have direct knowledge of people
of all faiths and none whose last weeks of life have been transformed
from times of fear, anxiety and pain to peaceful and virtually
pain-free acceptance.
THE BILL
IN THE
CONTEXT OF
THE NATURAL
ORDER
4. The drive to give and to preserve life
is one of the most powerful of animal instincts. Mothers of all
species fight ferociously to protect the lives of their offspring.
Babies born in the most adverse conditions of war, disease and
famine cling to life and respond remarkably well to only minimal
standards of care.
5. Medical practitioners accept that seriously
ill and injured people often defy unfavourable prognoses through
sheer determination to survive.
6. Our society has rightly held the conscious
giving of one's own life to save that of another, or in defence
of one's beliefs, to be an act of supreme heroism and sacrifice.
7. By contrast, when we speak of "losing
the will to live", we are describing a condition of despair,
a departure from the natural order. A decision to seek to end
one's life, or to seek to have it ended, results from a sense
of hopelessness, a belief that death must be preferable to the
physical pain or loss of personal independence (both of which
are recognised triggering factors in clinical depression) presently
being endured.
8. In such circumstances, our clear duty
to a fellow human being, rather than to collude with the person's
despair, is to do whatever is possible to alleviate the pain,
both physical and psychological, that has led him or her to seek
assistance to die. This is the underlying principle of palliative
care, which is the hallmark of, but is not exclusive to, the hospice
movement.
9. The first duty of medical practitioners
is to do no harm. The alleviation of pain is at the heart of medical
practice; the administration of pain-relieving medication is held
to be a licit and positive practice, even in circumstances in
which the medication will itself shorten life.
10. To ask a doctor or other medical practitioner
to assist a person in ending his or her life is to move beyond
the aim of pain alleviation; it goes against the principle of
non nocere. The compassion doctors and nurses rightly feel for
the patients in their care should not be used a lever of persuasion
to set aside that principle.
THE BILL
IN THE
CONTEXT OF
EXISTING LEGISLATION
11. The intrinsic value of human life has,
for many centuries, been the underlying principle of the rule
of law. Crimes against the life of the person rightly attract
the most severe penalties. Even in time of war, the taking of
human life outside of recognised rules of engagement attracts
the opprobrium of the international community and is punishable
in international law as a war crime.
12. If enacted, the provisions of this Bill
would directly contradict Section 58 of the Mental Capacity Bill.
For the government to give time to a Private Member's Bill, the
effect of which would be to render inoperative safeguards built
into its own legislation, as recently amended, is irrational.
THE PRACTICAL
IMPLICATIONS OF
THE BILL
13. The dual purpose for which this Bill
is proposed to be enacted is twofold: ". . . to enable a
competent adult who is suffering unbearably as a result of a terminal
illness to receive medical assistance to die . . . ; and to make
provision for a person suffering from a terminal illness to receive
pain relief medication."
14. The latter provision, as described in
Section 15 of the Bill already exists. It is difficult to see
what purpose this provision serves, either in the title of this
Bill or in Section 15, other than to draw attention to the one
universally acceptable proposal; this might, in fact, mislead
members of Parliament and the public, who may not be aware that
this is already an entitlement exercised under the oversight of
doctors but, more often than not, nurse managed. To include this
provision could soften opposition to the more contentious proposals
in the Bill.
15. Sections 2 and 3 enumerate a comprehensive
list of "qualifying conditions" which must be met before
the patient may proceed to execute a declaration that he or she
wishes to be assisted to die.
16. The gradual erosion of these safeguards
may be envisaged. The Bill as it stands only applies to competent
adults who are suffering unbearably. How soon will it be before
a campaign begins to extend its provisions to relieve the unbearable
suffering of terminally ill children? Obviously, minor children
could not be competent to make the declaration; therefore parents
or guardians would be permitted to do so on their behalf. Once
the principle was conceded that a responsible adult could make
the declaration on behalf of a suffering, but incompetent minor,
it would be only a short step to permitting an adult child to
make the declaration on behalf of an elderly, incompetent parent.
It would come to be seen to be unfair for a suffering, terminally
ill but incompetent person to be left unassisted for the lack
of an appropriate adult relative; another competent adult could
be appointed to make the declaration. Thus, carefully constructed
safeguards could be set aside with relative ease, apparently for
the best of motives.
17. Both the solicitor witness and the lay
witness to the advance declaration, as provided for in Section
4, are required by sub-sections (3)(b) and (4)(b) to make an assessment
as to the patient's soundness of mind, which neither is likely
to be professionally competent to make. Solicitors, as far as
we are aware, are not trained to assess competence in a matter
of life and death.
18. There is an implicit assumption in the
requirement in Section 7 for an attending physician or a consulting
physician who has a conscientious objection to assisting a patient's
death to refer the patient to another physician who has no such
conscientious objection, that such a conscientious objection will
be the exception, rather than the rule.
19. Moreover, the requirement to refer to
a physician who has no such conscientious objection renders the
objecting physician complicit in an outcome to which he or she
has a conscientious objection.
20. The provisions of Section 7(1) and of
Section 10(1-3) relating to protection for physicians and other
medical personnel are silent with regard to discrimination in
career progression.
21. The establishment of various monitoring
commissions, to cover either countries or regions at the discretion
of the Secretary of State, is a potential cause for concern about
lack of consistency of application; there is scope for considerable
variation between commissions in the application of the qualifying
conditions for making an advance declaration.
22. The requirement for the attending physician
to send the file of documentation to the monitoring commission
only after the assisted death (or attempted assisted death) has
taken place, and for the monitoring commission to determine at
that stage whether the qualifying conditions have been met is
hard to understand. A determination that the qualifying conditions
have not been met can no longer protect the patient.
23. On every day in the year, throughout
the United Kingdom, in hospitals, hospices, care homes and in
their own homes, terminally ill patients request and receive medication
for the relief of pain and distress, as described in Section 15.
At least one member of this Steering Committee has direct personal
experience of the administration of such palliative treatment
to a close family member in hospital. There is no need, legal
or ethical, for this Bill to be enacted to guarantee this entitlement.
24. The power given to the Secretary of
State in Section 16, to make regulations by statutory instrument,
gives him or her power to go beyond the intentions of Parliament;
the requirement for such statutory instruments to be approved
by resolutions of both Houses of Parliament is not a realistic
safeguard (as the examples in paragraph 16 illustrate).
25. None of the safeguards in the Bill will
(or, indeed, could) protect the patient from psychological pressure
(perhaps self-imposed) to decline palliative care in favour of
assisted suicide, in order to avoid being a burden to family or
medical staff, to free up resources of staff, beds or medication.
The Bill, if enacted, could in fact exacerbate a desire for self-harm
in vulnerable people. It is possible to envisage hard-pressed
medical staff not seeking to deter such patients.
CONCLUSION
26. There is a well-established and commonly
understood principle that "hard cases make bad law".
There can be few "harder cases" than the prospect of
terminally ill patients suffering pain and distress that is capable
of relief, and the compassionate desire to relieve that suffering
is laudable.
27. We believe that the capabilities of
modern medicine render the ending of life to prevent such suffering
unnecessary. Good nursing care provides the opportunity for the
patient to live the final stages of his or her life, initially
approached with dread and fear, as a time for reconciliation,
final family contacts and peace.
28. We believe that there is intrinsic value
in all human life, at whatever stage. Respect for human life is
not, however, an exclusively Catholic, Christian or even religious
concept. We have sought to demonstrate that respect for life is
enshrined in both the natural order and the British legal system.
29. This Bill would, if enacted, remove
a vital safeguard only recently inserted by amendment to the government's
own legislation, and is therefore misconceived. We are convinced
that is also represents a significant departure from an underlying
principle of British law and would be the likely precursor of
legislation to permit the wider use of euthanasia.
30. The Association of Catholic Women strongly
urges members of this Select Committee to recommend that this
Bill should not proceed.
SUMMARY
1. INTRODUCTION
(PARAGRAPHS 1-3)
— The Association of Catholic Women,
listed in the Catholic Directory but independent of the Bishops'
Conference of England and Wales, is an organisation of more than
1,000 women and men "supporters", many of whom have
direct experience of the work of hospices at home and abroad.
— This response, from the Association's
Steering Committee, is informed by this experience.
2. THE BILL
IN THE
CONTEXT OF
THE NATURAL
ORDER (PARAGRAPHS
4-10)
— The drive to give, preserve and cling
to life is powerful; examples abound of the expectations of both
medical science and common sense being defied.
— The desire to choose death is an
aberration, motivated by despair, the response to which should
be to seek to alleviate the pain (physical or psychological) which
gives rise to it.
— To ask doctors or nurses to comply
with a patient's wish to end his or her life is to ask them to
deny their principal duty to the patient and to collude with the
patient's despair, rather than try to treat the symptoms giving
rise to it.
3. THE BILL
IN THE
CONTEXT OF
EXISTING LEGISLATION
(PARAGRAPHS 11 AND
12)
— The intrinsic value of human life
has been the underlying principle of the rule of law since earliest
times.
— The provisions of this Bill contravene
this principle and contradict provisions recently inserted into
the government's own legislation.
4. THE PRACTICAL
IMPLICATIONS OF
THE BILL
(PARAGRAPHS 13-25)
— The provision in the title of the
Bill and in Section 15, to enable a person suffering from terminal
illness to receive pain relief medication, is unnecessary, in
that such medication is already routinely administered to terminally
ill patients whether in hospital or not.
— The "qualifying conditions"
outlined in the Bill, while apparently tightly drawn, are vulnerable
to gradual erosion over time, especially in view of the provision
to give power to the Secretary of State to make regulations by
statutory instrument.
— There is an inherent assumption in
the qualifying conditions that doctors who hold a conscientious
objection to assisting a patient's death will be few in number,
and the requirement that they refer to another doctor who does
not object makes them complicit in the action to which they hold
a conscientious objection.
— The patient is not protected by the
proposed monitoring arrangements; neither is the patient protected
from psychological pressure to cease being a burden and to release
medical and care resources.
5. CONCLUSION
(PARAGRAPHS 26-30)
— The desire to alleviate the pain
and suffering of terminally ill patients is laudable.
— The capabilities of modern medicine
render the taking of life to prevent such suffering unnecessary;
skilled nursing and palliative care can enable patients and their
families to experience their final days and weeks as a positive
and peaceful ending.
— The Bill represents a significant
departure from an underlying principle of British law and medical
ethics, and is misconceived in that it would remove a vital safeguard
recently inserted by amendment to the government's own legislation.
— The Association of Catholic Women
strongly urges members of this Select Committee to recommend that
this Bill should not proceed.
23 August 2004
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