Select Committee on Assisted Dying for the Terminally Ill Bill First Report

CHAPTER 6: Public Opinion

Introduction

215.  The question of whether assisted suicide and euthanasia should be legalised is a highly complex one, which is the principal reason why we were established as a select committee to explore the issues in depth with the appropriate professionals as a basis for reporting on Lord Joffe's Bill. But it is also a question which affects all of us as citizens, as we shall all die at some point and many of us will develop terminal illnesses or have the care of relatives in this situation. For this reason we have sought to form a view of how the public at large feel about a change in the law. In doing so we have not commissioned opinion research of our own but rather sought to measure, via a review of opinion surveys over the course of the last 10-20 years, the state of public opinion and any movements in it over that period. The report of the organisation (Market Research Services - MRS) which carried out the review for us appears as Appendix 7. This chapter summarises the findings. Necessarily we have been selective, focusing on those surveys which appear to have most immediate relevance to the Bill.

216.  We also issued (see Appendix 2) a general invitation at the outset of our inquiry to anyone who wished to write to us, either by letter or by email, to express his or her personal views of the Bill. By 30 September 2004 we had received over 14,000 letters and emails in response, and some 83,000 cards or emails which formed part of organised petitions. After summarising the MRS report therefore we provide a synopsis of our mailbag.

General Caveats

217.  MRS found that virtually all the surveys which had been carried out over the period were quantitative rather than qualitative in nature. That is to say, they consisted of opinion-poll type research directed at ascertaining how many respondents agreed or disagreed with specific propositions rather than in-depth research (on the focus group model) designed to assess responses as complex and sensitive issues are explored. For this reason, the report concluded, the surveys which have been carried out "tend to produce findings which at best may be considered one-dimensional. Simple, direct questions placed without a proper explanatory context and with limited options for reply can sometimes produce results which in fact may be misleading"[68]. The same problem, says the report, applies to omnibus surveys, which are questionnaire surveys, such as the periodic British Social Attitudes (BSA) surveys, of nationally-representative samples of people covering a variety of topic areas. Such surveys "are particularly useful for simple issues such as consumer choices or social topics where respondents can be assumed to have a broad understanding of the topic area and of the consequences implied by particular response options. Where these conditions cannot be assumed and, as with euthanasia, the issues are potentially complex and far-reaching, the omnibus may not be the ideal tool for providing understanding. This seems to be particularly the case with surveys of the general public, where an understanding of the potential impact of euthanasia/PAS legislation clearly cannot be assumed"[69].

Basic Attitude Surveys

218.  These caveats having been made, the report concludes that, as regards basic public attitudes to assisted suicide and euthanasia, "it is evident that there is a great deal of sympathy, at least for the concept of euthanasia, and it seems likely that the level of sympathy has grown in recent years"[70]. More specifically:

• A MORI poll of 1987 commissioned by two organisations active within the Pro-Life movement showed 72% support among those questioned for the legalisation of euthanasia;
• BSA surveys in 1984, 1989 and 1994 showed an increasing majority (75% rising to 82%) in favour of doctors being allowed to end the life of a patient suffering from "a painful incurable disease";
• NOP polls commissioned by the VES in 1976, 1985, 1989 and 1993 showed a similar pattern of support for the proposition that adults should be allowed "to receive medical help to an immediate peaceful death if they suffer from an incurable physical illness that is intolerable to them";
• Similar NOP polls commissioned by the VES in 2002 and 2004 showed over 80% support for the proposition that "a person who is suffering unbearably from a terminal illness should be allowed by law to receive medical help to die, if that is what they want".

219.  The BSA survey, notes the MRS report, "differs from many others in at least one potentially important aspect—it is not commissioned by any outside organisation with a commitment to one side or other of the euthanasia debate". MRS reports also the BSA's conclusions that "the apparent trend towards the belief that euthanasia should be legalised in certain circumstances is part and parcel of a broad process of secularisation in western society—and, as such, seems set to grow" and that "neither of the 'principled' approaches of those for or against legalising euthanasia—liberty of the individual/duty of the state to preserve life—adequately represents the more pragmatic approach taken by most individuals when asked to view the issue on a case-by-case basis"[71].

Surveys of Specific Groups or Aspects

220.  The report proceeds to examine specific aspects of public attitudes to assisted suicide and euthanasia, as revealed in recent opinion surveys. Drawing on the 1994/5 BSA survey, MRS found little or no correlation between views on this subject on the one hand and age, gender, social class or party political allegiance on the other. It did however find some correlation between views of assisted suicide/euthanasia and certain personal characteristics, including:

• Regular church attendance (more opponents)
• Race (proponents mainly white)
• United Kingdom nationality (more opposition in Scotland)
• Able-bodied (more likely to oppose)
• Education (proponents often more educationally qualified)
• Links with other moral issues (opponents more likely to oppose abortion and—to some extent—capital punishment)

221.  The attitudes of disabled people appeared to be more mixed. A 2003 poll for the Disability Rights Commission suggested, though on the basis of a small sample, that disabled people were concerned that they might be threatened by euthanasia legislation, while a 2004 YouGov survey carried out for the VES suggested that disabled people supported the ADTI Bill as strongly as able-bodied people.

222.  A 2004 YouGov poll for the VES asked whether, if the law were to be changed to allow assisted suicide, respondents would trust their doctors more, less or the same. 70% said that that such a change in the law would not affect their trust in their doctors, while 9% would trust their doctors more and 9% less.

223.  In an NOP omnibus survey, carried out in 2004 for the VES, 55% of respondents chose their doctor as the person whom they would wish to help them to die, if that were legal. The other choices were a relative (19%), a friend (9%) and—surprisingly low—a nurse (2%).

224.  60% of respondents in this last survey also felt that elderly people might be more nervous of going into hospital if euthanasia were to be legalised. Similarly, in the 1987 MORI poll referred to above 71% of respondents felt that people permanently dependent on others for medical or nursing care might request euthanasia in order not to be a burden on others, with only 12% disagreeing. The same survey, reported MRS, suggests that there is a fairly widespread disinclination to trust next of kin to request euthanasia for patients who are unable to communicate.

225.  A 2004 VES-sponsored survey suggested that 47% of the population might be prepared to break the current law to assist someone else to take his or her own life in the case of terminal illness and unbearable suffering.

Views of Politicians

226.  The views of politicians, as revealed in two surveys (1995 and 2004), are in striking contrast with those shown above. In 1995 70% of MPs opposed and 27% supported the principle of voluntary euthanasia for the terminally-ill. By 2004 the opposition had risen to 79%. MRS speculates that the gulf between the attitudes of politicians and those of the public might be explained by an assumption that "MPs, by definition, are more accustomed than most to taking into account the implications for society as a whole of proposed legal reforms as a separate issue to their personal feelings on the subject"[72]. Another reason might be a perception that, while a majority of the electorate as a whole might indeed favour or have no objection to a change in the law, the electoral consequences of favouring rather than opposing euthanasia could be more serious.

Views of Health Care Professionals

227.  The MRS report then turns to the views of doctors, where a number of surveys have been carried out of varying quality and scope. The views expressed by doctors, the report observes, "generally enjoy a higher level of credibility on the assumption that medical practitioners can be assumed to have at least some direct experience of end-of-life conditions and therefore to be able to answer questions more meaningfully on this basis than others"[73].

228.  According to the report, "euthanasia is clearly a subject which presents very many doctors with profound professional and personal dilemmas… It seems likely that medical professionals view the issue of the legalisation of euthanasia as less straightforward than the lay public as a whole because of their direct experience of working with patients, and there is some evidence to suggest that the closer the experience of end-of-life patients, the less sure the professionals are about the prospect of a change in the law in favour of euthanasia"[74].

229.  Against this background MRS draws attention to:

• a 1987 NOP telephone survey of 301 GPs, which suggested that, if the law were to be changed along the lines of the ADTI Bill, 53% would not carry out euthanasia on a patient, 35% would consider doing so and 10% might consider doing so.
• a 1993 survey of 312 GPs and hospital consultants on attitudes of doctors to requests for euthanasia. 46% of those questioned (51% of GPs and 40% of consultants) would be prepared to consider practising euthanasia if asked by a competent patient. 32% would not. There was however a significant proportion of undecided respondents.
• a 1995 Doctor magazine omnibus survey of 2150 doctors, in which 44% supported legal reform while 53% rejected it. 43%—slightly more GPs than hospital doctors—would consider practising euthanasia if it were legal.
• a 1996 BMA News Review survey of 750 GPs, in which 46% of GPs supported and 44% rejected legal reform.
• another 1996 survey, by Professor Sheila McLean, of 1000 respondents which showed, inter alia, a sharp distinction between the attitudes of medical practitioners towards assisted suicide on the one hand and euthanasia on the other—with 43% favouring the former and 19% the latter.
• a 1998 postal survey of 322 United Kingdom psychiatrists, 38% of whom believed that euthanasia should be legalised and 35% of whom were willing to assess the psychological suitability of applicants for euthanasia.
• a 1999 survey of 333 geriatricians (45% of all United Kingdom doctors in this speciality), 80% of whom felt that euthanasia could never be justified, though 23% felt that it should be legal in some circumstances.
• a 2003 Opinion Research Business survey, carried out for Right to Life, which showed that, of 986 respondents, 22% would favour a change in the law to allow euthanasia, while 61% would be opposed.
• surveys (2003 and 2004) commissioned by the VES, which suggested that 33% of doctors might favour a change in the law, though with some indication of waning support for euthanasia between the two years.
• readership surveys by the Nursing Times in 1988 and 2003. In 1988 44% of nurses expressed a willingness to be involved in the administration of lethal drugs to suffering terminally ill patients, while in 2003 (according to the journal) two thirds of nurses believed that euthanasia should be legalised.
• 2004 qualitative research carried out by Help the Hospices, which concluded that the introduction of euthanasia legislation was seen within the hospice movement as capable of changing the ethos of hospice care for the worse and of eroding the relationship of trust between physicians, carers and patients.

The Committee's Own Postbag

230.  Between 14 July, when the invitation to offer personal views to us was issued, and 30 September we received 9,709 letters and 2,720 emails from individuals who wished to comment on the ADTI Bill. In addition, there were 1,800 stereotyped letters, proformae or letters with multiple signatures. A large number of people also signed petitions either supporting or opposing the Bill.

231.  Of the 12,429 people who wrote individual letters or emails to us, 6,284 (50.6%) supported the Bill and 6,145 opposed it. The balance of opinion is broadly the same if the stereotyped letters etc are included in the count—7,283 (51.2%) supporting and 6,946 (48.8%) opposing. Interestingly, letter-writers were more supportive of the Bill than email-senders—55.3% of them supported the Bill as against 33.6% of those who sent emails to us. Of those who sent in petitioning postcards or emails, 67,879 (including 57,765 cards addressed to the Human Rights Campaign and forwarded to the committee in bulk) favoured the Bill, while 15,374 opposed it

Conclusions

232.  The MRS report drew the following conclusions on the results of the surveys which it had identified and analysed. It is worth quoting at length:

"The research carried out up to this point into public and health sector attitudes to the legalisation of euthanasia is limited in value and cannot be accepted at face value as an authentic account of opinion within the United Kingdom. The subject matter is extremely complex and sensitive and therefore very challenging for anyone attempting to gain a meaningful understanding of opinion.

"This is particularly the case with regard to the attitudes of the general public, whose real views on euthanasia are clearly obscured by a lack of information on the subject and by the lack of opportunity to reflect in an informed way upon the implications of any change in the law for themselves and for society. The levels of agreement/disagreement with the concept of euthanasia which the numerous polls record are effectively built on what might be termed a "knee-jerk" reaction to the simple options provided by these polls and do not form a very useful guide to public opinion as support for legislative change.

"Nevertheless, the apparent groundswell in public agreement with the concept of euthanasia cannot be dismissed and it is evident that there is much sympathy at a personal level for the concept of legally releasing those wishing to die from their pain and those willing to help them from legal consequences. However, if the decisions of the Committee are to take authentic account of properly informed public opinion, a significant investment in more appropriate forms of research is undoubtedly required"[75].

233.  On the results of surveys among health sector professionals, the report goes on to say that:

"health sector professionals tend by definition to be better informed about the context and potential implications of the legalisation of euthanasia, but here again most research is superficial in coverage and only a few attempts have been made to understand the basis of the opinions of doctors and others, which from the data appear to vary in different directions over time. Here too some fresh, impartial research, again of a deliberative nature, is required in order to gain a full and useful understanding of health sector views"[76].

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68   See Appendix 7, Section 2 Back

69   See Appendix 7, Section 2 Back

70   See Appendix 7, Section 3.1 Back

71   See Appendix 7, Section 3.1 Back

72   See Appendix 7, Section 4 Back

73   See Appendix 7, Section 5.1 Back

74   See Appendix 7, Section 5.1 Back

75   See Appendix 7, Section 6 Back

76   See Appendix 7, Section 6 Back