The law today results in many people facing grievous and prolonged suffering at the end of their lives combined with utter indignity and powerlessness.  We don’t treat animals we care for in such a barbaric way yet the law denies human individuals control over this last passage through life.

The law is ignored by many caring doctors, who assist their patients to die out of compassion, but are opening themselves up to a charge of murder.  It places patients at risk of making spontaneous and ill-informed decisions to end their lives.  It influences patients with progressive physical diseases to end their lives early than they need to because they fear they may not be able to at a later stage.

The case of Diane Pretty illustrates the unbearable suffering to which people may be exposed.  She was paralysed from the neck down.  She had virtually no decipherable speech.  She had a short life expectancy.  Yet her intellect and her capacity to make decisions remained unimpaired.  She wanted to be spared the suffering and indignity of death at the hands of motor neurone disease at the end of its term by controlling when and how she died.

Her disease deprived her of the opportunity to commit suicide and accordingly, she wished her husband Brian to assist her.  The British courts, although sympathetic to Diane’s plight found they could not help under the law.  Neither could the European Court of Human Rights.  After exhausting the legal avenues open to her to have her husband Brian help her commit suicide she died in pain and distress in the way she did not want.

Diane Pretty’s case is not unusual.  What was unusual about it was her determination to stick to the letter of the law.  The Sunday Times reported on 15 Nov 98 that as many as 27,000 people have been helped to die at their request by doctors withholding treatment or prescribing lethal doses of drugs.  A confidential study of 300 doctors had one in five of them admitting breaking the law in this way at the patients request, admitting to an average of five cases each.  This of course doesn’t cover doctors helping their patients to die without their consent, but out of compassion and perhaps a judgement about what they would have wanted.  Research in countries that have confronted this issue such as Belgium and Holland would indicate that in Britain today 1% of all deaths result from illegal assistance from doctors to end the lives of patients at their request and up to 3% without an explicit request.  This could involve 26,000 people in the UK every year.

These figures sound astonishing until one considers that this is an experience that is likely to touch most of us.  These days a third of people can expect to die of cancer and how many of those cases have resulted in people dying of a lethal dose of morphine rather than the disease.  If our relatives have been involved we are likely to have regarded it as a merciful release from the pain, suffering and indignity.  Why can’t the individual concerned have some say over the matter?

The case for a change in the law is based on personal autonomy and freedom of choice.  The need for a change becomes stronger as lingering deaths become more usual as medical science improves.  In the past doctors were thought to know best.  However today we expect the patient to take decision about their care after considering the views and advice of doctors.  Surely this applies to the most important decision of all?

Opponents of giving people power to exercise control over the manner and time of their death are motivated by religious beliefs about the sanctity of life, but rarely discuss the issue in these terms, relying instead on arguments about the safeguards that will be required, using the term euthanasia to conjure up visions of national socialist racist eugenics.  They will argue that good and palliative care will control the pain so that everyone can die with dignity and without suffering.  Whist it is clear that quality palliative care is the preferred option of most, when it’s available and too often it is not, for others that is not the solution.  Pain is not the main reason for most patients asking for help to die.  Most requests come from people who are suffering because they cannot bear the indignity of total dependence on others, of lying inert on their beds, probably with tubes and wires attached or plugged into them and suffering the misery of double incontinence.

It’s about time we gave these people, quite likely to be us at the end of our lives, the right to exercise some control over the manner and time of their end.  Simply possessing that power may be enough to bring relief without it ever having to be exercised. 

Safeguards will be required and it will be the job of legislators to design them.  In Parliament Lord Joffe has been the latest to do this in his Bill introduced in the last session.  Legislators in Oregon, Holland and Belgium have found a way to do this and it is time for the principle of compassion in dying to be put into practice in the UK.