“There are no safeguards”
As reported in the Jersey Evening Post on Saturday, the Health Minister Deputy Tom Binet argues that States Members rather than an Ethical Committee should decide whether an assisted dying service should be established in Jersey.
We vehemently oppose all moves to change the law.
One the main parts of the debate / proposal is whether Jersey should adopt a route one approach (for terminal illness) or route two (incurable medical condition leading to unbearable suffering) and yet we have consistently campaigned against both of these demonstrating examples of how medical professionals have made mistakes in the past and often get the date of expected death wrong. Furthermore medical science continues to evolve and once incurable conditions can now be treated.
Our Chairman, Dr John Stewart-Jones (ret’d Jersey GP) articulated the following points as to why Euthanasia should have no part in medical care.
The proposed legalisation of Assisted Dying, a euphemism for Assisted Suicide and Euthanasia would result in a seismic shift in the way that healthcare has functioned and developed over many years. There would be changes in the way that society views and treats those who are vulnerable.
A recent Danish Report of 17 Ethicists on Assisted Dying concluded that ‘legislation cannot be developed which will be able to function properly, and that the only thing that will be able to protect the lives and respect of those who are most vulnerable in society will be an unexceptional ban. They also pointed out that ‘euthanasia risks causing unacceptable changes to basic norms for society, the health care system and human outlook’. They came to this conclusion having studied the effects of legalisation of Assisted Suicide and Euthanasia in jurisdictions where legalisation already exists.
There are grave concerns held by many in Jersey who are opposed to the law which has been previously proposed as it is very similar to the Canadian model, which legalised Assisted Suicide and Euthanasia in 2016 and has been extended with their safeguards falling away since the law Medical Assistance in Dying (MAiD) was first introduced. Vulnerable people are put at risk and there have been reports of euthanasia being implemented for reasons that include deafness, chemical sensitivity, and various social problems. In Oregon, and Belgium reasons have included Anorexia Nervosa, and Autism in the Netherlands.
Prior to legalisation of MAiD in Canada, those in favour repeatedly said that they would not be like the Netherlands or Belgium with a proud claim as Canadians that they were not like them and that they would have strict safeguards. The reality has been that in a matter of 6 years all the safeguards have fallen away, and Canada now has the most liberal laws in the world relating to Assisted Dying, and Jersey has been recommending a very similar model as its starting point.
An eminent and highly regarded Canadian Professor Harvey Schiffer penned an article in a Toronto newspaper last week in which he wrote:
“The success rate for rigorously developed and evaluated medical procedures rarely exceeds 90 per cent. Errors in diagnosis and treatment have adverse consequences, including death. The direct consequence in MAID is wrongful death. Given that Canada has the most permissive MAID structure in the world, with an approaching 60,000 deaths to date without a mental illness as sole criterion provision, were politicians and legislators prepared to publicly acknowledge and be accountable for the between 2,000 and 4,000 wrongful deaths that may have already occurred?”
This is an astounding risk that our Jersey politicians must consider in their decision on how they should vote in the coming months.
Several years ago, there was an outcry regarding the use of the Liverpool Care Pathway and how it was misused in end-of-life care in the UK by medical staff who followed it as a tick-box methodology. There are people in Canada expressing their view that MAiD could be the next public apology that those in authority in Government may need to make. There is a question now and that eventually will be asked of Jersey politicians as to why they voted for legislation of AD when they had clearly been warned about the risks of harm to vulnerable people.
Vulnerability:
There are no sufficient safeguards for euthanasia or assisted suicide. The proposed law will affect vulnerable people. The latest figures in Oregon USA reveal that 43% of cases of persons who had assisted suicide did so because they believed that they were a burden to others. What has been put forward as a ‘right to die’ will, for a significant number of vulnerable people, result in them believing that they have a ‘duty to die’ due to being a burden on carers and relatives. Vulnerable people due to age, disability or illness will be especially at risk of harm.
Elder Abuse is hidden and very common, particularly financial abuse. The proposed so called ‘safeguards’ will not protect the elderly from coercion and manipulation by unscrupulous relatives who for selfish motives will manipulate the vulnerable person for financial gain and even their own convenience. ‘Hourglass’, a UK charity states: ‘One in six older people are victims of abuse.’
In Jersey in 2021 about a sixth (18%) were 65 years or older, which equates to about 18,000 people. Calculation of the UK equivalence of Elder Abuse would mean that there could be thousands who suffer, and for a significant majority of these, it will be financial abuse. Even a small proportion of this number would be exposed to coercion and manipulation and therefore early death by Assisted Suicide and Euthanasia. Eligibility Criteria and process are often wrongly considered to be equivalent to safeguards, but they cannot determine where there is hidden coercion of the vulnerable or exclude the request for Assisted Dying because the person believes that they are a burden to others.
Unbearable Suffering:
The Jersey proposals have during the public consultations stated that Assisted Suicide and Euthanasia would be implemented for ‘unbearable suffering’. Should ‘Route 2 – Long term Illness with unbearable suffering’ be implemented through the present legal proposal or any future proposal, then this raises the question – can suffering be reliably estimated and understood? It is very subjective and there are no known methods or tools for measuring or estimating suffering by healthcare professionals.
Although the present proposals exclude mental health disorders, this will not be the case in practice as these co-exist with physical illnesses. A person with severe Anorexia Nervosa will eventually have physical symptoms due to their condition and could request assisted dying on that basis.
Any person with anorexia over 18 years of age would qualify under the proposed ‘safeguards’ by being an adult, having capacity, being terminal if they failed to take enough nutrition, suffering unbearably and, since it is no longer seen as a solely psychological illness, would fit the requirement for it to be a physical illness. A person’s estimate of their own suffering is strongly affected by a wide range of treatable issues including psychosocial support, loneliness, and depression. Physical illness and depression commonly co-exist. In Belgium, 82.8% of causes for “unbearable suffering”are of a psychological nature, including loss of autonomy, loneliness, despair, feelings of unworthiness.
Normalizing Suicide
There are claims that the legalization of Assisted Suicide reduces the ‘unassisted suicide rate’ in jurisdictions where Assisted Dying has been legalized – this is not the case. There is new evidence coming from Australia that in certain age groups there has been an increase in ‘unassisted suicide’. Professor David Albert Jones has recently submitted evidence in a Peer Reviewed Paper in which he states that new research finds that Voluntary Assisted Dying (VAD) has failed to reduce the rate of ‘unassisted suicide’ in Victoria, Australia. Published in the Journal of Ethics in Mental Health, the Paper found that suicide among older people (over 65s) has increased by more than 50% – one more suicide per week than before the introduction of VAD.
As a GP in Jersey for decades I have been very privileged to be involved in the end-of-life care of many patients and what has been described by those who are pro Assisted Dying with statements such as people ‘rolling around in agony’, is not recognisable to me over my 36 years as GP. There will be difficult cases, and I accept that there is not a 100% guarantee in persons having what could be described as a ‘good death’. However, my experience with palliative care involvement and their expert input, has resulted in a peaceful end for patients.
It appears that this is borne out by a quote in the Irish Times Newspaper 10 Nov 2020:
‘Dr Twomey said that, while he couldn’t speak for everyone, based on the experiences of the members of the Irish Palliative Medicine Consultants’ Association (IPMCA) who have cared for thousands of highly complex palliative care patients with severe symptoms over many decades, it was “an extremely rare event” that extreme pain and distress could not be managed.’ (End of quote)
The Danish Ethics report also concluded that the very existence of an offer of euthanasia will decisively change our ideas about old age, the coming of death, quality of life and what it means to take others into account. They considered euthanasia to be in conflict with palliative care and are therefore against the legalization of euthanasia as long as we as a society have not exhausted the possibilities for relief.
Having had the privilege of being a GP in Jersey for 36 years my conclusion is that Euthanasia is not Healthcare, and that it should have no part in medical care for the reasons and conclusions that the Danish Report have stated. There needs to be an in-depth assessment of the provision of Palliative Care in Jersey, with support provided through government, which would give Jersey an opportunity to become world class in the provision of Palliative Care rather than opting for a law that results in the killing of patients. Euthanasia and Assisted Suicide should be kept completely out of healthcare as the consequences of inclusion will be dangerous and harmful to many who are vulnerable and who require assistance in living not what has been described euphemistically as ‘assisted dying’.
Dr John Stewart-Jones (Retired Jersey GP)