Lord Carlile writes…Examining the evidence on assisted suicide

Simon Beard’s article on what he calls ‘the debate around legalising assisted dying’ is so replete with errors, half-truths and spin that it is difficult to know where to start with the correcting pen.

He refers to “the estimated 500 people who commit suicide each year due to a terminal or chronic illness”. The estimate he refers to was made in a report by Demos on the incidence of suicide among seriously ill people. This report does not state that 500 people commit suicide each year because they are terminally or chronically ill. It estimates that “approximately 10 per cent of suicides that take place in England involve people with either a chronic or terminal illness”. That is not the same thing as saying that these suicides are attributable to serious illness. Moreover, only a small proportion of these suicides involved people who had received a diagnosis of terminal illness – the group to which Mr Beard believes any ‘assisted dying’ law should be limited.

The piece talks confidently of “the 2,000 people who receive some form of illegal assistance from a physician to end their lives each year”. He appears to be referring to research carried out a few years ago by Professor Clive Seale. This suggested, based on anonymous responses to questionnaires, that 0.5 per cent of deaths in the UK might have resulted of euthanasia. While the reasons for such anonymity are clear, it is dangerous to place too much weight on the findings stemming from them. What they provide is an indication. In fact, Professor Seale comments in his research that in the UK “euthanasia, physician-assisted suicide and the ending of life without an explicit patient request are rare or non-existent”. Reflecting this view, Professor Seale commented orally to Lord Falconer’s self-styled ‘commission on assisted dying’ in 2011 that “it does sometimes happen in UK medical practice but pretty rarely”.

Mr Beard believes that, if we were to have an ‘assisted dying’ law, “a police investigation must be conducted before a person is assisted to end their life, not after they are dead”. Perhaps I should point out that the police do not investigate crimes before they are committed. Any inquiries carried out before an assisted suicide would have to be subjective assessments of such things as mental capacity and freedom from coercion. These are not as easy to establish as Mr Beard appears to think, especially in these days where many doctors operate in multi-partner practices and do not have first-hand knowledge of their patients’ family backgrounds.

Finally, the piece appears to demonstrate an imperfect grasp of the law governing assisted suicide. He appears to believe, for example, that a decision not to prosecute in the public interest signifies that the Crown Prosecution Service takes the view that the assisters “just haven’t done anything wrong”. That may possibly be his view, but it is not what the public interest test is about. A decision not to prosecute in the public interest means that a prosecution is not necessary in order to protect the public, as may well be the case for an isolated act of assistance with suicide in which there has been no malice or manipulation. Licensing assistance with suicide is something quite different. It changes the dynamic completely, as we can see from the experience of Oregon, where the number of such suicide deaths has risen nearly fivefold in the last 15 years.

Simon Beard’s article may pass muster as campaigning propaganda, but it is not grounded in serious research or knowledge of the law.

* Lord Alex Carlile of Berriew QC is a Liberal Democrat peer, deputy high court judge and practising barrister, and was the independent reviewer of terrorism legislation between 2001 and 2011

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  • Danny Langley 7th Feb '13 - 2:11pm

    The “five-fold” increase in physician-assisted suicide in Oregon is from 16 users in 1998, to 27 in 1999, to 65 in 2010.

    Clive Searle’s 2009 survey of 3,733 UK doctors found that 21.8 per cent of UK deaths attended by a medical professional involved the withdrawing or withholding of treatment “often with the agreement of patients and relatives, which the doctor at the time believed might hasten death.”

    This is different from euthanasia, but can’t be ignored. Euthanasia occurring in 0.5% of all deaths as you cite mirrored the figure Searle got from his 2006 research. But you’ve missed some key conclusions he made as a result of the research, namely that it showed no evidence of the so called ‘slippery slope’.

    You have previously said that the Netherlands uses euthanasia “as an alternative to an expensive palliative care system that it does not have.” This is also not true: the proportion of palliative care beds in Netherlands and Belgium is greater than that of all their surrounding countries except the UK. The Economist ‘Quality of Death Index’ listed very many countries and had Netherlands in 7th place, and 4th in the category of ‘basic end of life healthcare environment’ (UK: 28th).

  • Richard Dean 7th Feb '13 - 6:04pm

    Many of the arguments on this topic have been well rehearsed in the previous debates here on LDV. My impression from Simon beard’s article was that he wanted to avoid accountability. Thus, after the police had certified a suicide as ok, it seemed he wanted that no-one could subsequently be held accountable for assisting it, or prosecuted.

    This idea of non-accountability is contrary to LibDem values, and to UK law, and would give a whole new meaning to the phrase “police state”. It appears to extend in law the dangerous principle that the police can sanction what would otherwise be considered to be a crime. Their occasional deadly actions against persons they believe to be dangerous is an example of how they already have this power in limiting circumstances, and they are of course accountable. It is also an example of how questionable their decisions may be. But if we now extend this principle and require the police to provide a permissions service in other situations, what else will they subsequently be allowed to sanction?

    At a the very least, legislation to permit assisted suicide would need to ensure that those involved remained accountable for the death, and could, if evidence became available, be prosecuted for incitement to suicide, for providing misleading information leading to a person choosing suicide, for negligence in verifying permissions, and probably for a host of other offences whose definition might make the exercise rather problematic.

    We don’t need to have everything we do prescribed in law, but we do need to retain the principle of personal accountability for everything we do and for all time. The rules governing the decisions of the Crown Prosecution Service may or may not be robust, but they do seem to provide a valuable service of smudging the proverbial line between offence and non-offence, something that statue law itself probably cannot do.

  • Simon Beard 8th Feb '13 - 4:29pm

    Dear Alex

    Thank you for responding to my article. I hope to produce a reply to all of your points shortly. However in the meantime I wanted to say that on one point we are in complete agreement. My statement that there are “500 people who commit suicide each year due to a terminal or chronic illness” is incorrect. It is a, very embarrassing, misuse of statistics. All I can say is that it genuinely was a mistake on my part and that I have asked the LDV team to print a correction on my original post to that effect.

    I agree with you that this could be an overestimate as some of these people will have ended their lives for reasons other than their condition. However I also agree with your colleague Eric Avebury that it may in-fact be an underestimate because “…because coroners are aware of the social stigma of a suicide verdict.” (https://www.libdemvoice.org/eric-avebury-writes-assisted-dying-32650.html). The fact is that we really don’t have any evidence of how many people commit suicide ‘due to’ a terminal illness.

    As for your many other claims, as I say I intend to respond to them shortly.

    Dear Richard

    No, I had no intention of arguing that people should avoid accountability. I said that I believe “a police investigation must be conducted before a person is assisted to end their life, not after they are dead”, that does not in any way rule out another investigation carried out after the death should there be any evidence of irregularity. It’s just that by then it would obviously be too late to help the person who has died. Since this is a point Alex mentions in his article I’ll say more about it in my response to him. Sorry to blow away your straw man.

    On a different point, you mention that your arguments on the subject have been ‘well rehearsed’, however I have only ever seen them in the comments section, which is hardly as well read as the articles themselves. I realise it may be a red rag to a bull on here, but have you considered trying to put your best arguments together to propose the thesis that Assisted Dying should not be legalised, rather than just using them in response to the views of others? A Liberal defence of prohibition is something I would find very interesting to read.

  • Richard Dean 8th Feb '13 - 7:31pm

    I find that people’s comments are often a lot more interesting, and a lot more informed, than some original articles. “Well rehearsed” in some circles simply means “repeated ad nauseam, let’s not do it again!”.

  • Danny, you give us the Oregon data up to 2010 but you fail to mention that the total has gone on rising – by 2012 the figure was 4.8 times that in 1998. You also omit to mention that Oregon’s population is less than half that of Greater London and that a similar law in Britain could be expected to produce around 1200 assisted suicides a year here.

    I am not clear what point you are making about withdrawing or withholding treatment. Refusing burdensome treatment and withdrawing futile treatment are both legal and medically ethical. They are quire different from taking action with the intention of ending a patient’s life.

    You also omit to mention that the Economist survey ranked Britain first in quality of end of life care or that The Netherlands, for all its palliative care beds, doesn’t recognise palliative medicine as a clinical speciality, as we do here in Britain.

    If we are going to discuss these matters, let us at least do so with regard for the evidence

  • Simon Beard 8th Mar '13 - 1:36pm

    Dear Alex

    This response has been waiting many weeks whilst I tried to persuade LDV to print a correction on my original article. Unfortunately they have refused to do that, so here is my response to your other points.

    You should not be so dismissive of the claim that over 2,000 people each year are assisted to die by a physician. This figure is derived from research published in a peer reviewed scientific journal (Palliat Med April 2009 vol. 23 no. 3 198-204). It may be the case that it is lower then that for other comparable countries and that it carries a wide margin of error. However, it is still strong evidence for my claim that the vast majority of Britons who receive assistance from a physician to end their lives do so illegally in the UK and that the most significant effect of a law on assisted dying would be to provide a legal framework for these people, rather than to stop people ‘having’ to travel to Switzerland where assistance is legal.

    You next argues that I am wrong to suggest that we could have a law that requires police to investigate before an assisted death is allowed to take place. I would hate to argue with Lord Carlile about what the police can and can’t do, but surely it is the case that parliament could introduce whatever safeguards it liked when introducing a law to legalize assisted dying? At present however, parliament chooses to introduce no safeguards at all, relying either on the Swiss law for those who can make use of it, or else the deterrent affect that assisted suicide is illegal. How strong can that affect really be when it is not backed up by prosecutions?

    Your final objection is that I am wrong to link the claim that assisting a terminally ill person to die is not, in itself, wrong with the fact that people are not being prosecuted for assisting terminally ill people to die. You claims instead that “a decision not to prosecute in the public interest means that a prosecution is not necessary in order to protect the public”.

    I find it alarming that you would suggest that leaving a person who has acted both illegally and wrongly unprosecuted would ever not represent a danger to the public. Surely there is a slippery slope here between leaving certain immoral and illegal acts unprosecuted and producing a situation in which prosecutors routinely turn a blind eye to both legality and morality and so open themselves up to abuse. The only way to stop this is to have a law that society is willing to uphold and to prosecute people for breaching.

    If however, you really think that assisting a terminally ill person to end their life is wrong you would surely want those people who do it to be punished. On the other hand if you do not then surely you would be in favor of changing the law so that assisted dying is allowed when it is morally acceptable but prosecuted and punished when it is not? I am not at all clear about where you stands on this question.

    You end your piece calming a slippery slope of your own, on the grounds that “the number of [assisted deaths in Oregon] has risen nearly fivefold in the last 15 years’. This is absolutely true and I can see how, for somebody who believed in the sanctity of life, it could be deeply troubling. However for me these are not just statistics, they are real people with real lives and I wouldn’t want to judge whether this trend was good or bad without knowing more about the circumstances of each individual death. I therefore find it just as relevant that the number of people who make use or Oregon’s Death with Dignity act due to a fear of being a burden on family and friends or of receiving inadequate pain control have fallen over the same period.

    It is a sad fact that both sides on the assisted dying debate tend to use statistics as if they were weapons. In truth they are the common evidence both sides need to study and understand. What both sides should focus on is putting these facts in the right context. I have tried to demonstrate this point in both here and in my previous article and I am happy to consider any further objections to my use of the evidence. However I see nothing to alter my original opinion that if the debate focuses too heavily on the case of people travelling to Switzerland to die then it misses some vitally important issues.

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