You say murder, I say euthanasia

The Science Museum has a new exhibit. It is a combination of syringe driver and personal computer that, when loaded with a mixture of a fast-acting barbiturate and curare (which causes total paralysis and so stops breathing), operates as a euthanasia machine.

It was given to the museum by the Voluntary Euthanasia Research Foundation of Australia, and was brought to the new Wellcome Wing by its developer, Dr Philip Nitschke. The arrival of this object was marked by a Euthanasia Forum, chaired by Sir Stephen Tumin, featuring a panel of speakers of various shades of opinion, including Dr Nitschke. They were, to be honest, far less interesting than the audience.

Most striking were the disabled people, who – eloquently and passionately – argued that a society which legalises the killing of sick people, even if it is supposed to be limited to those who actively request it, sends a dangerous message to its members: the lives of those who are sick, in pain, limited in their ability to operate in a self-sufficient manner, are worthless.

The disabled, they argued, all too often internalise such messages, which may make them ask for euthanasia when, in fact, there is much satisfaction in their lives. And what of the elderly who already suffer lower-quality NHS care because of their age? Won’t they, too, be made to feel worthless?

Their opponents countered that those who are terminally ill, in a state of constant physical as well as emotional and mental pain, have a hellish experience. Modern hospice care does not work for everyone, and anyway isn’t available everywhere. And what of those who are not terminally ill but in a state they find unbearable – paralysed, helpless, communicating only with eye blinks, and liable to live so for many years? And those who are sunk deep in a persistent vegetative state? Surely they should be able to die at their relatives’ request? Aha! was the response: relatives may have their own selfish reasons for wanting to be rid of a sick person.

And so it went on, the now familiar set of arguments pro and con, the passion of the antis (“You are despicable!” hissed one old lady at Tumin during the coffee break – although all the poor man had done was chair the event fairly) matched only by the scorn of the pro-lobby, one of whom said with vehemence that “these people are sentimental idiots”.

The row at the Science Museum suggests that we need a pragmatic answer to a pressing human problem. So far, debate has centred around the possibility of legalising euthanasia, perhaps on the Dutch model. The drawback with this solution is that it would give politicians the power to meddle. This is precisely what happened in Australia, where euthanasia was legal for a very short time: a change of government brought a swift change in the law, and only four cases of legal euthanasia actually took place. We can’t possibly want anything so important to be left to political whims.

I have a proposal (I put it to the Science Museum forum). Given that the number of people wanting voluntary euthanasia is very small (as opposed to the very large number of people who do not want energetic treatment at the end of their lives if they are terminally ill and/or unable to communicate, and have written advance directives or “living wills”), we don’t need a blanket permissive law, but a pathway that would enable complex cases to be considered individually. There is a precedent. When Tony Bland was appallingly injured at the Hillsborough disaster and fell into a persistent vegetative state, his family, after years of witnessing their son’s dreadful condition, and with the doctors’ support, appealed to the courts for permission to withhold artificial feeding. It was granted.

This meant, in effect, that Tony Bland died of starvation and dehydration, and, although he had no consciousness, no one can know for sure whether he had any sensation. Many people felt this was a fudged decision: it gave the permission to bring about death, but did not ensure euthanasia, which is a totally painless death.

Let us take this concept one step further and allow people in extremis to apply to a court (made up of lay representatives, as well as legal and medical experts) that would be responsible for ensuring that all possible palliative care had been offered (remembering that the cash-strapped NHS still does not provide hospice care for all in need) and that there was no psychiatric illness present to account for the death-wish (depression needs treatment before it needs a lethal dose). The court would also have to be quite sure that there was no pressure by relatives for the wrong reasons, such as their own pain at the sight of a suffering loved one rather than the patient’s wish, and possible pecuniary benefit.

Some applicants might be refused. But it would be an equitable and decent way to treat very ill people as individuals, and to be, above all, compassionate. It would put an end to the need for doctors to practise on a “don’t tell, don’t ask” basis; and to those heart-rending “mercy-killing” cases that occasionally come to court, as in the recent trial of an 80-year-old man who – abandoned by the support services he needed to care for his wife, who had Alzheimer’s – attempted to kill both her and himself.

Would the public accept such a scheme? I believe that people will agree that this case-by-case approach is the best way out of this painful, apparently insoluble, ethical dilemma.