Sermon at Matins on Sunday 4 October
4 October 2009 at 10:00 am
The Reverend Robert Reiss, Canon in Residence
On the night of 20th January 1936 Lord Dawson, the physician to King George V, issued a bulletin on the state of the King’s health. ‘The King’s life’, he wrote, ‘is moving peacefully to its end.’ He then injected into the King a mixture of morphine and cocaine which no doubt relieved pain, but which he knew would also bring about death quite quickly, and he issued the statement then because, according to his notes it would be better for the announcement ‘to be carried in the morning papers rather than in the less appropriate evening journals.’ The King died in Sandringham about an hour after the injection was administered.
The fact that he had done that and recorded it in his medical notes did not appear in Dawson’s biography even though his biographer had read the medical notes in the royal archives. The biographer, Francis Watson, explained his decision ‘Lady Dawson did not want it in the book and I readily agreed. I did not think it appropriate.’ But Watson did recount it in a journal called ‘History Today’ that was published 50 years after the King’s death, so the fact is now in the public domain.
Dawson himself voted against a bill in the House of Lords that would have legalized euthanasia, but he had consulted George V’s wife, Queen Mary and his son, the future Edward VIII, who said that they did not want the King’s life needlessly prolonged if his illness was clearly fatal. In the debate in the House of Lords Dawson spoke of a Mission of Mercy, and called for the conscience of individual physicians to be trusted rather than for any change in the official regulations. Since then, but particularly in the last year or so, there has been a huge debate in this country about the appropriate way of dealing with the end of life, and it has become something of a battleground. Various factors have made that debate more difficult.
First, there are the clear advances that have been made in medical science that certainly mean that in many cases doctors can delay death if they wish. Secondly, there have been various examples of medical misbehaviour, of which the most notable was that of Dr Shipman, now regarded as the biggest mass murderer this country has known, who as general practitioner killed many of his elderly patients and whose actions have resulted in medical decisions now being examined in the sort of detail that simply did not happen before. Thirdly, there have been some strong statements from Members of Parliament and others calling for a change in the law to make assisted death more acceptable than the current law allows. Fourthly, and perhaps inevitably, it has now become a subject much discussed in the national press; indeed scarcely a week goes by without some newspaper producing an article on the matter, with the articles varying from the responsible to the sensational rather reflecting the spirit of the particular newspaper. It is this that has turned the whole area into a rather unattractive battleground, with the extremes on each side making some extraordinary statements. One advocate of a change in the law, the previous Lord Chancellor no less, accused the Archbishop of Canterbury of a lack of compassion simply because the Archbishop did not agree with him, and yet others on the other side rebuked the new President of the Supreme Court merely because he said he had sympathy for those who found themselves in the predicament of having to decide how to deal with the wishes of a relative who wanted to die. Neither side, I suggest, has a monopoly on compassion.
And sadly it has not just been an exchange of words. I heard the other day from a doctor of the case of a consultant paediatrician who had openly and honestly discussed with a dreadfully disabled child’s parents the options open to them. The paediatrician accepted the parent’s decision that it was best simply to give that child tender loving care rather than to make the medical interventions that might have prolonged the child’s life for a few months but no more, but when the death occurred a nurse, acting in the name of some so-called Christian values, complained about the paediatrician’s actions. He was suspended, but then died of a heart attack possibly brought on as a result of worry surrounding the suspension before the disciplinary case could be heard. I am not at all clear what Christian values were really upheld by that nurse’s actions.
In thinking about this whole issue we need to distinguish between three things. First, there is what is sometimes called passive euthanasia which can take two forms; administering drugs which are administered to relieve pain, but which might have the effect of shortening life, as was the case with the mixture of morphine and cocaine that Lord Dawson administered to the dying King; or failing to take actions that might otherwise prolong life, like giving massive doses of antibiotics to someone full of some disease. Secondly there is assisted suicide, which in some legal jurisdictions is permitted, whereby the patient is given the means to bring about their own death. Thirdly, there is active euthanasia, which is the deliberate act of someone, normally a doctor injecting something that has the sole and specific purpose of bringing about almost instantaneous death.
In this country and in many other countries the first, passive euthanasia is quite common and normally not contrary to the law. I believe most doctors will try to ascertain a patient’s own wishes before deciding at what stage passive euthanasia should be permitted, but there is always the danger, of which doctors are well aware, that a grieving and disturbed relative might subsequently seek to bring a case against a doctor who has allowed passive euthanasia in circumstances other than the relative deems appropriate. It is clearly helpful if potential patients can declare their own wishes unambiguously in writing while well, although of course there is then always the danger that a patient might change their mind as death actually approaches, or that the patient’s wishes are not known to a hospital doctor who might have to treat them in some unforeseen emergency. But I have to say from my own family’s experience in the case of a now long dead but much loved aunt, that there is equally a fear in some patients and their families that passive euthanasia is not always allowed when it should be. I have a very clear memory of the aunt in question, who had declared to us her family that she was quite ready to die having lived to a very good age, being then given a massive dose of antibiotics by a doctor, an act which both my mother and I believed was quite wrong and contrary to her wishes, and which had the effect of prolonging her life for a fairly miserable and unhappy further six months. Mistakes in this area can be made both ways. Perhaps what does need to happen is for all of us, including those in the medical profession, to accept that death is a natural end to life, and striving officiously to keep alive is not always a humane or helpful thing to do.
To go to the other extreme, the third option of active euthanasia in the sense of administering something that has the specific and sole purpose of killing someone is, of course, illegal in this country and in many other countries. Most religious leaders here, both Christian and others, have united in being opposed to any change in the law on that, normally on the grounds that if it were permitted it would make many elderly and vulnerable people very reluctant to go into hospital in the first place because they would fear what might be done to them. Many doctors take a similar view, and would feel it a breech of their oath as doctors actively to take life as opposed to passively allowing it.
My own impression is that those who are asking for the law to be changed to allow more active euthanasia are on the whole intelligent, thoughtful and articulate people, but I am not sure that all of them have grasped what it might feel like to be someone without those particular gifts. Yet a presumption to protect the vulnerable and disadvantaged does seem to me to be something required in any civilised country’s legal system. So personally, as I believe palliative care has advanced enormously and people need not die in pain, but can be allowed to die with dignity through passive euthanasia, I would not favour any general change in that law to allow more active euthanasia.
But what then of the middle case, self administered suicide or, as is often the case, a suicide desired by someone who nonetheless needs assistance from someone else in achieving what they want. If I was ever consulted by someone who was contemplating that, I would certainly try to discourage it. I would point to the possibilities of very good palliative care that means that no one should die in physical pain, and indeed even in the case of the aunt I mentioned earlier I do not think she was ever in physical agony, she suffered from purely emotional and mental distress at her wishes about death not being respected. I would also say from my parochial experience of having been with people when they died, shared no doubt by most clergy, that it certainly does not inevitably involve a loss of dignity.
But what about the person who nonetheless still wished to bring about their own death at a moment when they could not face life any more, even if that might be prior to any moment when passive euthanasia might be a realistic option. Should they be allowed to do that, and should those who might be needed to assist them in the process be prosecuted? There are certainly those who argue that the law should be changed to allow assisted suicide in such circumstances, and anyone who is at all sensitive to the needs of others in such circumstances must have some sympathy for those involved. But there is an element of discretion open to those who might bring prosecutions, and personally I believe that discretion is a more constructive vehicle for dealing with the issue. My own view, for what it is worth, is that we should not change the law as such; loosing the prohibition on assisting in the ending life deliberately might have all sorts of unintended consequences and we might wake up in a few years time and find that we were then encouraging something that many would find very repugnant, with elderly people feeling under huge pressure from their families to end their lives for financial reasons or because of their reluctance to become, as they see it, a burden for others or because, wrongly I believe, they fear a painful and lingering death. But the call by the Law Lords to give some guidance on the circumstances in which prosecutions would not be brought is a helpful way through this dilemma. I am glad that the guidance issued by the Director of Public Prosecutions includes requiring a very clear statement from the patient concerned when they were in health on what their wishes were; that those assisting suicide in a particular case should not involve those who might have a financial benefit from the consequences of that death, and that the DPP is in effect discouraging the emergence of clinics in this country that simply specialised in assisting suicide in such circumstances. The existence of such clinics here would, I fear, certainly result in undue pressure being brought on some vulnerable people to agree to suicide in circumstances where they really did not want it. But I do not believe myself the Church should in principle oppose the DPP’s guidelines. Passive euthanasia is always, in my view, the best option, and the one most respectful of the essential sanctity of life, but respecting other people’s freedom of action is also an important principle, including their freedom to end their lives. To find the right balance between the sanctity of life and giving people their freedom in what will inevitably always be very distressing circumstances will never be easy. Personally I think the Director of Public Prosecutions has made a very good start at finding that balance, and I believe he deserves our thanks and support.