West London Humanists and Secularists

"Old Age Rational Suicide - Meeting 21/02/2013"
A Talk by Dr. Michael Irwin

Society for Old Age Rational Suicide was founded by Dr Irwin in Brighton and Hove in 2009 on December 10th - Human Rights Day. This date was also chosen because the Voluntary Euthanasia Society, now called Dignity in Dying, was originally founded at the BMA HQ on 10th December 1935, some 12 years or so before Human Rights Day was established by the UN after WWII. At the beginning, the two main objectors were the Medical Establishment and Church groups. In Scotland there is a similar organisation to Dignity in Dying called Friends At The End (FATE).

Dr Irwin recommended the website of Compassion in Dying where there is advice about establishing a Health Care Proxy, such as a Spouse or Best Friend, who can explain to the doctor one's wishes - this is covered now by the Mental Capacity Act, 2005. They also offer a free download of a Living Will or Advanced Directive. These give people the chance to declare their choice to withdraw or withhold treatment if they do not wish to continue. This of course needs adequate protection in situations where perhaps the patient is not able to tell the doctor their desires because of brain damage or dementia, or if, say in a case of pneumonia to ask for as much treatment as possible or no more treatment.

Dr Irwin mentioned something called euphemistically "The Liverpool Care Pathway" which is medically approved sedation to reduce painful symptoms before one dies - this being legal. What at the moment is illegal is for the doctor to give a lethal injection or medication to swallow. This is legal in the Netherlands, Belgium, Luxembourg, Switzerland, and in the states of Washington and Oregon in the USA. Annual open reports are published by these countries giving figures and statistics. Switzerland is the only country to accept foreigners for this purpose. There are two places, Dignitas in Zurich and Ex Internat in Berne. The whole procedure can take up to four months needing much form filling and documentation,(which can need the birth certificates of ex-spouses!) several interviews and a final fee of £8-9K which covers preliminary reports, transport, 3 nights overnight and the doctor's fee in Zurich.

Dr Irwin described the very dignified and, one could almost say pleasant and social occasions when he has taken people to Zurich and Berne. On several occasions he and others have had interviews with officials from the Coroner's office, a local hospital and once in Switzerland, because there was a two month discrepancy in the date of birth on the birth certificate and on the passport, he had to sign a long document in German to clarify and indemnify etc. with a police official, but everyone there was very kind and apologetic for troubling them. In Switzerland a doctor is always present (to help if the patient has trouble swallowing for example) but the privacy of the family and friends is always respected. This service has been available in Switzerland for 40 years. On returning to the UK, sometimes friends and relatives have been questioned and even arrested but none has been charged.

Dr Irwin told us of the Royal Euthanasia of King George V in 1936 when he was obviously dying from several strokes and pneumonia. After consultation with the Queen and Princes, the royal physician, Lord Dawson gave a lethal injection into his jugular vein, and the editor of the Times was then informed so that the nation would learn of the King's death next morning. During the first of many discussions in the House of Lords, Lord Dawson later declared that there was no need for a law as all good doctors would do it!  Dr Irwin confirmed, as a retired GP, that nearly all GPs hate bureaucracy so tend to trust their own instincts and training!

There have been many debates on the subject sometimes the religious lobby voting against and sometimes the other side winning the vote. In 2006 Lord Joffe brought in the Bill for the Terminally Ill, which lost by 148 - 100 out of a total of 850 members! He pointed out that every member had a private GP and tended to die at home! In 2013 Lord Faulkner plans to bring in a Bill for Doctor-assisted [dying] for the Terminally Ill.

Several surveys by reputable companies normally find 68-67% in favour and 18-19% opposed. A recent telephone survey found about 60% in favour, but this has been put down to the fact that callers tend to want to please the questioner and therefore give a quicker answer, whereas if an online survey is conducted the respondent has more time to think, maybe of an elderly infirm relative, and would tend to vote in favour. Surveys in the House of Commons tend to show about 33% in favour of such a bill.

Not all religious leaders were against these ideas; Canon Dick Shepherd and Lord Donald Soper were in favour. Dr Irwin pointed out that there is no place in the bible where suicide is declared as sinful. It seems Saint Augustine declared suicide a sin when many of his supporters were choosing to leave their wretched lives for the 'better life in the Next World'! It was important to clarify killing, which was taking life against someone's will.

Several questions from the group raised the problems facing different social strata and how long was a reasonable prognosis, people living longer, etc. and Dr. Irwin said that most people who chose voluntary suicide tended to be well educated, had been used to being in control of their lives, professionals and reasonably comfortably off. He pointed out that very few rich people died in hospices as they could afford good home care. Careful discussion with families and carers was important so that neither they nor the patient felt undue onus or pressured nor seeming un-caring about the others' feelings. Dr Irwin pointed out that in the UK palliative care is generally very good, but not uniformly across the UK.

The question of whether this was the beginning of a slippery slope was succinctly answered with the analogy of ending the slave trade: people were worried that ex slaves might marry white women, buy houses, get the vote etc. and now we have a Black President of the US!

SOARS publishes a very concise and informative booklet and on page 14 under PROCEDURES for OLD AGE RATIONAL SUICIDE it says:
For a new law, in the UK, that would allow mentally competent, very elderly individuals who sincerely believe that they have lived a completed life, whose bodies are now severely failing them, to have rational suicide with the assistance of an understanding, compassionate physician, it would be essential to have very strict procedures in place. It then lists 4 main points and safeguards:

  1. Two physicians
  2. Privately interviewed by experienced official to check that it IS being done of their own free will
  3. A waiting period of at least 2 months and the medication only being available on the actual day and taken in presence of a physician or qualified assistant ( see above why in Switzerland a doctor is always but unobtrusively present)
  4. Detailed reporting to a central government office, by all those involved, would be essential.
William Morton 25 February 2013