Tuesday, October 27, 2009

British Doctor Explains Change of Position on PAS.

A British doctor, Raymond Tallis, writes for The Times today that he has changed his mind about assisted suicide and cites the example of Oregon, where Death with Dignity has been legal since 1994, for his conversion.

Tallis will join Debbie Purdy, the multiple sclerosis patient who recently won a court case in Britain to allow her husband, Omar, to assist her travels to Switzerland for assisted suicide, before a panel at the Battle of Ideas in London to argue for physician-assisted suicide (PAS).

Once a staunch opponent to assisted suicide, while serving as chairman of the Committee on Ethical Issue in Medicine at the Royal College of Physicians, Tallis explains why he has since changed his mind.

The case for such a Bill to me now seems clear. Unbearable suffering, prolonged by medical care, and inflicted on a dying patient who wishes to die, is unequivocally a bad thing. And respect for individual autonomy — the right to have one’s choices supported by others, to determine one’s own best interest, when one is of sound mind — is a sovereign principle. Nobody else’s personal views should override this.

So where did my initial opposition come from? I was in thrall to numerous incorrect assumptions. But the evidence changed my mind.

Culled from Tallis' article, here are his reasons to support assisted suicide:

1. Palliate care does not eliminate need for PAS because it cannot eliminate suffering among all patients and because PAS has shown to actually improve palliative practices

2. Availability of PAS has not inhibited advancements in palliative care, in fact, Oregon has the best palliative care in the US

3. Writes Tallis:

I also shared the worry that legalising assisted suicide would break down trust between doctor and patient. This is not borne out by the evidence. A survey of nine European countries put levels of trust in the Netherlands at the top. And this is not surprising: in countries with assisted dying, discussion of end-of-life care is open, transparent, honest and mature, not concealed beneath a cloud of ambiguity, as it is in the UK. And the knowledge that your doctor will not abandon the therapeutic alliance with you at your hour of greatest need will foster, not undermine, trust.

4. Legalizing PAS doesn't lead us down a slippery slope to involuntary euthanasia because legislation prevents it from doing so.

5. The legalization of PAS in Oregon and elsewhere didn't create a mad rush to die. Few elect the hastening of death.

6. Lastly, Tallis notes:

As a geriatrician, I was also worried that assisted dying would be offered to, or imposed upon, those who are most disempowered. A very detailed analysis of the data in Oregon has shown that there is an under-representation of those groups and an over-representation of comparatively well-off, middle-class white people — feisty characters who are used to getting their own way.

He continues:

Well, I happen to believe that even small numbers of people going through unbearable hell are important. The availability of assisted dying would bring much comfort to many more sufferers than actually use it because it brings a sense of having some control.

Death from dehydration and starvation in patients who have no means of securing an end to their suffering other than by refusing food and fluids, or botched suicides, reflect the unspeakable cruelty of the present law. To accede to someone’s request for assisted dying under the circumstances envisaged in the Joffe Bill is not to devalue human life, or devalue the life of a particular human being, or to collude in their devaluing their own life. It is to accept their valuation of a few remaining days or weeks of life that they do not wish to endure.

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