It seems like every day there is a new push to legalise euthanasia in the UK. This week, Prue Leith has called on parliament to debate euthanasia before the next general election. Keir Starmer has said that he is committed to allowing a vote on assisted dying if Labour gain power. And in Holyrood, the Liberal Democrats have put forward a Bill which would decriminalise euthanasia in Scotland if passed.
It is physicians who will have to be at the heart of the legally sanctioned killing process
Often when euthanasia is debated, the focus is on the terminally ill and the impacts on wider society – which would certainly be profound. But one group of people tend to be overlooked, even though they would have to be at the heart of any euthanasia programme: the doctors who would have to administer the ‘treatment’.
Ever since the creation of the Hippocratic code with its injunction ‘First, do no harm’, doctors have been dedicated to preserving human life. It’s why in 2024 international codes of medical ethics prohibit physicians from participating in judicial executions, using their expertise for torturing prisoners, using psychiatric drugs to sedate political dissidents, and transplanting trafficked organs or those from executed criminals.
And while there have been many members of the profession who have failed to live up to these ideals – whether from political coercion, greed or just plain malevolence – in general, this commitment to preserving life has made doctors among the most trusted people in modern society.
Although it may sound rather pretentious, the goal of preserving life is what I signed up for when I qualified as a physician at St Thomas’s Hospital in 1978. And it has remained a guiding principle for me and my colleagues working in the fields of intensive care and paediatrics.
When you work in a hospital, it is not uncommon for a patient to ask you to kill them. When asked this, we gently refuse. We are here to care and to find ways of treating the misery, but we don’t do killing. It’s not what we are here for.
This is the terrible implication of the move to legalise euthanasia in the Assisted Dying for Terminally Ill Adults (Scotland) Bill.
It is physicians who will have to be at the heart of the legally sanctioned killing process. It is a doctor who will first ensure that the patient has a terminal illness, defined vaguely and ambiguously in the Bill as ‘an advanced and progressive disease, illness or condition from which they are unable to recover and that can reasonably be expected to cause their premature death.’ The physician will have to make sure that the patient is registered with a GP in Scotland (although the GP will not need to be involved in the euthanasia decision or even informed). They will have to check that the patient understands their situation and the effect killing themselves will have on their family and friends. They will examine the patient to see if they have sufficient mental capacity and have to be satisfied they are acting of their own free will, and without coercion or inappropriate influence from others.
Then, when the legal formalities are completed, it is a doctor who will order the lethal medication, calculate the dosage, obtain and hand it over, ensure that the patient takes it in the correct manner, and then stay with the patient until they are dead. Finally, once the physician has certified the death, they will be legally instructed to produce a false and patently misleading death certificate – saying that the certified cause of death was the underlying disease, rather than the lethal poison that had just been administered.
There was a time when Scottish physicians were looked up to as representing the acme of expertise, wisdom and respectability. But this Bill will move us a long way from the likes of Alexander Fleming and James Simpson.
If society in its wisdom has concluded that there should be a legally sanctioned method for certain eligible people to end their own lives, then why should it be qualified physicians who are tasked with the dirty work? Helping people to kill themselves will surely have emotional and psychological repercussions. A review of the research on doctors in the Netherlands, where euthanasia was legalised in 2002, concluded that ‘the shift away from the fundamental values of medicine to heal and promote human wholeness can have significant effects on many participating physicians. Doctors described being profoundly adversely affected, being shocked by the suddenness of the death, being caught up in the patient’s drive for assisted suicide, having a sense of powerlessness, and feeling isolated.’
What will the consequences of this be for the future of the profession? Do most people really wish to be looked after by doctors who have become specially trained and experienced in the grisly mechanics of ending their patient’s lives? Although it is proposed that no doctor will be forced to participate, will it be possible for those who believe strongly that assisting suicide is wrong to continue to work within the NHS? How can I continue as part of a healthcare team, trying to protect the lives of my patients, when other members of the team are discussing the option of suicide with them? Will doctors put all their heart into suicide prevention for some of their patients whilst they are also assisting others to kill themselves?
Since the days of Hippocrates, we have drawn a clear line between curing and killing – a bright and shining line that is being irreversibly breached. For the sake of medics – and patients – we should be very wary of taking this dangerous step.
Comments