Martin Green: Give patients ‘choice’ over when they die
By Tim Ross
Terminally ill patients who want to commit suicide should be able to receive medical help to die, a government adviser on care for the elderly has said.
Martin Green, a dementia expert for the Department of Health, said patients who were too frail to take their own lives were being denied “choice” and “autonomy” because assisted suicide is illegal in the UK.
In an interview with The Daily Telegraph, he urged ministers to review the law and suggested that a referendum or a free vote in Parliament should be called to settle policy on the issue.
“If you’re going to give people ‘choice’, it should extend to whether or not they want to die,” he said. “If people have got the capacity to make an informed choice then it is my view that they should be allowed to make the informed choice.”
His remarks were welcomed by campaigners for a change in the law but will fuel concerns among disability charities and Christian groups who fear that legalising assisted suicide would put elderly and disabled people under pressure to end their lives.
Mr Green, the chief executive of the English Community Care Association, which represents nursing and care home groups, is one of the country’s leading experts on support for the elderly and has advised ministers on a number of key dementia policies.
He is among the panel of experts that drafted new Department of Health guidelines on services for dementia patients, published in July, and has been one of the government’s three national dementia “champions” since 2009.
His intervention follows a series of high profile cases in which terminally ill patients have sought help from relatives to commit suicide, or have travelled to the Dignitas suicide clinic in Switzerland where doctors have supplied them with lethal poison.
Last year, the Director of Public Prosecutions published revised guidelines that detailed factors making the prosecution of family members who helped loved ones to die less likely. Chief among these was clear evidence that the suspect was motivated by compassion.
However, police investigate all cases and there is no legal protection for doctors or other professionals who assist a suicide, an offence which carries a potential sentence of 14 years in jail.
Mr Green said that while the NHS and social care systems were organised around the “mantra of choice and control”, this does not extend to terminally ill patients who want to end their suffering but are physically incapable of committing suicide.
Medical professionals and carers will ask patients where they want to die, what their “cultural needs” might be and how to support their family members.
“But if I come and say to you I want to die, that is not a choice that the system allows me to have,” he said. “In terms of people who have cognitive function, it seems to me to be wholly consistent to say, if you’re going to give people choice and control and autonomy, it should extend to whether or not they want to die.”
In other areas of life, disability discrimination laws mean that those who are physically unable to “engage in the activities of normal citizens” are entitled to support. Therefore, this support should extend to assistance from medical or legal professionals to die “because this is an element of choice that people are being denied because of their impairment”.
However, even with safeguards that seek to ensure patients remain genuinely committed to their decisions, it would be impossible to eliminate the danger of abuse entirely, he said.
“It might be a small minority but you will never ever be able to eliminate risk and you should never pretend you can,” he said.
Mr Green has given evidence to the Commission on Assisted Dying, an inquiry organised by the think-tank Demos and chaired by the former Labour Lord Chancellor, Lord Falconer.
Next month, the High Court is due to hear a test case in which a paralysed man with “locked in” syndrome is seeking permission for doctors and lawyers to help him to commit suicide.
However, opponents of legal reform include the Church of England, most medical organisations, and the disability charity, Scope, which has warned that “a substantial majority” of disabled people fear that legalising assisted suicide could increase pressure on them to end their lives.
Dr Peter Saunders, campaign director at the Care Not Killing Alliance, said British parliamentarians had repeatedly rejected reforms over fears for vulnerable people who see themselves as a financial or emotional burden on their families.
“In a free, democratic society, we know that there are limits to personal choice,” he said. “Even with so-called safeguards, to allow people to choose to have help to kill themselves would be open to exploitation and abuse.”