Senior doctors in the UK on Monday expressed concern over the number of Britons suffering from non-fatal illnesses such as rheumatoid arthritis and kidney disease who have used the Swiss suicide service, Dignitas.
Their fears were raised after the Guardian obtained a list drawn up by Dignitas that reveals the medical conditions that have driven 114 Britons to end their lives at the clinic.
The document shows that while many had terminal illnesses such as cancer and motor neurone disease, others had non-fatal conditions that doctors say some people can live with for decades.
It covers the medical history of all but one of the 115 Britons who have died with Dignitas’ help since the first did so in 2002. It identifies 22 conditions in all. Thirty-six of the 114 unnamed Britons had various forms of cancer, 27 had motor neurone disease and 17 had multiple sclerosis.
But two had Crohn’s disease, an inflammatory bowel disease; two were tetraplegics; three had kidney disease, which can be usually treated by dialysis or a transplant and one had rheumatoid arthritis — all conditions that doctors say are not terminal.
The details have prompted deep concern among senior doctors, calls for the UK health service (NHS) to provide much better end-of-life care and a renewed debate over demands for a new legal right of assisted death to render the growing British use of Dignitas unnecessary.
Steve Field, chairman of the Royal College of General Practitioners, said: “I’m horrified by this list. While I appreciate that some patients with conditions like these experience great suffering and misery, I’m concerned because I know that many of the conditions outlined are conditions patients live with and can live with for many years and continue to have productive and meaningful lives.”
While most of the conditions could contribute to a patient’s death, equally people with many of them — such as AIDS, cancer and tetraplegia — could, with the right treatment, lead fulfilling lives, Field said. NHS palliative care was too often “rather patchy,” said Field, who was “worried” that not all the 114 patients may have been aware of treatments that could have prolonged their lives.
John Saunders, chair of the Royal College of Physicians’ ethics committee, said: “The conditions are so varied that it suggests that Dignitas is not undertaking the adequate medical assessment [of patients seeking its help] that might be expected. The list does suggest that Dignitas is cavalier in arranging for people to end their lives.”
Tony Calland, chairman of the ethics committee at the British Medical Association, the doctors’ union, said: “This list raises considerable concern. There are some conditions such as Crohn’s disease and rheumatoid arthritis that, whilst extremely unpleasant, are eminently treatable and many of the symptoms can be relieved. To go off and commit suicide simply on the basis of these conditions would be premature and unreasonable.”
Their fears were echoed by Edward Turner, whose mother Anne, a retired doctor who had the incurable degenerative condition supranuclear palsy, became a focus of the right to die debate when she killed herself at Dignitas in January 2006.
“The principle should be that if somebody is terminally ill and has started the process of dying, it’s not unreasonable for them to have an assisted death. When people have non-terminal conditions, that’s more troubling,” he said. “I don’t want to see assisted suicide legalized for people who are disabled but not dying because morally that’s a different thing. With the right care and support someone with tetraplegia, for example, can find quality and meaning in life.”
Research published last year in the Journal of Medical Ethics showed that 21.2 percent of all those of various nationalities ending their lives at Dignitas had a non-fatal illness. The suicide at Dignitas last September of Daniel James, 23, from Worcester who was left paralyzed from the chest down in a rugby accident, sparked a debate about the morality of it assisting the non-terminally ill to die.
Sarah Wootton of Dignity in Dying, which campaigns for terminally ill, mentally competent adults to be able to end their lives, said: “This information is a wake-up call. We face three choices: we can ignore the problem, we can seek the prosecutions of those that accompany a loved one abroad to die or we can safeguard the process.
“The only logical way forward is to clarify the law so that it clearly distinguishes between assisted suicide, which should be prevented, and assisted dying, which should be regulated,” she said.
Next week’s annual conference of the British Medical Association will debate calls to end the threat of imprisonment hanging over those who go with loved ones traveling abroad to commit suicide, and a right of assisted dying in the UK for the terminally ill.
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