Assisted dying: Should it be legal in the UK?

We spoke to Rebecca Wilcox – she’s the daughter of television presenter Dame Esther Rantzen, who has terminal lung cancer – and Dr Cajetan Skowronski, a geriatric and palliative care doctor.

Cathy Newman: Rebecca Wilcox first, I wonder if you’ve talked to your mum about today and what it means to her.

Rebecca Wilcox: Yes. I mean, it means so much to us. It’s an extraordinary moment. And we’re so grateful to Kim for bringing this forward, because there is a time now that people are accepting that assisted dying can be done safely. There can be layers of protection. We can create legislation that will protect the vulnerable and that will listen to those groups that are worried, but will enable choice for those who want to end their deaths, to curtail their suffering so that their life doesn’t become marred by the memories of a painful, horrible, protracted death. Which is what happened with my father.

Cathy Newman: And you’re understandably emotional today.

Rebecca Wilcox: It’s been hugely emotional, not least to hear the wonderful Jenny in your package, who I talked to early on in my discovery about the assisted dying campaign. She is a force to be reckoned with. And what a wonderfully erudite argument for assisted dying. What she would like is no pain. She saw her partner go through pain and she would like the choice. What I would like is people who are of faith and have a reason for their religious beliefs that they don’t think that we should end our lives, that there is a sanctity of life, I would like them to come out and say that. I would like them to say I am a Catholic. I believe in the sanctity of life. That is my choice. Whereas my choice as an agnostic or as someone that believes in a humane way of living, I believe that it is my choice and my mother’s choice that they have a calm, peaceful, dignified death.

Cathy Newman: I’ll come back to the religion point in just a second. But Dr Cajetan Skowronski, it doesn’t seem a lot to ask, a calm, peaceful, painless death. And at the moment, as you saw from Jenny in the piece, you know, palliative care just doesn’t cut the mustard.

Dr Cajetan Skowronski: Right. And that’s a really important point. Thank you very much for raising it, Cathy. And my deepest sympathy to Jenny and her family and I’m not denying that there are really tragic cases out there. But a lot of it, in my experience, having worked with hundreds, if not thousands, of people who’ve died over the years under my care as a geriatrician and working in palliative care, my experience is that most deaths are actually pain free. And I think it’s actually, it’s important to dispel any misinformation that this debate brings up. Lots of people assume because of this debate that all death is very painful. And so most deaths are pain free. The deaths where pain is a factor, we’ve got excellent medications to help control that. And yes, there are a few cases, and in my experience I’ve seen probably three where we’ve really struggled to control the pain. And these cases are tragic, but we can do all sorts of other things to help support the patient.

But I’d like to, as this is such a deeply personal debate, I’d like to raise something from my background, which I’ve been thinking about a lot as I’ve been hearing about this bill. So my grandmother became very unwell and very frail. She was a very selfless person, as many people in that generation are. She was a fan of Esther Rantzen’s, and she would always do everything and always sacrifice herself for everyone around her. And she found it very difficult when she had to move in with us so that we could care for her ,when she was nearing the end of her life. And she’s in the last year of her life. And we had so many wonderful moments together, even though there were elements of suffering in there, including the birth of my daughter, her great granddaughter, who she was able to cuddle before she died, which she might not have had if this bill had been in place, because she would have felt she’s a burden and it would have been offered to her because she was in the last months of life.

Cathy Newman: Rebecca, there are lots of points to pick up there. But just the point about most deaths being pain free and, you know, the elderly towards the end of their lives might feel a burden. What’s your take on that?

Rebecca Wilcox: My take on that is, that my experience, the people that I’ve met, they have not been pain free deaths and there has also been the fear of a painful death coming towards you. Yes, the majority of deaths within the NHS within palliative care, the doctors that work with people who are in these stages of life, are clearly brilliant angels that we should respect. But the fact is there is a limit to what drugs can do, and sometimes they just don’t work. And I know from experience and from reading the report carefully, the Health Select Committee report that came out earlier this year, that so many people with a terminal illness feel calm and a sense of weight lifted off their shoulders, knowing that this is an option, knowing that assisted dying is an option. They don’t have to take it up. Again, this is a choice. They can sign up for and never do it. But just knowing that there is that option, that protracted, painful death is not going to happen to them, irregardless of whether the drugs don’t work, and on the front of the vulnerable people. I just wanted to answer about your wonderful grandmother who was a fan of my mother, who would want me to get this point out. I’m not bribing you at all with time, but basically vulnerable older people do not have safeguards at the moment. The law is a mess at the moment, there are no safeguards in place, there aren’t layers of safety.

Dr Cajetan Skowronski: The safeguards they do have is that we do not offer them poison in hospital or in hospices. That’s a very big safeguard and our society will shift radically. This is a recipe for an absolute disaster.

Cathy Newman: Arguably it is already happening because people…

Dr Cajetan Skowronski: Yes it is already happening in Canada.

Cathy Newman: No. I was making a different point. Assisted dying is already happening here because in theory, it’s illegal. In practice, people are not being prosecuted.

Dr Cajetan Skowronski: For assisted dying?

Cathy Newman: You know, that people are helping their relatives to go.

Dr Cajetan Skowronski: Doctors are not killing patients in this country.

Cathy Newman: But relatives are helping their relatives to go, is my point. But they’re not being prosecuted necessarily. It’s a mess already.

Dr Cajetan Skowronski: It’s a mess, but it’s on a much smaller scale than it would be. 15,000 people died last year in Canada from medical…

Cathy Newman: But we’re not talking about Canada here, are we?

Dr Cajetan Skowronski: I mean, we have to look at the available evidence in all other spheres of medicine, in all other spheres of society. We look at all the available evidence.

Rebecca Wilcox: I’d love you to look at the evidence. I’d love you to quote the report. Could you please quote the report? Could you please look at the report which says there is no slippery slope, that vulnerable people are far more protected. I would love to let you finish. And so could you let me finish? The disability campaigners are 78% in favour of a law change for assisted dying. The report could not have been clearer. It is evidence fact based, 14 months of investigation. As a scientist yourself, you must respect data.

Dr Cajetan Skowronski: Yes, that’s exactly what I’m trying to say. And the way that assisted suicide has snowballed in Canada and the way it snowballed in Belgium and Holland, and is being offered to people who are perfectly physically fit in their 20s, just because of mental health problems, is very clear evidence that once you let this genie out of the bottle it cannot be put back in.