Medicine
Hemlock on the NHS
John Linklater The supporters of legalised euthanasia find a new advocate in the form of surgeon George Mair, who hit the headlines last Friday by admitting that he had deliberately killed a number of patients, with their consent. Having heard the satisfaction which he experienced, to take but one example from the unhealthy, handsqueezing scene When he killed a woman to the accompaniment of Beethoven's ninth symphony, it was not altogether surprising to find that Mr Mair suffered from psychosomatic Pain and nausea brought on by the nlore routine duties of caring and Curing, and that he retired from Practice prematurely. Mr Mair claims that he only i(illed when the patient requested or hinted at it. The patient with advanced cancer, however, is not in a Position to give the free consent Which Mr Mair claims. He is in pain, and trapped by the disease, and will ultimately accept whatever advice, he is given by his physician. One Cannot help feeling that Mr Mair Was playing God, without God's omniscience, and that this was adequately demonstrated by the Patient to whom he gave a lethal dose, who then slept for many "ours to awake refreshed and die n,aturally a few days later: Mr Mair laid not take the hint. All doctors will, at times, have given patients with terminal cancer such large doses of analgesics to control the pain, that the patient Probably died of the dose rather than the disease. Let us not, however, confuse this with deliberate ldiling. A lesser dose was not enough and it was given to relieve Pain: it was not given in order to T.113r Twycross of St Christopher's 1.'°sPice, and others experienced in !errninal care have pointed out that fear and ignorance or uncertainty a;re the principal factors in terminal "tress, and that if the doctor is ,PrePared to give his time, sYmrthY, explanation and support, 'erY little remains of the original :elite Pain. Pain is, in fact, hardly ver purely physical or purely rriental, but a mixture of varying froPortions of both of these facOrs, and a patient who is properly ocared for usually dies a good death
surprisingly small doses of 'IMPle analgesics.
soT.he danger now is that our ciety is in its collective, experi
mental adolescence, rejecting and proving the ancient taboos, and that anything which is presented as an innovation is likely to be accepted regardless of the fact that it has been tried before and abandoned for very good reasons, or because it turned out to be the thin end of an utterly unacceptable wedge. Mr Mair sees himself as a reformer and is therefore inaccessible to arguments based on reason or experience or common sense.
Apart from the lesser offence of falsified certificates as to the immediate cause of death, the principal crime which Mr Mair claims to have committed is that of aiding and abetting suicide and of exploiting his professional knowledge and position to end the lives of patients who lacked the courage or conviction to do this themselves, notwithstanding that the means were almost certainly on their bedside table. He thus encouraged the act. It is irrelevant to plead that he was merely advancing the inevitable by a few months at the most. Last year, one of my patients died comfortably at the age of ninety-eight, having been judged too old and weak for operation to remove a cancer from his right lung when he was seventy, and having been a source of joy and symbol of stability to his family in the interval. Physicians are not God.
Whenever we overthrow well established principles, forgetful of the fact that citizens will always tend to accept permissive legislation as a moral guide, we run into ills and injustices far worse than those which we seek to cure. The law to relieve the hard-luck abortion cases, for example, has led to a ten-fold increase in abortion in seven years and the creation of a sort of sub-human species of children in the womb. Similarly, in the case of suicide, we used to concede that many of those who took their lives did so while the normal balance of their minds was disturbed. This would have been the charitable verdict on the mother of a young family who suddenly took an overdose, perhaps as a sort of sacrificial gesture, while suffering from the effect of prolonged environmental stress.
By over-reacting against selfrighteous Victorian ethics and declaring, that suicide is not a crime, however, we have not only weakened one of the deterrents, but also confused our statistics: coroners' juries are bringing in an increasingly high proportion of verdicts of accidental death. Our resulting absurd ambivalency is best epitomised by the comment of the Irish coroner who listened to the verdict, nodded gravely, and added, "Sure, he killed himself by accident while cleaning the muzzle of the gun with his tongue."
Let us, at least, remain perfectly clear that it is a crime to assist or encourage a man to take his life, whether under stress or duress or in pain, or not in pain. The General Medical Council, the British Medical Association, the defence unions and the law must now unequivocally declare themselves to remain utterly opposed to what Mr Mair claims to have done.
If they do not do so, we shall face de facto euthanasia, on demand, to be ratified later. Old folk tend to be much afraid of becoming a burden to their relatives. Even the acceptance of de facto euthanasia would put an intolerably cruel pressure upon them, as a sort of obligation to "do the decent thing" as soon as any disease was discovered which might conceivably be certified as "terminal." Mr Mair would be the first to concede that some doctors may not be too scrupulous about accurate certification. We should, in fact, be taking one further step back to*ards the cold, stoic philosophy of the pre-Christian world, and barbaric hedonism. Even if firms of undertakers did not set up in lucrative business with doctors to open sunshine homes of rest for the aged, on a par with our private abortion chambers, we should cer tainly be faced with a National Health Service providing not only newspeak health for the unborn child, as it now does, but death at any age by hemlock.
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