British Steps Toward Euthanasia

Steven Mosher
By Joseph A. D'Agostino
PRI Weekly Briefing
27 May 2005
Vol. 7 / No. 20
Reproduced with Permission

In the Netherlands, the routine killing of the ailing aged and disabled newborns, even without their parents' or loved ones' consent, has become public knowledge. The rest of Europe does not seem far behind, and recent developments in Britain, the nation perhaps most similar to the United States, could tell us euthanasia's future in developed nations.

Regular readers of the Weekly Briefing know that First World nations, particularly those of Western Europe and Japan, face the rapid aging of their populations due to three factors: The failure of their peoples to have enough children to replace them; the impossibility of importing enough immigrants to make up the difference; and the much greater longetivity produced by modern technology. Nations are facing a tripling of the proportion of their populations over 65 in the next 45 years, and even worse, up to a quintupling of the proportion over 80. Pension and health care costs will increase accordingly.

How can a smaller workforce support these costs? It will not be able to. So is mass euthanasia of the old and unfit on the horizon? Three recent developments in Britain point in that direction. A government agency has endorsed age discrimination in the provision of medical treatment, a doctor's group is opposing the right of terminally ill patients to decide on their own treatment, and the Mental Incapacity Bill has classified food and water as withholdable medical treatment for those deemed mentally defective. The latter two developments do not apply to the elderly exclusively, but most of the people affected by them will surely be aged.

Because Britain, like most of Western Europe, has a socialist health care system (called the National Health Service, or NHS), politicians and government bureaucrats are empowered to decide what sort of treatment people receiveŅor don't. They are looking for more ways to cut costs, and that search will become more and more urgent over time.

"The Labour government, having championed the population control policy in the UK over the past 45 years, now finds itself with an aging population, and can no longer afford to care for the sick and elderly in the health service," says Greg Clovis, Director of Family Life International UK. "It has now changed the law with the Mental Incapacity Bill so that food and water are now regarded as medication. Now doctors have the right to starve their patients and allow them to dehydrate if they regard the patients' quality of life to be low. We now have the most anti-life government the UK has ever known under Tony Blair."

Age discrimination is politically incorrect, part of the pantheon of incorrect discriminations whose number grows every few years. NHS' National Institute for Health and Clinical Excellence (the Orwellian NICE) wants to prune that garden slightly. It proposed taking age into greater account when doctors prescribe medication in draft guidelines issued last month. The final guidelines won't be issued until the end of June. On the subject of age and drug treatments, the guidelines conclude, "Health should not be valued more highly in some age groups rather than others. Individuals' social roles, at different ages, should not influence considerations of cost effectiveness. However, where age is an indicator of benefit or risk, age discrimination is appropriate."

These guidelines could be interpreted benignly. Or they could be interpreted to mean that an expensive drug should be denied to a 70-year-old woman because statistically, she's likely to benefit from it only eight more years since women live, on average, to be 78. Or she shouldn't get the drug because her body is less likely to heal than that of a younger person's. As advocates for the elderly in Britain complained, these new guidelines could be the thin end of the wedge.

NICE defended itself this month, saying that it won't apply these guidelines to the NHS. NICE Chief Executive Andrew Dillon said, "The institute has to make difficult decisions about how well treatments work and which treatments offer the NHS best value for money. We know that factors such as age and lifestyle can influence how clinically or cost effective a treatment is, and we are asking people whether NICE is getting it right when we take this type of factor into account during the development of our guidance."

Dillon noted that NICE has recommended age discrimination in the past by withholding some fertility treatments from women under 23 and over 39 "as treatment is most likely to be effective in this age range." Forty-year-olds need not apply, based on cost effectiveness. That's socialism: If you don't fit into the average, you don't fit at all.

Britain's General Medical Council (GMC), a doctor's group which sets and enforces standards on doctors, decided that food and water delivered artificially can be withheld from a patient if that "patient's condition is so severe, or the prognosis so poor, that providing artificial nutrition or hydration may cause suffering, or be too burdensome in relation to the possible benefits."

Needless to say, the possible benefits of food and water include continued life, and that benefit cannot be realized without their provision.

Leslie Burke, a man dying from cerebellar ataxia, filed suit, asserting that he wanted to set his own treatment rules before his condition became so bad that he might not be able to communicate. He fears that doctors will starve and dehydrate him to death when he is still conscious but unable to swallow, and that he will suffer terribly while he is killed in that manner. Instead, he wants his desire to be feed through a tube honored. He won in court, but GMC appealed the ongoing case. GMC wants doctors, not Burke, to decide on his treatment.

GMC's lawyer argued that honoring such a request would put Burke's doctor "in an impossibly difficult position, for a doctor should never be required to provide a particular form of treatment to a patient which he does not consider to be clinically appropriate."

Britain's Mental Incapacity Bill, passed by the House of Commons last month, allows doctors to kill mentally disabled people. It also requires doctors to kill those who ask for death by withholding treatment such as food and water by tube. Pro-life doctors and nurses may have to leave the medical profession.

The Royal College of Psychiatrists has matter-of-factly stated its own view on the withholding of treatment from those judged mentally unfit. "Advance decisions to refuse treatment may cause individuals unintended distress, harm and prolonged suffering. There should be a duty on professionals to try and ensure that an advance decision is not leading to unintended harm," says the college. So you can decide in advance to kill someone, but don't tell him. "Patients should be given the right, which must be taken into account, to express positive wishes about how they wish to be treated. Such wishes cannot be binding upon the health professional," the college states flatly. "Attorneys or Court-appointed deputies should not have the authority to require a health professional to provide any particular specified treatment, as opposed to the power to refuse consent."

The same document praises "respect for self-determination." This is the kind of self-determination the aged and the disabled can expect in the future Britain and Europe.