Death defying act

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In response to Paul Brownsey (Letters, 24 February), I submit that there are vast and significant differences between refusal of treatment and asking for help to kill oneself.

These suggest that anyone wishing to die is more likely to be vulnerable to pressure from others to take the latter than the former decision.

In asking for help, a person only has to communicate his or her decision twice under the provisions of Margo MacDonald’s bill for that request to become legally binding on his or her medical attendants.

In the former case, it is a stable and continuous inner commitment which can be changed at any time and is therefore less open to the influence of others.

Also, in acceding to a request not to give treatment, a medical attendant is only acceding to the expressed wishes of a patient.

In the case of a patient then dying, the cause is the pre-existing condition, not the meeting of the request.

In the case of prescribing a fatal medication, the medical attendant is making a necessary though not sufficient contribution to the death; as well as meeting the request, there is a causal connection there.

In response to Bill Morrison (Letters, 24 February) there is always the possibility of stopping eating, carrying out the ultimate expression of personal autonomy, which advocates of assisted suicide constantly refer to as justification for their cause, instead of what Marie de Hennezel, the author of Intimate Death: How the Dying Teach Us To Live, calls “imposing an excessive demand on others”.

Bill MacDonald

Harmony Court

Bonnyrigg

I did not respond to Paul Brownsey’s challenge (Letters, 21 and 24 February) to produce evidence of pressure being brought to bear on patients to refuse treatment because this is irrelevant to my argument.

I have no evidence that it is happening in particular cases at the moment, but I think Bill Morrison’s letter, which mentions the part that financial considerations play in his support for the legalisation of assisted suicide, points up the possibility of such pressure being a very real danger if the law were changed.

What Mr Brownsey ignores is that where assisted suicide is available, as in Switzerland, it is not necessarily in the last stages of terminal illness that it is applied. There, people who may have many years of life expectancy may undergo assisted suicide, such as someone with quadriplegia. In view of the vagueness of the qualifying criteria in Ms Margo MacDonald’s bill and her stated hope that these may eventually be extended, I have no confidence that her bill would protect the vulnerable.

It should be noted that the Royal College of General Practitioners (RCGP), having completed a survey of its members and conducted a thorough consultation, has reaffirmed its opposition to a change in the law on assisted dying (RCGP website, 21 February).

Out of the 1,700 members who responded, 77 per cent were opposed to a change in the law.

Among the reasons for opposition cited were that it would “put the most vulnerable groups in society at risk” and that “it would be impossible to implement without eliminating the possibility that patients may be in some way coerced into the decision to die”.

Along with the RCGP, the British Medical Association, the Royal College of Physicians, the Association for Palliative Medicine, the British Geriatric Society and the World Medical Association are all opposed to the legalisation of assisted dying.

We should consider these stances seriously before rushing into such legislation.

(Rev Dr) Donald M MacDonald

Craiglockhart Grove

Edinburgh