Dani Garavelli: What gave this GP right to decide?

Though it’s clear many of those Kerr treated regard him as a good doctor, there’s something about his unerring faith in his own judgment that I find unsettling. Of course, it must be difficult to see people in pain, worse still to have them beg you to relieve it. Nevertheless, even as a GP, it takes a certain degree of arrogance to assume sole responsibility for deciding whether or not a person’s life has been rendered intolerable by their illness and whether, when they say they want to die, they are expressing a moment’s desperation or their settled will.

The most troubling thing about Kerr is that it seems unlikely that any of the patients he “helped” would be eligible for assisted suicide even if legislation were introduced. As far as it is possible to tell, none were terminally ill. Two were suffering conditions which impacted on their quality of life – one man couldn’t get out much, while his failing eyesight made watching TV difficult, and the other had a debilitating bladder condition. Neither, it might be argued, were at the extreme end of impairment. And the wife of the first man – who killed herself after Kerr supplied drugs to facilitate their suicide pact – wasn’t physically ill at all, just suffering from agoraphobia.

Kerr was convinced the couple’s suffering was insupportable, but could nothing have been done to make their lives better? Might some care package not have been put in place to help them get out more? And how could Kerr – or anyone – be sure the wife did not feel under pressure to comply with her husband’s wishes? Perhaps she felt that, after so many years together, it wasn’t fair to refuse to die with him. Perhaps she was just scared of being left alone. But who’s to say what happiness might have lain ahead if she had been encouraged to make a new life for herself? More disturbing still, in 1998, Kerr was suspended from practising medicine for six months for prescribing sodium amytal to an osteoporosis-sufferer who wanted to die because she was worried she would be a burden on her family.

Far from convincing me of the merits of assisted suicide, Kerr’s intervention raises a series of disturbing questions about the danger of doctors with agendas, the subjective nature of quality of life assessments and the risk that elderly people might feel duty-bound to kill themselves so no one else has to care for them.

Much as I admire MacDonald, I have always had reservations about her bill. Once people know they have the option to end their lives, will they even try to adjust to difficult new circumstances? And once assisted suicide is normalised, will the emphasis shift away from counselling and palliative services?

On one level, however, Kerr’s admissions do underline the need for new legislation, albeit not as he intended. It is worth noting that the procurator fiscal decided not to pursue a case against him (although this is now being reviewed). In part, this is because the law on assisted suicide in Scotland is ambiguous and the Crown Office has shied away from bringing culpable homicide charges. The situation in England is equally unsatisfactory. There, High Court judges last year ruled doctors could not end the life of Tony Nicklinson, who had locked-in syndrome, without threat of prosecution; yet, since new guidelines on assisted suicide were brought in by the Director of Public Prosecutions in 2010, dozens of people have helped family members attend the Dignitas clinic in Switzerland, without a single charge being laid.

This is problematic, firstly because a significant proportion of those who end their lives at Dignitas are not terminally ill and, secondly, because if people are determined to die, it is better they do so at home. But I guess that’s what happens when a gap forms between the law and public opinion – actions which are technically illegal become decriminalised by stealth, but with none of the safeguards that would apply if an act of parliament had been introduced. With the emphasis on the motivation of the facilitator rather than the condition of the patient, there is no real guidance as to what is and what isn’t acceptable. Is it OK for a well-meaning relative to assist in the suicide of a man paralysed in a rugby match? A dementia sufferer? A teenage self-harmer? Since the leniency policy does not apply to physicians, it also means the entire burden of responsibility for the death is placed on the patient and their relatives.

If assisted suicide is going to happen anyway, it would surely be better to have the parameters under which it is allowed set out in statute. A commission into assisted suicide in England and Wales last year suggested it should be allowed only where the patient was over 18, terminally ill with less than 12 months to live, making a voluntary choice and not mentally impaired. The person should be independently assessed by at least two doctors and administer the medicine themselves. MacDonald’s bill, defeated last time round, would allow those with degenerative conditions, a trauma or terminal illness, to seek a doctor’s help in killing themselves.

Neither proposal seems ideal to me (I’d prefer more emphasis on improving quality of life) but both are better than the present situation. They would put strict limits on the kinds of patients eligible for assisted suicide and would, hopefully, prevent doctors like Iain Kerr taking the law into their own hands. «

Twitter: @DaniGaravelli1