Jeremy Laurance reviews the evidence that doctors already assist covertly in suicide.

Independent Feb 18th 2010

In February 2010 broadcaster Ray Gosling admitted to smothering to death a friend dying of AIDS in intolerable pain.  Do doctors tacitly assist patients to die?  And is this morally wrong?

Do doctors kill? Ray Gosling claims that, in contravention of the Hippocratic Oath, some have helped patients end their lives and have even turned a blind eye while others – friends or family – carried out the deed, as he did for his dying lover.

He is almost certainly right about the former, but almost certainly wrong – except in the rarest of instances – about the latter.

No one knows how widespread the practice of euthanasia or assisted suicide is in the medical profession. Fifty years ago, country GPs assisting at a home birth would give a quick visual check of the newly delivered infant and, if all was not right, in some cases place a pillow over the baby’s head and say: “I’m sorry Mrs Smith, there seems to be something wrong…”

Such killings were widely, if privately, seen as merciful medicine. They would not happen today – doctors are less isolated, medicine is more tightly regulated and attitudes have changed. Instead, attention has switched to the other end of life and the question of how to “ease the passing” of the terminally ill by increasing the dose of painkilling drugs.
Central to this judgement is the doctor’s intention. Privately, many will admit to having “crossed the line” between alleviating pain and shortening life. Occasionally, one breaks cover and sticks their head above the parapet. Earlier this month, the renowned cancer specialist Karol Sikora described how as a young registrar in the 1970s he had helped a 14-year-old boy with then-incurable leukaemia to die.

He wrote: “My consultant turned to me and said: ‘Sikora, I don’t want to see this boy again. Don’t let him suffer.’ I understood. I doubled his dose of morphine, which I knew could suppress his respiration. The child died overnight, peacefully, with his family around him. That is what doctors used to do. We didn’t call it assisted suicide or euthanasia. We called it ‘easing suffering’.”

Easing suffering is what doctors are supposed to do. If this has the secondary effect of shortening life, that is an unfortunate but unavoidable consequence of the primary intention to relieve pain. But distinguishing which is the primary and which the secondary intention is in practice often difficult.

In the late-1990s, Dr David Moor, a Newcastle GP, claimed to have helped 300 patients die over a 30-year career. Unwisely, he let slip enough details of one case – that of 85-year-old George Liddell, a terminally ill cancer patient – for a prosecution to be brought.

It became clear during the trial that Dr Moor was being prosecuted for what he said rather than what he did. He was charged with giving Mr Liddell a lethal dose of morphine, but in court he claimed that all he had tried to do was relieve his patient’s “agony, distress and suffering”, as any other GP would have done. The jury acquitted him, but the judge punished him for his “silly remarks” by awarding a third of the costs against him.

Nigel Cox, a consultant rheumatologist at the Royal Hampshire County Hospital, could not rely on the same defence when he was accused of killing Lillian Boyes, 70, who had had arthritis for 13 years, was in extreme pain and had let it be known she wanted to die. Supported by Ms Boyes’ family, Dr Cox gave her a lethal injection of potassium chloride. But the drug had no medical use other than to stop her heart. He was convicted of attempted murder and given a 12-month suspended sentence in 1992.

The ambivalence of the medical profession about assisted suicide was well caught by a 1996 Lancet editorial which said:

“There is a gap between what the profession collectively states and what individual members in practice sometimes do, under a cover that smacks of sophistry.” Lancet

Dr Michael Wilks, who chaired the British Medical Association’s Ethics Committee for a decade until 2006, says: “I see this whole battle over the involvement of doctors in assisted suicide as the last battle for patient autonomy.”