Perhaps the most effective speech in yesterday’s debate in the British House of Commons about assisted dying came from Dr Philippa Whitford, an MP for the Scottish National Party. She spoke after many years of experience as a specialist breast cancer surgeon. Here are some excerpts.
(For more news on the debate, see our Careful! blog.)
I believe that this is not just a tidying up of a small legal anomaly. It is, rather, a crossing of a Rubicon, as was mentioned earlier. It is changing and legalising the killing of one person by another, regardless of the reasons why we would want to carry that out.
The Bill’s weaknesses have been mentioned, such as the problem of finding general practitioners who would write a report. In actual fact, quite a lot would be willing to do that, but not so many would be willing to be involved in the act of assisted suicide. Where would the independent expert be found? Some 96 percent of palliative care specialists are utterly against this Bill. They object to the name of it; they consider what they do is assisted dying, and what this is, is assisted suicide.
I do not want to talk about the small print, however. That will be explored over the day. My objection is basically in principle.
Many Members will be aware of my interest; as a breast cancer surgeon for 30 years, I have been involved in the journey to death of many patients, but as a doctor I have never considered that death was a good treatment for anything, no matter what was wrong with anyone.
People would choose such an option for lots of reasons: the fear of being a burden, the fear of dying, and most of all the fear of suffering. The responsibility to deal with that lies with us. Who is making them feel that they are a burden—is it their family or their friends, or is it society? Who is letting them down in their palliative care? It is us.
As the hon. Member for Totnes (Dr Wollaston) mentioned, the services are patchy in some areas. Not everyone has access to palliative care, but I started out in 1982 when women did not know when they went into theatre that they had breast cancer because we did not have the ability to diagnose it.
I worked for an eminent professor in Glasgow, and we lived in the ward in those days, and I watched patients come back from theatre having had the lump removed. If it was cancer their breast was removed, and that was it—no choice. They found out they had cancer by groping themselves on the trolley, because if they had a lot of bandages and a drip, that meant they had lost their breast and they had cancer.
Watching people die of cancer was awful at that time. They were cachectic [emaciated by disease], they were in pain, and we had very limited hospice and very little palliative care support in the hospital.
But 30 years later that has changed. Whereas 40 percent of patients would live 10 years then, now 80 percent do so. Our patients know exactly what operation they are going in for. They have hours of discussion with us, and until a few years ago I would have been involved in their journey if that cancer came back, in their palliation and in their terminal care.
That journey can lead to a beautiful death.
The event that had the biggest impact on me as a junior doctor was the death of a lady whom I had looked after for many months. When I came on to the ward that night, the nurses said, “I think Lizzie’s going.” She was curled up in her bed, obviously quite upset, and when I asked her what was wrong, she said she was frightened and she did not know what she had to do.
I said, “You don’t have to do anything. You just have to relax. You just have to let go.”
We had the family in. West-of-Scotland male is not good on emotion or openness, so I took her son in and I spoke to her again about what was happening to the point where he could tell her that he loved her and how much he was going to miss her.
I went for my tea, and when I came back she was sitting up holding court with the whole lot of them. I thought, “Oh no, we’ve called it wrong”, but she was gone in an hour, and it was beautiful.
That made me commit to working with cancer patients. If I had not made it as a surgeon—which, as a woman at that time, I was told flatly that I would not—I would have gone into palliative care.
I have seen change in the journey for patients. We heard the hon. Member for Mid Bedfordshire (Nadine Dorries) describe the last two weeks of the life of her friend, and that is something that we see repeatedly—that the patient is ahead of the family. We are always utterly open with patients.
We no longer have a situation in which a family member says, “Don’t tell my mum. Tell me, but don’t tell her.” The patient will always know, because the fear is that when they see their death coming, they will know that everyone has lied to them and they will be on their own.
My job was not just to look after the patient; it was to look after the whole family. All these illnesses are diseases of the whole family, and we want the family to be left with the knowledge that they did everything they could and were able to express their love at the end of their loved one’s life.
Things have changed for cancer patients. I have not had a cancer patient ask me for a quick way out, an escape, for decades. We need to ensure that palliative care is offered to people with degenerative illnesses, of which we are all afraid.
When the public support this measure, they are not actually thinking about the last six months of a terminal illness; they are thinking about Alzheimer’s, about motor neurone disease and about Parkinson’s, none of which the Bill would address. It is therefore inevitable that this would migrate. As the hon. Member for Totnes said, we should support palliative care and we must ensure that it is available to people who are dying, regardless of their illness. We need to change our tone towards the people who live in our society, so that old and vulnerable people no longer feel that they should get out of the way.
All our horizons will narrow as we get older.
Someone who was hill-walking when they were 20 might not manage to do so when they are 80. I have seen patients who are grateful to be at home being wheeled out on to the patio in the sun and having a good blether with their son who has come home from London. They consider that a good day. We might consider it horrific, looking at it in advance, but when we get there we will have changed.
We should support letting people live every day of their life until the end, and make sure that, as legislators, we provide the means for them to live and die with dignity and comfort. We should not say, “When you can’t thole it [stand it], take the black capsule.”
We should vote for life and dignity, not for death.
Philippa Whitford is a Scottish surgeon and Scottish National Party politician. She has been the Member of Parliament for Central Ayrshire since May 2015. She is the SNP Health spokesperson in the British House of Commons.