Physician-assisted suicide as a means of ending chronic illness and suffering threatens to destroy the relationship between doctors and patients, and would cause a moral crisis in the National Health Service, a leading specialist in palliative care has declared.

David Jeffrey, a former chairman of the ethics committee of the Association for Palliative Medicine, was speaking a week after Baroness Warnock told The Times that Britain should take an “unsentimental view” of its 700,000 Alzheimer's sufferers.

Lady Warnock said: “If you're demented, you're wasting people's lives, your family's lives, and you're wasting the resources of the NHS.” She said that the country was in danger of developing a “two-tier death service”, with wealthy but chronically sick people able to travel abroad to end their lives in an assisted suicide, while other patients were left to suffer “in their own backyards”.

Dr Jeffrey, who this week published an ethical guide titled Against Physician-Assisted Suicide, said he deplored the suggestion that NHS resources were wasted on Alzheimer's treatments. He said that a recent survey showed that 94 per cent of palliative care specialists in Britain opposed any change in legislation. A policy reversal would fly in the face of medical opinion and represent “a huge paradigm shift” in care, he said.

“Suddenly, you could kill someone as a medical good and it becomes a treatment option. That would lead to an enormous change in healthcare and on a practising basis it would be very hard to maintain trust.” Dr Jeffrey said that the distress and pain of the chronically ill had to be addressed, but so, too, did their fears.

“Some of those who have been prominent in campaigns to change the law have been articulate and able to express themselves confidently. My concern is with people who are frightened, possibly depressed and bit confused.

“These are people who don't know where to turn and who feel they are a burden. The law has to protect them,” he said.

Palliative care - therapy, pain control, medical, nursing and psychological care - could achieve “a good quality of life” for people with dementia, as much as it can for cancer suffers or those with MS or motor neuron disease, he said.

At the end of their lives, encouragement and affirmation were required by patients who often had low self-worth. But those who argued for euthanasia unwittingly played on the depressive mindset of the very ill and achieved precisely the opposite effect, Dr Jeffrey said.

“There are so many times I have seen people who have said, ‘I don't want to go on any longer.' The essential role of the doctor or nurse is to get into the shoes of the patient. You say, ‘Help me to understand,' and sometimes, ‘Do you ever get so depressed that you no longer want to go on living?'

“I can ask that question now because the patient knows that there are ground rules: ‘I am not going to kill you, I do not seek your end.'

“If there were a law and I asked such a question, the patient might think, ‘Gosh, what is this doctor thinking?' Instead of freeing someone up, the patient might think, ‘Is he suggesting assisted suicide? Does he want me to top myself?'”

Proponents of assisted suicide point to its use in Switzerland, Belgium and the Netherlands. Campaigners such as Lord Joffe and the Scottish Liberal Democrat MSP Jeremy Purvis have also been impressed by laws in Oregon in the US that allow the practice.

Dr Jeffrey, who has studied in Oregon on a Winston Churchill fellowship, said he found few points of comparison with the NHS. Hospice care takes place largely in the home, where it is often reliant on voluntary, untrained staff. Instead of offering continuing care the effect was to abandon people as death approached, he said.

In his book, Dr Jeffrey cites the case of Gary, a former army instructor who was being treated in a hospice for terminal cancer. His predicament had made him depressed and he was determined to commit suicide.

But in discussion with a doctor, Gary revealed how he was missing the Army, and that he had been looking forward to a passing-out parade of young recruits. A wheelchair was found, Gary attended the event, and found a party had been arranged in his honour by his former charges.

“His life was transformed,” Dr Jeffrey said. “He had a purpose and his demeanour completely changed. He died two weeks later, comfortably. People's lives always have that potential. Even in the midst of suffering there can be change. You just don't know what will happen.”

Against Physician-Assisted Suicide is published by Radcliffe Publishing. www.radcliffe-oxford.com

HIPPOCRATES AND HYPOCRISY

In 400 BC, Hippocrates, the father of modern medicine, said: “I will give no deadly medicine to any one if asked, nor suggest any such counsel.” Today, most doctors are still bound by this oath, though not in the Netherlands, Belgium, Switzerland and the state of Oregon

Research from the Netherlands — where euthanasia has been legal since 2002 — has found that assisted suicides do not always result in “dying with dignity”. Complications (spasms, nausea or vomiting) occurred in 7 per cent of cases of physician-assisted suicide, and problems with “completion” (a longer than expected time to death, failure to induce coma, or coma followed by awakening) occurred in 16 per cent of cases

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