Lord Joffe's bill to legalise assisted suicide is being debated by the House of Lords again.
Dr Nigel Sykes
Consultant in palliative medicine
As the debate continues, some people with progressive illness have spoken of their support of a change in the law, fearing that age, illness or medical interference will involve a loss of dignity at the end of their lives.
As a palliative care physician, I provide pain relief and care for hundreds of people who do not speak out, but whose deaths have been achieved with peace and dignity, through care and not killing.
We owe the many the right to high quality end-of-life care and I do not believe that a change in law best serves their interests.
Doctors know that their future practice stands to be severely compromised should this Bill succeed
The Royal College of Physicians has responded to their members and renounced their neutral stance in favour of giving patients the support and advocacy they need.
Doctors know that their future practice stands to be severely compromised should this Bill succeed.
Social, professional and personal de-sensitising to taking human life will be just one unwanted effect.
There is a real danger that in a health care environment subject to economic pressure, possibilities to provide comfort for patients would not be pursued fully if the law were to be changed.
Provisions in Holland and Belgium, Switzerland and the US state of Oregon, allow assisted suicide or lethal injections.
The risk is of a gradual change in how we look after those who are elderly, chronically ill or disabled
These are mostly aimed at people who are very close to the end of their life anyway but, in fact, studies show that fewer than one in 20 of this group wish to discuss euthanasia with their physician.
Even among those who do, few persist with the idea once they discover what hospices and palliative care can offer, and once other symptoms, such as depression, are addressed.
The purpose of euthanasia is usually framed legally as the relief of "unbearable suffering," but if this is so there is no obvious reason why it should be restricted to the terminally ill.
Indeed Lord Joffe is open that he would like assisted suicide to be of "much wider application."
In an ageing society beset by increasing health and social care costs, the legal and social acceptance of any form of euthanasia may well affect attitudes and decisions in care delivery.
The risk is of a gradual change in how we look after those who are elderly, chronically ill or disabled.
Paradoxically, legislation driven by people's fear of loss (of capacity, dignity and control) may end up sacrificing the very care, hope and personal choice that they would want at the end of their lives.
Dr Nigel Sykes is a consultant in palliative medicine at St Christopher's Hospice, London.