Assisted Dying: Dangerous Territory

OK.  I’m probably going to upset a fair number of regular readers by taking a counter-intuitive position.  Many of those who would agree with me on the EU, or on climate change, or that “the facts of life are conservative”, may also tend to take a traditional view on a wide range of ethical issues.  This is true to some extent in the UK.  More so in the US.  I may agree with the Tea Party on small government and low taxes, but I don’t necessarily agree with them on abortion or assisted suicide.  I’m more likely to go with Ron Paul than Rick Santorum.  (Ron Paul appears to have voted against a ban on physician-assisted suicide in 1999, although I’m not too clear on his position since then).

We’ve just had the report from Lord Falconer’s pretentiously-titled “Commission on Assisted Dying”, which despite its neutral name seems to have been driven and funded by pro-euthanasia interests.  We’ve also had a predictable response from the medical and political establishments, from the commentariat and the bien pensants.  I’ll quote just one example, but it’s fairly typical.  Sheila Hollins, past president of the Royal College of Physicians and president-elect of the BMA, writes didactically “Sick people need help to live, not help to die”.  

The tone of much of the criticism reflects this extremely patronising Hollins piece.  The unquestioned assumption is that we — the medical profession, the politicians — should decide what your rights are, and when and how you should exercise them.  For heaven’s sake, what about the patient’s opinion?

I’d start from a more libertarian position.  If we don’t have rights with respect to our own lives, do we have any rights at all?  We have various portentous declarations of human rights that always talk about “The Right to Life”, but unless that includes the right not to live, then it’s not a Right to Life at all — it’s an onerous duty to go on living, whether we like it or not.

I have great respect for all those who have profound moral scruples about suicide, or abortion, or divorce, or blood transfusions.  And these people clearly have a right to refuse assisted dying, or abortion, or divorce (subject to the law and the spouse’s view), or blood transfusions.  What they do not have, in my book, is the right to impose their own moral scruples on the rest of society, which may not agree with them.

Politicians who pontificate about the life and death of their constituents are on very dodgy ground indeed, but I am, I suppose, entitled to discuss my own life and death.  I have already made out a “living will”, asking my family and carers to respect my wish not to be kept alive by heroic medical interventions when recovery is beyond hope.  As the old rhyming couplet has it, “Thou shalt not kill, but needst not strive/Officiously to keep alive”.

But I feel that this living will, and the proposals of the “Commission on Assisted Dying”, do not go far enough.  The report specifically requires the informed consent of the patient.  Yet this denies the right to die to those increasing numbers of elderly people whose conscious, meaningful life has been terminated already by dementia.  As we conquer many of the diseases of early and middle life, and as we extend life expectancy, so the numbers of elderly suffering from severe dementia will, sadly, increase.

I should like to be able to make a more comprehensive living will, so that if in the future I were to suffer seriously from dementia, if I were unable to remember who I was, or to recognise my family, if I were unable to confirm my wishes in the matter, I could nevertheless be allowed to pass away in short order, and not be kept a half-alive, vegetative shell of what used to be a man, for months or years.

It is especially sensitive to raise the issue of cost in this context, but again I claim the right to do so at least for myself.  I should hate to think that tens of thousands of pounds a year (whether from my estate or from the taxpayer) should be spent to keep me in limbo and vacancy.  I would rather leave my estate to my family, and allow scarce medical facilities to be used for someone else with some hope of recovery.

I am unimpressed by those who argue that a right to assisted suicide would lead to old people coming under pressure from their families to die.  I suspect most are more likely to come under pressure not to do so.  In any case, most human activities involve some degree of risk, and require appropriate safeguards.  We should manage the activity and the safeguards, not turn our backs on an important question for fear of misuse.  And we should think of the rights and freedoms of all those who are terminally ill, or foreseeing dementia, who may desperately want to have the consolation of a dignified way out.

As Shakespeare said of King Lear: “Oh let him pass!  He hates him much that would upon the rack of this tough world stretch him out longer”.   Or as Simeon says in the New Testament (Luke 2:29): “Lord, now lettest thou thy servant depart in peace”.

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17 Responses to Assisted Dying: Dangerous Territory

  1. Mike Stallard says:

    I am a Catholic.

    We were right about birth control and also about abortion. Both were the thin end of the wedge.

    We have dealt with the “problem” of corrupt priests. (I thought most of the people who are so loud in their condemnation were from public schools!) In every parish, nowadays, there is a large bossy woman with specs to see it doesn’t happen.

    So please do not dismiss us over euthanasia.

    The State is inefficient, it gets most things almost – but never completely – right, leaving a vast margin of error. Nevertheless there are certain things which the State must do and which cannot be left to individual conscience.

    Like stopping murder. Like arresting burglars. Like punishing rape. Like fending off enemies.

    Killing people – yes unborn babies are included here – is wrong. The State, not individuals, not doctors, not politicians, must protect everybody – Jews, Muslims, Gay people, the unborn, women and children, criminals even. Everybody.

    Even people who want to commit suicide.

    PS In the abortion issue (bless you) the words got plasticised – “foetus” “woman” “termination”. Please let us call “murder”, “suicide”, “doctors”, “poison” what they are. Don’t let us use Newspeak here. Death is death.
    PPS I am quite honest in stating my basis for belief. Will everyone else please follow my example. If you are a Benthamite, for instance, (Greatest Happiness for the Greatest Possible Number) you may well take a very different point of view.

    • Dear Mike: I absolutely don’t dismiss you, and as I made clear in my piece, I would argue robustly for you to be free to live according to your principles. But I would not support any attempt to impose those principles on others who take a different view.

      • OK.
        So let us look down the line for twenty years or so.
        Old people (Soylent Green anyone?) are expected, when they feel they have had enough, to go into a transition parlour (TP) where they get a good meal and a nice drink which puts them, like animals, to sleep.
        Sort of like abortion really. With a nice kind lady to advise you and hold your hand during the ‘procedure’. And school children being prepared to “transition” by being given a trip to the “TP” as part of PHSE?

  2. I am a Beagle D O G. Cruelty is ugly, and low. Death can be slow, and extremely unpleasant, in every way possible. Mercy has virtue. When people are dying. When cure is not possible, and there is a plea for help, to cut the process short in a kindly way. it would be cruel to turn away and deny what could be given. A dog would not allow dogma to cloud judgement.

    ‘Suicide’ is an unhelpful word, and concept, when someone is dying.

  3. Civalisation can be measured by the value a society puts on human life. The more civalised a society the higher value is placed on human life.

  4. David C says:

    I too usually take the libertarian view of things, and respect people’s right to die by their own hand. But I can’t agree that others should have the right to help in the process. What is being proposed is a mere prettification of the ugliness of death. There is no moral difference between giving a sick man who wishes to die an ‘end-of-life-sedation’ after receiving a doctor’s permit, and bludgeoning him to death with a baseball bat.
    The first is neat and tidy, that’s all. We may start by giving the state the right to issue death permits with associated form-filling, signatures, incompetence, EU interference, but you of all people should know that won’t be the end of it. How long before a doctor is up on a charge for selling end-of-life certificates to bored husbands and wives?
    Giving state bureaucrats the right to issue death tickets is a Fabian wet-dream and those on the right, or libertarians, should have no truck with it.

    • I disagree, David. The issue is whether it can ever be right to assist someone to die, and I have argued that it is, provided they made their wishes absolutely clear at a time when they were competent to do so. After that, the method is almost immaterial, except that it should be humane and should certainly be (as you put it), neat and tidy, as far as death can ever be neat and tidy.

      • David C says:

        Yes. In my opinion there is a big difference between it sometimes being right to assist someone to die, and it being legally approved in advance. I hope that I personally am not called upon to truncate someone’s life in the circumstances we are talking about: if I was, I probably feel compelled to do what I was asked. I would not, however, wish to be able to ‘sanitise’ the ugly act by seeking official legal approval in advance.
        Thanks for your reply Roger: we agree on many things, but this isn’t, and will not be, one of them.

  5. Gail says:

    I agree with you that ths is a very personal choice and should not apply to everyone automatically. I also believe that each case should be considered by a panel of unbiased medics unknown to the person concerned. The wish of the individual should be paramount whether it be for or against euthanasia. How many times do we hear people say “we’d be locked up if we kept an animal in that state?” and when a person dies, “at least they are not suffering any more.” So where there is obvious suffering and the patient has had enough, let them go peacefully. The Liverpool Pathway is the first step on this very slippery slope.

    • Sort of like abortion – two doctors, lots of counseling, no after effects, painless procedure and smiles all round?
      And of course grieving – closely supervised by a dedicated medical team in cooperation with social workers?

  6. Miles Ellis says:

    My father died recently at the age of almost 96. He led an active life until only a few months before his death, but the last few weeks of his life were agony for him and for all who loved him. Many times, when he was lying in his bed in severe mental agony, he said to me “It shouldn’t have to end like this” and I could only agree with him. When he finally went it was a blessing and a mercy for him, and a relief for all who knew him.

    He wanted to die. He knew that he didn’t have much longer and, above all, he did not want to end like some others in the wonderful Care Home where he spent the last four months of his life who were unable to do anything for themselves. He wanted to die with dignity, not as a vegetable, and not even as a shell of a man who could not feed himself or go to the toilet unaided.

    It is a difficult decision, and one that must be taken with due care to avoid the potential slippery slope. But nobody who has watched a loved one begging to be allowed to die in peace can believe that it is wrong to allow such a wish to be carried out.

    On this issue, as on so many others, I am totally in agreement with Roger.

  7. Ian says:

    What worries me is recent legislation allowing people to be bumped off (nil by mouth, even fluids) in their own best interests (sic), even without their approval. The fancy health department name for this is the “Liverpool care pathway”. I think the realpolitik of such recent political concern with euthanasia is, frankly, just the desire to keep spending down – on pensions and NHS costs. The altruistic interests are only wheeled out to provide cover for what amounts to mass murder. You thought this only happened in nazi Germany? Think again. Socialist Sweden was compulsorily sterilising the physically disabled as late as the 70’s, obviously to save money on welfare and hospital costs. And we have a pensions black hole looming. Perhaps if we stopped paying benefits to the feckless (like the banks) there wouldn’t be such a need to exterminate the helpless.

    • I agree Ian. The wishes of the patient (perhaps given earlier in a “living will” while mentally competent) should be at the heart of the decision. And a big shot of morphine is a whole lot kinder than denying fluids.

  8. eyeopener says:

    its not just the liverpool nazarus pathway thats wrong its the governement that are allowing it to be used. that are wrong as well.

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