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”.