Best articles on assisted dying

Former-lord-chancellor-Lo-001Here are the best articles I have come across making the case against the Assisted Dying Bill. There are some very powerful arguments here; if the Bill is passed, all these will have been set aside.

A moving reflection from the Digital Nun:

My argument would be that Lord Falconer’s bill is deeply flawed. When one is ill oneself, one is very conscious of the burden one places on others. Any decent person would want to ease that burden, but opting for assisted dying is, I think, very questionable. One can be mentally capable of making decisions yet emotionally too vulnerable to make a rational decision. Again, it is striking that Lord Carey talks about the pain of watching someone one loves suffering — the onlooker’s pain, not the pain of the one actually sick or dying. In the West we don’t like seeing pain. We try to shut it out, eliminate it; but that is not what compassion is. Compassion is sharing the pain, accompanying the other through the valley of darkness and the shadow of death. That takes guts and faith in equal measure. We can protest that we don’t have such faith; that such courage is beyond us; but we won’t know until we try.

Two accounts from people who have, or might well be, directly affected by this questions themselves. The first is a posthumous article by Christopher Jones, who died from cancer in 2012, and wrote the piece six months before his death.

My reflection on this experience centres on the fact that at three periods – the diagnosis of secondary cancer, the traumatic experience of chemotherapy, and the prognosis of incurability – I was subject to extreme stress and a sense of hopelessness, and I might have been open to the option of ending my life by legal means, had these existed. The legal prohibition of this course was immensely helpful in removing it as a live option, thus constraining me to respond to my situation more creatively and hopefully. In hindsight, I now know that had I taken this course, I would have been denied the unexpected and joyful experience of being ‘recalled to life’ as I now am….

In summary, my experience has reinforced my conviction that the law prohibiting assisted suicide is an essential bulwark against well-meaning but unwarranted judgments about the value of life and the desirability of ending it in order to minimise or eliminate suffering. In my view, suffering is inescapable in this situation, and ought not to be allowed to trump all other considerations, especially when palliative care is taken into account. I do not claim that my experience trumps all other experience of end-of-life decisions, but it introduces significant considerations which are not usually acknowledged by supporters of a change in the law.

The second is by Hannah, who has Inflammatory Bowel Disease and associated spondyloarthritis.

I live in chronic pain, with little hope of long-term relief. I sometimes can’t get off the toilet. I have trouble walking. I sleep for ten hours a night and still feel like I am wading through treacle. I know what it is like to suffer. Yet I am against assisted dying, in spite of the fact that there are days when I think: why go on? If this is it for the rest of your life, why continue?

I am a young and independent person, yet I have sometimes fretted about the burden of worry and distress I place on my loves ones, and thought in my darker moments that it may be better for all concerned if I were to die and allow people to mourn and get on with their lives. If this has crossed my mind, how much more so those who have severe disabilities which place a great burden of care on their loved ones?

“But why should people in intolerable pain suffer for the sake of what might or might not happen further down the road?” Let me flip this argument on its head: why should the many disabled and vulnerable people who currently live in this country be put at risk of harm and distress for the sake of a few, understandable though their wish to die may be?

Giles Fraser weighed in with his usual energy:

When the moral history of the 21st century comes to be written, I predict we will look back with horror at how the word choice became a sort of cuckoo in the nest, driving out all other values. This week, in an editorial, the BMJ decided that patient choice now trumps the Hippocratic oath. The moral language of the supermarket has become the only moral currency that is accepted. Which is why, for me, assisted dying is the final triumph of market capitalism: we have become consumers in everything, even when it comes to life and death. And as history demonstrates, the losers in this equation are always going to be the most vulnerable.

Professor Theo Boer was an active campaigner for euthanasia in Holland, but he is now horrified at what has happened.

‘Don’t do it Britain,’ said Theo Boer, a veteran European watchdog in assisted suicide cases. ‘Once the genie is out of the bottle, it is not likely ever to go back in again.’ Professor Boer admitted he was ‘wrong – terribly wrong, in fact’ to have believed regulated euthanasia would work. ‘I used to be a supporter of the Dutch law. But now, with 12 years of experience, I take a very different view.’

‘Whereas in the first years after 2002 hardly any patients with psychiatric illnesses or dementia appear in reports, these numbers are now sharply on the rise. Cases have been reported in which a large part of the suffering of those given euthanasia or assisted suicide consisted in being aged, lonely or bereaved. Some of these patients could have lived for years or decades. Pressure on doctors to conform to patients’ – or in some cases relatives’ – wishes can be intense. Pressure from relatives, in combination with a patient’s concern for their wellbeing, is in some cases an important factor behind a euthanasia request. Not even the review committees, despite hard and conscientious work, have been able to halt these developments.’

The latest euthanasia figures for the Netherlands show that nearly one in seven deaths are at the hands of doctors.

Peter Saunders has written incisively in response to George Carey’s contribution to the debate:

But there is no discernible Christian world view underpinning what he says. Nothing of the fact that God made us and owns us; nothing of biblical morality or the sixth commandment; no doctrine of the Fall; little insight into the depths of human depravity and the need for strong laws to deter exploitation and abuse of vulnerable people; nothing of the cross or the resurrection; no hope beyond death; nothing of courage and perseverance in the face of suffering; no recognition of the need to make one’s peace with God and others before death; no real drive to make things better for dying patients and no real empathy with the feelings of vulnerable disabled and elderly people who fear a law like Falconer’s and will be campaigning in force outside parliament next Friday.

Carey has instead produced a piece that is high on emotion but weak on argument that capitulates to the spirit of the age; that enthrones personal autonomy above public safety; that sees no meaning or purpose in suffering; that appears profoundly naïve about the abuse of elderly and disabled people; that looks forward to no future beyond the grave and that could have been written by  a member of the national secular society, British humanist association or voluntary euthanasia society.

He also offers a response to Desmond Tutu, analysis of what the Bill might actually mean in practice, the lessons learned from Oregon State, and a frightening analysis of how the white, well and wealthy are bankrolling the euthanasia lobby:

The world’s fourth richest person, Warren Buffett, ploughed $1.23 billion into abortion groups over eleven years, a media watchdog has found…In a similar way the pro-assisted suicide campaign in the UK has been bankrolled by wealthy businessmen…

It deeply troubles me when I hear of very wealthy and powerful people using their money to finance efforts to legalise medical killing through abortion, assisted suicide or euthanasia…These rich men all use the language of autonomy, choice and compassion but taking another person’s life through abortion or euthanasia, or helping them to kill themselves through assisted suicide, is actually to eliminate all future choice.

Iona Heath, president, Royal College of General Practitioners, puts a medically-informed argument against the Bill:

The first [reason] is a deep concern that it will be impossible to draft a law robust enough to protect the vulnerable. As the philosopher Onora O’Neill made clear, speaking at the Royal Society of Medicine in June 2010, support for assisted dying is based on respect for individual autonomy, yet the influence that one person can have on another makes legislation to permit assisted dying intrinsically risky…

The second reason for my discomfort is that medicine seems once again to be preparing to offer a technical solution to an existential problem. One of the huge challenges of human life is to find ways of living a meaningful life within the limits of a finite lifespan that will always involve loss of love and the inevitability of grief.

Jenny McCartney offers a powerful case against in the Spectator:

The Assisted Dying Bill argues that the terminally ill are a special group who could be legally hurried towards death. Campaigners have hinted that this could one day be extended to the disabled. What then would we really be saying about equality of value, if the terminally ill and disabled were the only groups in society granted permission for assistance to die?

It is disingenuous simply to argue that ‘assisted dying’ would only be open to those who truly desired it. Desire itself is subject to external pressure, and vulnerable to shifts in social atmosphere: it can be generated, not only from independent will, but also from isolation, guilt and despair. The terminally ill patient endures the gross indignities of a failing body, is acutely demanding of resources, and clearly sees the cost that care exacts from weary family members. The last months can no doubt be horrifying for some. And yet I have also seen friends approach their final days with remarkable serenity and lucidity.

I have offered my own analysis of the role of ‘experience’ in the debate:

The appeal to experience can turn us into moral solipsists, where we can say nothing beyond our own existence, and so we all have to make moral decisions in isolation from one another. But more often this appeal to experience is presented as tyranny: not only can you not argue against my experience, you are forbidden to offer any credible alternative to what I propose. To do so is to devalue my experience…You are not allowed to question my view—but you are not even allowed to offer any alternative, since this is just suppressing my and others’ experience.

And Andrew Goddard follows this with his analysis of the arguments:

In conclusionas we consider the current proposed change to the law and doubtless others in the future, it is vital that the emotions that we rightly feel in the face of suffering and dying and the desire to do something to help do not prevent us engaging in serious, reasoned reflection. The points above highlight that even Christian leaders often fail to do this when they critique the current situation. They also often fail to promote the clear, indisputably Christian alternative. The obligation to show compassion which is at the heart of Lord Carey’s argument is one which – with Christians playing a leading role – has found expression in the medical and nursing professions (which risk becoming compromised if implicated in the deliberate ending of life, hence their widespread caution or antipathy to changing the law) and in particular in the provision of hospices and palliative care for the dying. As the Church of England calls for a Royal Commission in this area it needs not only to continue its reasoned defence of the law but also to consider afresh how, as we face the possibility of changes in the law and the need to be distinctively counter-cultural, it can support this alternative embodiment of faith, hope and love in the face of suffering and death as the true expression of Christ-like compassion.

A Catholic blogger makes interesting observations about whether the Bill has any democratic mandate:

The second point to note is that the basic substance of the Bill has already been rejected by Parliament on several occasions before. Lord Falconer appears to have picked up the mantle of Lord Joffe – another unelected member of the House of Lords – who on four previous occasions put forward a Bill for “Assisted Suicide” (NB see how Lord Falconer is now using the word “dying” rather than “suicide”, more on this very serious wordplay in a subsequent post). Now, if a man were repeatedly to ask a girl out, despite her adamant rebuttals of his intentions, we might start to speak in terms of harassment. Similarly, one might ask how many times is it appropriate to ignore the repeated will of Parliament and seek to persuade it otherwise through the repeated introduction of private member’s bills, where nothing has substantially changed since the last time either House was asked to examine the Bill?

Justin Welby commented on George Carey’s argument and set out his own concerns:

[On Carey] Were it to be presented by a candidate in a GSCE religious education exam, I should expect an examiner to take a dim view of it. [More widely] Abuse, coercion and intimidation can be slow instruments in the hands of the unscrupulous, creating pressure on vulnerable people who are encouraged to “do the decent thing”. Even where such pressure is not overt, the very presence of a law that permits assisted suicide on the terms proposed by Lord Falconer of Thoroton is bound to lead to sensitive individuals feeling that they ought to stop “being a burden to others”. What sort of society would we be creating if we were to allow this sword of Damocles to hang over the head of every vulnerable, terminally ill person in the country?”

Welby has also joined with other religious leaders in a shared statement:

As leaders of faith communities, we wish to state our joint response to Lord Falconer’s Assisted Dying Bill. We do so out of deep human concern that if enacted, this bill would have a serious detrimental effect on the wellbeing of individuals and on the nature and shape of our society.

Every human life is of intrinsic value and ought to be affirmed and cherished. This is central to our laws and our social relationships; to undermine this in any way would be a grave error. The Assisted Dying Bill would allow individuals to participate actively in ending others’ lives, in effect colluding in the judgment that they are of no further value. This is not the way forward for a compassionate and caring society.

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8 thoughts on “Best articles on assisted dying”

  1. It all comes down to a “we put down a beloved family pet when we can do no more for it and it is in pain, why do we treat people worse?” argument. I can see the arguments on both sides to be honest. As long as the vulnerable are protected an no one feels compelled to do it because they are a burden, I’m not sure I am against it. Those are huge caveats though.

  2. Ian, the same concerns over emotional pressure apply to a patient’s right to withdraw from treatment, even if such withdrawal is fatal. Should a patient lose that right?

    If not, then these concerns aren’t the fundamental issue.

  3. James, in common law countries there is no special “right to withdraw from treatment”. There are laws against assault and battery. These make it unlawful for a doctor to treat, or even touch, a person without that person’s consent. Leaving aside questions of competence, as long as those laws stay in place (and they will stay in place) any person can refuse treatment at any time even if that means they will die.

    • Janice, an exemption to the assault law could easily be created by Parliament or the courts. It hasn’t been. A patient who relies on life support to survive can demand, “Let me die,” and their caregivers must comply, even if they have a good prospect of recovery.

      Such a decision, along with a DNR notice, is just as prone to coercion as assisted suicide, perhaps more so. If it’s not objected to, then coercion can’t be the main issue.

  4. James, I’m having trouble understanding your meaning. Are you arguing that coercion isn’t the main issue because people can be coerced into demanding to have their treatment stopped (“and their caregivers must comply”) even if they have a good prospect of recovery?

    I ask because, whether or not a person currently needs life support, if they have a good prospect of recovery but insist on refusing treatment then a psychiatric/competence assessment would be requested and treatment would continue while that was done. If they’re found to be depressed, which is usually the case, and refuse treatment for that they’d probably be scheduled and treatment would continue. Of course, if they had a doctor of the Harold Shipman/Philip Nitschke variety things could turn out very differently.

    • I’m saying that, if coerced suicide is the concern, there’s no substantive difference between withdrawing treatment and assisted dying.

      Yes, a person could be placed on a psych hold if necessary. This would apply equally to assisted suicide.

      • But I think all ethicist agree that there *is* a huge difference between withdrawal of treatment and assisted dying. That is the whole point of this debate, isn’t it?


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