Assisted Dying…the debate continues

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July 31, 2014 by Paul Goldsmith

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Friday a fortnight ago saw British pluralist democracy offer an excellent demonstration of what it is capable of. Whilst I would like to see the House of Commons have the guts to debate this issue, the fact that the House of Lords had a long debate on assisted dying, with more applications to speak than many times previously, whilst outside pressure groups for both sides were allowed to protest and support loudly, showed what a mature political culture we can have. The media have managed to make coverage of the issue sensible as well – with the Times sketch writer choosing to cover the proceedings in the Lords in a far more poignant manner than you would usually expect.

The idea of changing a law so that someone can help you die in the last six months of your life if you are terminally ill is complex, because there are so many unintended consequences possible. Even though we often don’t end up at the bottom of the slippery slopes that are talked about, with the bottom of this one being avaricious families bumping off their relatives to get hold of their money, the mere fact we are holding the debate has had an effect on some people. My local Vicar told me that some of his older congregants feel that the fact this debate is even taking place makes them feel like they must be a burden on their children and grandchildren. Is this really a debate that should be taking place, instead of one about how we can make our parents and grandparents more valued and happier in society once they are past the age where they can produce offspring or sell you something? As someone who is always determined that issues ARE debated, and that people are not stopped from contributing, however unpalatable their views – I can see their point.

But back to the House of Lords. I think it’s worth quoting a few of the speakers, because there was a 50/50 split in their position on this issue. Reading them has really made me think. Before I started looking into this more deeply, I was convinced that I would want the law to go through, that I wouldn’t want to be a burden, that I wouldn’t want a long protracted death with my last years filled by pain and sense of uselessness. The trouble is, what happens if when I get to that age my children are just about to have my grandchildren and I would like to hang around to see them for as long as I can? What pressure might this law put me under?

Lord Falconer, whose Bill this is – pointed out that the current law “provides an option of an assisted death to those rich enough to go abroad and for the rest it provides despair and often a lonely, cruel death”

Lord Mackay questioned whether assisted suicide will actually lead to a dignified, comfortable and speedy death. He has seen evidence that this is not always the case and is concerned that people aren’t questioning that assertion.

Baroness Campbell, who suffers from spinal muscular atrophy, and spoke from a wheelchair through a ventilator, said she found the debate “frightening”, adding that it was unlikely given her condition that she would be refused if she asked for assistance to die. She said she could find many doctors and lawyers now who would support her right to die “rather than improving my situation or helping me to change my mind.” The Bill frightens her because “in periods of my greatest difficulty I would be tempted to use it.” She said that it was noticeable that the majority of disabled and terminally ill people did not want the bill – “Supporters of this bill argue there is a hard and fast distinction between terminal illness and disability. I can tell you absolutely there is not. The bill purports to offer choice: the option of premature death instead of pain, suffering and disempowerment. But it is a false choice. It is the burglar who offers to mug you instead.”

Lord McColl – a senior surgeon, was concerned that assisted death could become regarded as “just another treatment option” and that the change might create a society where thevulnerable, dependent or weak believed they had a “duty to die”. He mentioned that even a “subtle pressure not to go on living” was too much, and he also felt that the bond of trust between doctor and patient could be destroyed, particularly because a doctor’s duty was “above all to do no harm”.

But Baroness Greengross, who had spent more than two decades as chair of a Age Concern England, felt that it wasn’t about giving someone a new right, it was more the that once you were incapacitated you had no other way of terminating your life, unlike someone who wasn’t incapacitated, and for that small number of people, it was about giving back their freedom of choice.

Lord Tebbit, a Conservative peer with a wife who has been paralysed since the Brighton Bomb in 1984, questioned the use of the phrase ‘right to end our lives’ that Baroness Greengross had used. He said that “we do not have that right – we only have the capacity to do it”. There would now be financial incentives to end the lives of the “frail, the handicapped, the ill and the elderly”. Those being cared for sometimes have moments of black despair and say things like “I would be better dead, so that you could get on with your life”.
But Lord Joffe asked what answer could be given to those “mentally competent, terminally I’ll adult patients for whom palliative care is not the solution and who appeal to their loved ones for assistance to end their suffering by ending their lives?” This was followed by many personal stories of people in that position.

Baroness Finlay questioned the ‘safeguards’ that so many peers had bounced for during the debate. One of them was that a signature of a second doctor would be needed. But “Who is going to find this second doctor? He or she is likely to be known to the first doctor as someone who sees physician-assisted suicide as a reasonable response to severe progressive illness”.

Lord Mawhinney told the story of his mother, who had, in her last years, kept telling her family she was a burden. He felt that she could do so with the confidence that her family loved her enough to overcome any feeling of burden. But, he wondered “how many others will think that they are a burden and will not be met by similar support and love?”.

Former Metropolitain Police Commissioner Lord Blair described the police investigation that has to take place at the moment each time there is a suspected assisted suicide. “The house will be a crime scene, tents, officers in forensic clothing, photography, the seizure of computers, last letters, presents, bank statements…..the funeral delayed for a post-mortem…the relatives with months of anxiety waiting for a prosecutorial decision“.

Meanwhile, Baroness O’Cathain was worried about the effect on medical professions of having to make these decisions. “It is all right for us who don’t have to do the deed, but what about the people who do? And how long does it stay in their memory?” She was backed up by Lord Empey, who felt that it would create a situation where doctors became specialists in assisted dying. Lord Brennan added that it “dismantles the Hippocratic oath by creating two kinds of doctor: those will will not help you to kill yourself and those who will”.

Lord Brennan was also concerned about the bill leading to legislation and further legislation, because “the more we are told about autonomy and choice, the more a group of litigants will say to the court, ‘I want to exercise by autonomy and my choice. Why is it restricted to the terminally ill? Why six months? Why the discrimination between those types of cases and me?

Baroness Grey-Thompson, a famous Paralympian, argued that disabled people felt that the bill lacked protections that would stop it being extended beyond those with a terminal illness, pointing out that she had been told, even this week that “you must have wanted to kill yourself many times in your life”, which wasn’t so.

The former Director of Prosecutions Lord Macdonald pointed out that “there is a clearly defined discretion to protect those who face an impossible choice and to act from motives that are beyond reproach”.

But the Labour peer and noted scientist Lord Winston,who had suffered from diabetes and was in and out of hospital for the last years of her life, said that “we have been talking about the dignity of planned death, I don’t believe in that planned death being dignified”. He added that there is much more dignity “in being able to ensure people wherever possible die with their relatives around them in an unplanned death.”

Lord Birt, the former director general of the BBC, talked about us being a free, secular society, in which the presumption should be that adults are free to do what they wish, subject only to not impinging on the rights of others. He said that I can see no reason at all for denying individuals the right to manage their own imminent, irreversible and prospectively painful, wretched or deeply distressing death – in their own interest, and in the interests of the loved ones that they will shortly leave behind”.

But Lord Harries of Pentregarth, a former Bishop, worried about the slippery slope that I mentioned at the start of this article. He pointed out that the assisted dying bill will inevitably lead to another bill which “allows people with severe illness at any age to seek lethal drugs“. He suggested that “if we are on over by compassion for people who have only six months to live, how much more do we feel compassion for someone who may have a totally incapacitated life ahead of theme for years, if not to decades…it is totally inconsistent to argue for autonomy for in the case of those who are dying and not others who may be in even greater distress.”

But supporting the bill was former Conservative Home Secretary Lord Baker, who talked about the suffering of Chris Woodhead, the former chief inspector of schools, who has motor neurone disease, and has described it as where you live in a prison which gets smaller by six inches every year. Baker said that “If it ever fell to me to be in that position, on, and not to be in control of my bodily functions, I would not want my gift of life to continue – and I would want to be the person who made that decision.”

Sadly, the House of Commons will not be touching this debate, as this close to an election no party wants to get stuck into something so contentious. It may be, however, that Labour will commit to a free vote in it in their manifesto. Reading the words above, I don’t know what I think, but I do hope that the quality of this debate continues.

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