“That’s Death”
assisted suicide and the commodification of life.
I write this partly to tease out what I think about the question of “assisted suicide”, partly in the hope that it might help any reader also think through the question, and partly because I want to offer my arguments to my MP ahead of parliamentary debate next month. I begin with several preliminary clarifications.
First, there are those secularists who simply wish to deny me a voice on the grounds that I am a Christian. That seems an extraordinarily irrational view: to refuse to consider an argument because you object to the faith of the person making it. I accept that, without my Christian faith, I could have a different vision of what a good life, a good society might be; indeed, a different understanding of humanity. However, the only way to judge any argument is on its own merits. You (should you be such a secularist) may conclude that irrationality runs all the way through it so strongly as to vitiate it of any force, or you may be surprised that there is a reasoned argument to which a response is needed. If you are committed to reason, though, that should be your conclusion after engaging my argument, not your premise for dismissing it.
My second preliminary is to insist that we need to be clear on the distinction between “allowing to die” and “assisting suicide”. Both some life-at-any-cost conservatives and many liberal campaigners for the latter often perform sleight-of-hand in confusing the two. Some families are not good at letting their loved ones die, but the proper and compassionate response is to help them accept the reality of death, and seek to make it a good one through both the psychological and emotional letting go, and appropriate physical care. There is no virtue in prolonging a patient’s life because the family can’t accept the approach of death. A “Do Not Resuscitate” notice is often a kindness as well as a recognition of reality.
It is also the case that the administration of pain-relief medication may hasten death, but this is such a textbook case of the principle of double effect (the intended outcome trumps the side-effect) that it hardly seems worth mentioning. These all fall into the category of “allowing to die with dignity” and, I would judge, most of us arguing against “assisted suicide”, are strongly in favour of “dying with dignity”. It is an unjustified and dishonest rhetorical strategy, not borne out by the facts, for those in favour of “assisted suicide” to pretend that only they care about dignity, or that dignity is inseparable from autonomous choice.
My final preliminary is about the language we use. The only neutral term for what is currently being proposed is the one I have used: “assisted suicide”. This is clearly about helping someone who wishes to kill themselves to do so. “Assisted dying” is too vague. It embraces not only the possibility of palliative pain-relief hastening death, but also the family and others giving the dying person permission to die — and many of us who have sat by the bedsides of the dying have experience of them needing that permission. It also, for those who have done this, may well embrace the administration of the last rites, where someone has needed a sense of being at peace with God and family in order to let go. This is an argument about a very specific sort of assistance, and “assisted suicide” is the specific terminology.
All that said, I think there are six arguments I want to advance for why any change in the law is mistaken. First stands the Hippocratic oath. Although the phrase “First, do no harm” is not, in that precise wording, part of the original, it does fairly well sum up the paragraph dealing with treatments dietary and pharmacological. (The text is most readily accessible on Wikipedia.)
The idea (related to my second preliminary point above) is simple: any medical intervention is predicated on the belief it will be helpful. Intervention needs a higher moral bar than non-intervention; positive moral acts need a clearer justification than the moral consequences of inaction. The idea that my doctor will only pursue a treatment if they believe the action is not harmful, but has a chance of helping, is fundamental to the way the doctor-patient relationship works as a relationship of trust.
The degree of outrage expressed in response to the crimes of Harold Shipman, and now to the (much disputed) crimes of Lucy Letby is so strong and passionate because their actions are believed to contravene the very purpose of their calling. Doctors and nurses are not meant to be killers, and public anger, and a desire for vengeance, when they are found to be so, bears its own witness to the atavistic sense of wrongness society feels when those tasked with healing turn out to be killers. There seems to be quite a high social cost to normalising the idea of the doctor as dispenser of death.
Second, and related to that, is that the NHS is an inexhaustible black hole when it comes to government funding, and expensive hi-tech ground-breaking treatments will always have a cachet of sexiness that the routines of palliative care will never match. Once assisted suicide becomes an option for those who most need palliative care, it introduces the possibility that the culture of high-achieving medical intervention will push out the culture of care. Doctors, like all of us, like to achieve success, and that success is most frequently defined by cure. The success of enabling a good, pain-free, passing from this life accompanied by loving attention takes a lower place in the institutional pecking order than a successful rare transplant or an innovative intervention through gene-therapy. An already distorted culture (from both palliative and preventative medicine) will be further pulled out of shape, away from investing in palliative care rather than spectacular cure.
Next, in my experience, we should affirm that there is such a thing as a good death even with a terminal illness lived out over time: the last months of life have had a savour of specialness about everything undertaken, the pain has been well-managed, people have had time to say goodbye, the person has reached a state of peace, with God or the universe. Sometimes that has been hard-won, and there have been periods of anger, grief, guilt and pain before this stage is reached, stages at which they might well have been likely to ask for assisted suicide if that choice had been available.
Such deaths, sometimes after having passed that stage of seeming unbearability, help the bereaved live through their grief much better than those who have not worked through the process. Short-circuiting the process with a lethal injection at one of the earlier times of pain or anger would have deprived the person of this astonishing late flourishing of the spirit, and burdened the family with a grief-intensifying guilt to overshadow every memory of the good with bitterness. The aim of everyone who “assists” in the process should be this kind of dying, where a real human dignity is achieved in the face of death, rather than one in which the possibility of mastering death is snatched away.
Related to this is, of course, the point that many have made. Many older, frailer and sick people say to their families and loved ones something like: “I’m such a burden to you.” Such a sentence can mean quite a wide variety of things, from articulating a sense of uselessness, to seeking reassurance that they still matter, are still loved. The conventional response, “Of course you’re not” will not always be true, or will mask a more complicated response, such as, “It may feel like that right now, but it doesn’t matter: we love you and will do everything we can for you.” But once introduce the possibility that “doing everything we can for you” includes helping you kill yourself, and the dynamic of “being a burden” becomes a conversation about the precise point where feelings of uselessness are given their ultimate affirmation, and the value of the vulnerable is measured in terms of the effect on the carers. And this is without even considering the benefit of the legislation for the grasping relative, who is weighing mum’s remaining days against the diminishing inheritance expended on social care.
That brings me to my fifth point, where my vision of humanity is inevitably entangled with my faith, although I shall try to express my points without drawing on specifically Christian language. Dame Esther’s campaign for assisted dying treats death as a consumer experience: the ultimate in freedom of choice for the autonomous individual. The most important aspects of our lives, however, unless we are severely sociopathic, are our relationships, and especially those that involve love. If one person in a relationship is constantly imposing their choices on the other, demanding that their choice is the only one that counts, we call that abusive. This is the most significant aspect of living as part of an ultimately transient and contingent world: we discover our humanity in interdependent living.
We all begin our lives entirely dependent on the love and care of others. Many of us end our lives in a similar way. Unless we recognise an absolute value in each individual life that makes moral demands on us to love, care and cherish that life so that it flourishes, we deny that it is simply being human that makes us equal at a fundamental level. (For me that absolute and radical equality of value irrespective of capability is rooted in an understanding of God as the creator of humankind, endowing men and women with an inalienable dignity. I know others ascribe a like equality of value, but can’t see the basis on which they do it is anything other than arbitrary.) The root value of a person is not dependent on their abilities, but their existence. Once start to unpick that seamless garment, and you have diminished everyone’s humanity: “send not to know for whom the bell tolls, it tolls for thee.”
We grow into our humanity by testing ourselves against limits, and discovering which we live within, which we can overcome, which we can push against, which we have to learn to accept. Many of us have marvelled at the way the Paralympics have displayed some of that. The athletes both accept their disabilities, and triumph over them, and show us all something glorious about our humanity, even if they do so in exceptional ways. Death is simply the ultimate boundary of our humanity, often encountered with some attendant degree of suffering. To cause it deliberately, is to surrender our humanity to its power. To accept it when and as it comes is to affirm our humanity in its face, and master it: a lesson I hope many younger people have absorbed from the contrast between Harry Potter and Tom Riddle (Voldemort).
Finally, then, I come to the sort of argument I normally try to avoid: the slippery slope. The Leadbetters and Falconers of this world assure us that the bill is very narrowly drawn and there will be safeguards abounding in the legislation: Esther’s Law is not intended to be the Harold Shipman Memorial Act. The problem is that in this area of law there is copious evidence that a slippery slope does exist, and those who start down this apparently short cul-de-sac of assisted suicide of the terminally ill adult, suddenly find themselves on the Cresta Run, hurtling past one supposed barrier after another.
A young adult in the Netherlands is able to apply for assisted suicide to deal with her depression. A middle-aged man in Canada applies for assisted suicide (without the knowledge of his family, it is claimed) on the grounds of hearing loss. It would be easy to multiply examples. From having been a response to exceptional circumstances, assisted suicide now accounts for 4.1% of all Canadian deaths. They started with something narrowly circumscribed and good intentions, and they have proved this path is very slippery indeed.
I hear their assurances that their legislation will be different, and I am profoundly sceptical. Not only is the evidence of other countries (the only actual evidence we have) against them, but they seem to place a touchingly naïve faith in the goodness of our institutions. Yet the idea that institutions are trustworthy because they have good intentions has been disproven by copious evidence: the Post Office scandal, sexual abuse in the church, the infected blood scandal – all these offer a counter story. Any institution can turn from serving the people it is intended to help, and concerned only with promoting and protecting itself, it will then defend its actions at almost any cost, provided it is the individual, rather than the institution who pays that cost. I am sure they mean what they say about protections, but they offer precious little evidence that they can deliver on their intentions.
These then, are my six reasons for asking our legislators to oppose this bill. I think they make a reasoned and reasonable case, and a stronger one than the arguments for consumer choice and faux-compassion which is all the proponents really have to champion. “You wouldn’t do it to a dog!” is not much of an argument; we selectively breed, and buy and sell dogs as property. We have historically well-documented moral objections to doing the same to humans.