A doctor friend told me the other day that when he was taking a patient through her care programme plan – it’s now required for elderly and terminally ill patients – he asked her, as delicately as possible, how she wanted to die. She looked appalled. ‘But I don’t want to die,’ she said.
And that is probably the view of quite a few Brits, notwithstanding our greater openness about death. Lord Falconer’s bill on Assisted Dying, which passed its second reading in the Lords on Friday and now passes to committee stage, has at least got everyone talking about dying, though I still can’t quite get my head round his pronouncement that the bill, if passed, would mean ‘less suffering, not more deaths’. Look, the number of deaths will be precisely the same with or without his bill; the question is, will doctors be expediting the process by handing lethal medication to their patients to enable them to commit suicide.
The question hasn’t quite taken a party political dimension yet, but can we just note that Ed Miliband has intimated that Labour, if elected, would make time for the bill to be considered in the Commons. At present, without Government backing, it’ll die all by itself. We should perhaps be taking that on board: you’re more likely to get assisted suicide with a Labour government.
In the wake of the marathon debate – 10 hours – in the Lords, with peers queuing to speak, the bill as proposed looks like even more of a mess than it did on first reading. It’s opening a door merely in order for it to be pushed open further at the first opportunity. As Rabbi Julia Neuberger points out, the criterion that the patients in question should have a life expectancy in the opinion of two doctors, of no more than half a year, is nonsense.
For one thing, there is no exact prognosis when it comes to predicting how long a patient has to live; lots of people stubbornly hang on for years after their doctors predicted a couple of months. The grimmest cases of human suffering are also not going to conclude with death in half a year; the unfortunates with locked-in syndrome, for instance, could last far longer. And these individuals will be the first to challenge the restriction that patients must be able to administer the lethal injection themselves. Why should the able bodied be privileged over those who happen to be physically unable to act for themselves? You can see the restrictions being flouted on compassionate grounds even while they’re touted as safeguards.
But once the principle is accepted that doctors may kill their patients – and it is the nicest moral distinction that separates the provision of lethal medication from its administration – then our descent down the slippery slope begins. All the subsequent modifications and liberalisations will be minor adjustments once the great principle is accepted. Then the stories will start to emerge of the elderly individuals who did not actually meet the strict criteria for assisted suicide, but were given encouragement by their relatives to take the step. Lord Tebbit stated the obvious during the debate when he said that it gives the avaricious a stake in the suicide of their relatives.
But the useful thing about the debate is that it has raised some crucial issues around death and dying that have been left unaddressed. The proponents of assisted suicide who point out that at present, it is perfectly legal to allow someone to die by withdrawing food and, more importantly, water, are dead right. But dying of thirst is one of the worst deaths imaginable. In the course of the debate I learned that in some hospitals, there are restrictions on the amount of morphine that may be administered to a patient in acute pain, lest the dose kill the patient. It should be pretty elementary moral philosophy to distinguish between the intention to kill and the intention to relieve suffering, even if the outcome is the same in both cases. Then there is the question of the funding and provision of palliative care and of hospices – both indispensable for dignity in dying.