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Assisted Dying: Death of Hope

Mal Fletcher
Posted 14 June 2011
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Author Terry Pratchett has made no secret of his desire to request an assisted death at the time and in the manner of his choosing.

In a BBC documentary aired last night, Mr. Pratchett, who suffers from the onset of Alzheimer’s disease, said: ‘Is it possible for someone like me, or you, to arrange the death they want?’

‘When I can no longer write my books, I’m not sure I will want to go on living,’ he added.

The argument over assisted dying and its bedfellow euthanasia is not a new one.

Indeed, the issue of whether one has the ‘right’ to end one’s life has long been a subject that has vexed philosophers, ethicists and theologians alike. The idea of empowering another party, in law, to ‘assist’ in the process, to actually inject the chemical that ends a life, is an extension of that debate.

Yet in our time, the debate has taken on an almost trendy quality. Recently, a number of prominent British celebrities, among them actor Patrick Stewart, publicly announced that they will be seeking an assisted death when, in their own estimation, they will no longer be able to function independently or to enjoy a certain quality of life.

The enshrining into law of the right to assisted death may sound very tolerant, but it is a ticking time bomb. It is a disaster waiting to happen, especially in the longer term, and for more than moral reasons alone.

Its potential impact on our social structure should not be underestimated.

First of all, there is the issue of how assisted death, were it to be legalised and instituionalised, would be administered.

Dignitas is a privately owned Swiss organisation that provides assisted dying as a service. Much has been made of the stories of the few British people who’ve paid the fees and travelled to the clinic in Switzerland to die.

Very little is written about the many thousands who stay at home and receive palliative care, passing away relatively peacefully in the hands of caring family members and professionals. (When did you last see a TV documentary on aged or sick people who die well, in a hospital or care facility or at home?)

Terry Pratchett honestly admits that Dignitas sounds like something of a ‘one stop shop’, offering a highly mechanised and impersonal approach to dying.

Yet this is the inevitable eventual result of empowering professional practitioners to end a life upon request when care, if not cure, is available.

At present, we worry – rightly – about the impact of privatising areas of the National Health Service. Our concern is that profit motives may quickly become more important than the burden of care.

Indeed with some aged care facilities, this has already proven to be the case. Procedures for patient care have been trimmed to balance the books of private enterprise ‘care providers’.

The ‘business’ side of the equation has taken over the duty of care.

Many will argue that assisted death should only be legalised if the procedures are to be carried out in government-run, publicly owned facilities, by highly trained and accredited professionals. Not so long ago, we were saying that about aged care homes.

The private, profit-seeking sector will always look for ways to engage with the growing edge of new social phenomena.

What makes us think that we wouldn’t soon see the emergence of a profit-making industry devoted to ending life, where the business of dying is more important than the duty of care?

It is inevitable that more organisations like Dignitas will emerge as privately owned death clinics. There is, to be sure, a healthy income to be made from trading in the promise of a comfortable death.

If assisted death were legalised in Britain, it may only be a matter of time before we saw elegant death ‘boutiques’ – though they obviously wouldn’t be branded that way - offering a cosy demise to members of the well-heeled classes.

This would soon be followed by less scrupulous companies offering a scaled back version to the poorer classes.

When interviewed, advocates of assisted dying almost invariably express motivations based on the fear of a worsening physical or mental condition.

Let’s be in no doubt about this: it is usually the fear of suffering, not actual suffering itself, that is at the core of the debate about assisted dying.

Much wider and more representative studies than the BBC programme have revealed that it is not the onset of pain that causes people to request assisted death. It is the anticipation of suffering or debilitation that drives most of those who consider this drastic course of action.

Emotional trauma rather than physical pain have given rise to the decision to die.

The Netherlands was among the first European nations to introduce liberal euthanasia laws. According to a study undertaken by a major Dutch University a few years ago, only five percent of patients who decided to go through with doctor-assisted suicide listed pain as the biggest factor in their decision.

The most prominent factor was the fear of suffering – and twenty-four percent of the people surveyed said that fear of humiliation was their strongest motivation. (At the time of the study, more than a third of all euthanasia cases in that nation were AIDS related.)

According to an article published in the Journal of Medical Ethics in 2008, 21% of people receiving assisted dying in Dignitas do not have a terminal or progressive illness, but rather ‘weariness of life’.

For these people, Dignitas merely offers them a sure-fire way of committing suicide: it is an act of convenience and not in any sense one of necessity. Surely, we would see an increase in suicides were assisted dying to be legalized in Britain – and many studies bear out the devastating impact a suicide has on those who are left behind, including family and friends.

A very generic law would be absolutely useless in the case of assisted dying. Given the possibilities for abuse and even criminal acts, regulations would need to be iron clad, leaving little room for interpretation.

Yet the law would be dealing in the highly subjective areas of psychological and emotional trauma, so it could not possibly hope to be concise and definitive.

In the end, we all fear the pain and the loss of control that either severe sickness or old age may bring, but how would assisted dying laws possibly decide when it is appropriate for an individual to act on those fears? Would it be six months before debilitation occurs? A year? Perhaps longer? When exactly would it be legal for someone to set up a contract to die?

And how can the law possibly hope to define debilitation? What is totally debilitating for one person may be quite manageable for another, especially if they are given the kind of patient care for which many hospitals and hospices have become well known.

What we’re really talking about with assisted dying is not a change in law as much as a realignment of our basic cultural values. This is the side of the story Mr. Pratchett’s programme fails to acknowledge.

The idea of the sanctity of human life is a cultural more that has given us great strength as a civilisation. It is one of the core values which has allowed us, thus far at least, to avoid the kind of collapse seen in earlier civilisations. Almost invariably, a tolerance for killing gradually crept into great civilisations over time, mortally weakening social structures.

Supporters of assisted dying will argue that safeguards can be installed to protect the more vulnerable members of society. But this is naive -- it places far too much faith in systems that are set up and run by fallible human beings.

For all the talk about safeguards, present euthanasia laws in Europe  are wide open to abuse. No law is water tight; there are always loopholes and people are able to twist laws, especially when they're loaded, as these laws can only be, with subjective language.

Far from protecting the weak, assisted dying laws will make things harder for many of the more vulnerable people in society. Is there a bottom age limit for making such a choice? What should that limit be?

Dutch laws allow 12 to 15 -year-olds to request euthanasia, as long as that their parents approve. We all know how impressionable and vulnerable 12-year-olds can be, which is why we have such tight laws to protect them from pornographers, for example.

So, how can 12 -year-olds be expected to make a totally ‘voluntarily and well-considered’ decision to end their lives, as Dutch law requires, especially when they're seriously ill? And what kind of hope are we sending our children, when we tell them their best hope in all the world may be death?

Some people will use a ‘quality of life’ argument to defend assisted dying. Indeed, this seems to be Mr. Pratchett’s position. If he can no longer do what he loves, he says he would rather die.

Understandably, people of great distinction in any field will not want to lose the facility that has made their name, or through which they can enrich the lives of other people. Yet there may well be other ways in which their example can serve not only theirs, but future generations.

Indeed, the generational impact of laws on assisted dying is one of the most powerful arguments against them. What one generation allows but barely tolerates, a new generation will often treat as the norm, taking things even further.

So, if we allow assisted dying today, will we allow involuntary euthanasia in twenty years from now? Yes, it is unthinkable now, but quality of life arguments similar to those used by assisted dying advocates could be – and have been – made to support it.

Assisted dying, like euthanasia, may seem a merciful option for those who face an uncertain future due to the onset of age-related illness, or for those to whom medical science offers only limited hope for recovery.

Yet heroic stories emerge all the time, of people young and old who beat the odds – not necessarily by ridding themselves of disease, but by refusing to cower in its shadow. These people refuse to give up on long-held dreams, often doing the most daring things as they approach the end of life.

This unwillingness to go quietly, this commitment to leaving a legacy of hope in the face of adversity, is something we celebrate. It is a form of heroism that inspires us all to do more, to live more fully whatever our situation.

In the world of modern medicine, relatively few people die in total agony. Even those who face debilitating conditions are for the most part able to die with dignity, without helping the process along in an artificial way.

We would all wish for a quiet, peaceful and painless death. But trying to ensure that through the introduction of assisted dying is a recipe for social confusion and the breakdown of hope.

What’s your view?

Should assisted dying be legalised in your country?



Keywords: assisted dying | euthanasia | terry pratchett | bbc documentary

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