For this next exercise I would like you to imagine yourself being in the end stages of a terminal illness. It could be severe multiple sclerosis, motor neurone disease or diffuse and aggressive cancer. Every day is wracked with a painful struggle with the only thing to look ahead to being your inevitable death. I want you to imagine knowing that when it does come, it will be slow and protracted. Perhaps your respiratory muscles will fail and your lungs shall slowly fill with fluid. Perhaps it will come peacefully in your sleep. You can hope.
This may not describe the experience of every person going through a terminal illness, but it will describe some and it is for these people that I write this article. Contrary to some traditional views on morality and ethics I do think that there are some states of living which are worse than death. Death is not painful, it is the big zero, an absence. We are not conscious for the period before we were alive and have no reason to suppose we will be afterwards. The process of dying can be incredibly painful. It is monstrous that people can be forced to live in this pain; it is tantamount to torture. If this comes to my door, I want to be free to make the decision to have my suffering ended by a qualified physician and not have some politicians with no knowledge of me or my pain make the decision for me. A doctor is not allowed to impose their personal beliefs on a patient, so why can Westminster?
Euthanasia, defined as ‘a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering’¹. Currently it is illegal in the UK, voluntary or involuntary. I believe that this is a gross mis-imposition by the State. Obviously, if someone doesn’t want to die, then leave them well enough alone, why are we even discussing this? However, if they are of sound mind but not body, why shouldn’t they be able to ask for that kind of help? This is termed physician-assisted suicide. There is a delicious Catch-22 here. You need to in a rational frame of mind to make this most important of decisions. However, should I want my life to be ended, I must be depressed. Suicidally depressed people are not in a rational frame of mind, thus I cannot make this decision. It is an infrequent situation, but thanks to modern medical advances and the increasing ability of doctors to keep people alive (read: alive, not well) it is cropping up more and more.
As of writing there are nine countries (and a handful of US states) where euthanasia is legal. Basing our law on the Canadian bill which was recently passed, I would like us to become the tenth. It’s not through lack of trying; in the 21st century there have been five attempts to pass assisted suicide bills through Parliament, who rejected them. The last Assisted Dying Bill ran out of time in the Committee stage because we were too focussed on the upcoming election. Currently only one doctor has ever been convicted in the UK, Nigel Cox. He was given a 12-month suspected sentence. The General Medical Council took no further action and Cox returned to work the following year.
The wording of the law is so poorly written that Debbie Purdy made the tabloids after her legal battle to protect her husband if he helped her travel abroad to seek assisted suicide to escape her primary progressive multiple sclerosis. The court could not determine that her husband wouldn’t be prosecuted. She died in a care home in 2014. As of writing, 92 Britons have gone to Dignitas in Switzerland (publicised by the late Sir Terry Pratchett) for an assisted suicide. But what about those for whom this is not an option, for expense or ease access if nothing else?
We are able to make advance directives refusing treatment, such as the DNACPRs. The infamous Liverpool Care Pathway and other end of life care allow for withholding a treatment, such as food or fluids. So I can slowly starve to death, great. The difference between withholding treatment and administering treatment leading to death is like the classic ethical conundrum with changing the train tracks to save five people from the oncoming train at the expense of the life of one. One option allows you to push one person in the path of the train. The other allows you to push a button and switch the tracks, thus hitting the one person instead of the many. Either way, the outcome is the same.
The above in ethics is termed ‘The Trolley Problem’ and it explores the Principle of Double-Effect. In medicine, this refers to the circumstance where an act resulting from a legitimate motive also has a consequence which is normally avoided. With assisting dying, the desire to alleviate terrific pain via a morphine injection may lead to a shortened life. For some, this is ethically indefensible and the debate stops there.
Opposition to well-regulated system of assisted suicide for grave circumstances is borne of our infantile moralities. God says that suicide is a grave sin you say? That’s all well and good, but what if I don’t believe in the Catholic God? Hippocratic Oath? Sorry, no removing bladder stones for you then. If its respect for human life you want I suggest that you consider whether the positions of some people can truly be termed an expression of human life and not merely existing. I’m not even going to dignify the ‘slippery slope’ fallacy with a response.
The concept of ‘The Sanctity of Life’ is the ultimate expression of paternalism. I do not want to overreach and say the life of every tetraplegic person is of miserable torment. However, the reverse is currently true. It is said that just because your life options are limited, doesn’t mean that it is over and one can still go on to fulfilling things. That may be the case, but it is not the decision of the Church, the State or anybody else. I want it to be my decision. I write this from a personal perspective because circumstances change. Currently I am fortunate in my good health, however, tomorrow I could be hit by a truck or start to notice a unilateral foot drop (MND for those of you who didn’t see The Theory of Everything). Circumstances change and if they do I want the option to be there to change them permanently. The Right to Die provides a certain security. To be able to say, ‘no, I have had enough’ and quietly retire, just a large dose of morphine. It would be cheap, it would be painless. Of the ways to go, it would seem the most favourable.
¹ by the House of Lords Select Committee on Medical Ethics