209. The inevitability of legalised euthanasia
The certainty that our nursing homes are going to be chock-a-block with
old and infirm people in the coming years, looked after by badly-paid,
under-trained nursing assistants who will, in some instances, inflict
even more cruelty than occurs now, means that euthanasia will come in
with a swing before too long. Many religious people and some politicians,
including my own MP, have been resisting it. But the problem is going to
be so huge that when a minority of middle-class people who have signed
living wills, as I have, say that they'd actually welcome dying in a
dignified way before they inflict too much work on others or before they
become too gaga will pass through the legislatures of developed countries
with ease because it will at least relieve politicians of part of a
serious and growing problem.
Mary Warnock, who has been a brilliant observer of the human scene in
this country for some decades and is highly respected on all sides, was
once one of those who resisted the legalisation of euthanasia. I must
confess that I was irritated that she, of all people, should have done so
-- even more than I am presently irritated by my own MP who has just
written me an extraordinarily long letter explaining why he is against
it. However, Mary Warnock's resistance might have been for the best after
all, because she has now changed her mind and the testimony of such a
convert after her own real-life experience will be a powerful influence
when legislation is next planned. And this, it is to be hoped, is not
going to be too far ahead. I'd certainly like it to be in place before I
become a burden.
Her own article below is a well-argued piece of writing. I only disagree
with her on the matter of mercy killing. I think this is desirable in
principle -- as I carried out for my previous dog and will do so for my
present one when in extremis (unless she survives me, which is quite
possible). Mercy killing is also inevitable in my opinion.
Keith Hudson
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I MADE A BAD LAW -- WE SHOULD HELP THE ILL TO DIE
Lady Warnock, who once sat on a House of Lords committee that rejected
legalising euthanasia, has since watched her husband die and now says the
law should be changed
Mary Warnock
House of Lords select committee is about to be set up to consider the
issue of assisted suicide. Ten years ago I sat on a committee that was
concerned with the more general concept of euthanasia. At that time we
concluded that the law should not be changed and that assisted death
should remain a criminal offence unless a decision should be made in
court making it permissible for the patient to die in very particular
circumstances, such as when someone is in a persistent vegetative state
and needs a life-support machine to be turned off.
A great deal was made at that time of the distinction between killing and
allowing to die, neither doctors nor nurses being prepared to contemplate
killing when the whole ethos of their professions demanded that they
attempt to keep people alive.
This seemed to me a wholly bogus distinction. The committee also
considered the case of terminally ill patients. It was alleged that a
doctor could never be sure that a patient was in fact terminally ill nor
that an extra dose of morphine, for example, would hasten death. This
seemed an odd argument for doctors to use.
I was a member of that committee and I went along with its conclusions,
conscious nevertheless that the arguments leading to the conclusions were
suspect and therefore that the conclusions were not to be regarded as
written in stone.
I believed that at some time or other the medical and nursing professions
would have to face the fact that being alive was, in certain
circumstances, contrary both to a person's wishes and his interests, and
that palliative care, even if available, would not render his suffering
endurable.
The establishment of the new euthanasia committee is the outcome of a
private member's bill, introduced into the House of Lords by Lord Joffe,
a highly intelligent, sensitive and humane man.
It is a bill of extremely limited scope. It proposes that those who are
terminally ill and within sight of death and who are suffering severely,
but who are of sound mind and who have expressed a wish to die before
their condition becomes yet more unbearable, may be assisted to die,
without the risk that whoever assisted them should be charged with
murder.
There has been one recent case, that of Diane Pretty, that caused
widespread pity and partly motivated these proposals.
She was an intelligent person who knew exactly how her paralysis from
motor neurone disease would progress until in the end she would die of
suffocation. She was physically incapable of committing suicide herself,
but she knew that if her doctor or her husband helped her they would be
liable to a charge of murder. Her appeal for assisted death was turned
down by courts in Britain and by the European Court of Human Rights and
in the end she died of suffocation, just as she had feared.
Like many others I was moved by Diane Pretty's case. In a less traumatic
way my husband suffered similarly. He had a progressive and incurable
lung disease called fibrosing alveolitis. Like Diane Pretty, he had a
horror of suffocation and knew this would be the manner of his death.
After the consultant at the Brompton hospital could do no more for him he
was in the hands of our GP, a trusted friend.
When my husband confessed to him his terror of suffocating, the doctor
said: "We will not let it happen, I promise," and after that, I
suppose, increased the dose of morphine.
Death came and not too horribly. But this doctor was putting himself at
risk. I am certain that what he did was right. He was acting from
compassion, surely the deep motive of the medical profession at its best.
I support Lord Joffe's bill because I cannot believe that what happened
to Diane Pretty was justifiable.
We are told that hard cases make bad law. But if cases are very hard then
I believe it is time to look at the law again. The new bill seeks to
legitimise assisted suicide only for the perhaps smallish category of
people who are known to be near death, who are suffering and who are
mentally competent and of course who have expressed a wish to
die.
It is essential to recognise these limits. It would provide, too, that
more than one doctor would have to agree that the conditions were all
satisfied.
There are those who would oppose the bill on absolute grounds, generally
derived from the religious belief that deliberately to end a life
at whatever stage is contrary to God's commands. For such believers,
arguments turning on the patient's suffering or his wishes will carry no
weight. They will never regard assisted suicide as acceptable, whatever
the law permits.
I think I understand this dogmatic belief though I do not share it. But
the law cannot be determined by a particular religious belief. There must
exist moral considerations behind the law separate from religion (even if
influenced by it) deriving their authority from an idea of the common
good.
I am therefore more interested in the arguments against the bill put
forward by those of no dogmatic faith. These often take the form of the
so-called slippery slope argument.
If the admittedly small group targeted in Joffe's bill are allowed to be
helped to their death, who will be next? Won't there be a gradual erosion
of our abhorrence of murder, until in the end we think it's all right to
kill off anyone who expresses a wish to die or anyone who is incurably
ill or in pain or who is terminally ill but mentally incompetent to
express a wish? Is that the sort of society we wish to live in?
Many of those who deploy such arguments add that palliative medicine can
ease the suffering of the dying and that if we concentrate on improving
such care and ensuring that it is accessible, then the bill will be
unnecessary. On this point there is evidence that some suffering cannot
be alleviated by medicine, however skilled the treatment.
As for the slippery slope, the whole point of legislation is to place an
immovable barrier to prevent our slipping further down it. On one side of
the barrier is assisted suicide for those who genuinely want it and who
anyway are on the verge of death, imposed by one person on another who
has expressed a wish to die.
If Joffe's bill proposed a new category of such death called mercy
killing then I could see the force of the slippery slope argument and
would oppose the bill. But it does not do this. Assisted suicide is a
different thing. We should trust the medical profession to observe the
criteria laid down in the bill. If they did not they could be
prosecuted.
There are other objections based on the difficulty of ensuring that the
criteria are indeed satisfied. What is the definition of terminal
illness, for example? How do we ascertain that someone is really
competent to make a decision to die?
In some cases it might be difficult to determine such matters. But this
difficulty should not be used to prevent relief for the clear-cut cases,
for Diane Pretty and others like her.
I am not arguing that anyone has a right to assisted suicide: I am
arguing rather that sometimes compassion demands that they be allowed it.
Doctors, unless their religion forbids it, should come to accept this as
part of their duty.
The Sunday Times -- 14 December 2003
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