What's wrong with the Falconer Bill?

On Sunday I was asked for my views on ex-archbishops endangering the lives of disabled and ill people. Well, it was the World Cup and I needed a day off; so I promised something on Monday. (Sorry - missed my deadline!) And this, I hope, will be it. Actually rather than knocking two well-meaning old codgers, I think I’ll write about about Lord Falconer’s deceptively innocuous-sounding bill on “assisted dying” whose second reading takes place in the House of Lords on Friday.

It’s summarised in Parliamentary business papers as “A Bill To enable competent adults who are terminally ill to be provided at their request with specified assistance to end their own life; and for connected purposes.” 

A commentator summarised its contents like this: “His bill would make it legal for doctors to help mentally competent adults with less than six months to live to kill themselves. Two doctors would need to agree that a patient met the criteria and the option would not be open to minors, people without mental capacity or those who are not terminally ill.

“The final step would involve a doctor (or nurse) hand-delivering lethal drugs to the patient at a time and place of their choosing and staying with them while they took the drugs and until they were dead.”

I’m indebted also to Peter Saunders for the following three headings. He is not to blame for the comments thereafter, which are mine.

It’s unnecessary

The law

The present Suicide Act makes it illegal to aid, abet, counsel or procure the suicide of another, or an attempt by another to commit suicide, with a maximum penalty of no more than 14 years in gaol. The law is hedged round with safeguards such as prosecutions being carried out only by the Director of Public Prosecutions (within compassionate guidelines) and all the processes of jury trial and appeals. The law as it stands enshrines absolutely the protection of life, but allows the leeway of public interest and compassion, in other words, Portia’s principle of justice and mercy. The fact that in the 53 years since the Suicide Act was passed there has been no contentious court case is evidence that it’s not a bad piece of legislation.

End of life care

An aunt-sally propagated by the assisted-suicide lobby is that at present many doctors in fact covertly kill their terminally ill patients. I think they refer to the double effect of ceasing treatment or administering drugs with the intention of mitigating symptoms and alleviating pain. There is a category difference between that intervention and what the bill proposes (from understandable motives). A doctor friend of mine commented yesterday:

“Desmond Tutu, as quoted..., is completely misunderstanding the issue of assisted dying and my worry is that the bill will be passed based on these misunderstandings.

“Scenario 1) A person is terminally ill. It is their time to die and further treatment is futile and unnecessarily prolongs suffering (e.g. Repeated courses of chemotherapy, or the intensive care treatment of Nelson Mandela described in this article). We don't need a change in law for this. We need sensible, compassionate care.

“Scenario 2) A person is terminally ill and has a 'settled wish' to die. Two doctors therefore agree to end that persons life by way of administering drugs. This is what the bill proposes.” 

The accusation that palliative care specialists intend to kill their patients rather than ease their last hours has to my mind a hint of malice about it. 

Hippocratic oath v necessity

Nursing = caring

As I understand it, the aim of the bill is for health professionals (such as doctors and carers) to be allowed to take someone's life or to assist in their suicide: so for example allowing my doctor to administer a lethal injection at my request. That opens the door to doctors ceasing to be healers and carers, and becoming dealers in death. That is one of the most valuable safeguards in the DPP's Guidelines on Prosecution in respect of Assisted Dying, preventing health professionals helping someone taking their own life. I guess that's why the BMA is against a change in the law. As events proved, in Tony Nicklinson’s case for example, there was no necessity for a doctor to end his life. He could refuse treatment and ask for only symptom control and pain relief.

It’s unsafe

The bill itself

There are many aspects of the bill itself which are glaringly unsafe. For example the six month cut-off point: as any honest doctor will admit, such a precise prognosis is notoriously hard to make - witness the case of the “Lockerbie bomber” Al Megrahi being released having been given three months to live by the country’s leading cancer specialist, Professor Karol Sikora, and enjoying another three years of life back home. I know a number of people, such as the late Alison Davis, who are profoundly grateful that an early exit was not open to them, since they went on to live many more years of fulfilled life. For example the assessment of mental competence and settled desire simply by two doctors. There is no specifying of who the doctors should be, what their qualifications should be (for example psychiatrists). Presumably they would be doctors in favour of assisting death, and the prospect presents itself of the situation emerging in Holland of mobile euthanasia clinics with a couple of doctors ready to sign the necessary papers on board. For example, the requirement of informed consent. Does that mean being given a leaflet about local hospices, or palliative care packages? In my experience there’s no real alternative to visiting and staying in a place where you can experience care from the real experts.

Its implications

The proponents of assisted suicide often pillory the idea of a “slippery slope”. But experience shows it is unwise to do so. The Benelux countries and Switzerland (the only European nations with voluntary euthanasia) have witnessed a steady relaxation of the safeguards originally in place there. In the two US states where assisted suicide exists the number has steadily increased. Times of austerity (like the Depression of the 1930s) have seen a rise in euthanasia - see “Action T4” in Wikipedia (http://en.wikipedia.org/wiki/Action_T4). Disturbingly one can hear hints of this in Desmond Tutu’s “But why is a life that is ending being prolonged? Why is money being spent in this way? It could be better spent on a mother giving birth to a baby, or an organ transplant needed by a young person. Money should be spent on those that are at the beginning or in full flow of their life.”

Peter Saunders’ comment is pertinent. “The right to die can so easily become the duty to die and the generation that has killed its children through abortion could very easily become that which is killed by its children through euthanasia and assisted suicide. Add in economic crisis, debt, cuts in health and welfare and the argument gains force by playing on popular prejudice against those perceived to be a drain on families and the state.”

Lord Carey cited cases of permanently disabled people to explain his change of mind. Yet they of course are not covered by this bill. One see how inevitably the argument will be, “Why not these people?” “And why not teenagers younger than 18?” “Why not those with a longer-term terminal illness? Those with a chronic painful condition?” And so euthanasia is upon us. Disabled campaigners such as Tanni Grey-Thompson and Baroness Jane Campbell are clear in warning of this danger.

A further real danger is that of the disabled and chronically experiencing explicit or implicit or self-generated pressure to ask for euthanasia. Personally I think the last is the most likely, as the disabled, chronically ill and elderly seek to alleviate the expense and anxiety of those who care for them, whether family or state. And it would also be naïve to underestimate the amount of elder abuse in this country.

It’s unethical

Compassion

Stephen Hawking who like me has a rare form of MND not long ago propounded what I call the “pet theory”. It goes something like this: we have our pets put down when they’re suffering. Surely people deserve better than that? However it’s also true that we have them put down because they become incontinent, because their vet bills rocket and because, to be blunt, they’re no longer afford us pleasure. In other words, it’s more about us than the pet.

Compassion, it seems, is often confused with pity. The true and original meaning of compassion is to suffer with, to stay with someone in their pain and darkness. It doesn’t mean to put them out of their misery; it doesn’t mean concurring that their life has lost its value; it doesn’t mean euthanising them. That’s a cheap imitation of compassion. True compassion is costly emotionally and often financially.

Investment in universal best palliative care is the true expression of compassion, not the offer of a cocktail of barbiturates, which is a perversion of therapy. 

Defence of the vulnerable

"You are not a burden."

Another mark of a civilised society is its attitude to the weak and vulnerable. Eugenics gained traction in the early 20th century, wanting to produce healthy strong and racially pure men and women. The weak went to the wall. I'm not concerned for myself - although I don't look forward to the process of dying - but I am concerned for the vulnerable, the disabled who don't have a voice, for the elderly who are at risk through dementia or frailty - for those who are increasingly regarded as a burden on their families, on society, on our nation's resources. It's those people our laws should protect. Ironically Lord Falconer’s bill seems to me to be about people who are far from vulnerable. It’s about determined people concerned to maintain control over their lives come what may.

Rights

Rights only come with responsibilities. My right to life, or to death, can't be isolated. If my demanding the right to die endangers the lives of others, then my responsibility to them trumps my choice. You can’t have a community, you can’t have a society where each person insists on his or her rights. Rights, in my view, are not possessions. They are what we afford each other. The danger of this legislation is that it begins to remove the right to life of the many to accommodate the right to choose of the few.

Value of life

Neither is life a possession. Life is bigger than us. We are a part of life. We are granted a share in the adventure which is life. In financially straitened times, such as we are told we are now in, there is a real test on the horizon: what do we value more - money, or life? That will be the measure of our society. I know what I would prioritise.

The value of life was long ago encapsulated in a simple principle, “You shall not murder”, a word which includes intentional killing, and also from carelessness or negligence. In other words life, of whatever perceived “quality”, is precious and to be protected.

Lord Falconer’s bill, well intentioned though it may be, is in my view unsafe and opens the way to consequences which, though denied, are entirely logical extensions of the breach in this principle.