The day after the day before

I can’t say I’m surprised, but I am disappointed. Dignity in Dying (formerly the Voluntary Euthanasia Society) has invested many hundreds of thousands, if not millions, of pounds behind well publicised personal stories and legal cases which have been very effective in persuading general opinion that dying is frequently nasty and that we should have the right to choose when and how to die. That organisation always resists using the term ‘suicide’, which is what they advocate, realising that it opens up the accusation of devaluing life. So I’m not surprised that MPs have after an impressive debate by a narrow majority eventually given way to the pressure. (My highlight speeches: Tom Tugenhadt (MP for Tonbridge, Con) and Preet Kaur Gill (MP for Edgbaston, Lab) speaking against, and lowlight: Kim Malthouse (MP for NWHampshire, Con) speaking for.) 

So… along with many thousands of disabled and chronically ill people our worst fears have been realised. The House of Commons have narrowly voted through Kim Leadbeater’s Private Member’s Assisted Dying Bill (Terminally Ill Adults (End of Life) Bill). The majority of 23 means that had 12 voted the other way, it would have failed. I am disappointed. However in voting for assisted dying/suicide MPs have inadvertently added to our society’s fear of death, our reluctance to accept dying is as much a part of life as birth. In the words of Job, ‘The Lord gave and the Lord has taken away.’ 

Since having my particular rare and slow form of Motor Neurone Disease for 25 years, the idea of taking my own life has occurred to me and to some professionals. I have as a result thought long and hard about the subject. Personally, although utterly disabled and needing 24/7 hour care, I have no desire to shorten my life, but more generally I also believe that any legalising of causing or contributing to someone’s death is dangerous for society. The sanctity of life or right to life is a principle too important ever to be breached. Once one exception is allowed, you give permission to further breaches in the future. Contemporary examples abroad as well as European history teach us that despite all the initial limitations mission creep will happen. Other exceptions will be legalised on seemingly reasonable grounds, if for six months, why not for twelve, or 24? Why not for any length of “intolerable” suffering? Why not for those who are or consider themselves to be a “burden”? Why not for those who will be too disabled to contribute economically to society? There's not one jurisdiction abroad where the first narrow restrictions have not bit by bit been broadened.

One of the most important interventions before the vote was, in my view, that by the Royal College of Physicians and the Royal College of Psychiatrists a week ago expressing their reservations, including: “Vulnerable patients particularly those with remediable mental health or other unmet needs, are not adequately protected by the current bill.” It is very easy, and understandable, for people with long term disability or incurable illness (such as myself) to have severe depression and mood swings. I’m sorry that not enough MPs heeded the advice of the most involved professional bodies. 


However I have a number of friends who disagree with me, often after personal experience of watching a loved one die. I sympathise and I suppose that I must be glad for them that the MPs have represented their wishes. And I would never condemn them if they decided to choose the route of assisted dying for themselves. I hope they won’t have to.

Meanwhile I trust that, when the Bill comes to the upper house, their Lordships will fulfil their function of revising it wisely and effectively. They certainly have relevant expertise, for example, judges, ethicists, and most relevantly in the field of palliative care - which is in danger of being squeezed following this bill. As Gordon Brown pertinently asked, “When only a small fraction of the population are expected to choose assisted dying, would it not be better to focus all our energies on improving all-round hospice care to reach everyone in need of end-of-life support?” 

Don't screen us out

There are so many things on my mind at the moment, from academy schools and benefits to the simple joys of spring. There was a very good programme just over a week ago on the BBC called The Battle for Christianity, presented by Professor James Beckford, who pointed out the frequently proclaimed demise of faith in this country has been greatly exaggerated. A very informative programme.

However, that's not first on my mind. I recently saw a title I liked, "From Conception to Completion", which to my mind means that we should be concerned about life from its beginning to its end. This post is concerned about its beginnings. I wrote to my MP on 18th March:

Dear Ed

Monday is World Down's Syndrome Day, I gather, so I hope you won't mind my writing to you on a matter of personal interest to me.

My goddaughter's (now in her 40s) older sister was born with Down's Syndrome and is still living a fulfilled life.  Much, I'm sure, is due to the care and hard work that her parents devoted to her in her early years.  In my view and in theirs it would have been tragic if she had been screened out before birth.  Ultimately she has enriched their lives.  I think there is a real danger in pursuing the trend to eliminate prenatally any babies who do not conform to our standard view of what is "healthy".  I suspect it was this sort of policy that led to the dangerous rise of eugenics pre-war.

The UK National Screening Committee (UKNSC) has recommended that a new technique, 'cell free DNA' (cfDNA), is implemented into the country's Fetal Anomaly Screening Programme (FASP). This is an antenatal  programme by which pregnant women are given tests to detect whether their unborn babies are disabled through initial blood tests, and on the basis of the probability these give, the choice of more invasive prenatal diagnostic (IPD) tests.

IPDs carry a risk of miscarriage and a small minority of women do miscarry due to them. The cfDNA technique meanwhile, is a non-invasive prenatal test (NIPT) that works by genetically analysing fetal cells in the mother's blood for signs of fetal anomalies. The UKNSC believes that introducing cfDNA as a secondary test, would reduce the numbers of women that go onto IPDs, and thereby reduce the miscarriages that are caused by them.

A pilot study that the UKNSC themselves commissioned, however, concluded that if implemented, cfDNA would lead to 102 more Down's babies being detected every year.

The latest figures (http://www.binocar.org/content/annrep2013_FINAL.pdf) tell us that 90% of babies who are prenatally diagnosed with Down's syndrome are aborted. Much of this is due to the pressure that parents feel to abort their baby due to some bias in the system, and the profound lack of information or support offered to them. If then, as the UKNSC pilot study predicted, 102 more babies with Down's syndrome would be detected due to cfDNA implementation, 92 of these would be aborted. Based on the most recent figures for Down syndrome births (2013), this would mean a decline of 13% reported live births of babies with Down's syndrome.

This would have a profound long-term effect on the population of people with Down's syndrome in the community and enable a kind of informal eugenics in which people with certain kinds of disabilities are effectively 'screened out' of the UK population before they are even born. Implementing cfDNA at this stage would effectively mean introducing a worsened form of informal eugenics into our culture than already exists.

Would you please consider talking to Jeremy Hunt MP, asking him to halt cfDNA implementation and provide medical reforms that will bring support to people with Down syndrome  and their families and alleviate the discrimination that they commonly experiences.

If would like to read more on this, please visit the campaign site www.dontscreenusout.org.

Thank you.

Yours sincerely

Down's syndrome children face extinction

I confess that the meat of this letter was borrowed from the admirable Don't Screen us out charity, but it is something about which I feel strongly, as I believe many people with disabilities do. They see the tendency by "normal" people and politicians to view their lives as not worth living, and therefore better to eliminate before birth. Whereas I, having lived an active "normal" life before my MND, understand now in a way I hadn't fully seen before that living with disability or "abnormality" is by no means an inferior sort of existence. Indeed only yesterday I received an email from a fellow MND patient who said that she felt she was a "stronger and better person" now. Too easily do those who pass laws for us assume that they know the answer; too often, I fear, they are led by economic convenience rather than by human understanding.

We should not forget that the Nazi pogroms had their roots in apparently benign eugenics.

Anyway I had a reply from Mr Vaizey - which contained, to be honest, pretty much what I had expected, the standard government-speak statement.

Dear Michael,

Thank you for contacting me about non-invasive prenatal testing (NIPT).

I understand your concerns and I recognise that with the correct help and support, most people with Down’s syndrome are able to lead healthy, active and more independent lives.

The NHS Fetal Anomaly Screening Programme (FASP) in England offers women choice in pregnancy. Screening is described as an option, not an inevitable aspect of routine antenatal care. The screening programme is careful to explain that choosing not to have the test is a valid option for a woman. Women are invited to make an informed choice based on their own values and beliefs about whether to participate, and regarding options following receiving their results.

The UK National Screening Committee (UK NSC) advises Ministers and the NHS in all four countries about all aspects of screening policy. In January 2016, the UK NSC announced its recommendation that screening for Down’s syndrome using non-invasive prenatal testing (NIPT) be introduced as an additional test into the FASP, as part of an evaluation. This follows a full review of the published scientific and cost evidence relating to NIPT, following combined testing. A copy of the UK NSC’s review is available at http://legacy.screening.nhs.uk/fetalanomalies

Ministers welcome the UK NSC’s important recommendation on NIPT which has the potential to transform antenatal care. I know that the Government is currently considering whether this could be introduced as part of the NHS FASP.

Thank you again for taking the time to contact me.

Yours sincerely,

To give him his due, as well as being a minister of state, Ed Vaizey is a good constituency MP, and I believe he does give such ethical matters his serious attention. 

I just hope that we never reach a brave new world of standard model human beings.

Why "How to die?" - my question

I see I'm quoted in the Daily Mail today. Quite fairly I'm glad to say, although I don't think of myself as a "campaigner". Just someone with an insidious and very slow type of MND who is quite concerned about how little coverage good and natural dying receives in the media - of whom the BBC is just one example. And it matters because the media does a lot to shape public opinion, including in the area of suicide - which is of course the subject of tonight's BBC documentary, "How to die - Simon's choice". I shan't be watching tonight - but I might catch up tomorrow. Maybe the Mail's article tells me enough, including that Simon Binner's widow, Debbie, would have preferred him not to have gone to Switzerland. "I would have preferred him not to go,’ she admits. ‘There is a beauty in caring for someone who is dying. I loved Simon. I would have loved to nurse and cherish him to the end." What an amazing woman! 

In 2000 the World Health Organisation issued guidelines about the way the media should treat the matter of suicide. Near the beginning, there's a section headed: "IMPACT OF MEDIA REPORTING ON SUICIDE

"One of the earliest known associations between the media and suicide arose from Goethe’s novel Die Leiden des jungen Werther (The Sorrows of Young Werther), published in 1774. In that work the hero shoots himself after an ill-fated love, and shortly after its publication there were many reports of young men using the same method to commit suicide. This resulted in a ban of the book in several places (1). Hence the term “Werther effect”, used in the technical literature to designate imitation (or copycat) suicides.
"Other studies of the media’s role in suicide include a review going back to the last century in the United States (2). Another famous and recent case concerns the book Final Exit written by Derek Humphry: after the publication of this book, there was an increase in suicides in New York using the methods described (3). The publication of Suicide, mode d’emploi in France also led to an increase in the number of suicides (4). According to Philips and colleagues (5), the degree of publicity given to a suicide story is directly correlated with the number of subsequent suicides. Cases of suicide involving celebrities have had a particularly strong impact (6).
"Television also influences suicidal behaviour. Philips (7) showed an increase in suicide up to 10 days after television news reports of cases of suicide. As in the printed media, highly publicized stories that appear in multiple programmes on multiple channels seem to carry the greatest impact - all the more so if they involve celebrities. However, there are conflicting reports about the impact of fictional programmes: some show no effect, while others cause an increase in suicidal behaviour (8).
"The association between stage plays or music and suicidal behaviour has been poorly investigated and remains mainly anecdotal....
"Nevertheless, there is always the possibility that publicity about suicide might make the idea of suicide seem “normal”. Repeated and continual coverage of suicide tends to induce and promote suicidal preoccupations, particularly among adolescents and young adults."

The normalisation of suicide as a remedy for chronic and terminal illness, or disability, is the reason last November I wrote to Lord Hall, the BBC's Director General. Here's my letter, followed by the delayed reply from one of his underlings.

26^th November 2015

Dear Lord Hall

I am writing to you on a matter of personal concern to me as I have a chronic and life-limiting disease.

You were quoted two days ago as saying that the next charter should not be an attempt to tell the BBC what programmes it could or could not make.  Whilst I agree with that aim completely in principle, it is most important that the Corporation also maintains its commitment to editorial impartiality in all its output, especially in news.  To that end it needs to be accountable, ultimately to those who pay for it through their representatives.

My particular concern is to do with the Corporation’s treatment of end-of-life issues.  Although generally your news outlets make an effort to represent opposing views when the subject is debated, there seems to me a consistent disposition to focus nationally on stories of people ending their own lives (travelling to Dignitas etc) rather than on the many more who choose a natural death and the work of hospices, palliative care doctors and nurses.  I do of course realise that news consists of the exceptional.  Nevertheless, the media both reflect public opinion and mould public perception.

My wife woke up recently to hear an account of a ‘beautiful’ death at Dignitas.  A few weeks before, Victoria Derbyshire did a feature on a man who had announced his imminent death there.  I was in touch with the planning producer at the time who wrote to me.  ‘I will certainly talk to my editor about your suggestion of covering good end of life care on our programme – as I think that would definitely be a very interesting and important issue to cover.’   I have only praise for that producer who was more than helpful.

What concerns me is that inevitably in an organisation as large as the BBC there is a danger of an editorial orthodoxy which ironically discourages diversity of viewpoint in its creative output.  There are many inspiring stories of surviving against the odds and of good natural dying out there, which are newsworthy, and yet we see and hear precious few of them, it seems to me.

The media affect the mood and culture of our society.  To focus on stories of death can induce an atmosphere of fear and hopelessness in the audience.  Whatever is in the next charter, I hope it will keep in place some sort of independent oversight in order to ensure negative and positive are balanced in your output. 

Yours sincerely

Michael Wenham

Lord Hall of Birkenhead

Director-General

BBC

London W1A 1AA

cc         Rona Fairhead, BBC Trust

            Ed Vaizey MP

            The Rt Hon John Whittingdale

As the BBC might themselves put it, Lord Hall declined to reply but the corporation did issue a statement. A bland and predictable response, sadly. It remains to be seen whether we see any more positive programmes to encourage those of us with incurable disabling conditions that there is an alternative to topping ourselves.  

The sincerity of computers

"Dear Mr Wenham,..." (sic) So begins an undated letter to me about renewing my blue badge, or as the letter prefers, my Blue Badge. Its ending has been puzzling me.
"Yours sincerely
 Oxfordshire County Council" (sic).

Can a county council really be sincere, I wonder, writing to me about my old blue badge, telling me to cut it up and post it back to them? I suspect not. When I was first eligible for a blue badge, I received a letter from a polite young, I imagine, lady, whose name I still recall. She could be and, I'm sure, was sincere. However, there's no longer any name anywhere in sight on the letter. So what am I to conclude?

My conclusion, as a former RSA Basic Clerical Skills moderator, is this: that the polite and literate Ms Cundy has been replaced by semi-literate automated computer software. Clearly the letter is generated from a database (possibly programmed by the said Ms Cundy before her removal). And some oaf has created a standard letter format with inconsistencies of punctuation (decide whether you will use commas or not in the address and signing-zoff lines) and the most inappropriate of signing-off phrases.

So now, I receive a letter from a machine which tells me it is sincere. Harrumph! In the words of Victor Meldrew, I don't believe it. What next? xxx at the bottom? A series of emoticons? Leave out the pretence at sincerity, please. That would be at least honest. Or how about employing another young person who needs a job?

The letter The Guardian didn't print

A week ago, when I was away on a much-needed break with my family, the media, led by The Sun, was full of the case of Mr Bob Cole, a councillor from North Wales, who was due to commit suicide on the Friday afternoon in the "Dignitas" self-styled clinic in Zurich. It was clearly a media-event  pre-orchestrated by the pro-euthanasia lobby in this country. ITV had contacted me for an interview on the Thursday, but I wasn't then well enough to oblige. So I did the next best thing I could and sent a letter to The Guardian newspaper, before we left on holiday.

This was what I wrote:

Sir

I am sad to learn that The Sun has lent its megaphone in support of what appears to be the latest salvo in Dignity in Dying’s campaign to legalise assisted suicide.  No one can fail to be moved by Mr Cole’s suffering nor that of his late wife.  However the campaign threatens to open a Pandora’s box of unintended and dangerous consequences for those of us who suffer from chronic, terminal or disabling conditions – and indeed ultimately for our whole society.

Mr Cole is quoted as having “no wish to die in pain without any dignity”.  Neither do I.  I have a very slow form of MND, and although I don’t relish the prospect of dying I have confidence that my dignity will not be sacrificed and my symptoms will be well managed, thanks to advanced palliative care pioneered by the hospice movement.  Ironically, in our sophisticated culture, the populist campaign is based on an immature fear of the process of dying.  Rarely is that process easy, and as our population ages so the difficulties increase.  However short-circuiting the process, which is what Dignitas and assisted suicide offer, merely adds to fear and militates against acceptance of the inevitable, and good dying.  Deliberately ending life, also known as killing, is no way to go.  Expanding and investing in palliative care, which is real compassion, is the better way.  

The vast majority of disabled and vulnerable people are protected by the law as it stands, and fear any change.  To pass a law which admits that some lives are less valuable or worthy of protection, as has happened wherever euthanasia or assisted suicide have been made legal, is a thoroughly dangerous precedent.  I trust MPs resist the loud siren-call of press magnates and listen to the voice of informed reason.  Keep us safe.

Yours etc

Sadly, The Guardian, whilst making quite a thing of the event, chose not to print my response the next day. I am sorry because I think that opinion formers such as journalists and law makers such as MPs need to be made aware that euthanasia is not a good universally acknowledged - anything but.

The ex-archbishop and the disabled

George Carey was the last but one archbishop of Canterbury. He hit the headlines on Saturday by performing a volte-face on assisted suicide in an article in The Daily Mail. Some speculated that it was a deliberate attempt to steal the thunder from the present incumbent who was about to achieve a notable break-through in the matter of welcoming women bishops without splitting the Church of England. I don't subscribe to that view. I believe, though I've never met him, that Lord Carey is well-intentioned.

I understand that he can be stubborn. However I do wish he had listened what the disabled community is saying. Not Dead Yet sums it up simply.

"The key messages we want to get across are

• We are deeply concerned that a change in the law will lead to disabled people – and other vulnerable people, including older people - feeling under pressure to end their lives.
• The issue tells us a lot about public attitudes towards disabled people.
• Why is it that when people who are not disabled want to commit suicide, we try to talk them out of it, but when a disabled person wants to commit suicide, we focus on how we can make that possible?
• We believe that the campaign to legalise assisted suicide reinforces deep-seated beliefs that the lives of sick and disabled people are not worth as much as other people’s. That if you are disabled or terminally ill, it’s not worth being alive.
• Disabled people want help to live – not to die."

I was sufficiently disturbed to send him an email. I'm not surprised that I've had no reply, but I don't like to waste my efforts. So here, suitably edited, is what I wrote.

Dear Lord Carey

No doubt you are receiving a blitz of correspondence at the moment!  But I hope you will take time for this one.

I'm the youngest son of your predecessor but one at St Nick's in Durham, John Wenham.  Indeed I was born while he was vicar there.  Now I have Motor Neurone Disease (PLS variant).  I don't know how long I have to live, but know the sorts of things that lie ahead for me and my family.  I am now utterly dependent on my wife for my survival and for my day-to-day needs.  

I have consistently admired your doughty defence of the Christian values underpinning our society.  So I was sad to hear on the news last night of your intervention in the assisted suicide debate.  Clearly I don't know what Damascene experience you had to change your mind, whether it was meeting Tony Nicklinson or other experiences in your pastoral ministry.  When I met Tony Nicklinson for a morning, I came away immensely saddened that he was unwilling to recognise the love with which he was surrounded, both from his wife and daughters and from his carers.  His life was limited, but it had great value - as does all life.  Of course, neither he nor Paul Lamb would have been helped were Lord Falconer's bill to pass into statute, with its attempted safeguards.  That would come later if Lord Falconer's Commission on Assisted Dying saw its implied conclusion fulfilled: 'we do not consider that it would be acceptable to society at this point in time to recommend that a non-terminally ill person with significant physical impairment should be made eligible' (emphasis mine).  As a terminally ill person with significant physical impairment but with hopefully more than six months to live maybe I'll be next in line.  You cite Tony and Paul as evidence for necessary change.  Would you want to legislate also for cases such as theirs?

In your article you write movingly about our Lord's compassion for the suffering around him.  However I see him only offering healing and enhanced quality of life to those he met, never death.  Can it be the Church's role to advocate suicide instead of care to the end?  Isn't that what compassion really means - suffering alongside?  Would Jesus ever have abrogated the sixth commandment, which means, I understand, killing intentionally or through carelessness or negligence?  It seems to me that we are much more faithful to Jesus when we are involved in healing diseases and in palliative care.  

I don't doubt that Lord Falconer, the folk at Dignity in Dying and yourself are motivated by pity for those in pain, which is of course good. But there is also a strong agenda for personal autonomy, the right to choose.  As Terry Pratchett put it, 'My life, my death, my choice.'  Life, and death, is more than that though, isn't it?  Rights go with responsibilities.  If my insisting on my right endangers others in any way, then I must forego my right. 

I could write more about the ambiguities of the 'safeguards' in the bill, but I will simply urge you to hear the voice, in the debate, of those who see the dangers of opening this particular door for the disabled, the elderly and powerless vulnerable.  I hope you might consider, if not voting against the bill, abstaining and recommending an official royal commission to consider all the issues of end-of-life care, before the pressures of austerity and emotion push us into a position which we later come to regret.

Yours sincerely 

I was chatting on line to psychologist friend yesterday, and she said: "These things occur to me: 1. Many psychotherapeutic approaches theorise about the threat to our sense of self posed by death (a threat which exists regardless of our physical health state). It seems to me that this Bill is actually an unconscious response to this fear (dressed up as something very different!). However, in my experience, avoiding and bypassing fear will only increase it. This, I think, is the connection to 'the slippery slope'; 2. It is premised on something falsely believed to be absolute (6 months' prognosis); 3. It does not, as you point out, provide an understanding of the complexity of informed consent which is so dependent on many factors...social, societal, emotional, physical, intellectual etc...." Nicola's first point was new to me and rings true. Trying to avoid the fear of death by bypassing it will only reinforce it.

The Bill is debated on Friday. I guess that's the time for all the faithful to get praying and all the mobile to get protesting.

Finally something I heard yesterday about our approach to suffering: "Pain is inevitable; misery is optional." We don't have to choose misery and pessimism whilst facing the reality of pain. 

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.