Matters of life and death

I woke on Saturday to hear two oddly juxtaposed items on the radio. The first was a discussion on Farming Today about the problem of the male offspring of dairy cows. As I understand it, the dilemma is that they’re not much good for beef and so the practice has been to kill them at birth. The spokesman for Compassion in World Farming was predictably opposed to this, and I got the impression that his view was winning traction more generally. The second was a headline item on the news immediately following it. This was about the exit polls from the Irish referendum on abolishing the Constitution’s Eighth amendment, which banned all abortions except when the mother’s safety was in danger. For this there was general approbation, implying that at last the Republic of Ireland had caught up with the modern world. Later in the day when the official result of a two-thirds yes vote was confirmed, the news included prolonged and loud celebration of the victory.

What struck me was the very peculiar dissonance of our concern for the new-born uneconomic calves and apparent disregard for unborn babies. I understand that medically provided abortion is far safer than any alternatives, and I understand that women who become pregnant against their wills have a case to be allowed to choose to continue with their pregnancy or not. I also understand those who argue for the rights of the unborn child to be taken into account. The NHS website’s description week 10 of pregnancy reads:

“The ears are starting to develop on the sides of your baby's head, and the ear canals are forming inside the head.

If you could look at your baby's face, you would be able to see an upper lip and two tiny nostrils in the nose. The jawbones are developing and already contain all the future milk teeth.

Picture from NHS website

The heart is now fully formed. It beats 180 times a minute – that's two to three times faster than your own heart.

The baby is making small, jerky movements that can be seen on an ultrasound scan.” In other words from very early on we describe a foetus as a baby.

I suppose the question is, Is it really, as I recently heard, a matter of the rights of a woman against the rights of an egg? When does a baby begin to have rights? And are his or her rights ever equal to those of the mother – or even of a new-born calf? 

And I ask myself, should the unconfined celebrations of women’s choice not have been tempered with sorrow for inevitable death of the babies whose lives will be terminated?

In this country we have seen the increasing use of abortion to kill unborn children with Down’s Syndrome and disabling conditions. We have also seen it spreading to become “on demand” and as a desperate form of contraception. I hope that Ireland never passes legislation that allows abortion to be as misused as it has become here. And personally I trust that the North doesn't get railroaded into a rush to become like the rest of the UK.

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. 

In the public eye

I really don't enjoy being in the public eye, but Jane and I were on Channel 5's evening news tonight: http://www.youtube.com/watch?v=227RAHqVDiA#t=12. We'd been interviewed about assisted suicide, which is in the UK news again because there's an appeal case before the Supreme Court basically seeking to legalise the practice for some. It's really a continuation of the Tony Nicklinson and Paul Lamb case, arguing for doctors killing an incapable terminally ill patient who wants to die because of "necessity".

The filming took about three hours - the clip they edited (well, I must say) played for less than two minutes. I hope it provided some evidence that not everyone with a "terminal condition" and very few disabled people want euthanasia legalised. I think Channel 5 got on to us because of an item we'd done for Yahoo News a couple of months ago which came on line last week. You can see Jane and me and the dogs here: Terminally ill man on why life is our greatest gift (Yahoo). (Jess has since been put down.)

There are many reasons why relaxing our laws to allow even a limited intentional taking of life is a bad idea. But they of course lack the emotional punch and sentimental appeal of horror stories. For myself I am always slightly suspicious of highly coloured accounts of personal suffering. They seem to me to be attempts to persuade by-passing the intellect. Of course the end of life is an emotional subject, and emotion should play its part, but if we abandon reasoned discussion we make ourselves prey to all kinds of prejudice and irrationality.

So what are my reasons for devoutly hoping that the nine Supreme Court judge reject this latest assault on the sanctity of life? Here are some notes.

Unintended consequences

I don't suppose the legislators who, acting from the best of motives, brought in the Abortion Law foresaw that it would become a charter for disposing of many thousands of babies with Down's Syndrome or a cleft palate.

Hard cases

Make bad laws. Our system combines case law and legislation. The place for considering ethical issues as hard and complex as this is Parliament, not the law courts.

Compassion?

Yes, I have compassion for people in pain and disabled and terminally ill. Tony Nicklinson said to me the difference between himself and me was that I could commit suicide if I wanted. It's not actually true. But compassion doesn't really mean killing someone. It means sticking with them through pain. It means relieving their symptoms and minimising their pain. It means good palliative care.

Prof Hawking's "pet" theory ("You would let your dog suffer") is one quarter right, three quarters wrong. We had Jess put down because her life was miserable, but also because she became doubly incontinent, was likely to incur costly vet's bills, was no longer much fun to have around. 3 of 4 reasons were to do with our discomfort, not hers.

Defence of the vulnerable

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, the depressed, 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. The court case seems to me to be about people who are far from vulnerable. They actually are strong-willed, if desperate, and well supported.

Hippocratic oath v necessity

As I understand it, one request in this case 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. I guess that's why the BMA is against a change in the law.

As events proved, there was no necessity for a doctor to end Tony Nicklinson's life. He could refuse treatment and ask for only symptom control and pain relief.

Discriminatory

All of us may refuse treatment: none of us may demand treatment. To allow one class - ie. paralysed - to demand would discriminate against others and set a precedent for any to demand "treatment" as we wished.

Justice and mercy

The present Suicide Act protects the absolute primacy of life - but allows room for mercy with the discretion of prosecutor, judge and jury. It has worked, and it isn't broken. Don't try and change it.

Fear

The disabled fear a change in the law. We feel at risk. We don't want to be endangered.

Many ageing people fear it. The majority of elder abuse takes place in the home or in care homes.

The campaign for euthanasia encourages fear. It feeds on our natural fear of pain, of dying and of the unknown. And it fuels that fear.

Fear is toxic to a healthy society.

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.

'My life'

Actually life isn't our possession. We are part of life.

Religion

Everyone has a philosophy of life. Mine informs my view, just as anyone else's affects theirs. However, my objections are pragmatic. I'm concerned about the consequences of eroding the law for our society. I'm concerned about cheapening life - reducing it to a commodity. I'm concerned about protecting the vulnerable. I don't want our country to go the way of Belgium, where they're moving towards euthanising children, or of Holland when we could face 13,000 assisted suicides a year. I'm concerned that we never see euthanasia as an easy way to reduce our NHS and care costs.

Public policy affects individuals

After Wednesday morning appreciating the NHS, we mosied down to Cornerstone to meet Jean, who’s recently been diagnosed with MND, and her husband, John. What a nice couple! They’ve lived in Grove all their married life. We share a number of the same professionals, like physio, GP etc. They were waiting for a stairlift to be fitted on Thursday, which will mean Jean will be able to sleep upstairs again. It does feel better going upstairs to bed. No doubt we’ll meet up again. In fact we’ll be seeing them again next week at the local MNDA meeting in Thame - about benefits. How timely!

I wonder whether they’ll have any light to shed on Moira’s plight. She has MND much worse than me (for example she can’t speak and can’t move), and lives on her own with a son and a full-time carer. Hitherto she has had Continuing Care funded by the local NHS Primary Care Trust. Now they’ve reassessed her and decided she’s not eligible after all - interesting idea since MND is degenerative. So they say she’ll have to apply to Social Services to fund her care. That will not come cheap, of course. One wonders, naturally, whether it’s more a matter of healthcare economies than patient needs. As far as I can see she should qualify for the NHS funding for her Continuing Care on more than one priority criterion. She’ll no doubt appeal, but in a fortnight she’ll have her funding discontinued and be left fending for herself. That seems a plain injustice. Why can’t her funding be maintained until the appeal is made (within 28 days) and a decision reached? I guess there’ll be more stories like this in the months ahead as public bodies tighten their belts. The sad thing is, it’s the vulnerable who get squeezed in the process.

Dr David Starkey

On Thursday evening there was an unexpected and most welcome item on BBC1’s Question Time from Derby, where the foster-parents, Owen and Eunice Johns, live. They’re the Pentecostal Christian couple who as a result of a jointly requested judicial review were declared unfit to foster children between 5 and 8 years old, because of their views on homosexuality. The judges ruled that they were potentially harmful to children entrusted to their care. Irrespective of the rights and wrongs of their views, that does seem to exclude everyone with opinions which are not politically correct. This was sadly illustrated by the two politicians on the panel, Margaret Beckett and Ian Duncan-Smith who in particular tied himself in knots about the case. 

By contrast, popular and trenchant historian, David Starkey was clarity itself. “I’m gay, and I’m atheist,” he began, “but I have profound doubts about this case. It seems to me that what we’re doing is producing a tyrannous new morality which is every bit as oppressive as the old.” He went on to describe his early experience of being hounded as a gay man, but he said we now have a ‘liberal’ morality which is in danger of being equally intolerant. He also talked about being a gay son of a Christian mother, who passionately hated his homosexuality, and he said it did him no harm. “It made me what I am.” We live in a complicated pluralistic society, and it’s hard. But we're in danger of creating 'thought crime'. “Just having a reach-me-down, off the hanger, imposed morality is a very bad idea.” I must say I warmed to him surprisingly and found myself thinking, “There’s a wise man. Refreshing to hear an atheist defending Christians’ and everyone's freedom with such intellectual rigour.” That of course cuts both ways, including Christians not imposing their morality on atheists. Argue for by all means but not impose. It’s worth listening to the discussion on the subject: BBC Question Time re Foster Parents.

A time to speak

Today I've had an article published in The Catholic Herald - which I must say I'm chuffed about. You can read it on line (http://www.catholicherald.co.uk/features/opinion/o0000320.shtml). I wrote a longer version which appeared elsewhere, but you can't access it on line. Basically I was saying if we don't say anything it will be assumed that the public consensus is in favour of assisted suicide. As Edmund Burke was reputed to have said, 'All that is needed for evil to triumph is for good men to do nothing.' Whatever view you take, this issue is too important to do, or say, nothing. There's a Downing Street petition, which says: "We the undersigned petition the Prime Minister to retain the law that makes it a criminal offence to assist another person to commit suicide". I've put a link to it ('PETITION') to make it easy to add your name. And although it says it's past the deadline for signing, I did it successfully today. So you probably can as well - but quick! Actually I think we also need to talk about it in the pub, at work, on the radio - wherever we get the chance. Because I think life and individuals' lives are infinitely precious. I don't want any of my ill, or disabled, or elderly friends to have their lives ended prematurely. That doesn't mean officiously extended, but it does mean faithfully and tenderly cared for until the end. Life is given to me; it's not mine by right. And you can quote me on that!