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Right to Die? John Wyatt

August 16, 2016

Support for assisted suicide is growing. I have mixed feelings but Lord Carey is in favour and I oppose most things he says. On the other hand, Michael Wenham, whom I respect, is opposed.

 

RTDThis book does not presume any medical knowledge as it seeks to help lay people understand the debate.

The arguments in favour of the legalisation of assisted suicide and euthanasia are no longer focussed on unbearable suffering. Instead there is a rising demand for choice and control over the time and manner of our death, coupled with fears about the social and economic consequences of increasing numbers of elderly and dependent individuals.

Although fear of pain is widespread, it has become apparent that with appropriate levels of medical expertise and palliative care resources, pain can be controlled. With skilled care and expertise no-one need die in agony. Now the central issue is the right to self-determination, and the diseases in focus are no longer cancer, but chronic debilitating neurodegenerative conditions such as motor neurone disease and multiple sclerosis.

The author traces the history of euthanasia. Nazi Germany spoke of those who were ‘of no slightest use to society.’ 60% in the UK supported the Voluntary Euthanasia Society when it was founded in 1936. While the Netherlands allowed it for incurable pain, Oregon allowed as individual to decide if he thought his life was worth living.

Cicely Saunders and many other pioneers of palliative care in the middle of the 20th century were motivated by Christian compassion to find ways of controlling physical and other forms of pain at the end of life. They discovered that, with skilled modern medical care, ‘it’s not necessary to kill the patient in order to kill the pain’.

The demographic time bomb of increasing life expectancy is set to unleash new social forces. There is a nightmarish vision of the future, in which large numbers of isolated and abandoned elderly people are kept alive to suffer a pointless, lonely and degrading existence, thanks to improvements in medical care. Then there are spiralling healthcare costs, particularly at the end of life, with every medical advance bringing new and more expensive treatments. How can health planners find a way to control their runaway budgets?

All this is exacerbated by the growing epidemic of Alzheimer’s disease and other forms of dementia. According to current predictions, someone born now has a one-in-three chance of developing some form of dementia in their lifetime. Martin Amis argues ‘There’ll be a population of demented very old people, like an invasion of terrible immigrants… I can imagine a sort of civil war between the old and the young in 10 or 15 years’ time.’

He is fair to his opponents in that he accept that they act out of genuine, if misguided, compassion.

Both Christian teaching and common humanity demand that we respond with compassion to ‘the desperate cries for help of terminally ill patients’.

But is killing the best practical and compassionate response that is available? Can’t practical compassion drive us instead to the provision of expert pain relief, psychological and spiritual support, and human companionship through the terminal phases of illness?

Palliative care is better than ever before, though one of my former pupils, a Roman Catholic, argued passionately that his mother died in agony despite this. However, the author accepts that not all hospitals do palliative care well.

The development of palliative care, pioneered almost entirely by Christian believers, is a striking demonstration of the belief that the process of dying need not be one of devastating loss and despair. The wellspring of modern palliative care was a Christian understanding of a good death. The goal of the pioneers was not only to help people to die well but also to help them live more fully before they died. The practical daily experience of all those who care for the terminally ill is that dying well can be an opportunity for personal growth, for self-discovery, and for the restoration and reconciliation of broken relationships

With a culture of increased patient participation, the introduction of the Patient Charter and the Mental Capacity Act of 2005, modern medical care is increasingly driven and controlled by patient choice. Why, if we have such choices about the rest of our lives, do we not have choice about the timing and manner of our death? Why, if we allow a mentally competent adult to refuse life-sustaining treatment, do we not allow that same adult to choose treatment which will bring about their death, within well-defined safeguards?

At its most fundamental, Christian love says to every person ‘It’s good that you exist, it’s good that you are in the world’, to use the words of the philosopher Josef Pieper. The problem with euthanasia and assisted suicide is that in effect they say precisely the opposite: ‘It’s bad that you exist. It would be much better if you were not in the world,’

It’s a shame that he resorts to quoting from that child’s bible, the NIV.

There is some repetition.

I would have found an index helpful.

 Quotations:

There should be a way out for rational people who have decided they are in the negative. That should be available and it should be easy. ….There should be a booth on every corner where you could get a martini and a medal. Martin Amis

‘When suffering is so great that some patients, already knowing that they are at the end of life, make repeated pleas to die, it seems a denial of that loving compassion which is the hallmark of Christianity to refuse to allow them to fulfil their own clearly stated request– after, of course, a proper process of safeguards has been observed. If we truly love our neighbours as ourselves, how can we deny them the death that we would wish for ourselves in such a condition? That is what I would want… .’  George Carey

Just as we can’t escape being confronted with death and dying in our personal lives, so also in the public arena these topics have taken on a strategic importance. Scarcely a week goes by without another high-profile media story highlighting the inadequacies of end-of-life care in our health services, or the tragic story of an individual who committed suicide to escape the suffering and indignity of a terminal illness. Some of those real-life stories feature in the subsequent chapters.

Sophisticated campaigning organizations across the world are using these personal tragedies as the driving force to change the law to allow various forms of medical killing. Their efforts seem to have been highly effective in influencing public opinion in favour of legislation for medically assisted suicide. In the UK, assisted suicide has been the topic of repeated high-profile debates in Parliament, and some have concluded that the pressure for a change in the law has become irresistible. Several prominent Christian leaders, including the previous Archbishop of Canterbury Lord Carey and South African Archbishop Desmond Tutu, have publicly stated that they have changed their minds. They are arguing that we have a specifically Christian duty to provide the option of a quick and painless suicide for those who request it at the end of life.

So what are the forces that are driving this demand for a change in the law? Is it about individual choice and control over our lives – what philosophers refer to as ‘autonomy’? Or is it about the prevention of suffering? Should medical killing be restricted only to those with terminal illness, or to all who are facing hopeless and unbearable suffering? Is it possible to construct a law which has an internal logical consistency and is at the same time robust and safe in practice?

Definitions are important because debates about medical killing have always been bedevilled by the deliberate use of ambiguous and euphemistic phrases such as ‘the right to die’, ‘assisted dying’, ‘easeful death’, ‘death with dignity’, ‘choice and control over how we die’.

All proposed changes in primary legislation have attempted to introduce medical killing under what are described as ‘strictly controlled legal safeguards’. For instance, Lord Joffe’s Assisted Dying Bill of 2005 stated that the individual must meet a range of criteria. In order to qualify for PAS individuals must a) be an adult who is legally competent; b) have a medically confirmed terminal condition with a limited life expectancy of six months or less; c) be suffering unbearably, which was defined as ‘suffering, whether by reason of pain, distress or otherwise, which the patient finds so severe as to be unacceptable’; and d) have expressed a ‘persistent wish to die’.

As Nigel Biggar has argued, the notion that we are all rational choosers is a flattering lie told us by people who want to sell us something. The uncomfortable truth is that much of the time we are influenced and motivated by social and psychological forces that we barely understand.

The removal of legal sanctions on those who made an unsuccessful attempt at suicide was an act of compassion towards the despairing and desperate. Suicide is only tolerated, it is not promoted as an aspect of individual freedom. The Suicide Act of 1961 enshrined the serious criminal offence of ‘a person who aids, abets, counsels or procures the suicide of another’. But over time legal toleration may be increasingly perceived as a matter of individual liberty. The current debates about prosecutions under the law of assisted suicide, including recent guidance issued by the Director of Public Prosecutions that ‘compassionate motivation’ on behalf of the perpetrator will be seen as mitigating the offence of assisting suicide, may have the effect of undermining the intention of legislation. But as Professor John Keown has written in this context, ‘Justice should be tempered with mercy; not undermined by it.’

It is common to find elderly people who are concerned that they are becoming an unwanted burden on their relatives and carers. Desiring to act responsibly and altruistically, they may come to perceive that it would be better for everybody if their life ended. There is a deep irony that the elderly people most sensitive to the needs and concerns of others are most at risk from manipulative arguments from false responsibility. Implicit social acceptance of assisted suicide could easily result in the perception of an implicit duty to die. As Professor Nigel Biggar has said, the legalisation of assisted suicide will make society more liberal at the expense of making it less humane.

Cicero, the prominent Stoic philosopher, wrote: ‘When a man’s circumstances contain a preponderance of things in accordance with nature, it is appropriate for him to remain alive; when he possesses or sees in prospect a majority of the contrary things, it is appropriate for him to depart from life.’

Mary Warnock has argued in favour of medical killing as a responsible option and not only in cases where pain is insufferable: ‘If you’re demented, you’re wasting people’s lives – your family’s lives – and you’re wasting the resources of the National Health Service. …if somebody absolutely, desperately, wants to die because they’re a burden to their family, or the state, then I think they too should be allowed to die.’

But in all cultures influenced by the Christian revelation, suicide has been opposed. It is never glorified in the Bible but instead is seen as act of hopelessness and despair, for example in the tragic ends of King Saul, the first king of Israel, and Judas Iscariot. Despite this, it is clear that suicidal thoughts are not uncommon in God’s people. Elijah wanted to die, but was sent on a sabbatical instead. Jeremiah wishes he had died in his mother’s womb but discovers that God has plans for welfare and not for evil, to give ‘a future and a hope’. Job, too, wishes he had never been born, but learns that God is infinitely greater than his own perceptions.

So suicidal thoughts are not unusual in God’s people, but suicide itself is not to be honoured and glorified, because human life is worth more than that. Both intentional killing and suicide are ultimately contrary to the Christian understanding of creation. Even when tempted to kill out of compassion, we come up against the limits of our creatureliness.

As ethicist Stanley Hauerwas points out, for most of us the initial reaction to witnessing suffering in another human being is to be repelled. Suffering tends to turn the other into a stranger. ‘Suffering makes people’s otherness stand out in strong relief.’ Yet suffering in another human being is a call to the rest of us to stand in community. It is a call to be there. ‘It is the burden of those who care for the suffering to know how to teach the suffering that they are not thereby excluded from the human community. In this sense medicine’s primary role is to bind the suffering and the non-suffering into the same community.’The sad reality is that, so often, modern medical and healthcare systems have precisely the opposite effect, as they isolate and marginalise the suffering.

The Hippocratic Oath, which originated several centuries before Christ, explicitly ruled out both euthanasia and PAS. ‘I will use treatment to help the sick according to my ability and judgement, but I will never use it to injure or wrong them. I will not give poison to anyone though asked to do so, neither will I suggest such a plan…’.

The Hippocratic tradition of medical practice drew a clear distinction between healing and harming. In most societies of the time the doctor and the sorcerer tended to be the same person. He with the power to kill had the power to cure. But the Hippocratic physicians dedicated themselves to the protection of life under all circumstances, regardless of rank, age, or intellect – the life of a slave, the life of the Emperor, the life of the immigrant. For more than 2,000 years the medical profession has attempted to maintain the distinction between killing and curing, framing itself publicly as a profession dedicated solely to the preservation of human life ‘under all circumstances’. It is part of the special calling, the medical vocation which doctors perceive in their protection of life. Hence doctors have refused to participate in judicial execution, in killing on the battlefield, in the torture of prisoners, and the use of drugs to control political dissidents.

As many who have gone before us have found, the end of our lives on this earth may be transformed by God’s grace into an opportunity for growth and internal healing.

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