A society that protects the vulnerable can never allow assisted dying

The challenging subject of assisted dying is once again back on the public agenda, with an all-important debate to take place on Friday in the House of Commons on a private member’s bil tabled by Labour MP Rob Marris.
At second reading, the key arguments will be thrashed out and the house will either kill it, or enable its progression.

Private bills, especially when not allocated any government time, often fail to become law, but if they pass a key stage like this and prove popular, their agenda-setting potential is enormous. It is for that reason that we must urge parliamentarians to oppose this bill and clearly signal Parliament’s affirmation of life.

I would like to point out that opposition to assisted dying is not an easy position to maintain. As it becomes an ever-more fashionable cause for the great and the good to latch on to, the two key attacks on us opponents are shouted ever-more aggressively.

We are either religious, or heartless. The first argument is simple: it is wrongly claimed that it’s nearly always religious people who oppose assisted dying, and if you reject a pro-life stance, founded on the notion that a god who gives life is the only one who can take it back, there’s nothing immoral in ‘helping’ some-one to control the end of their life.

Yes, I accept that the laws of God don’t hold this degree of sway over a lot of people, but as Justin Welby, Archbishop of Canterbury has made clear, the considered opinion of most faith leaders is deeply rooted not just in theological reflection but a vast amount of pastoral experience.

Yes, some people are guided by their religion, but assisted dying is also strongly and consistently opposed by the medical community which, even more than the clergy, is at the sharp end and will be at the sharp end of delivering the service of assisting death.

That takes us to the second argument: critics are heartless. Are most faith leaders heartless? Is the British Medical Association heartless? Is the palliative care movement heartless? There are, it would seem, lots of heartless people out there.

The appeal of assisted dying is a purely emotional one. A person enduring great suffering for whom life has become unbearable and who wants to die, must not be denied that wish, for to do so is cruel and denies them freedom and control over their own lives.

To oppose this choice, the argument runs, is to appoint ourselves judge and jury, patronisingly deciding that we know better and forcing them, however terrible their affliction, to tough it out. The reality is that no sensible critic of assisted dying would be so arrogant as to deny that for some people, life has become truly unbearable.

Who could have looked at the late Tony Nicklinson, trapped inside his body and unable to speak or move, and not even understand why he would wish to die? His may have been the most extreme case among the campaigners on this issue, but there have been others and there will be more.

It is these terrible cases that cause snapshot polls to demonstrate the popularity of assisted dying in the immediate aftermath of their becoming high-profile. It is these people who are used by assisted dying advocates to argue that it is the common sense thing to allow them to take their own lives if one wants to show them any kindness and compassion.

All this ultimately attests to the fundamentally dishonest nature of the pro-euthanasia line (and euthanasia is what this really is). Every recent British case that has brought this debate back to the surface, where the person was actually sick or disabled in the first place, has involved some-one in a long-term, debilitating predicament, and all of their cases would fall outside of the scope of the Marris bill, which insists a person be 6 months from death – the length of life for a terminally ill person is actually not easy at all to predict, by the way.

Hardly any of those who travel to Dignitas to end their lives would theoretically be able to do so in Britain under Marris’s proposed changes. Are we really to believe then, that the Marris bill would be the end of it?

The BMA points out that, “Only a minority of people want to end their lives. The rules for the majority should not be changed to accommodate a small group.” That’s very true, but Marris is proposing a change that will only benefit the minority of a minority, and the question that we have to ask is at what price?

The BMA starkly warns that “Legalising assisted dying could weaken society’s prohibition on killing and undermine the safeguards against non-voluntary euthanasia. Society could embark on a ‘slippery slope’ with undesirable consequences.”
To refute the ‘slippery slope’ argument, assisted dying supporters have to prove a number of points beyond any doubt.

First, they’ll have to argue that assisted dying can be offered within limits that political pressure won’t ever push back. The very concept of assisted dying, by its very nature, weakens society’s prohibition on killing. It enshrines in law the idea that, in certain circumstances, it is acceptable to kill some-one. If a person could not achieve death without your assistance, how are you not directly killing them if you assist? Supporters would like us to call it ‘assisted dying,’ but if you consider what it actually means, it could just as easily be described as ‘mercy killing’ or ‘assisted suicide.’ In fact, simply ‘killing people’ would do.

The fundamental protection of life itself would be undermined, and it wouldn’t be long before the arbitrary nature of limits of acceptable killing were called in to question.

The Marris bill is modelled on Oregon, where the limit is 6 months; for Marris, it’s also 6 months, but why stop there? As the cases I’ve mentioned above demonstrate, there are people suffering unbearable burdens who will have to live with it for decades and it is their plight which is driving this agenda. Is it they, or the dying cancer patient supported by excellent palliative care nurses in their own home already prioritising pain relief over longevity, who will want to take some pills more desperately? 

Why not help people a year, 2, 10, or 20 years from death as well? Numbers are arbitrary, and only serve as porous boundaries which will be pushed and breached before long. There is absolutely nothing concrete that changes at the stage where a person is 6 months from death: it can neither be predicted with any certainty or in and of itself give any indication of their quality of life.

Next, to reject the notion of a ‘slippery slope,’ it must be demonstrated beyond question that a legal change simply enables individuals already determined to end their own lives to access physician assistance, without itself altering anyone’s decision.

Is that actually what happens? Of course, it’s hard to say for certain, because speculative judgements about how people would act in different circumstances can never constitute evidence, but if it were not altering decisions, you would not expect to see a significant rise in take-up of assisted dying over time, unless accompanied by some equally significant and extraordinary demographic change or changes in the general rates of death.

However, Oregon has witnessed sharp rises in the 16 years since legalising assisted dying. The 2014 report revealed a staggering 44% rise in suicides and a 28% increase in lethal prescriptions from the previous year. In a single year, that means an increase from 73 suicides and 105 prescriptions in 2013, to 105 suicides and 155 prescriptions in 2014. This rapid rise is no exception but is in line with the year on year trend in Oregon.

The figures speak volumes: deciding to die in Oregon is becoming more and more of a norm and as Archbishop Welby argues in his article, the evidence from Washington and Oregon suggests that anything from 40% to 60% of those taking up the right to die cite concerns about being a burden as a factor in their decision.

He continues: “Once a law permitting assisted suicide is in place there can be no effective safeguard against this worry, never mind the much more insidious pressure that could come from a very small minority of unsupportive relatives who wish not to be burdened.”
It is misguided to assume that we can rely on the altruistic motives of relatives, and that there isn’t an ugly side to family life when it comes to inconvenient obligations of care, or even when it comes to inheritance.

It is equally naïve to believe that the best assurances of loving, caring relatives, can prevent a vulnerable person feeling like a drain and a burden, who if presented with the legal means to express a “settled wish” as Marris puts it, may well feel a duty to die.

Even without the shocking Oregon statistics, we needn’t dig too far in to the archive of case studies to find stories that clearly show the ‘I’m a burden’ fear as paramount in a person’s choice to end their own life, whether that fear arises from being frightened at the prospect of decline, or a more calculated, selfish mentality.

Consider the case of Jeffrey Spector, who ended his life at Dignitas before a spinal tumour could lead to his paralysis. In an interview, he explained: “I believe what I am doing is in the best long term interests of my family. They disagree, but they do accept I have my own opinion.” How awful for them to know that they factored so strongly in his decision, and how terrible that he could not be reassured by them. Few of us are ever truly alone, and I wonder what burden of guilt and anguish a comment like that leaves on the Spector family.

Even more troubling is the case of Gill Pharaoh, a 75 year-old healthy former nurse, who took her life because old age wasn’t “fun,” (yes, she was actually allowed to do it) and who wrote: “Old people are a burden on society. I watched my own mother become demented. Had there been a pill available at the time, I would gladly have put her out of her misery. I do not intend to follow that path myself.”
It may only be those extremely determined who would take a trip to another country to end their lives, but these cases show clearly that even with this option, some choose to sacrifice themselves to avoid being a burden, whether on loved ones, or wider society.

These are articulate individuals who, on the face of it, are making their own choices and couldn’t be forcibly deterred on the grounds of lack of mental capacity, but who, for different reasons, are actually vulnerable and in need of compassion to show them that every human being has worth and value, and that every life is precious, not to mention that the burden of their loss is far greater for the loved ones than any burden of care.

This takes me to the final point: if there is no risk of a ‘slippery slope,’ there must be a fool-proof way to judge capacity and determine that a request is being made entirely of the person’s volition that is fool-proof and cannot be contested.

In reality, no such fool-proof method exists. It may be obvious, for example, that a person with advanced dementia is not able to make this decision, but could any evidence of having previously expressed a wish to die in certain circumstances never be brought to court to try and legally challenge refusal on the grounds that we can prove what their wishes would be if they could tell us?

Britain’s judiciary is becoming increasingly imperious, having already, for example, enshrined in to law through the case law precedent, the idea that an adult can override a parent’s will on ‘reasonable provision’ rules initially aimed at protecting vulnerable children.

We should not assume that limits, rules and processes documented in legislation can’t be stretched through legal case precedent, especially with a bill as poorly written as the Marris bill which is simply begging for all kinds of legal disputes on both sides of the debate, because it introduces highly ambiguous concepts with no definition, such as the right of professionals objecting on grounds of conscience not to “participate.” It doesn’t even clarify what participation means, or acknowledge that any diagnosis that professionals make will constitute evidence about a person’s condition, so any medical professional can be a participant whether they defend a patient’s “settled wish” themselves or not. Little more than a sentence on the subject in no way assures me that my right to die isn't some-one else’s obligation to kill me.

That aside, what about some-one with early dementia? At what point are they too demented to be thinking straight, particularly if they can clearly and coherently articulate their wish, as sir Terry Pratchett could, pretty much up to the point of his death?

What about the possibility of depression as a factor limiting capacity? Arguably, Jeffrey Spector couldn’t cope with the fear of paralysis, whilst Gill Pharaoh may have been so traumatised by her mother’s illness, so that neither made a decision they would ordinarily have countenanced. To be fair, I think it’s unlikely with these cases, but thinking isn’t enough, and remember this: ordinarily, suicidal thoughts are in and of themselves an important diagnostic indicator for the very diagnosis of depression.

In Oregon, according to the 2014 report, only 3 people received a psychiatric evaluation, whilst Madeleine Teahan, writing in the Catholic Herald, has presented a number of disturbing cases from Belgium, where she regards there to be clear evidence of the dangerous character of a euthanasia trend in Europe.

The stories are worth quoting at length – stories which clearly show that any so-called safeguards, or checks on inappropriate requests by the medical profession, can be at best ineffective and at worst abused.
“Two months ago a 24-year-old Belgian woman was granted the ‘right to die’. Identified only as Laura, the woman was not terminally ill but was suffering from clinical depression and had decided: ‘Life, that’s not for me.’
Laura had entertained suicidal thoughts all her life. When she was six she had handled a loaded gun and imagined what it would be like to kill herself. Eighteen years later, instead of making plans for the future, she was arranging her own funeral. She told a local newspaper: ‘Death feels to me not as a choice. If I had a choice, I would choose a bearable life. But I have tried everything [else] and that was unsuccessful.’”

Here’s another story from Teahan’s article.
“But Rachel Aviv of The New Yorker recently took one of the statistics and uncovered the shocking story behind it. She looked into the case of Godelieva De Troyer, a beautiful Belgian woman who was killed by a lethal injection administered by Dr Wim Distelmans, the country’s foremost euthanasia doctor.
Aviv reported that Godelieva had attended therapy sessions since she was 19 following a troubled relationship with her parents. She married young and was determined not to repeat the mistakes of her mother and father when she raised her own children. But she eventually divorced her husband, who killed himself two years later.

The happiest time of Godelieva’s life was when she began a new romance in her early fifties. But when that broke down in 2010 she became seriously depressed and her relationship with her son, Tom, deteriorated. In the summer of 2011, when she was 63, Godelieva attended a lecture by Distelmans. In September she began visiting him at his clinic. Four months later she emailed her children telling them she had filed a euthanasia request.
Tom was not on speaking terms with his mother by then. He showed the email to a doctor who was familiar with Distelmans’s work and who reassured him that ‘there was no way that Distelmans would approve the euthanasia request without first speaking to the patient’s family’. Tom did not intervene because of this advice.
Three months later he received a brief posthumous letter from his mother, announcing that she had been euthanised in a Brussels hospital.”

Complexity, ambiguity and highly questionable definitive proofs of full capacity have always underpinned the argument for opposing legal changes to introduce assisted dying.

I am in no doubt that some people make a clear and rational judgement about their wish to die, and that there are circumstances in which you can hardly blame them. But separating those out from the depressed, scared, vulnerable and pressurized would have to be an exact science to introduce assisted dying safely, and in reality it isn’t. There’s no proof from any place that has gone down this route, that there isn’t doubt, and that the law isn’t abused. Dignitas has helped perfectly healthy individuals with nothing more than depression to die. Belgium has its own horror stories, as quoted above.

Marris’s bill is modelled on Oregon, where there is rarely oversight of the actual suicides, and where an enormous rise in lethal prescriptions and acts of assisted suicide sits alongside a near-complete absence of any psychiatric evaluations.

Equally, we cannot prove that the existence of the option to take up assisted dying without anyone being prosecuted doesn’t alter the choices people make or impose a ‘duty to die,’ but at their most vulnerable and with a combination of Oregon’s statistics and self-reported reasons for the choice from those who made it, we can show that it’s probable that it does.

So, whilst we must regard the horrendous suffering that some are forced to endure with the utmost compassion, and whilst we must never appear dismissive and uncaring when we oppose changing the law, we must nonetheless be uncompromising in our arguments, which, at their simplest, boil down to this: heartrending cases make very bad laws. No safeguards are unbreachable, no limits unmovable and no judgements of capacity and free will unquestionable.

Those who truly wish to die, if they are of sound mind, cannot now be forced to eat. Their desire for a quicker, less painful death is understandable, but a society that wants to protect rather than harm the most vulnerable, and to show humanity rather than abandon it, can never in their name introduce any instance where to kill some-one is acceptable or legal.

A society that protects the vulnerable can never allow assisted dying.