The
campaign for assisted suicide seems to be picking up a head of steam in
the UK, with the Mental Capacity Bill's stormy passage through the
House of Commons on Tuesday 14 December. It is certainly a step in the
direction of the legalisation of assisted suicide, despite the
protestations of its defenders. According to some readings of this
bill, a patient may request that he or she is deprived of food and
water in certain circumstances, and a doctor must obey this request or
face a possible five years in prison. In addition to this, Lord Joel
Joffe's Assisted Dying for the Terminally Ill Bill is currently under
review in the House of Lords.
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It is worth picking apart some of the arguments for assisted suicide.
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1. This is just about individual autonomy.
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According
to the Suicide Bill of 1961, individuals already have the right to
commit suicide. Nobody today could be hanged for attempting suicide, as
was the case in the nineteenth century - nor would they be imprisoned
for their unsuccessful attempt.
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Lord
Joffe's bill would remove the penalty, outlined in the Suicide Act, of
up to 14 years imprisonment for aiding a suicide. As the psychiatrist
Thomas Szasz has pointed out, '(s)trictly speaking, assisted suicide is
an oxymoron' (1). The only people who would be 'empowered' by this bill
would be doctors, who would decide whether or not the patient is
'competent', certify that the patient's illness is 'terminal' and
'[conclude] that the patient is suffering unbearably as a result of
that terminal illness'.
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2. We all need the 'right to die'.
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We
all have the right to die, with or without its sanction in law. All the
'patients' of Dr Jack Kevorkian, currently in prison in America for
having gone a little too far in assisting the suicide of Thomas Youk
(which was videotaped and shown on CBS's 60 Minutes), were physically capable of bringing about their own deaths.
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Anyone,
with a little forward planning and much determination, can kill
themselves. The Assisted Dying bill will instead place an onus on
doctors and carers to help individuals to commit suicide. One of the
most ugly arguments to come from the Voluntary Euthanasia Society is
that disabled people should have the right to die, too. We must be
clear that we are being obligated to give the proverbial man on the
bridge a push (or perhaps to make the bridge wheelchair accessible).
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3. Those opposing assisted suicide are a 'small religious minority'.
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It
is true that many religious groups vehemently oppose the Joffe Bill,
but they are not the only ones. They unite with medical representatives
and disabled groups, who fear that doctors' judgements about 'quality
of life' may imply that their own lives are not worth living.
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This is no abstract fear voiced by philosophers such as Baroness Warnock, as Jane Campbell, writing recently in The Times
(London), discovered. Campbell, who suffers from spinal muscular
atrophy, a muscle-wasting illness that means she cannot lift her head
from her pillow unaided, was hospitalised for a case of pneumonia. The
consultant treating her said that he assumed she would not want to be
resuscitated should she go into respiratory failure. When she protested
that she would like to be resuscitated, she was visited by a more
senior consultant who said that he assumed she would not want to be put
on a ventilator. According to the Disability Rights Commission, this
was not was not an isolated incident. As Campbell says, these incidents
'reflect society's view that people such as myself live flawed and
unsustainable lives and that death is preferable to living with a
severe impairment' (2).
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In
fact, it is those calling for legalisation of assisted suicide who tend
to espouse New Age religious values. 'Self-deliverance' is the term
favoured by Derek Humphry, former Sunday Times journalist and author of the best-selling suicide bible, Final Exit. Delivery to where, Mr. Humphry? Dr Timothy Quill, who admitted in an article in the New England Journal of Medicine that he had helped a patient die, has written a book called A Midwife through the Dying Process.
To an atheist (like myself), death is not an 'experience' but the end
of all experiences. Do assisted suicide advocates wish simply to
replace rituals formerly carried out by priests?
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Finally,
you need not be Christian to agree with the Archbishop of Canterbury
that 'the respect for human life in all its stages is the foundation of
a civilised society'.
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4. Allowing the right to die is the hallmark of a civilised society.
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To
break the taboo against suicide would be a sure sign of societal
breakdown. Though the disintegration of society and the disappearance
of socially integrating institutions receive much attention, there is
little recognition of the relationship with the right-to-die movement.
The sociologist Emile Durkheim made the point that 'Man is the more
vulnerable to self-destruction the more he is detached from any
collectivity.' Is suicide not the most awful manifestation of the 'drop
out' society? To encourage it is a celebration of alienation and
anomie. The taboo on suicide marks the recognition of our
interdependence. We should maintain it.
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Even
Mary Warnock pointed out, what sort of society tells its members that
it values their right to starve to death, especially if they are a
burden on society? Surely a mark of civilisation would be to offer
people in despair some sort of argument that their lives are
valuable, that they do have some worth. Instead, right-to-die advocates
project their own gloomy estimation of the worth of human life on to
these poor souls.
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5. The central issue is pain.
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Not
according to any available study. In 1995, an update to the
authoritative Remmelink Report on euthanasia in Holland, where the
practice has long been accepted and is now legal, showed that pain
played a role in only 32 percent of requests for euthanasia. In no case
did pain represent the sole reason for requests. In Oregon, USA, under
right-to-die legislation that is seen as a blueprint for Lord Joffe's
bill, only 28 out of 129 physician-assisted deaths in the first five
years cited pain as the most important factor (the primary reasons was
fear of what the future might bring) (3). The suffering occurring at
the end of life is real enough, but it involves fears rather than
simply physical pain.
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6. This is all about 'dignity'.
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What
sort of dignity? Right-to-die campaigners condemn the lives of the
disabled as bereft of dignity, apparently associating dignity solely
with control over bodily functions. According to this definition, if
someone loses their bodily 'autonomy', they no longer have human
dignity. In my mind, dignity comes from bearing up under suffering we
meet throughout our lives rather than letting it destroy us, and from
facing fears rather than caving in to them.
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7. Many are forced into 'lonely, back-street suicides' because of our restrictive laws.
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The good news is that fewer people are actually committing suicide today. In spite of the case of Mrs Z (see A ticket to die),
very few Britons become 'suicide tourists'. In six years, only 180
people took up the option of assisted suicide under Oregon's
right-to-die law, which is less than one percent of those requesting
information about it. Even in Holland, where assisted suicide has been
legal for some time, the numbers are low. Prominent campaigners for the
right to die such as Timothy Leary have backed out of suicide at the
last minute. In most polls, those who are keenest advocates for
legalising assisted suicide are the young. The elderly, whom one might
imagine have most cause, tend to shun it.
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The
real power behind the right-to-die campaigns is fear. Imagine,
campaigners say, if you were trapped, forced to live a life you no
longer wanted, unable to end it yourself. But as Elizabeth Kubler-Ross,
pioneering author of On Death and Dying, noted, the attraction of assisted suicide is really about the projection of present fears about life on to dying.
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We
must ask what a person is saying when they ask for assisted suicide. If
an individual was determined to die, they would hatch a plan and tell
nobody about it. By asking for an assisted suicide, an individual is
expressing their despair about their prospects, their fear for what the
future holds. Why would they express despair unless they wanted some
sort of connection with others? Why would someone with a true wish to
alienate themselves from human contact forever tell someone about it?
We ill serve those who express hopelessness by agreeing with them and,
worse, cheering them on.
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8. Amending the Suicide Act to allow assisted suicide would restore a right enjoyed by classical societies.
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In
fact, approving of suicide as a therapy would be unprecedented in human
history. Assisted suicide advocates often justify their beliefs by
invoking ancient societies, especially Athens, where apparently
rationality reigned and suicide was tolerated. Yet in fact, at that
time suicides were buried away from other graves; the suicide's
self-murdering hand was cut off and buried apart. Ancient Greeks and
Romans often took their own lives for reasons of grief, high patriotic
principle, or to avoid dishonor, but these deaths gained meaning by
emphasising societal values. Plato allowed that suicide might be
permitted for reasons of painful disease or intolerable restraint, but
he argued that the subject had first to plead their case before the
Senate.
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The
solipsism of today's suicide advocates stands out. Suicide for the
reason that an individual's life is wretched puts aside relationships
with others. It ignores the union between the dead, the living, and the
as yet unborn. To throw away a life for such paltry reasons mocks those
who, in the past, sacrificed themselves to extend and enrich life, and
risks demoralising those who are just entering our world.
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However,
one precedent for a tolerant view of suicide exists. Germany between
the years of 1900-1945 presupposed many of the ideas of the assisted
suicide movement (4). Depends on your view of 'classical', I guess.
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9. The real problem is modern technology's ability to keep people alive indefinitely.
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Did
someone invent a cure for death that I didn't hear about? The blurb on
one book notes: 'As medical technology advances to the point when any
human life can be maintained almost indefinitely, questions related to
the "quality" of that life inevitably arise.' (5) It is instructive
that the authors chose not to celebrate the triumph of medical science
but to look for potential problems.
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10.
It is best to die as you choose, surrounded by friends and relatives at
home rather than by tubes and monitors in a hospital.
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We
cannot control when and how we die; to give the 'right' to do so is as
meaningful as giving people the right not to die of heart attacks or
accidents. The holistic, back-to-nature view, apparent in many medical
ethics books, imagines that we have become alienated from death and
over-reliant on trying to extend life by technological means. It is
understandable that many people would prefer to die away from a
hospital, but the search for a 'good death' will forever prove elusive.
Every death is ugly and undignified, as life is wrenched away, leaving
an inanimate, waxen corpse. Those who seek the security of a good death
seek to inure themselves to uncertainty, perhaps because they have
witnessed the prolonged death of a close relative or friend. But this
is a projection of our own technophobic fears on to the dying person.
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So
shall we project our own cramped and gloomy worldview on to those who
are most sensitive to counsels of despair? Or shall we continue to view
all human life as valuable, doctors as curers of physical disease
(rather than prescribers of death for therapeutic reasons), and life as
worth living?
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(1) Killing to be kind?, by Thomas Szasz
(2) 'A right to die? I'm more concerned that everyone has the right to live', Jane Campbell, The Times, 2 December 2004
(3) Statistics available at the Five years under Oregon's assisted suicide law section of the International Task Force on Euthanasia and Assisted Suicide website
(4) See Death and Deliverance: 'Euthanasia' in Germany 1900-1945, Michael Burleigh, Cambridge University Press, 1994
(5) Quality of Life: The New Medical Dilemma, ed James J Walter and Thomas A Shannon, Paulist Press, 1990
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