The Guardian view on assisted dying: a clash of moral visions
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Version 0 of 1. The central question about Rob Marris’s bill to allow assisted dying is whether it represents the beginning of a very slippery slope. By itself, the bill is modest and careful. It excludes all but the terminally ill, and people with dementia, even if they are terminally ill; it requires medical and legal approval for every case and it does not require doctors to perform an act of deliberate killing by administering the fatal dose. A very similar law in Oregon has been taken up by only 0.3% of those eligible in the last 18 years. So it’s clear that by itself this bill would not allow the kind of brutal large-scale elimination of the unwanted and unhappy that opponents fear. It appears to have enough crampons to keep from sliding down towards the precipice of large-scale, state-sanctioned euthanasia. At the same time, this wealth of safeguards must disappoint many supporters of assisted dying. This bill would not have eased the plight of many high-profile cases. Tony Nicklinson, for example, had a condition that was dreadful but not terminal. He would not have benefited. The most common fear of those people who say they would rather not be kept alive into extreme old age is dementia. They could not choose to die under this measure. Their relatives must watch them dwindle with all the emotional and indeed financial anguish this will entail. It is hard to believe that the Marris bill, if passed, will satisfy those who argue for assisted dying on the grounds of personal autonomy. The libertarians of the Economist have already made it clear that the bill, and the Oregon legislation on which it is modelled, don’t go nearly far enough. In their view the “right to die” should extend to anyone who really, sincerely wants to exercise it, whether or not their illness is terminal, and even if their suffering has no physical cause. Mental anguish alone should be grounds for demanding a lethal prescription, according to the autonomists. But of course the right to die, in this sense, already exists. Suicide is legal, as it should be, and is no longer condemned even as a very grave sin. It is also legal for any adult to refuse particular treatments, as it should be. These rights are proper and undisputed. The line that is being crossed by the proponents of autonomy is that they claim the right to ask other people to help us kill ourselves, and will in due course claim the right to compel them to do so. For if I have the right to demand a certain course of treatment, even if it is fatal, then the refusal to grant this right must come to seem immoral, and may come to be seen as something that should be illegal as well. That is where the slope becomes impossibly slippery. Suicide is only apparently a solitary act. In reality, other people are always involved both in its causes and its consequences. There are cases where people are driven to suicide by others. Even an apparently neutral attitude by the rest of society to the act can push unhappy people over the edge, which is why newspapers don’t publish details and often avoid the word itself when reporting death. To accept the argument from autonomy unexamined would vastly increase the social acceptability of suicide, and thereby increase its prevalence. It would also implicate medical professionals in the business of killing. An absolute right to die – like so many of the rights claimed by libertarians – would strengthen the position of those strong enough to assert themselves and make life worse for the relatively weak and powerless. It would bring our dying under Thatcher’s rule, that there is no such thing as society: there are only individual men and women and their families. The arguments do not break down into religious and non-religious. As we can see by the example of Lord Carey, religious beliefs shift under the pressure of circumstance and experience. Death trumps dogma. At the same time, it is possible for unbelievers to have profound and justified reservations about a change in the law. Disbelief in a benevolent God does not compel belief in the benevolence of humanity. No settlement can be perfect, and any line that the law draws – including the present one – must have deserving cases on the wrong side of it. This is perhaps the hardest thing to admit, but one of the most necessary for an adult discussion. You cannot frame a law that will wriggle like an eel around all the possible complications of the question. If we are both to protect unwanted people, and at the same time allow Tony Nicklinson’s wife to help kill him, that is only going to be achieved by judicial discretion. Everyone who has thought seriously about the problem agrees that death must be made kinder, or at least kept within the bounds of its inherent cruelty. Yet the wider problem of cruel and prolonged death is sidestepped in this debate. Hardly anyone wants to die in hospital, but more than half of us will do so. Nor will it be planned. Death in hospital is overwhelmingly associated with emergency admissions. The safeguards in the Marris bill are so stringent that it is difficult to believe they could form the basis of a workable national system. Some 500,000 people die in England and Wales every year – 15 times as many as in Oregon. If the same proportion of them choose assisted dying as have recently done so in Oregon, there could be several thousand cases a year before high court judges; several thousand extra interviews on a literal matter of life and death, each to be conducted by two psychiatrists at a time when NHS appointments are supposed to last 10 minutes. It’s hard to see it working. Such strains can only increase the pressure towards a later law more clearly based on an absolutist notion of individual autonomy. It may be that even the strongest crampons will buckle. MPs will on Friday confront a choice between two duties to protect. They have to decide which matters more. If they believe that their first obligation is to protect some of those who are weak because they are dying in anguish, then the bill should pass. But if they are more concerned about protecting those who are weak because they are no longer deemed useful to anyone, they should vote against. |