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Legalise assisted suicide, for pity's sake

Mary Warnock October 19 2008

The death of Daniel James, the 23-year-old rugby player who visited a Swiss euthanasia clinic last month, is the most appalling burden his parents will ever have to bear, whether or not they are prosecuted, and whether or not they are sent to prison for what they did on his behalf.

They decided to believe him when he said that after he was paralysed in a scrum his life was of no value to him, and that he would prefer death. It was not a sudden decision but one taken over many months, during which he had shown, by attempting suicide, that he was in deadly earnest. They made a deliberate moral choice, and carried it out in what must have been an agonising journey to Switzerland. Their courage has been enormous; but it would be hard to deny that they acted unlawfully.

Not everyone faced with the life that Daniel James foresaw for himself would react in the same way. There are many stories of young people suffering similar injuries who have decided that their lives are still worth living, however limited their physical powers. But there are others who cannot stand the thought of forever being completely dependent on others, however loving. In their eyes, life in itself is not valuable, only the freedom and enjoyment that life gives. Daniel James had time to decide that without such freedom death would be better. It was this decision that his parents respected, allowing him his final freedom to choose.

This case, coming so soon after the test case brought by Debbie Purdy, is bound itself to become a test case.

If Mr and Mrs James are not prosecuted, though the evidence against them is crystal clear, it will seem that, though assisting someone to die is a crime if the death occurs in this country, it is permissible if the death occurs in a country whose laws permit it. There are three ways to interpret this.

First, it may suggest that assisting someone to die is not intrinsically wrong, but only contrary to the law, like driving on the right in the UK. Alternatively, it may suggest that we have moral scruples about assisted dying but are prepared to turn a blind eye if it is not in our back yard. Or, we may seem to be saying: 'We have failed to find a way to legislate to permit assisted dying that is not subject to abuse. If other countries have succeeded, let us take advantage of their laws.'

If the prosecution proceeds but the accused are not convicted, or are bound over, then the question will be whether the law will ever be fully implemented. And as it becomes plain that it will not, so it will be increasingly disregarded, though family members or doctors will remain in a state of uncertainty when they disregard it. This was the position in the Netherlands between 1973 and 2002, when doctors openly provided assistance to die in cases of acute suffering and generally escaped prosecution on a plea of 'necessity', where the duty to relieve suffering outweighed the usual duty to preserve life. In 2002, the law was changed so that assisting death in certain specified circumstances was no longer a crime, and the uncertainty was brought to an end. But before the change in the law, public opinion would have made it hard to secure a conviction in court. A jury is unwilling to convict where the prisoner seems to face an unjust penalty.

The case of Mr and Mrs James, like that of Debbie Purdy, thus presents a legal dilemma. Whether or not they are prosecuted, the law will be challenged. There are many, of whom I am one, who believe that we must try yet again to change the law, not by excluding from criminality those who assist death by taking the suicide abroad but by liberalising the laws of our own country. One argument is that it would be unjust if only the relatively wealthy could lawfully be assisted to die. But the more crucial argument is this: we have a moral obligation to take other people's seriously reached decisions with regard to their own lives equally seriously, not putting our judgment of the value of their life above theirs. Mr and Mrs James have sadly and dramatically carried out this moral obligation.

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Baroness Warnock: Euthanasia abroad would mean a 'two-tier death service’
Lucy Bannerman October 4, 2008

Baroness Warnock was opposed to euthanasia until her husband's doctor helped him to die painlessly in 1995

Baroness Warnock, Britain’s leading expert on medical ethics and a vocal supporter of euthanasia, has said that it would be wrong to give immunity from prosecution to relatives who help terminally ill patients to die abroad.

Lady Warnock, 84, who recently provoked an outcry when she said that people suffering from dementia should be allowed to end their lives for the greater good, said that unless the ban on assisted suicides was also lifted in Britain, such a move would lead to a “two-tier death service”.

“It would seem to me to be a blatant abuse to say we are going to allow for assisted suicide abroad but not in our own backyard,” she told The Times.

Lady Warnock was commenting in the wake of the High Court case brought by Debbie Purdy, who had primary progressive MS diagnosed in 1995, and who is now confined to a wheelchair. Ms Purdy, 45, has said that when her condition becomes unbearable she hopes to end her life at a clinic in Switzerland or Belgium where assisted suicide is legal, but wants to know whether her husband will be prosecuted if he helps her.

Dignitas, a Swiss charity that helps to organise assisted suicides, claims that more than 100 Britons have travelled to Switzerland without anyone being prosecuted. However, Ms Purdy says that it is not enough for British authorities to appear to be turning a blind eye; she wants the Crown Prosecution Service to clarify its position.

The High Court reserved its judgment on her case yesterday.

But in a surprise intervention yesterday, Lady Warnock – who has long advocated that euthanasia be legalised in Britain – said it would be a “mistake to change the law to guarantee immunity from prosecution” in such cases because it would be “inconsistent to say we allow it abroad but not here”.

She said that such a move would be unfair because “only those who can afford it can take this particular way out. People talk about a two-tier health service – this would be a two-tier death service.” She added that there was a risk that if people had to travel abroad to end their lives “they have got to pick a time where they are actually fit to travel so they probably die earlier than they need to”.

Lady Warnock, a life peer who in the 1980s chaired an inquiry into the ethical issues surrounding IVF, also defended her recent suggestion that people with Alzheimer’s and other forms of dementia should be helped to end their lives if they felt that they were becoming a burden to their family and to the NHS.

“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,” she said.

“I’m fully in agreement with the argument that if pain is insufferable, then someone should be given help to die, but I feel there’s a wider argument that if somebody 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.”

Lady Warnock, who outlines her argument in an article called “A Duty to Die” to be published in a Norwegian medical journal, added: “It seems to me that we all know we are mortal, but I think now with the increasing number of old people, we have got to face the consequences of that. And I think we have been quite slow to do that with Alzheimer’s.

“With 700,000 people suffering, it really is a problem that has got to be faced. The fact is we have to take a fairly unsentimental view. Care may get better, but if so, at huge cost. There’s no point saying we ought to spend more, because we can’t.

“People talk about it as if the only respectable motive for wanting to die is for your own sake. But it seems to me just as respectable to want to die partly for the sake of others, and for the sake of society.”

Lady Warnock insisted that she was not suggesting that severely disabled people should be encouraged to end their lives. “There are dozens of [disabled] people I know who do contribute an enormous amount, and enjoy life . . . Of course, these people should not be put in any way of risk. It is entirely dependent on quality of life.”

Take, for example, she said, someone in the later stages of dementia “who has no pleasure in their lives”.

“If society has an obligation to look after them, I really want to know what for? For whose benefit? It’s not for the benefit of society, as the person is not in a position to contribute, and it’s not for the benefit of the person, so it must be something abstract about our being unable to bear saying ‘We can’t do this any longer’.

“If I were in a state of acute misery or pain, or an insufferable degree of dependency, I don’t see why I should feel an obligation to others to let them keep on changing my nappies.

“It sounds very callous, but most people I know dread being kept alive in a state of mental incapacity, more than cancer or anything else. If so, then I don’t see why society should force them to go through with something they fear the most.

“People often argue that if it becomes legally permissible to end one’s own life, or to be helped to end one’s own life, then people will begin to feel that not only should they be allowed, they ought to. Then they argue these people are under coercion.

“But I don’t follow that argument, because the kind of people who are most likely to not want to be a burden to the NHS are the kind of people who have never wanted to be a burden or dependent on the community. So the decision will be just a culmination of the way they have lived their lives.”

Asked if this might be an invitation for inheritance-hungry relatives to bully the vulnerable into seeking an early death, Lady Warnock conceded: “There may be people who are bullied into asking for death because they have been persuaded it is their duty.” However, she said: “Anything can be abused. The fact that something might be abused is not an argument or else we would never develop certain drugs, we would never get anywhere . . . One has got to have some trust in the motivations of people.”

However, as a safeguard she proposed independent arbiters to question the motives of anyone wanting to end their lives.

“This is why any advance decision to seek assisted death when the time comes needs to be formalised, a statement witnessed and, if necessary, the patient questioned by an impartial nonfamily member, perhaps a psychiatrist, to determine whether he or she is acting under undue pressure.”

She also recommended that dementia sufferers make living wills, or advance directives, appointing a trustworthy third party, such as a relative or medical professional, to decide exactly when their time should come as their condition deteriorates.

Lady Warnock’s conversion to the cause of euthanasia came late. She sat on a Lords select committee that agreed on a ban on euthanasia in 1993. But later she publicly defended the GP who helped her own husband to die in 1995 two years after he developed a terminal lung disease.

“He had a horror of suffocation,” she recalled. “We had a very sympathetic GP who promised him this wouldn’t happen. What happened next is veiled in mystery. He promised that Geoffrey would not suffer and adapted the dosage of morphine.”

Now a grandmother of seven, with one great-grandchild, Lady Warnock said that she had prepared a document in readiness for her own death. “It is not very satisfactory, but it is all I’m entitled to. It says that if I contract pneumonia, I cannot be given antibiotics or artificial hydration or nutrition, no intrusive treatment, that would keep me alive for longer.

“It doesn’t really serve what I would most like it to cover, which is to avoid being a helpless zombie.”

Warnock in her own words
On dying dutifully
“During life, a person will have been admired if he really wanted to do his duty, or to do what he regarded as in the best interests of his family, his community or his country. He will have been thought well of for not always preferring his own interests to those of others. Why, then, when he has reached the end of what he may regard as his useful life, may he not be allowed to do what he thinks is in the best interests of those he loves, or impersonally, in the best interests of the State, which is expensively caring for him? Why may not someone who has always really wanted to behave well be recognised and admired in continuing that desire, in asking for death?”

On the death of her father, Archie, a housemaster at Winchester College, and an elder brother, before she was born
“When I think back to my childhood, death had no emotional meaning at the time. It was just a fact of life. There were siblings that I never knew. I did think it was sad. But mostly, if I got an overwhelming desire to laugh in school prayers, I would use it to try to sober myself up. It wasn’t anything emotional. That was the way life was. I was never confronted with mourning somebody’s death until much later when my friends died.”

On her role as a philosopher provocateur
“I think of myself as a raiser of moral questions, as someone who tries to think of difficult issues dispassionately, and help others distinguish between what is a gut reaction and what can be justified rationally. I have no claim to see things more clearly. But I do think I can explain myself clearly, and help people see all sides of the question.”

On a GP assisting the death of her terminally ill husband
It was just a sort of trust he had in his doctor. That it wouldn’t be allowed to get too terrible. A lot of people say, ‘But you will make it all right?’ By that, they don’t mean a cure. I think that this unspoken trust is very important. Now it is always assumed that people want to live as long as possible . . . It used to be true that GPs did hasten the deaths of their patients. I know my father-in-law [a GP in Leeds] used to tell us stories how he had helped an aged patient or neonate to die”

See also
Elderly people with dementia waste the lives of others
The right to choose death
The Ethics of Euthanasia


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