The dam’s about to burst on the right to die – but politicians and administrators are either fearful or have their hands tied, or both.

David Aaronovich opines in the Times 28th May 2015: The dam’s about to burst on the right to die

The official line is contrary to David’s and NHSreality’s opinion, but in this respect the politicians are following rather than leading. It’s really the same reasoning as for NHS rationing. They fear more votes to be lost by having an honest debate… than won by supporting change. Whether it’s facilitating a good death and patient autonomy and choice, or fostering these beliefs with regard to the Welsh Health service as a whole, our politicians and administrators are either fearful or have their hands tied, or both. Meanwhile inequalities increase, as those with the means and the information take advantage of a foreign service…

As with abortion and divorce, politicians are terrified of letting us make our own decisions. Make no mistake, change is coming

The water is rising and pressing and this dam too will break; in my lifetime we will achieve a “right to die”. If I wasn’t certain of it before the suicide of Jeffrey Spector this week in Switzerland, I am now. Where once the reaction to his decision to go to the Dignitas clinic might have been uncomprehending, horrified even (he was not ancient, nor was he terminally ill, and — like me — had three beautiful daughters), it has in fact been understanding and sympathetic.

Jeffrey Spector is me and he is almost every single person I have spoken to in recent months about how they envisage their own deaths. Just the day before the photographs appeared of Mr Spector’s “last supper” I met an old friend walking down the sunny road in Hay-on-Wye. I can’t remember how we got on to the subject — absent friends, I suppose — but we began discussing old age and then, almost inevitably, what we would consider the minimum standard of life worth sticking around for. It was an abstract discussion, of course, and we both knew that we might change our minds when faced with the reality of incapacity or misery. But at the heart of it was one simple proposition: we wanted the right — and hoped for the ability — to be able to decide for ourselves.

The water is rising. There is a fissure, a disconnect between the law and what a growing number of people regard as their own most basic fundamental right — to decide how, optimally, to leave this life. This fissure also divides the ordinary, moral person from those religious and secular figures supposedly leading any discussion on ethics and morality.

Put in the most simple terms, they fear our use of our own discretion about dying. They do not trust us to do the right thing. They are scared — as they almost always are — about the consequences of an extension of our personal autonomy.

It was this way on divorce. On women’s marital rights. As late as 1984 the Criminal Law Revision Committee (the forerunner of the Law Commission) was arguing against the idea that a married woman had the right not to have sex with her husband.

Up to 1967 women who found themselves to be pregnant had no right to decide on a termination. In 2010, after 50 years of struggle for gay rights, the Labour equalities minister, Harriet Harman, was not prepared to risk supporting gay marriage. It was, she said, “a developing area”. Within four years the first gay couples in Britain were legally wed.

And now they will be in Ireland following last week’s vote, yet the irony there is that women may not enjoy the physical autonomy that a gay man may. Abortion is severely restricted — even the latest law provides a right to a termination only where a woman’s life can be shown to be at risk. One result, of course, is the constant flow of young Irish women to Britain for terminations, their numbers a statistical representation of Irish social hypocrisy.

Which is exactly what Jeffrey Spector was for us — a representation of our hypocrisy. Our law will not be enforced to the extent of stopping him going to Switzerland or prosecuting those who helped him get there, and no one is seeking new laws to criminalise the Swiss citizens who provided the means. Instead we wash our legal hands of him. It was in Switzerland, there’s nothing we need to do. Not us, guv.

Mr Spector’s family issued a gentle statement. “While this was a difficult and painful time,” it said, “as a family we supported and respected his decision 100 per cent.” Ask yourself this question: if his family respected his decision, why wouldn’t the law? Who was affected more than they? Who had greater right to complain?

There are several arguments used against any move, however minimal, towards a right to die. And of course, as with abortion, divorce, gay rights and any other extension of autonomy, there will be some unwanted consequences. Even so, these arguments need dispatching for the bad logic and poor morality that they contain.

I will spend no more time on the dishonest “better palliative care, not killing people” trope than to point out that no such binary choice exists. In fact I am reasonably certain that a demand for better palliative care would be one result of a system where people thought harder about how they wanted to end their lives.

Then there’s the “bad relatives will elbow their elderly family members towards the exit” argument. Maybe a few will. Maybe a few already do. But we can frame laws about that, and in any case that putative danger cannot override the concrete right of the majority to ownership of their own lives.

Finally there’s the “burden” argument. This word is, I think, a sincere mental roadblock laid down in front of synaptic traffic. It seems to mean one thing but in fact connotes another. If I say I do not want to be a burden, I mean “I may not wish to be a person who — whatever the moral character it supposedly builds in others — has to have his faeces cleaned from him twice a day.” It is the effect on me (not just on the burdened) of being the burden that is intolerable. It isn’t how I wish to live.

This is not a column about the law, but about the principle. Yet it illustrates my point that Mr Spector would not have qualified for an assisted suicide in this country even under Lord Falconer’s Assisted Dying Bill, whose uncertain progress was interrupted by the election. In fact that bill as now amended resembles nothing so much as the latest Irish abortion law. You have to be practically dead already before you can be allowed to die.

No, I’m talking not about assisted dying, but about the right to die. If I feel my life is not worth living, and I can demonstrate that this is my settled will and not some whim, and if it seems reasonable to suppose that I will not change my mind or that my circumstances will not alter radically, then I must (and eventually will) have the right to do it. And if doctors are unwilling to help, as many were over abortion, then hopefully there will be a cadre who — wanting the same rights for themselves — will assist.

Mr Spector haunts me. “I am a proud person,” he wrote, “a dignified person, independent and self-motivated. It is me who is doing this.” Amen, Jeffrey. The sound you hear is not just weeping; it is the dam creaking.

 

This entry was posted in A Personal View, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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