In discussion so far about legislation proposed in the UK, I find that people are more swayed by opinion and sound bites than facts. They come up with that thing about “you wouldn’t let a dog die like that…so why would you let a human?”. The answer is that insofar as they are like humans, or like family, we do everything in our power to keep companion animals alive, and don’t put them down when there’s still some life in them. They are a bit like beloved children. Precious race horses get shot on the ground if they break a leg, and gorgeous greyhounds get exterminated when they can’t race any more. That’s not about being humane. That’s because they are not worth saving because they are a commercial drain if they can’t race. It’s more like farming than having a companion animal. So when someone says, “You wouldn’t let a dog die,” I have to reply that it depends on the dog, and whether it is worth keeping. And remind people that for humans, we work on the assumption that it doesn’t depend on the human, because we are all worth keeping. And if someone says there are some people not worth keeping, that’s a different story. But let’s be honest about it and not try to pretend assisted suicide is like what they do for a dog.
When we talk about the worth of a particular medicine or procedure for some people we don’t say, “It’s worth it for him because he’s young and has a contribution to make, but not for her because she’s had her life and got six grandchildren.” What we talk about is the value to each of them as a human. It’s not worth it for him because it will have horrible side effects and extend his life for no more than a month, but it is worth it for her because she’ll get back to normal after the side effects and have years of good quality life. We talk about quality adjusted life years (QALYs) as a unit to express that balance of risk and benefit. When the benefit is minimal we can stop treatment, or refuse it, and keep people comfortable. We don’t need new laws for that.
There’s quite a complex story there involving some sleight of hand. People who want to change the law have said it is to create certainty for people who don’t want to risk going to jail for “helping someone ‘out’ themselves”. Most of those who are commenting are assuming that the legislation is to stop people dying in pain. Did you notice the “switch”? But even if that’s the motivation, mostly people don’t die in pain and it is not legislation that is needed to stop it. It is medicine and nursing care. Which is to say that even with new legislation people who don’t get access to good palliative care could die in agony. It’s a deliberately created muddle.
Why do people think it is highly likely that they will be kept alive and in agony near the end of life? It’s because there are some well publicised anecdotes where it has happened. And why does a celebrity with lung cancer campaign for assisted suicide? It’s because campaigning is the thing that gave meaning to her life, and this is the only campaign that she can do right now that will capture attention. She is throwing herself in to the mix for one last big show. I have huge compassion for her, but she’s not going to have to live in a society that is dealing with the aftermath. And I’d rather she was using her dying breath to campaign for more funding for hospices. She has the rich pals and the contacts. The aftermath she will not see is likely to resemble the situation in Canada and the Netherlands where some shocking changes have crept in as a result of court decisions that loosen up the criteria for helping people to kill themselves - just a little bit here and there. Less about deathbed agony and more about people being made aware that they are no longer economically productive.
If you’ve ever been in such pain that you think you might die, and then you pray you will die, and shout out for it, you know what I’m talking about. I’ve had pancreatitis. That was very, very bad. Assisted dying legislation was not going to get me out of that, but I’d have accepted a bullet. Then I got better with some morphine and other stuff. I’m glad they didn’t shoot me when I was asking for it.
So what about dementia? I spend a lot of time with carers of people with dementia whose lives are made very tough by their loved one. They sometimes mention that life will be better when the person dies. Different carers have different levels of tolerance. One man couldn’t stand it when his wife made slip ups at the table in posh company. One woman put up with her husband long after he wouldn’t come out of the house at all, was aggressive and didn’t even know her name. One daughter says her dad is so happy now in his care home with good food, and entertainment and people to listen to his stories, but her brother says that he’s an empty shell living in limbo who makes him shudder to look at. Will families, however subtly, persuade people to suicide at an early stage before they start to drop their food or have to move into care? It’s horrible to consider, but it’s exactly what’s happening in the Netherlands. And if there are carers who have a low tolerance for even observing or living alongside the weaknesses that a person with dementia shows, I am not persuaded that they will be able to resist exerting the imperceptible pressure that would lead an older person to believe that it was for the best, and their own wish, that they take their lives.
To be clear, if someone else unknown to me takes their life it is not my business. If I am near them and witnessing it I would try to stop them. I’m not a “right to life” campaigner and believe in a woman’s right to terminate her pregnancy. But I just don’t understand why any government would regard it as their duty to make doctors, nurses, and pharmacists entitled to give adults help to suicide. The more people know about it and how it is done and how it works in other countries, the less they like it.
