The debate around legalising assisted dying seems increasingly to centre on the case of suicide tourism; whether people should ‘have to’ travel to clinics in Switzerland where they can legally end their lives. Whilst this is undoubtedly an important trend, it is merely a side show to the real issue and masks three important facts about assisted dying.
1 – Very few people travel to Switzerland to end their lives.
In the last 10 years less than 200 people have travelled to Switzerland to end their lives. That’s quite a lot. However, it’s far fewer than the estimated 500 people who commit suicide each year due to a terminal or chronic illness. More importantly, it is completely dwarfed by the 2,000 people who receive some form of illegal assistance from a physician to end their lives each year in this country according to the most recent research. Legalising assisted dying in the UK isn’t about whether or not people have to go abroad to end their lives. It’s about whether the thousands of people who end their lives in this country do so with the protection of a sensible legal framework, or whether they are forced outside the law.
2 – The Swiss law represents an extreme point of view.
Since many people see the ‘problem’ of assisted dying as people having to travel to Switzerland to end their lives, it is easy to see the ‘solution’ as simply important Swiss law to this country. However that fails to recognise that the Swiss law surrounding assisted dying is rather extreme. Not only does it allow foreign nationals to travel to Switzerland to end their lives, but the only legal protection it offers to people receiving assistance to end their lives is that that assistance is not being provided for ‘selfish’ reasons. I for one think that is appallingly lax as it provides little if any protection for the mentally ill or those who, as Dignitas puts it, are merely ‘tired of life’. I very much hope that any UK law would ensure that assistance is only provided for the very best of reasons, such as if a person has already received a terminal diagnosis, and that a police investigation must be conducted before a person is assisted to end their life, not after they are dead. These are not features of the Swiss law, but they could be features of any new UK law.
3 – People who do assist somebody to end their lives abroad are breaking UK law.
The law against assisted dying in the UK is profoundly clear. It is illegal to ‘aid, abet, counsel or procure the suicide of another’. Anyone who has helped another person to end their lives abroad has clearly broken this law; they just haven’t done anything wrong. It is for this reason that it is not found in the public interest to prosecute people, and it’s increasingly hard to see how anyone ever would be prosecuted for breaking the law in this way. However, this seems to leave the law widely open to abuse. Anybody wishing to compel a person to end their life abroad would be breaking the law. However they may be able to count on the protection of a society that is in almost unified agreement that this law should not be enforced. The more we pretend that ‘suicide tourism’ is not a crime in this country, the more we open ourselves up to abuse by the unscrupulous. The only real protection would be a law we could accept and properly enforce.
It’s easy to see why it has become so convenient to bring up the example of Dignitas so often when debating assisted dying. However, doing so obscures too many of the crucial issues. If we want to see a real change in the law we need to change the terms of the debate.
* Simon Beard is Academic Programmes Manager at the Centre for the Study of Existential Risk and a two time PPC for Dartford. He lives in Cambridgeshire.
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32 Comments
It is nice to see arguments on this topic being made plainly and without too much heavy emotional content.
However, on the point of “breaking UK law”, there are circumstanes in which assisted dying is effectively, albeit not technically decriminalised – the DPP’s guidelines are here http://www.cps.gov.uk/news/press_releases/144_09/
I view “Being tired of life” as a perfectly reasonable reason to end it. It’s not anyone else’s life, it belongs to the person living it.
Having a mandatory waiting period, with counselling, to make sure that the person in question isn’t going through a temporary blip, seems like a reasonable level of concern for society to take. But in the end, I believe in individual self-determination.
Andrew Martin: I’m well aware of the DPPs guidlines and the effective decriminalization of assisted suicide, however it is still against the law. When we decriminalize certain offenses this can have unintended consequences for the rest of the law, and I think that here it might potentially make it very hard for a prosecution to be made for certain forms of assisted suicide, even where may be some evidence of coercion, because there is now a public expectation that people have a right to travel abroad to end their lives there.
Andrew Ducker: I’m not against your point of view. However I think this is something that we should have debate as a nation. If we just adopt Swiss law, either de jure or de re, then we important all of its features, including the fact that a person can be assisted to die when they are simply tired of life. There are lots of other laws out there and I’m just not sure this is the right one for us.
The idea that a person owns his or her life seems untenable in anything but a one-person-per-island existence. People in a society have a duty and responsibility to avoid damaging others. If I was to decide to kill myself, it would certainly damage my wife and children, it would probably kill my mother. At the very least I would need to get their agreement beforehand.
People also have a duty to avoid creating a more subtle damage in which a society becomes immunized against unpleasantness. Violence on TV is not good for impressionable people, perhaps sociologists have a technical term, but I’d say it creates a bad “atmosphere” in the culture. Widespread expectations of an exit through assisted suicide would also seem to do that.
The statement that nobody owns their own life is hardly a liberal one. Certainly we all have duties and responsibilities towards others but they also have duties and responsibilities towards us. None of that is the same as saying that they should have an absolute veto under all circumstances over when and how we die . My wife and children are in full agreement with me on this one – we would all prefer each other to have that choice should the circumstances ever arise.
A caring attitude that, in extremis, permits people to choose the time and means of their own death is hardly analogous to one that casually accepts the portrayal of violence as an integral part of its culture. Of course both can be part and parcel of a single society and, should we ever legalise assisted dying, we would be in exactly that position.
John Stuart Mill, a noted liberal, argued for what is now known as the Harm Principle, that the actions of individuals should (only) be limited to prevent harm to other individuals.
This principle is very fundamental, underlying many others – for example, it is demonstrably true that the suppression of freedom of speech causes damage to people because the way human beings are made is such that speech is a way we develop, make progress, enjoy interaction, and resolve psychoses.
On this basis, if my suicide were to harm others, there would be a valid liberal reason for preventing me from doing it.
http://en.wikipedia.org/wiki/John_Stuart_Mill
That’s not so clear. For instance, I might have a neighbor who has taken an intense dislike to me. That dislike might be so intense so as to cause him (or her) severe psychological distress every time he (or she) sees me. Could my neighbor demand that I be forbidden from walking where he can see me, or perhaps even from going out of my residence at all? Could he require me to move, or to quit the country?
Probably not, because we balance various “harms”. There are several reasons why my neighbor’s self-perceived harm should not be used to dictate my movements. First, because of the harm it would do to me; second, because of the greater harm that would be done if such a rule were universally generalized; third, because of the potential for abuse, whereby a tender concern for one person’s wounded feelings becomes an instrument for controlling the lives of others.
Harm is not easy to either qualify or quantify, which makes weighing the possible harms of an action, in their infinite variety and complexity (who and how many are harmed? what is the nature and severity of the harm? is the harm immediate or something that will only appear after a time, and do we know that for certain or only guess it?) a very difficult task, subject to personal judgments varying by knowledge and experience, and also very much subject to bias and prejudice.
The Harm Principle is perfectly clear. It is what distinguishes liberalism from selfishness. It is also what allows liberalism to exist, because without it others might fear liberalism so much as to extinguish it.
In the case of competing harms, the principle would be consistent with one of Harm Minimization. If your neighbour is so upset by your presence as to be positively harmed by it, then there might indeed be an argument that you or your neighbour move.
It is certainly possible to quantify harm. In some cases we do it through laws, for instance the law that allows a person to be jailed for theft, for terms that vary with the value of what is stolen. Theft has been considered to be a harm that can be evaluated by a judge. In some cases, harm is judged by parliament or by precedent, and quantified through rules that judges apply to determine damages. In other cases, harm is quantified by negotiation – such as a negotiation between neighbours.
I agree that the assessment of harm can be affected by bias, prejudice, and personality. One of the benefits of freedom of speech and communication is that these things can be pointed out, and so hopefully avoided.
Then you’ll admit that it’s possible that the harm which might accrue to an individual who is forced not to commit suicide could be judged greater than the harm which could befall this individual’s relatives and intimates. Or, conversely, you could argue that suicide is a greater harm than any possible alternative, including a lingering, painful, expensive illness and death.
Who is supposed to judge the relative merits and demerits of these cases? I certainly couldn’t. All I know is my own emotional reality, which in reference to this question amounts to two things: (1) I think suicide, assisted or otherwise, is “squicky”, and certainly something which I have trouble even imagining; (2) I think that taking away an individual’s freedom to do as he or she likes with that most personal of possessions, one’s own body, is an offense to liberty and only justified in the most extreme of cases. All of which leaves me no closer to a well-defined opinion than before.
The Harm Principle is a fundamental tenet of liberalism, and implies that society’s demands trump those of the individual. This suggests that liberals believe that society is the final judge of what is harm, and of how harmful something is.
Society implements this responsibility most obviously through its justice system, but also, less obviously, through its medical and religious systems. In respect of assisted suicide, the legal opinion seems to have been given in cases like that of Diane Pretty. The ability of medical science to provide drugs to mitigate pain suggests that the balance has moved in favour of life and away from suicide.
I suggest that another implication of the Harm Principle would be that a law is not needed unless there is a harm being done, now or imminently, that the law can prevent.
Just a moment. Do you really think that “society’s demands trump those of the individual” is a fundamental principle of liberalism? I don’t want to misquote you, so please confirm that that’s what you meant to say.
Think about the Harm Principle. It says that the demands of society – in the form of people’s demands not to be harmed – trump those of an individual whose actions would harm those people.
@Simon Beard. Thank you for clarifying the present legal position. I also like your title: ” … it’s not all about Switzerland you know … ”
Assisted dying is presently legal in four European countries – Netherlands, Belgium, Luxembourg and Switzerland.
A Bangor University poll conducted last year placed support in Britain at 71%.
Based on a study carried out on behalf of the Swiss Medical Lawyers Association, support for assisted appears to be reasonably strong across the countries included (Austria, Britain, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Portugal, Spain and Sweden). Greece is apparently the least supportive with ‘only’ 56% being open to considering it.
The topic of a change in the law is under discussion in France and Germany.
So the question appears to be do we start to discuss this rationally including the need for many vital safeguards the majority of us would seek in any change in the law or do we allow a very vocal minority to essentially block even any consideration of the majority wish.
Speaking of the very vocal – Richard Dean has a history of absolute and total opposition on this topic and, when it was raised by Eric Avebury on January 15th, part of one of Mr Dean’s many posts was, “ … Avebury isn’t incapacitated. he can starve himself to death right now if he wants to. If he can’t bring himself to do that, then he has made a very clear choice to live. I like his choice. He’s pretty good at inventing interesting impossible situations to discuss about! …”.
How compassionate.
I wonder if I am detecting another “liberal” characteristic here – “I have no rational arguments against yours, therefore you are a bad person” ? Dissonance theory?
Dear Richard – I was attempting to use independent facts (rather than opinion) to show that it is a widespread desire across much of western Europe to properly discuss this matter. I have frequently read and supported others of your posts (= I don’t think you are a bad person) but on this topic, your position is that ‘your’ view is the one that must prevail over the 71% of the general population who would appear to desire their wishes on this topic to be taken seriously.
As they effect individuals, some of your postings on this topic have boiled do to – it doesn’t matter what you think, your life does not belong to you anyway/if you don’t like it you don’t need to eat/drink.
Sorry, psychology is not my area of expertise but perhaps you might enlighten us further on the ‘liberal’ characteristic of attempting to reduce the contradictions between ones thoughts and behaviours – sounds dangerous stuff to me – though not quite as bad perhaps as that other Liberal weakness, that of attempting to find a balance between the needs of the few and those of the many.
I am going back to tiling the bathroom now but will give some genuine thought (no, really) to your ‘Dissonance’ comments while undertaking this task and the pyschological discomfort and delusional benefits derived from it. Kind regards.
Hello Stephen. My position is that I am entitled to state and argue my view. Stating and arguing a view implies nothing about numbers of people who agree or disagree with it or anything else. My arguments are arguments. They are sometimes thought long and sometimes thought short, but never like-it-or-lump-it assertions. As it happens, I polished my rhinoceros skin today, and varnished half a door for a relative. It looks nice, and I hope and trust that your tiles do too!
I lost sight of this thread a few days back, but I simply wanted to state that I have never before heard “society’s demands trump those of the individual” given as a fundamental liberal principle before, and I should have said that a really fundamental liberal principle was that individuals have at least some irreducible rights which “society”, in the form of a system of laws and administration, is bound to maintain and protect against whatever demands some transient majority of “society” might attempt to ask of them. In fact this principle is, I believe, so fundamental that it pre-dates Liberalism and goes right back to the Whigs.
Hello Richard
Re your thoughts concerning freedom of speech, I am sure every contributor here agrees with you.
Various contributors, myself included, have asserted that the life of a person belongs to that particular individual, not exclusively, not to the complete detriment of others but certainly more than it does to say judges, doctors, priests, politicians etc. The law, medical science, political policies are all in a constant state of flux. Religious beliefs also change – you only need look at the early Christians and compare them with their early medieval Catholic counterparts or with today’s multi-denominational Church (apologies to those of other beliefs!).
All things change and, in human societies in particular, change is inevitable. We just need to ensure it is progressive.
Fellow Liberal Democrats enlightening each other on this topic is the best way for us and wider society to reach balanced policies through which to ensure the temporarily despairing or longer term vulnerable are never victims of what seeks to be a positive, empowering and compassionate policy.
In the Eric Avebury thread, one contributor who opposed assisted dying mentioned the possible use of legal highs. To me that actually sounded like a promising idea for further discussion. Pain is not exclusively physical.
I do understand your views to be deeply held but opponents standing at the approach to a cross roads telling us it is a dead end will not convince those who can clearly see more than one route ahead. The crucial task is surely selecting the correct turning for the right reasons.
Touching on the libertarian point made by David and myself, it may be of course that you are not a mainstream Liberal Democrat and that you see yourself more as a 19th Century Liberal … we do benefit from the regular insights from JediBeeftrix etc. The other alternative is that you are a rock-solid Liberal Democrat whose views are equally informed by a deep religious faith. I know this is slightly thin ice but I feel able to mention faith being as you raised questions as to my deeper mental motives!
The tiling is rewarding but painfully slow – so not unlike this thread! Regarding you polishing your rhinoceros skin, I’m surprised you had time to fit anything else in
Richard – what came out as a question mark at the end of my last post was in fact a smiley whenit was inserted! Stephen.
Crossroads my ***! Do I detect another characteristic LibDem tactic ? “You are entitled to your view, but other people have other views, therefore you are wrong”. Bertrand Russell would surely have been proud of that one.
There was neither a smiley nor a question mark – another LibDem trick to make me think I’m mad? A nice smiley is made by a colon followed by a dash followed by a closing bracket, ie : followed by – followed by ), so 🙂 I hope!
Societies do not permit individuals to do anything at all without the society’s implicit or explicit consent.
Being conceived is restricted in many societies, through encouragement of contraception. Being born is restricted in some societies where particular traits are less favoured, such as the trait of being female or being medically “imperfect” in some way.
Every communication to a person is done in a language which is determined by society, whose grammar guides that person’s thinking in certain directions and away from other directions, and which can limit the way a person can express any demands they may have.
Every choice that a person makes has consequences that society determines. A choice to play truant from school has consequent career damage, while a choice to sit orderly in class can lead to riches in a society which has determined, without the individual’s consent, that cleverness shall be rewarded.
The laws and norms of a society trump any desires of individuals that do not comply with those laws. Society will remove some or all of your freedoms if you steal, or if you damage property or people, including in some societies removing your freedom to stay alive.
In the UK, suicide used to be illegal. UK society did not allow individuals to do it. That changed with the Suicide Act. That act meant that society had determined that it had the right to decide whether to allow individuals to commit suicide. Society trumped the individual, but in this case explicitly permitted the act.
So it is clear, a society does not permit individuals to do anything at all without its implicit or explicit consent. Its demands always trump the individual’s demands!
Richard
I must admit one thing isn’t quite clear to me. Are you still pretending to be a liberal or not?
Chris,
Who or what I am is irrelevant to an argument about principles.
What is absolutely clear is the Harm Principle, which I understand is a fundamental liberal principle, asserts that society’s demands, for people not to be harmed, override an individual’s desires if those desires would result in people being harmed. Who decides whether principles should be applied to limit the actions of individuals? Society does! Who decides what the limits of application of those principles should be? Society does! The individual has decision-making power only in so far as the individual is one of the members of society.
So it’s pretty clear, liberals assert fundamentally that society’s rules take precedence over the individual’s desires. That assertion is what allows liberals to accept the Harm Principle. Of course in many situations society allows individuals to do what they want, but society always always retains for itself the right to regulate. No liberal would surrender that right, because being a liberal is quite different from being an anarchist.
It is striking that the way Richard frames “The Harm Principle” is precisely the opposite of the way it was framed by Mill. Mill approached it from the point of view of maximizing the individual’s freedom in or against society: he says that society has no other interest in controlling the individual other than to prevent harm to others. Richard stands this on its head, and makes it a statement of the extent of the rights of society against the individual, saying that “society” may do anything it pleases to restrict the freedom of the individual if it thinks it might cause harm to the same society. These two approaches are not the same, and can result in very different judgments. They do, however, point out a certain essential ambiguity in the “principle”: it offers no clear way of adjudicating between “the individual” and “society” which might not end up being grossly prejudicial to one or the other. Neither case is merely academic: the United States of America is one place where individual rights have often been cited as a justification for acts plainly injurious to society (like the “right” to engage in racial discrimination); the Soviet Union likewise frequently cited the protection of the common good of society as a reason for severely limiting individual rights. More modern examples can be cited as well.
I think that while the original “harm principle” is a good place to start a discussion about the place of rights in an ethical system, its essential ambiguities do not make it a good place to end one. I would therefore hesitate to call it “fundamental”. I think it is no better, as a starting place for a political-ethical discussion than, say, “do unto others as you would have them do unto you” or “the greatest good for the greatest number”.
I am certainly thankful for the enlightenment about Mill and the way he approached the Harm Principle, as well as the interesting information about its application in the US and the Soviet Union. I agree that the Principle is a statement of some limits to which society should go, AND of some limits to which individuals should go. I see no ambiguity in the AND, but I see a big ambiguity in the question of who should decide what “harm” is?
I disagree with Mill in one other respect – society surely has an interest in socialising individuals to an extent much greater than Mill seems to suggest? For example, education provides individuals, not only with facts, but with disciplined ways of processing information, and the ability for individuals to process well makes society better for everyone. So, education has aspects of control, but also aspects of liberation and mutual benefit.
Similarly , the working week is very strongly controlled for most people – that control helps to generate wealth, and is normally outside the purview of the Harm Principle. But it mostly prevents most people from experiencing processes of relaxation that last more than a weekend, and for some people this prevention is a harm. Society invents new concepts for people who need significantly longer periods of recovery – dropouts, nervous breakdowns, etc.. The working week and the invented concepts are ways that society controls our thinking and our desires, and these controls seem to be way outside Mill’s thinking.
In a logical system, would we not start from something that is fundamental, and deduce its consequences? So if we start with the Harm Principle, isn’t it that principle that is fundamental? I suppose it depends whether we are trying to analyse something or trying to synthesize something. I guess Mill was trying to synthesize – to start from some simple principles and end with a system of living in society.
Well, so much for insomnia. While ambiguities are problematic, inconsistencies are probably worse, so I feel that, if we start with the Harm Principle, then we should not end with something that is inconsistent with it.
Good evening Richard. Can I ask a very simple question – IF it were possible to draw up legislation that safeguarded people of EVERY vulnerability, would you be willing to allow those of us with a long-term stated/written belief in assisted dying to have the OPTION of an assisted death available to us as the end of our natural life was approached?
Another LibDem trick – the Hypothetical Question Ploy? If we lived in an idealized world, would you …?
In the real world, it is the individuals with that stated belief who become the vulnerable. In the real world, if some people are allowed to experience a process, others can be attracted to it too, just because it exists. In the real world, “wanting” is something that society controls to a huge extent, and the control is in part achieved through permissions and expectations. In the real world, rule about dying can cause harm to the living.
Pain is real, and helpful, and its absence isn’t. The HQ Ploy assumes an artificial world that does not exist, and never will. Having never experienced such a world, with my preference and love for the real, and with my knowledge that has been defined only by the real world , I have no means of knowing what I would do in an artificial one!
🙂
@Chris “Richard, I must admit one thing isn’t quite clear to me. Are you still pretending to be a liberal or not?”
I think we have the answer to your question – Mr Richard “Pain is real, and helpful, and its absence isn’t” Dean is surely not liberal or a Liberal Democrat.
“Who or what I am is irrelevant to an argument about principles.”
It’s just that on another thread I noticed you using the word “we” with reference to the party, which suggested you were either a member or a committed supporter. On the other hand a lot of the other things you say – such as”Another LibDem trick” above – suggest the opposite. I think it would be helpful if you could clarify where you’re coming from.
Ok, Stephen, I admit it, I have paid my LibDem dues. 🙁 What relevance does that have to anything?
Alex Carlile has produced a forceful critique of several claims I make in this article, which can be found here – https://www.libdemvoice.org/lord-carlile-writesexamining-the-evidence-on-assisted-suicide-33105.html
This is ill imformed bit of research, those returning home from helping someone to die is not subject to prosecution under the DPP guidelines 2010. Such as Dr Anne Turner, her children haven’t been prosecuted. Debbie Purdy is the one who made sure these guidelines were released to make sure her husband Omar wouldn’t be prosectued on his return. I suggest that next time you write about such a sensative topic, you should get your research right and use more tact.