When Lord Falconer put forward his Assisted Dying Bill, I had no idea it would generate so much interest. Similar bills have gone before the Lords before, and similar bills have failed, by a wide margin.
However, this bill is gathering a remarkable head of steam ahead of its second reading in the Lords this Friday, 18th July .
The Church of England’s General Synod’s decision to reject the bill and call for a Royal Commission is reasonably predictable, but it’s becoming clear that opposition to the bill is far from universal among faith group leaders. Support from Desmond Tutu and Rabbi Jonathan Romaine, both deeply liberal as well as respected, is very welcome, but Lord Carey’s conversion comes as a bit of a shock, and now the Bishop of Buckingham has become the first serving CofE bishop to declare his support.
The CofE has only just embracing women bishops – hooray – and we cannot expect it and other more conservative faith institutions to move too far, too fast on another equally fundamental traditional position such as this; but the Church is clearly beginning to shift.
Across society as a whole, there is, I believe, a far greater understanding of the need for reform than there was a decade ago.
For those who believe in a deity, the “sanctity of life” argument is increasingly tempered by recognition that using all the available medical technology to keep wretchedly unhappy and terminally ill people alive regardless of their wishes and their suffering may be frustrating rather than expressing a divine purpose.
For many of us, regardless of our beliefs, the sheer callous cruelty of forcing continued life on a person who may be suffering unending physical and psychological torment is the overriding concern. We cannot imagine what it must be like to know that one is close to death, that there is little or no joy to be had from life and no hope of change but only the certainty that one’s agony will be prolonged by others for as long as possible. If we truly care about someone, how can force on them continued suffering that we cannot ourselves imagine?
Of course, we have to protect those who cannot protect themselves, from being “helped on their way” against their wishes, or who may be put under pressure not to “be a burden” on their relatives. Nobody should be allowed to die for the convenience of others. The right to die is meaningless unless the right to life is protected.
And yet, current law is grossly inadequate. There is no closely regulated and monitored process whereby a terminally ill person may document their firm decision not to continue with life, taken after counselling, witnessed by doctors and sustained over a period. Instead, when a person’s life has been taken, it is left to the prosecuting authorities and juries to decide whether any good purpose is served by prosecuting and convicting someone who may or may not have acted in good faith, and who may or may not have been reflecting the settled wishes of the person who has died.
If the Bill were to become law, there would be a solid evidence base to demonstrate that the person had been terminally ill and expected to live less than six months, had been mentally capable, and had chosen freely and willingly to have their life ended. If that evidence base were not there, and a person’s death had clearly been assisted, it would be clear that a prosecution was justified.
That is at the heart of the Bill: for the terminally ill, it grants the right to die with dignity and at a time of their own choosing, should they make that choice freely and willingly; for everyone else, much stronger protection against anyone who might wish to force that choice upon them.
* Toby Keynes is Chair of Humanist & Secularist Liberal Democrats and an activist in Croydon. He is not a blogger.
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18 Comments
As a life long atheist, I am finding it really embarassing that some people seem to think you need to believe in a god or gods to see that there is something wrong with killing other people.
This isn’t about ‘dignity’ and it isn’t about people choosing to die. It’s a threat to remove the most vital protection we have in our legal system, the right not to be deliberately killed.
Toby Keynes
Where to start with this article when there are so many flaws in it. The language is emotive, inaccurate with regard to religious beliefs and the suggestion that killing rather than letting die is ‘kind,’ is little short of a bizarre twist of logic.
The description of what religious people actually believe in and advocate is inaccurate and misleading. Maybe I should not be surprised coming as it does from a member of the BHA/secularists but as I know some humanists who are well-informed and tolerant, I am genuinely surprised.
The very fact that last weekend there was a media ‘debate’ between Anglican Bishops with different arguments exchanged, shows how simplistic it is to reduce the position of faith communities to one ethical principle alone.
Archbishop Tutu comments that he believes in the sanctity of life but not at any cost. That is analogous to saying, ‘Do not kill but strive not officiously to keep alive.’ That is eminently sensible as a principle.
No side in this debate has the monopoly on the word ‘compassion’. All of us have had loved ones die through terminal illness at some point. I have had several members of my family die through cancer and other diseases but my relations had brilliant support from nurses and had access to palliative care. They did not suffer at the end and had peaceful deaths, thanks to the care and mercy of nurses and doctors carrying out their vocations to alleviate suffering.
My family is not a unique case of receiving good care either.
What is dangerous is to put the frail and weakest at risk by arguing it is acceptable to allow a doctor to provide lethal drugs to a sick person without psychiatric or mental health test, (as in Falconer), and to change the fundamental terms of the Hippocratic Oath in so doing.
The Falconer Bill if passed, which I sincerely hope it is not, erodes the cast iron protection in law for the weakest and most frail members of society. This may not be an issue for the very few high profile strong-minded individuals pushing for a change but I would ask them to regard people who are not as strong as them, who are not as lucky with having loving families and carers.
Far from being humane, this bill will allow the principle of suicide to become an acceptable form of death and lead to the people most in need of our protection to think it is their ‘responsibility to die.’ For example, in Oregon only one third of requests for assisted suicide cite unbearable pain as their reason – most cite ‘fear of being a burden.’
I do not want to live in a society where the elderly and sick think it is their duty to ‘depart’ for fear of being a burden, so I am opposed to assisted/suicide and Voluntary Euthanasia (the next step for the pro-euthanasia lobby).
Far from mercy and humanity, this bill is dangerous and frankly irresponsible.
Chris and Helen, you have both chosen to completely ignore the well stated point that clearly there must be protection to ensure that no- one feels they should go due to being a burden and to ensure that relatives, or others, are not allowed to do away with people.
I am prepared to accept that you oppose this change which, in my view, is a long overdue , humane and humanitarian measure. I’m not prepared to let you get away with blatantly untrue assertions that this law would result in frail and weak people having protection removed. It is absolutely clear that procedures will be exhaustive in preventing abuse.
@ Nigel Cheeseman: I do not make a habit of making untrue assertions about matters of life and death or resorting to emotional reasoning. I am simply drawing attention to the risks and flaws in changing the law.
This society does not need to draw up protections for the vulnerable and weakest by placing into the hands of doctors the power of legalised killing. The law we have now protects the rights of the weak against the strong in terms of legalised killing.
The so-called ‘safeguards’ in Lord Falconer’s bill are open to subjective interpretation by doctors and are therefore open to abuse. Who decides what is ‘mental capacity’ or ‘a settled wish’ and how would a doctor (especially one the sick person has not met before) really know that a dying person is not subject to subtle coercion and pressure?
In the Falconer bill, there is no requirement for a patient to undergo a full psychiatric assessment. Why not? Mental health is undoubtedly one factor that must be rigorously checked before being signed off for assisted suicide but not so in Oregon and not so in Falconer.
The unnecessary change in the law to protect the vulnerable, simply leaves them exposed to abuse and even more likely the expectation over time that they have a responsibility to die. This is not the ‘right to die’ as campaigners claim but a parody of human rights.
It is safer to maintain the firm boundary of the current law rather than pass a law which is clearly open to abuse.
Nigel, please read the following and explain why a new set of ‘exhaustive’ procedures would be followed, whereas the currents rules we do have are not being followed?
http://www.parliament.uk/business/committees/committees-a-z/lords-select/mental-capacity-act-2005/news/mca-press-release—13-march-2014/
Matthew, I have had a quick look at your link and will return to it later. In the meantime, the main debate is between those who support the right of individuals to decide when they will die and those who oppose that right. If you are, as I am, in favour, then once we have a majority we can ensure that safeguards are robust and enforced. If, on the other hand, you are opposed in principle to the right to die then it is disingenuous to use procedural arguments to bolster your case. I am pleased that some prominent churchmen are coming round on this as it would be dangerous were it to be a believer v. Non-believer argument.
Thanks, Nigel.
Helen,
You argue that the proposals are dangerous because they provide grossly inadequate protections for the sick and vulnerable.
Are they are protections that you could ever agree were adequate (bearing in mind that you are never likely to accept the broader case for assisted dying)?
Matt,
There will always be instances where medical professionals, as well as other in the caring professions, abuse their powers or fail to follow guidelines or regulations.
If the Bill were to become law, a doctor who had intentionally and actively assisted in the death of a patient, without that patient’s full consent and without being able to provide the required documentary evidence that all legal protections were observed, they would as a matter of course be facing a charge of manslaughter or worse.
I think that’s a pretty powerful disincentive.
Matt (Bristol): predictive stuff on computer led me to post ‘Matthew.’ Apologies.
Nigel (and I do sometimes answer to Matthew),
I think the approach taken by my occasional contact the Bishop of Buckingham is interesting as he sees it is partially an issue about quality of care and proposes that the Falconer Bill should be passed but then closely monitored to clarify whether people’s reaosns for seeking assisted dying related to the poor quality of care and support elderly people have in hospital or from their famillies and others.
My approach would be somewhat the other way round – the quality of care and the understanding of how to assess mental capacity and make best interests decisions needs to improve first, before the Falconer Bill is workable.
I confess I am philiosophically sympathetic to those who are opposed, but can see that most older people now want a choice; the issue then becomes for me, can we offer them a choice that is capable of being safely delivered in an equitable, unabuseable way?
Toby – a paper, theoretical disincentive needs to be made flesh by preparedness to proescute on the part of the police and CPS. There have not been enough prosecutions under the mental capacity act as it is, due to the poverty of understanding about it.
I have no idea why you go after religious people on this. Some oppose it, some don’t. But I’m not sure that people without faith will be particularly interested either way.
Much more interesting to me is the fact that the vast majority of medical professionals are fiercely opposed. There was a letter today of 27 medical professionals supporting it – reported by the Guardian as if the entire profession had called for the Falconer bill. But in reality, the BMA, Royal College of GPs, Royal College of Physicians, — The only vaguely representative body which calls for it are the editors of the BMJ, but their readership kicked up a fuss as they don’t agree. You can read the BMA position, which is opposed (and they have voted against moving to a neutral position as recently as 2012) here http://bma.org.uk/practical-support-at-work/ethics/bma-policy-assisted-dying
You also don’t mention the many disability organisations and campaigners who are opposed, because they are worried that the message this Bill sends is that if you are very sick, or disabled, or in pain – you should end your life. As a party which should be supporting disability rights, I am worried if we support a BIll which disability rights advocates reject! For example, this letter from, among others, the chair of Scope and the chair of Disability Rights UK. http://www.telegraph.co.uk/comment/letters/10875949/The-Assisted-Dying-Bill-devalues-the-lives-of-terminally-ill-and-disabled-people.html
This Bill is not a straightforward choice about autonomy. It is also about how we treat the most vulnerable in society, and ensuring that we do not treat the dying, sick or disabled as second class citizens. In a country where – unlike almost anywhere else in the world – we treat palliative care as a proper discipline, as anyone who has been close to someone in a hospice will attest, there are other ways of giving people who are dying dignity, without putting vulnerable people at risk.
As a liberal, I think this article by Professor Rob George – professor of palliative care at Kings, and a consultant at Guys – excellently sums up the need to protect the most vulnerable from this change in the law, because a fuller understanding of autonomy recognises the responsibility to restrain ourselves on behalf of others. http://www.bmj.com/node/759710
Josh,
I’m not sure who you’re accusing of going after religious people, or why.
In general, faith institutions have traditionally opposed any right to die, under any circumstances, and it appears that at present they continue to do so, but they do not necessarily reflect the views of the majority of their members – and their positions can change over time, as the CofE’s view of women bishops has changed.
As for the opposition of other institutions to the bill, what matters to me is the opinion of each and every person who is in the late stages of a terminal illness. It is their lives, after all, that we are concerned with here.
Josh, I don’t think Toby is specifically targeting religious people, I think he’s reacting to news stories that have been out this week because it’s been the CoFE General Synod, and so all the bishops have been hanging out at the University of York all week where it’s easy for journalists to get access and quotes as they react to each other.
@Nigel Cheeseman
Have you not noticed at all, that 100% of the point of this legislation is that it removes the protection provided by their being a ban on killing people? Please apologise for calling that a ‘blatantly untrue assertion’. It removes protection. That’s what it does. It’s all it does. It’s a bill to remove protection.
I am at present in the fortunate position of being in good health. However, if I developed a terminal or painful illness that would leave me wishing to die, I would hope to have the courage to end my own life by my own hand. Suicide used to be unlawful; it is not now.
I think it is grossly unfair of a person to ask another person, especially if that person is a doctor, to help them end their life. The argument for “assisted dying” given by one person I saw on television was that their condition would deteriorate to such an extent that they would be unable to commit suicide unaided.
So the question I ask is “Why wait until you are unable to end your own life by your own hand?” The answer I come up with is that the person is hoping for a medical breakthrough or cure. So asking another person to help them die is in effect asking them to give up hope on their behalf.
A person should, in my view, take personal responsibility for their own life and death.
Chris,
“Have you not noticed at all, that 100% of the point of this legislation is that it removes the protection provided by their being a ban on killing people?”
You do not distinguish between a ban on killing oneself and a ban on killing somebody else.
There is no ban on killing oneself, although as a society we make it as difficult as possible for people in certain circumstances (for example, when on remand) to do so.
There most certainly is a ban on killing anyone else, although even this is not universal. Soldiers have the right to kill. We all have the right to kill in self-defence.
The Bill would not qualify the existing ban on killing anyone else.
It would not allow any medical professional to kill a patient – but it would allow the medical professional, in very restricted circumstances and with strong safeguards, to give to a person, who was determined to die at a time of their own choosing but was physically unable, the means to die. A doctor might provide a fatal drug, but the person would have to administer it themselves.
There is no “right to kill” here, except for the right to kill oneself, which is a right that most able-bodied people already have.
Robert,
I do think this is a rather breathtaking argument: that someone who becomes physically incapable of killing themselves should lose any right to do so because they should have killed themselves while they were still able.
Somebody whose disease is progressive may have a great deal to live for, up until well after that point. They may have years of potentially highly fulfilling lives ahead of them, as well as the real prospect that their condition could be stabilised or reversed. However, there may come a point when they decide that there really is nothing left to live for; we should respect their right to make that decision, based on their condition, circumstances and prospects at the time when they make that decision.
One real advantage of the bill would be precisely that it would allow someone with a progressive disease to carry on for as long as they see any purpose in their life, even when they know that there may come a time when they may want to end their life because of the progress of their disease, confident in the knowledge that they will be able to end their own lives at that time, with assistance.
Surely, the last thing you would want is for anyone to feel pressure to end their lives while they still can, even while they feel that they still have plenty to live for.
“I think it is grossly unfair of a person to ask another person, especially if that person is a doctor, to help them end their life.”
Why? No medical professional would be forced to do this – that would be utterly appalling.
“A person should, in my view, take personal responsibility for their own life and death.”
This Bill would not take that responsibility away. It must be that person’s settled decision, and they must ultimately commit the act that will end their life. All anyone else would be doing is enabling them to exercise that personal responsibility – whereas you appear to believe that they should not be allowed to do so because they are physically disabled.
except for the right to kill oneself, which is a right that most able-bodied people already have
It’s an ability most able-bodied people have, but not all abilities are rights.
Dav:
Suicide is not illegal, and therefore any able-bodied person has an effective right to die by their own hand.
Are you suggesting that it should be made illegal again?