The Commission on Assisted Dying report need not be read. It is such a grave misunderstanding of the reasons and purposes for which people seek assisted dying, and what the acceptance of a person’s right to ask for assisted dying means, that the rest of the report is thereby rendered meaningless. It may have useful things to say about the history of the debate, and its present status in the United Kingdom, but about assisted dying it has nothing of value to say.
Here is the crucial paragraph from page 27 of the report. This indicates a complete failure to come to terms with the issue of assisted dying and the reasons for it. It is, in itself, in my view, self-contradictory, and would, if justified, render the decision for assisted dying, for anyone, a serious danger to those who are dying. That the commission did not see this indicates that they were bamboozled by the scare tactics used by the churches into believing that allowing one disabled person to choose to die would be to devalue the lives of all disabled persons, a claim that is simply absurd, but which, if true, would make their own proposal as dangerous as the right to die for the disabled is wrongly said to be.
The Commission proposes an eligibility criterion requiring a diagnosis of terminal illness. The Commission received evidence from many disabled people and does not consider that it would be acceptable to recommend that a non-terminally ill person with significant physical impairments should be made eligible under any future legislation to request assistance in ending his or her life. The intention of the Commission in recommending that any future legislation should permit assisted suicide exclusively for those who are terminally ill and specifically excluding disabled people (unless they are terminally ill) is to establish a clear delineation between the application of assisted suicide for people who are terminally ill and others with long-term conditions or impairments. The adoption of this distinction in any future legislation would send a clear message that disabled people’s lives are valued equally.
The Commission proposes that in a future framework, ‘terminal illness’ could be defined as an advanced, progressive, incurable condition that is likely to lead to the patient’s death within the next 12 months.
The Commission does not consider that any criterion based on ‘unbearable’ or ‘unrelievable’ suffering should be included in potential assisted dying legislation as we are concerned that a criterion based on suffering would be too unclear and subjective for doctors to assess; we believe it is only for the individual concerned to judge the extent of the suffering caused by their illness.
This is a complete misunderstanding. It is, quite plainly, a piece of nonsense. If a decision to grant assisted dying to a severely disabled person, such as Daniel James, for instance, would, in fact, as this assumes, send a message that disabled people’s lives are not valued equally, then, by parity of reasoning, the decision to grant assisted dying to a terminally ill person would send a clear message that dying people’s lives are not valued equally.
The mistake is a simple one. This is not a matter for doctors or anyone other than the suffering person to assess. Whether the person is capacitous, or is making the choice voluntarily, or is adequately informed: these conditions are obvious, and raise no important issues, except, of course, to make sure that they are met. But the idea that someone else can assess whether or not another person’s life is worthwhile living is very dangerous, and sends the wrong message.
Take, for example, the man in Wiltshire who is suffering from locked-in syndrome. He finds his life valueless, although he may live for many years. His judgement that his life is valueless is the basis upon which a decision for assisted dying should be made. If there is any doubt about this, then the question of the person’s capacity for autonomous choice is raised at once. But the idea that another person should make this judgement is exceedingly dangerous, and should be seen to be so. By making terminal illness itself the only significant criterion, the judgement is made that, in fact, those at the end of life are no longer valued, for this alone is necessary to justify assistance in dying. It is a judgement that anyone might make, and scarcely depends upon the person who is terminally ill. Qualifications such as voluntariness and absence of coercion, or informed consent, scarcely enter into the question, if the judgement has already been made that persons at the end of life are the only ones who can justifiably hold that life is no longer worthwhile. This is a matter that has already, by the very nature of this criterion, been decided.
If allowing those who are not terminally ill to receive assisted dying would send a message to others in similar circumstances that their lives are no longer worth living, then allowing the terminally ill to receive assisted dying would send the same message to the terminally ill. It is ridiculous to suppose otherwise.
The entire basis for assisted dying should lie in the right of the individual to choose to die, based on their own judgement that their lives are no longer tolerable or worth living. It is often said, of people with locked-in syndrome, or of those who are quadriplegic, or suffering from MS, or other degenerative neurological condition, many of whom may live for years in a state of complete and sometimes very painful paralysis or some other painful or desperate condition, that some people in those conditions find life worth living, after they have adjusted to their new circumstances — and that for this reason alone they should not be given the choice to die. A doctor once said to my wife Elizabeth: “There are all sorts of people who are paraplegic or quadriplegic, and yet they learn to let others do things for them, even the most intimate and what may seem to you now to be degrading things. But people get used to it, and learn to live their lives as fully as they can.” And that is sometimes true, but it is not true for all, as the story of Ramon Sampedro — about whose life and fight for the right to die the movie The Sea Inside was made — testifies. An individual, like Ramon, or like my wife Elizabeth, can make a judgement that they find their lives intolerable, and no longer worth living. They can be encouraged to live out the span of their lives, despite their “disabilities”. Counselling may even be provided for them, or Havey Cochinov’s “dignity therapy,” to see if we can convince them to change their minds. But if, in the end, they still wish to end their lives, and no longer wish to live in conditions that they find intolerable, then they should have the right to choose to die.
The emphasis must be placed on choice. Any other criterion implies that the lives of people in that condition are not valued or worthwhile. It is the simplest principle imaginable, and yet a commission of thoughtful people gathered together, presented with evidence from many people who tried to get this simple principle across, simply flubbed their lines, and came up with a contradiction! How on earth did they manage it? I just had to say it again!