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!
How did they manage it? Maybe because ultimately anything called “The Commission on Assisted Dying” is by definition a top-down bureaucratic body that is ill-suited to understand that the issue is fundamentally an individual decision that only needs outside assistance/regulation as to the execution(no pun intended) of that decision.
Stunningly, breathtakingly stupid. Not to mention insulting. It baffles me that the point you have made wasn’t obvious to the Commission. Indeed it baffles me that a modern society that values individual rights is even having this debate. What is more personal, more profoundly and intimately a matter of individual choice, than death? Why do we consider ourselves to have the right not to be unlawfully killed but not to have the right to die? And who do these ladies and gentlemen of the Commission think they are?
There might be any number of practical difficulties in framing the law so as to minimize coercion – though you have suggested that this might not be a substantial worry, based on the available data – but that is a reason for legislating in favour of euthanasia with care, not for refusing to countenance many types of euthanasia request altogether. Rape is notoriously hard to legislate against fairly, but no one suggests that we therefore shouldn’t try.
Ah, Isabel, “Stunningly, breathtakingly stupid,” seems to captuere the way I feel exactly.
It has always been my view that assisted dying should be available to any mentally competent adult, subject to safeguards that the decision has been taken without undue pressure from others, and perhaps with a built-in delay from the time of first requesting assistance to ensure that the decision is not a spur-of-the-moment one. Only one person can decide if a life is worth living or not, and that is the person living that life. As you have correctly pointed out, once you start defining classes of people who may be allowed the right to assisted dying, you stigmatise that class of people.
It’s clear to me that the religious lobby has successfully scared the representatives of the disabled into opposing any new legislation, and they in turn have persuaded the Commission to “protect” them from a change in the law. Such scaremongering is heinous.
Suicide is not illegal. Neither should assisting it be illegal, as long as the assistant is acting on the clearly expressed wishes of the would-be suicide.
@Isabel
Well put, and I particularly like the rape analogy.
Couldn’t agree more Eric. It was profoundly dissapointing to read their report and see that they had totally missed the point. I wonder how Terry P feels about it. Have you seen any comments from him yet anywhere?
Haggis, thanks for that detailed response. It is indeed dispiriting to find that the commission, after gathering evidence for a year, and pondering the issue, should come up with something that is, in effect, a self-contradiction, and does not meet the needs of those who are seeking assisted dying. The churches obviously have succeeded in using the disabled as tools to pervert the conclusions of the commission, and it — quite frankly — simply makes me angry.
Clod, interesting question. No, I haven’t seen any response from Terry P. I was not pleased with his own proposals in the Dimbleby Lecture, and perhaps some of the failure of the commission is due to his influence. Hard to say.
The ministry of justice lawyer is asking the judge to strike out Tony Nicholson’s case on the grounds that parliament must make the law here. Well, precisely.
http://www.bbc.co.uk/news/uk-16692351
Clod, thanks for the link. Tony Nicklinson’s condition is appalling – I cannot imagine how I could survive that without going totally deranged. Even if the Commission’s recommendations were to be adopted into law now, they would be absolutely no help to him. This just reinforces Eric’s point. One should be allowed to choose death regardless of one’s state of health – Tony is being discriminated against because he is so disabled that he cannot complete the act himself. If I didn’t live so far away I’d be tempted to offer my help.
Haggis, I simply find it incomprehensible why the commission should have come to the conclusion it did, given the evidence that it had before it, and considering that the conclusion it came to is self-contradictory. The mistake that they make is in thinking that it is appropriate for someone else to make the choice whether or not a life is worth living, and not the person whose life it is. This is just stupid, as the commission’s comments on the disabled shows it to be. I cannot, for the life of me, understand how it is possible for a group of adults to get together and make such an obviously bad decision. And when Tony Nicklinson’s case comes up, and you know that there are lots of other people like Tony and Daniel James who find life in their new circumstances intolerable, it is plain straight off that the decision was the wrong one. The commission should get back together and reconsider their arguments, because someone interjected something that set them on the wrong track. Problem is, of course, that the commission has accepted Dignity in Dying’s position, which is itself wrong — something that I find unintelligible as well. Someone in Britain should address themselves to Dignity in Dying and put on some pressure to get them to see the point.
You are right, Eric, some in Britain should… Unfortunately, I lack your eloquence and depth of understanding in these matters. For example, in my first reading of the Falconer report, I missed the dissonance to which you have drawn attention, although clearly noticed the fact that it was going for the easier option (of terminal illness only), as saw it. Nonetheless, I may have a go, probably quoting extensively from you, with your permission.
Update on Margo MacDonald – she has just announced a new attempt to get a bill through the Scottish Parliament: http://www.google.com/hostednews/ukpress/article/ALeqM5j3yI8nFvpmRx5zAD6pGffuKwlhRw?docId=N0083331327331050136A
Mrs Brains & I were involved last time round, so we’ll contact her again to see how we can help. I’ll try to convey our thoughts on the Falconer Commission’s report to her. As someone with a degenerative disease (Parkinson’s), she may be more sympathetic to the plight of the likes of Tony. That doesn’t alter the fact that the debate on the last Scottish Bill was badly flawed due to the influence of the religious lobby’s usual scare tactics. When Mrs Brains and I appeared on a short news item on STV, our case was “balanced” with an interview with a young man in a wheelchair with cerebral palsy, who said “I believe it puts people with disabilities or long term illnesses under pressure, and they might be forced into utilising the provisions of the bill”. (I have a recording of the interviews on a PVR hard drive, and would send it to you if I knew how to!)
If we are to progress to a sensible bill granting full human rights to everyone, we somehow need to engage people like this young man, and show him that there is no risk of this happening. I understand that cerebral palsy is not generally progressive, but abilities can deteriorate with age. It would be ironic if this young man found himself in need of assisted dying at some time in the future, and could not get help because these bills keep being defeated.
Thank you for this Haggis. This is something that I come to again and again. I convinced Dying with Dignity (Canada) that autonomous choice is the only plausible basis for assisted dying, but I was then a member of the Board. But of course you are at liberty to use anything that you find here at choiceindying.com if you think it will help. I repeat, of course, that this should be evident to anyone, even the guy in the wheelchair, if he’d only give it a moment’s thought. With terminal illness being the deciding factor, it will be (conceivably) easier to bring pressure to bear on people to end their lives, since the proposed law would in fact effectively devalue the lives of those who are terminally ill, so anyone who is terminally ill is already half way there. It’s really quite a silly conclusion to come to, and for all the wrong reasons. That’s why I can’t understand why they should have arrived at it. The Royal Society of Canada Expert Panel on End of Life Decision Making is much more reasonable in recognising this.
One thing that should have made this clear is that people who are not terminally ill in the sense proposed by the commission report, are still able to choose to have treatment withdrawn or to refuse treatment, both of which might conceivably hasten their deaths. It is simply beyond reason to suppose that others, for whom none of these options are available, and yet who find their lives intolerable, should be the only ones excluded from legal assistance in dying. Even the guidelines for prosecutors is better than this! How on earth could Falconer have arrrived at this conclusion? It beggars my imagination at any rate.
Margo’s consultation can been seen in full here:
http://www.scottish.parliament.uk/S4_MembersBills/Final_version_as_lodged.pdf.
Sadly, It seems that she is taking the same route as Falconer.
I had already drafted an email to her before I saw the details, so I’m now redrafting it. I see that in her request for submissions, which my email will effectively be, she has asked that any third party reference be deleted unless it is accompanied by written permission. I’d appreciate your permission if you agree, and to that end would like you to respond directly to me by email. If you have any specific points to make, please do so, and let me know if I may quote you.
Mrs Brains and I are currently studying her consultation paper, and she has already spotted some inconsistencies, which I intend to take up with Margo.
Once I’ve had a chance to study her consultation I’ll get back to you, and I may send you offline a copy of our response to it.
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