Roya Nikkhah reports, in the Telegraph, that PD James, the author of detective fiction for the discerning, and a conservative Peer, has revealed, in an interview with The Tatler, that she would

   … help a friend or family member die if there was “nothing to be done” and they “wanted to go”.

On the other hand she does not think that the country should change the laws of murder to accommodate such acts. You have to have the courage to act, she suggested, apparently comparing it to coming to the defence of a loved one being attacked.

“If I saw someone attacking one of my grandchildren in a way that was going to   kill and I had a knife, I’d stop it,” she said. “And maybe I’d stop him straight away by sticking the knife in. And I think the better so.”

All very dramatic, but it is not really the same thing, and it is unfortunate that James takes this particular line on assistance in dying. Baroness James apparently does not think that a person has a right to be assisted to die, and that it should be left to the courage of a person’s friends or relations to provide assistance, and then defend their decision in law.

This is a very strange point of view, and I am at a loss how to explain it. Dying with Dignity (Canada), put this part of the interview on its home page for a short while, but it certainly does not support the position of Dying with Dignity, which is to see legislation adopted in Canada which would make assisted dying legally possible. Why should a person in misery need to find courageous loved ones to provide the assistance, instead of the law making provision for such assistance? Perhaps she takes the same view as the Archbishop of Canterbury, who continues his opposition to assisted dying, and retails the same old arguments as before, without any apparent recognition that there are, after all, answers to the problems he raises, and no clear reason to suppose that the disaster he predicts will occur. As recently as February this year, the archbishop was still playing games with words, instead of expressing concern for the suffering of those who are dying or who are living with unacceptable (to them) levels of pain and disability.

In another Telegraph article, we are told that Rowan Williams, in yet another speech to General Synod, opposed assisted dying and predicted disaster:

In an outspoken address to the Church of England General Synod, he drew parallels with the growth of abortion and warned that changing the law would create circumstances in which life would be “legally declared to be not worth living”.

The parallel with abortion is telling. There is a widespread view, in the Church of England, at least, that the law legalising abortion in some cases was intended to be used sparingly. There was no reason to believe that the law would only be used in emergencies. In one estimate of abortion in Canada before and after legislation change, it is claimed that there were probably more illegal abortions then than legal ones now. That means that abortion had been widely used to control fertility, despite the fact that it was illegal. In Britain the assumption was made that legalising abortion was meant to deal with the small number of cases where, in the view of the Church of England, anyway, it was thought to be morally justified. The fact that the law eventually covered other cases has fed the myth that laws such as this are bound to be slippery slopes, and will be used in ways not originally envisaged by the lawmakers.

The truth seems to be that this is the way the Church of England justified its support for change in the law, by saying that it would only be used in extremis. But this is arguably not the way that women ever saw it. There are all sorts of situations in which, for the women involved, abortion may be indicated, situations not even imagined by the church’s support for the bill legalising abortion in some circumstances. What the bill did was to put women in charge of their own reproductivity, and they took fair advantage of it, as should have been expected. Instead of resorting, as women had done for generations, to back street abortionists, and unqualified quacks, women finally had a way of legally and safely terminating an unwanted pregnancy. The numbers reflected the change, but the Church of England, whose bishops, apparently, had supported a change in the law, found themselves with a situation that they had not envisaged, which made it look as though they supported abortion more or less on demand. This they are now unwilling to do in the case of assisted dying — which explains the Church of England’s inveterate opposition to assisted dying, and why it brings up the abortion issue as central to that opposition.

But the parallel between the abortion case and assisted dying does not hold. Not, indeed, that more people than expected will not take advantage of legalised assisted dying; because the church has already convinced itself, unwarrantedly, that the number of “extreme” cases of suffering that would justify assisted dying are very few. In the church’s own report on assisted dying, On Dying Well, this is clearly stated. In the introduction to the second edition (2000), Professor J. Stuart Horner, a Christian medical ethicist, questions the position of the Working Party (those, apparently, working on the report), writing that:

The Working Party seemed willing to entertain the possibility that in certain circumstances active killing might be morally justifiable (see page 10). The examples they give, however, are far removed from the bed of a dying patient. I believe that their doctrine of necessity may occasional apply in terminal illness. Such a patient would be suffering severe pain which could not be controlled or, perhaps, unrelieved vomiting or severe respiratory distress. These cases are extremely rare and would not even be considered until the patient had received treatment from a palliative care specialist and, ideally, the advice of a nationally recognized expert in the field. Most doctors would never see one in a professional lifetime. [xii; my italics]

Not a shred of evidence is given for either of the italicised claims, and it is, in fact, not true. Nor should decisions like this be left up to experts in the field, nationally recognised or not. It is this kind of expert control of dying that needs to be questioned. But it is on such opinions that the church’s report bases its argument. Recalling that central to Horner’s life was his Christian faith, it is hard not to conclude that his opinion is not an expert opinion at all, but based on a bias built into his religious way of understanding the whole process of illness and dying.

The real problem as usual lies with the locus of decision-making. Horner places it squarely with the medical practitioner. He speaks of the Working Party as being of the opinion that “active killing” might sometimes be morally justified. And the report itself, on the page referred to, has this to say:

It might be denied that there could even in principle ever be cases in which such an action [viz., the "deliberate decision to end the [patient's] life”] was justified. It might be conceded that such cases are conceivable, but maintained that in actual medical practice they do not or need not occur. It might be agreed that there are such cases, but argued nevertheless that a professional ethic which tried to take account of them would run too grave a risk of failing to ensure the right decision on most occasions. [10]

And then the text goes on to speak of the complexity of the issues involved in making the right decision, doing everything in its power to show that assisted dying is simply too risky and dangerous to envisage on any occasion, except in such extreme ones in which, after all, if a physician were to act, the General Medical Council and the law would recognise that his decision was the right one. Indeed, perhaps unsurprisingly, the church’s report comes to the same conclusion expressed by PD James. You have to have the courage of your convictions, and then justify those convictions before the law. Break the law, and then show that you were right to do it on this occasion. But if the law were changed, the report suggests, then the rare cases that Horner acknowledges, might then become more common (xii). And this is simply based on a misunderstanding of the reasons that people give for wanting assistance in dying.

But, as always, the focus of decision is put in the wrong place. The archbishop, as we have seen, holds that a change in the law would create circumstances in which lives of a certain quality would be legally declared to be “not worth living.” But this is nonsense. People who support assistance in dying are not saying that any particular quality of life is not worth living, but that what is worth living is to be left up to the individual to decide. This is what, as I have said before, renders most proposals for legalising assisted dying unsatisfactory, for they try to do just this: to define the circumstances under which a person may legally receive assistance to die. But what is a life no longer worth living to one person may be a life eminently worth living to another, and the law should not be in the business of determining where the line between one and the other is to be drawn. Nor should the law leave the matter up to medical professionals. It is not for them to decide when life is or is not worthwhile. This is a decision for individuals alone, and it is something which individuals should think about carefully before the time arrives to make it. So often everyone is left in an intractable situation, because no one knows what the patient would have wanted in a situation where he or she is no longer able to make a decision. Loved ones, doctors, and unwelcome intrusions by the church, all come together at such points of crisis to make decision-making nearly impossible, as happened in the case of Terry Shaivo. Tom Falconer’s book That Good Night is full of this kind of end-of-life decision-making in which there is no clear direction, and everyone is in a quandary as to what should be done. This is why the religious opponents of assisted dying continue to monopolise the field, because they have a simple, not to say simplistic, solution: just say no. What proposals for legalised assistance in dying are doing is encouraging mindfulness about the end-of-life, so that, when the time comes, this kind of uncertainty, in which religious certainties come in to (supposedly) save the day, is minimised, and loved ones and medical professionals all know what the patient wants and does not want, and where a person is free to choose, when choice is still possible, how the end of life should go for that person. For it is with the individual themselves that the decision should rest, and with them alone. And if it does, then the scenario painted by religious extremists like the Archbishop of Canterbury, who continues to pour religious oil on this fire, will not occur.

It’s time for the religious to acknowledge that they do not have the answers to these questions. They have answers that may be appropriate for, and may even be shared, by fellow believers, but they should not have the right to intrude these answers into the public discussion, as though they are relevant to the way ethics is done nowaday; it should not even be assumed that they have anything relevant to say to those who do not share their beliefs. Which brings me at long last to the pope, that aging virgin (or “virgin”) who continuously thinks he has a right to interfere in the lives of others, just because he makes an unsubstantiated claim to be the representative of Christ on earth. He’s a bit slow off the mark, since the book on sexuality that he has recently condemned was published in 2006, and has already received a few awards, and has been used in sex education courses since that time. But now he has decided, his wisdom apparently inspired, belatedly, by God, to condemn the book by the nun Sister Margaret Farley, who commends self-pleasuring for women, since it can help them to understand what turns them on and thus may help to strengthen relationship, regardless of the church’s view that masturbation is a “gravely disordered action.” Sister Margaret also supports gay relationship, in spite, once again, of the church’s condemnation of gay sex as being gravely disordered. I add this as an addendum to this post, which is mainly about assisted dying and the religious idiocy and dishonesty which regularly attends it, because the church’s view of sex and sexual relationship is of a piece with the church’s condemnation of assisted dying. It is based on outmoded ideas of the basis of ethical decision-making, and it is high time that we recognised that the religious mind not only does not have privileged access to the foundations of ethical decision-making, but, more than that, is more often wrong than right in its ethical pronouncements, and should have far less to say, in public discourse about morals, than it traditionally does say. People look to people like the Pope and the Archbishop of Canterbury as, in some sense, experts in morals. They are not. They speak for outmoded ideas about the human, and it is time that we recognised them for what they are: figures from the past still trying to make their voices heard in a field of human endeavour that has simply passed them by. They have no more of value to say on issues of morality, and perhaps even less, than the ordinary man in the street, who at least is in a position where serious moral decisions have to be made, and where pontificating will get them nowhere.

In closing I want to stress that PD James’ position on assisted dying, though it has received a great deal of press, is not one that should be supported. She speaks as a conservative peer, and, while she acknowledges that there are extreme cases of suffering where assisted dying would be justified, she does not think that legal provision for these cases should be made. There, I think, she speaks in error, and her words should not be given the disproportionate attention they have received.