Update, 16:37, Atlantic Daylight Time, Monday, 20th August 2012: “Required Reading” is now available in Polish translation at Racjonalista. Thanks again to Malgorzata for taking an interest in my occasional thoughts.
Update, 10:40 Atlantic Daylight Time, Friday, 17th August 2012: The Tony Nicklinson judgement is now in, and is downloadable as a pdf file here. I have not read it yet, but the judgement does not rule in his favour. According to the Telegraph:
Tony Nicklinson, the “locked-in syndrome” sufferer, broke down in tears on live television as it was confirmed that he had lost his legal battle to be allowed to die.
The judgement says that it is not up to the courts to decide the issue, but is a matter for Parliament to decide. However, it is clear that, in cases where Parliament fails to act to uphold people’s rights, the courts should make it clear that Parliamentary failure will not be upheld by the courts. While it is true that a judgement in favour of Tony Nicklinson might have had implications far beyond his case, the judgement could have made those implications conditional only upon Parliament’s failure to act. There is not a necessary or logical connexion between a favourable judgement in the Nicklinson case, and an immediate extension of that judgement to other similar cases. The cruelty of the judgement is the direct outcome of years of campaigning by religious entities which will continue to oppose assistance in dying no matter what the outcome. This case however shows how wrong Tallis is in the article linked below, to confine assisted dying to the terminally ill alone. Being trapped in your body, as Nicklinson is, and may be for many years, provides a lack of quality of life which may, in individual cases, be seen to be a great harm.
The following two articles are, for those who are concerned about assisted dying, required reading. The first is an article, published in the British Medical Journal, of the misery in dying of Ann McPherson, founder of Healthcare Professionals for Assisted Dying. Tess McPherson, Ann’s daughter, is also a physician, a specialist in dermatology, practicing in Oxford, and she writes a hair-raising account of her mother’s death which should put an end to the absurd spectacle of palliative care physicians like José Pereira claiming that palliative medicine can control all the pain, distress and indignity of dying. You can access Tess McPherson’s account as a pdf here.
The second article is by Dr. Raymond Tallis, who argues, in a passionate appeal for a change in the law. Again, I think he is wrong to restrict assisted dying to those who are terminally ill. What exactly counts as terminally ill? is one question that needs to be asked, especially since it is well-known that physicians no longer give prognoses in terms of length of time left to live. They are, at best, guesstimates. And some people with degenerative conditions, or who are trapped in their bodies like Tony Nicklinson, may live in misery for many years. Accounts of their lives can be just as harrowing as Tess McPherson’s account of her mother’s last days. Nevertheless, Tallis’s conclusion is eloquent, and expresses exactly the my sentiments, and the reasons why I began this weblog in the first place. Read the whole article, but pay special attention to this conclusion:
Because of the fancy footwork of those who have beliefs I do not share, this is a fate that could await me or those I love. A small but vocal group, prepared to bear other people’s suffering heroically for the sake of God, must not be allowed to impose their views on the rest of the medical profession, and through them on society as a whole. Opponents of change make a lot of noise – it’s time that the relatively silent majority made more.
This is religion in action, and do not tell me that it is not religion, but human beings, who do these things. Religion is at the heart of opposition to assisted dying, which is based almost entirely on religious prohibitions. Of course, it is human beings who carry out this religious mission, and they do it with great zeal, because religion is a powerful motivator to action. But it is religion itself that is the chief culprit here.
It is significant that, in response to the British Medical Journal’s decision to publish articles on assisted dying, that the blog, Christian Medical Comment, has taken up the struggle against assisted dying. Yet again, interestingly enough, just as Tallis says, they do not talk in terms of their religious reasons for opposing assisted dying. Instead, they focus on an article in which Iona Heath, President of the Royal College of General Practitioners, expresses her
‘deep concern that it will be impossible to draft a law robust enough to protect the vulnerable’ and expressed her discomfort ‘that medicine seems once again to be preparing to offer a technical solution to an existential problem.’
The first fear is unfounded. Switzerland has had legal assisted suicide for over seventy years without any obvious risk to the vulnerable. And as for offering a technical solution to an existential problem. The existential problem has to do with the conviction that some people have that death would be, for them, a good and a benefit. This, certainly is an existential issue, but it is not a problem, unless for other reasons (almost all of them religious) all suicide is regarded as an evil. As a standard textbook on bioethics states with exemplary clarity:
[I]f a person freely authorizes death and makes an autonomous judgment that cessation of pain and suffering through death constitutes a personal benefit rather than a setback to his or her interests, then active aid-in-dying at the person’s request involves neither harming nor wronging. To the contrary, not to help such persons in their dying will frustrate their plans and cause them a loss, thereby harming them. It can also bring them indignity and despair. From this perspective, causing death is not always an evil act. [Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics (sixth edition) (Oxford, 2009), 181]
An interesting additional observation about this statement is that at least one of the authors, Tom Beauchamp, is, I believe, a Roman Catholic, and teaches at a Roman Catholic university in the United States, but he is also a philosopher, and must arrive at the conclusion to which his arguments and principles lead.
It occurs to me, after considering it for half an hour or so, that I should add to this. Childress, as a Google search tells me, is Professor of Religious Studies and Professor of Medical Education at the University of Virginia. His first degree was a BD, Bachelor of Divinity. Also, it is worthwhile pointing out, in this context, that Udo Schuklenk’s contribution to the volume of essays which he co-edited with Russell Blackford, 5o Voices of Disbelief, is almost entirely about the intrusion of religion into legislative battles over bioethical issues, and is well-worth reading in this connexion.