Category Archives: Dignitas

Canadian woman goes to Dignitas in Zurich for an assisted death and is interviewed by CBC’s “The Current” before her departure

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Susan Griffiths is a woman with MSA, Multiple System Atrophy, a neurological disorder which, according to Wikipedia, is “associated with the degeneration of nerve cells in specific areas of the brain. This cell degeneration causes problems with movement, balance, and other autonomic functions of the body such as bladder control or blood-pressure regulation.” While she is not yet completely immobile or incapable of some enjoyment of life, she feared not being able to lift her hand in order to drink the barbiturates used by Dignitas for what they call an “accompanied death.” She was interviewed by Anna Maria Tremonti of CBC’s “The Current,” which was aired yesterday morning. Here is the interview:

You can also see a video of Susan Griffiths in The Winnipeg Free Press, explaining her reasons and reading a letter which she sent to every Member of Parliament asking them to change Canadian laws respecting assisted dying. She is a wonderfully eloquent person, and makes her points clearly and forcefully. As she says, for her.

[t]he future’s too grim. This is the right direction. It’s my life.

Dying, as I have said before, is the final act of our lives. We can either be passive towards it, or we can be active. We can simply die of the diseases which are destroying us, or we can take up arms, and make dying the final, decisive act of our lives.

Screen Capture of Susan Griffiths speaking about her letter to MPs about assisted dying

Screen Capture of Susan Griffiths speaking about her letter to MPs about assisted dying

One thing that people do not seem to recognise is that forcing a person to die in the way prescribed by their disease, and refusing them the right to make the decision themselves, and receive help from competent professionals, not only denies us what is reasonably thought to be a liberty right, it is also, effectively to turn us into slaves, living under compulsion. No other decision in our lives is so hedged around with restrictions such as this. Indeed, if we are being kept alive on machines, we can ask to have treatment withdrawn, thus effectively taking our own lives. This is no different, ethically, than receiving the kind of help to die that Susan Griffiths sought – and could not find in Canada. Thus she is forced to die in exile, as Elizabeth did.

Yesterday evening I was contacted by a radio station in Halifax, and asked if I would comment on this, and I was happy to do so. And once again the old chestnuts were pulled out of the fire, still apparently steaming hot, but in truth the same old unreliable prejudices hawked as arguments. Every time the question of the legalisation of assisted dying is raised the question of risk to the vulnerable is raised along with it. But no one seems to think that the vulnerable are at risk when withdrawal or refusal of treatment is in question. Why not? Perhaps because that is already legal. Indeed, more than that, treating a person against their will is accepted in the common law as common assault! You have to ask yourself: If this is so, then why is the compulsion to live through misery not an offence in law? And when you consider that people can be in as great a risk with DNR orders, and the right to withdraw treatment, as they would be were assisted dying legalised, this question is even more pressing. The truth is that we need to make sure that those who are asking for the withdrawal of treatment are competent, well informed, capable of understanding the information provided, and are making the request of their own volition. These are exactly the same conditions that would govern assisted dying. Decision would have to be durable (that is, held steadily over time), based on full information of the options and consequences, competent and voluntary. In addition to this, we know that assisted dying is happening now; we just don’t know how often, by whom, and for what reasons. People make the claim that people would die who should not die were assisted dying to be legalised, but since making assisting someone to die is a criminal offence, and doctors are not heartless, assistance takes place, but is unreported. We don’t know where we are on the so-called “slippery slope.” The arguments against assisted dying, just like against abortion, drives such activities underground. Alternatively, they force people to take matters into their own hands, very inexpert hands, and besides making suicide more desperate, makes it a lonely journey that a person is forced to make in desperation. Accepting that we die, and that some people need assistance to die to escape intolerable suffering, is healthier for society than making it furtive and secretive.

Susan Griffith can afford to go to Switzerland. Many people cannot. It is time that the government took this matter seriously, instead of having discussions in Parliament which do not reflect, at any level, what is now known about end of life decision making, and the bioethical imperatives that are involved. Assisted dying is still looked upon in religious ways. Suicide at the end of life is inappropriately being thought of in the same terms as suicide in the midst of life, like the desperate suicides of broken-hearted teenagers, or those who despair of success. It is time that people put their religious convictions aside and spoke about this in terms that are not slanted by religious prejudices.

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Old Age Rational Suicide?

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I’m not altogether sure what is meant by “old age rational sucicide,” but here is an example where, it seems to me, ordinary provisions for assisted dying would have provided all that is needed. There is a video and an article. I will upload the video here, and link to the articles in the Australian newspaper, The Age, here and here. So, first, the video, then a short comment:

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Michael Cook, the Editor of BioEdge, a conservative bioethics blog from Australia, is tied up in knots about this, partly because he thinks of Beverley Broadbent as relatively healthy, and partly because he questions the ethics of the journalist who reported Ms. Broadbent’s point of view without even trying to dissuade her from taking her life. As he says:

In the first place, a journalist is first of all a human being. Didn’t Medew [Julia Medew, the reporter] have a moral obligation to dissuade a relatively healthy woman from committing suicide?

Of course, the answer to that is: it all depends. If Ms. Broadbent had been a young person in the prime of life, who was suffering from a episodic bout of depression with a specific physical or social cause (like the loss of a loved one, a love affair gone wrong, or whatever), it would seem that this would be the appropriate thing to do. However, Ms. Broadbent’s reasoning is hard to fault. She is afraid of being caught up into the medical system in such a way that there is no escape, and rather than proceed with all the ramifications of starting the process she thinks it best to leave when she is still able to enjoy life, but may not be able to enjoy it much longer.

Of course, if Australia had provision for someone like Beverley, and could promise her that, if she started the process, she could exit the process at any time with medical help to die, if the process looked to be a long and arduous and ultimately pointless exercise in trying to stretch her life out another few months or years, that would require surgery or chemotherapy or radiotherapy, etc. The point here is that, facing an uncertain future, and having no legal way out of the complex of procedures that a biopsy might set in motion, she chose instead to stop the process before it began, because she did not feel confident of being able to stop it later with the sort of consummation that she had prepared for herself.

But the fault is neither with Ms. Broadbent, nor with Julia Medew, but with governments which continue to refuse people alternative measures at the end of life. My wife Elizabeth, for instance, might have lived some months longer. She would have had to suffer the continuing indignity involved, as she experienced it, of her nursing care, but she might have opted to stay longer, but only if she had an alternative ending of her own choosing at a time chosen by her. Failing that, she decided to go to Switzerland, and received help in dying from Dignitas, because the alternative would not have been available here. Michael Cooke is simply out of his depth.

He wants to add to Medew’s file blame for not following World Health Organisation guidelines regarding the reporting of a suicide, which warns of the copycat suicides that sometimes follow the reporting of a suicide. But Ms. Broadbent’s suicide was of a very different sort, and not likely to influence those who are liable to die by suicide for other reasons that would be invoked by the self-chosen death of a older person facing possibly difficult medical circumstances. A promise of assisted dying when her outlook became even bleaker, if that occurred, would likely have kept Ms. Broadbent alive. If governments refuse to legalise assisted dying because some people might die before their time, they must take into account the deaths of people like Ms. Broadbent, who might still be enjoying her declining years, had assisted dying been legal.

This Blog is really all about Elizabeth

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This is my first blog post at Free Thought Blogs, so I want, from the start, to explain my own reasons for being here, for thinking of myself as a “freethinker” (a term which still does not come easy to me), and for wishing to join a community dedicated to freedom of thought, atheism, and opposition to religious belief. I also want to make the point as clearly as I can, as I start out, how Elizabeth (my wife who died in 2007 in Zurich) is the main inspiration of all that I write, and the patron “saint,” if you like, of this Blog. Without her, I would have been a very different person indeed. I will also remark on some of my present interests and concerns.

At the masthead or banner of my blog choiceindying.com, there from the very beginning in December 2010, has been the tag line, “Arguing for the Right-to-Die and against the Religious Obstruction of that Right.” However, had it not been for Elizabeth, my wife of almost 18 years and best friend for 20, whose picture (sitting on a peak in the Lake District) is in the banner above, and who is now in my Gravatar image as well (precisely because what I am trying to say about her part in this is true), I probably would never have come to the point of disbelief, for not only was she a disbeliever long before I was, it was her struggle to die, when her MS, and the misery and pain and indignities associated with it, became so intolerable, that opened my eyes to the fact that, even for a liberal “believer” of the “Sea of Faith” sort, there were moral issues of great importance that I had simply overlooked by the general institutional support that accompanied my membership in, and action on behalf of, a specific religious institution. This stood out for me in stark relief the moment Elizabeth tried to take her own life, and failed, thus setting her on a course which would eventually take her to Zurich, where Dignitas, the assisted suicide organisation which accepts foreign applicants, helped her, with great kindness and dignity, to die, as she sought to do.

Elizabeth herself, though many years younger than I, was the formative influence in my life, far more important than schooling or religion. A woman of great integrity, energy, intellect and joy, she offered me unconditional love, and provided the basis for the freeing of my mind from the dead weight and trammels of my past. Though I do not believe in destiny, the shape my life took seemed – because I can only think of my life until the point that Elizabeth and I exchanged our love as but a propaedeutic and forerunner to the fullness of life that I would come in time to know with her – almost predestined, as though we were supposed to meet and fulfil each other’s dreams of love and commitment. This was expressed in a poem I wrote after her death, entitled “Easter Rising,” about an unexpected intimate encounter with Elizabeth very early on the first Easter morning after we had (earlier in the year) first exchanged our vows of love (and, truth be told, shortly before I would go out to celebrate another resurrection, in a more formal, liturgical way). The poem ends on this note:

One flame forever,
as in the snow,
deeply blended,
each to each,
we yielded,
as the sun began to climb,
and, as one, arose together,
that first Easter morn,
enfolded in each other,
a new creation,
of each other born.

Religion, from that point, began to play an increasingly secondary role in my life, and though I continued to function as a priest in the Anglican Church for all the years of our marriage — and was, indeed, more actively involved in the institutional life of the church on a diocesan level – it was perhaps inevitable that, with Elizabeth’s death, my active participation in that ministry should come to an end. I soon realised that “faith,” for me, had become not only very tenuous, but, indeed, an impediment to clarity of thought and fulness of life. I remember with great affection, however, the years I spent as a priest, and the people I served and learned to care for and admire during all those years, especially those years of priesthood which I shared with Elizabeth, who taught me (for the first time in my life) what it is to love and to be loved in return. It was when the beliefs of the church began to have an immediate impact on the life of the one I held most dear, that close relationship with the church, and participation in its official ministry became intolerable. It is important to recognise that the church does not truly acknowledge the right of its members to value things differently than these things are valued through the church’s institutional expression; and being an active and supporting member of the church is in fact to uphold and defend those values, even when one most strenuously disagrees.

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This blog, really, is all about Elizabeth

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This is my first blog post at Free Thought Blogs, so I want, from the start, to explain my own reasons for being here, for thinking of myself as a “freethinker” (a term which still does not come easy to me), and for wishing to join a community dedicated to freedom of thought, atheism, and opposition to religious belief. I also want to make the point as clearly as I can, as I start out, how Elizabeth (my wife who died in 2007 in Zurich) is the main inspiration of all that I write, and the patron “saint,” if you like, of this Blog. Without her, I would have been a very different person indeed. I will also remark on some of my present interests and concerns.

At the masthead or banner of my blog choiceindying.com, there from the very beginning in December 2010, has been the tag line, “Arguing for the Right-to-Die and against the Religious Obstruction of that Right.” However, had it not been for Elizabeth, my wife of almost 18 years and best friend for 20, whose picture (sitting on a peak in the Lake District) is in the banner above, and who is now in my Gravatar image as well (precisely because what I am trying to say about her part in this is true), I probably would never have come to the point of disbelief, for not only was she a disbeliever long before I was, it was her struggle to die, when her MS, and the misery and pain and indignities associated with it, became so intolerable, that opened my eyes to the fact that, even for a liberal “believer” of the “Sea of Faith” sort, there were moral issues of great importance that I had simply overlooked by the general institutional support that accompanied my membership in, and action on behalf of, a specific religious institution. This stood out for me in stark relief the moment Elizabeth tried to take her own life, and failed, thus setting her on a course which would eventually take her to Zurich, where Dignitas, the assisted suicide organisation which accepts foreign applicants, helped her, with great kindness and dignity, to die, as she sought to do.

Elizabeth herself, though many years younger than I, was the formative influence in my life, far more important than schooling or religion. A woman of great integrity, energy, intellect and joy, she offered me unconditional love, and provided the basis for the freeing of my mind from the dead weight and trammels of my past. Though I do not believe in destiny, the shape my life took seemed – because I can only think of my life until the point that Elizabeth and I exchanged our love as but a propaedeutic and forerunner to the fullness of life that I would come in time to know with her – almost predestined, as though we were supposed to meet and fulfil each other’s dreams of love and commitment. This was expressed in a poem I wrote after her death, entitled “Easter Rising,” about an unexpected intimate encounter with Elizabeth very early on the first Easter morning after we had (earlier in the year) first exchanged our vows of love (and, truth be told, shortly before I would go out to celebrate another resurrection, in a more formal, liturgical way). The poem ends on this note:

One flame forever,
as in the snow,
deeply blended,
each to each,
we yielded,
as the sun began to climb,
and, as one, arose together,
that first Easter morn,
enfolded in each other,
a new creation,
of each other born.

Religion, from that point, began to play an increasingly secondary role in my life, and though I continued to function as a priest in the Anglican Church for all the years of our marriage — and was, indeed, more actively involved in the institutional life of the church on a diocesan level – it was perhaps inevitable that, with Elizabeth’s death, my active participation in that ministry should come to an end. I soon realised that “faith,” for me, had become not only very tenuous, but, indeed, an impediment to clarity of thought and fullness of life. I remember with great affection, however, the years I spent as a priest, and the people I served and learned to care for and admire during all those years, especially those years of priesthood which I shared with Elizabeth, who taught me (for the first time in my life) what it is to love and to be loved in return. It was when the beliefs of the church began to have an immediate impact on the life of the one I held most dear, that close relationship with the church, and participation in its official ministry became intolerable. It is important to recognise that church does not truly acknowledge the right of its members to value things differently than these things are valued through the church’s institutional expression; and being an active and supporting member of the church is in fact to uphold and defend those values, even when one most strenuously disagrees.

You may continue reading this post over at Free Thought Blogs.

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*That it was largely written by Dworkin is my judgement, at any rate, basing myself purely on stylistic grounds.

Are there any religious experts? “Religion experts” on euthansia

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This post is now available in Polish translation over at Racjonalista. Thanks again go to Malgorzata.

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The Ottawa Citizen has an advice column which puts questions to so-called “religion experts,” who give answers on crucial issues facing individuals and society. There is a big problem with this, because religion experts are, almost by definition, not religion experts at all. What is there to be expert about? They might be experts in their own religion, but there is no such thing as a religion expert who is qualified to give religion’s answer to any question. A recent column in the Citizen’s “Ask the Religion Experts” column, for 31 January 2012 — thanks to Veronica Abbass for the link – asks the two questions: “Is euthanasia right? Would God want us to suffer?” And then the religion experts weigh in on the side of their favourite god. The nonsense that this makes of the questions should be clear right from the outset. We ask the experts their opinion, and all they can do is refer to the “experts” of their religion. According to Z, this is the way it is; according to Y, the truth is such-and-such, and so on. And, around the edges, a little lie or two will take you over the hump when reason fails.

The first one is perhaps the funniest. It’s by a Bahá’í scholar, Jack McLean. Seeing him described as a scholar reminds me of the day I took my M.Div. degree diploma and cut it to shreds. I no longer consider that to be a degree at all. It qualified me as an Anglican priest, but it no longer seems to me that there was anything to know, except, of course, historically, for the church does have a history (or perhaps I should say the churches have a history, for there is no point, during the whole history of Christianity, where there was an unquestioned unity within Christianity), but it is impossible to be a scholar of religion itself, for religion has no subject matter. The “theo” part of theology (the word ‘theology’ meaning, roughly, the logos of theos, or the reason, knowledge of god) is simply UA (on unauthorised absence), having departed his post, or, rather, never having been there in the first place, for all the confident pretence of religious believers, especially its officer class, to which, largely, the Ottawa Citizen has appealed for enlightenment upon a subject which has no object.

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Why did anyone think that pain was the only issue?

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An article in yesterday’s New York Times, oddly entitled “In Ill Doctor, a Surprise Reflection of Who Picks Assisted Suicide,” expresses surprise at the type of patient who chooses assisted suicide as a way of bringing their lives to an end. Indeed, the author, Katie Hafner, quotes Linda Ganzini, a professor of psychiatry at Oregon Health and Science University, as saying:

Everybody thought this was going to be about pain … It turns out that pain is kind of irrelevant.

When I read this I was deeply troubled, because it seems to miss the point altogether, and shows just how distant people are from understanding what happens when we die. Anyone who had understood this would not have made the mistake of assuming that pain was the central issue in appeals for assisted dying.

Recall, here, that assisted dying is all about choice. In England the association which first attempted — as long ago as 1936 — to get voluntary euthanasia legalised was called the Voluntary Euthanasia Legalization Society, and although one of the conditions specified in their propaganda for the right to receive voluntary euthanasia includes severe pain, the composition of the society itself should have been an indication that this was not really the issue. For the society was composed entirely of high-ranking physicians and men of influence and power, lawyers and churchmen amongst them, some of whom were members of the House of Lords — in other words, just the sort of people who customarily have a great deal of control over their own lives. One of them was the onetime Dean of St. Paul’s Cathedral in London, the Very Rev’d William Inge. But he was not the only supporter amongst the clergy, as this linked article in the Montreal Gazette confirms. They did not carry the day then, and they certainly have not carried the day with the contemporary Church of England, which, according to its website,

is opposed to any change in the law, or medical practice, to make assisted suicide permissible or acceptable.

The point, however, is that those who have come out in support of assisted dying are not at all the type of people who are content to lie back supinely and let other people make decisions for them. They are, by and large, active, educated people, known to value control of their own life and decisions.

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The Commission on Assisted Dying is embarrassingly wrong! How did they manage it?

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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.

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IanVisits said

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In response to a blog post on the Commission on Assisted Dying’s report, which is expected to be made public on Thursday, from the blog Cranmer (“Examining Religio-Political Agendas with Politco-Religious Objectives”),

IanVisits said…

The problem is that such a Bill would implicitly determine that some lives are simply not worth living: some existences are ‘second class’.

As someone who is likely to face a rather protracted illness and lingering death (unless I am hit by a car), I can assure you that some lives are indeed inferior to others.

Being stuck in bed with needles stuck in you and nurses constantly checking that you are still clinging onto life is unquestionably inferior to going out for a nice walk and doing what I want when I want.

I have already taken the decision that – funding permitted – I will take the option to end my life when it becomes unbearable.

At the moment, I have a choice, I can leave while still fit enough to get to Switzerland, or I can hang around a bit longer, but with ever increasing risks that I will wake up one day and be too ill to make the trip.

If I am stuck in the UK, the State will then force me to linger on in ever increasing levels of discomfort and decreasing levels of dignity until medical science eventually fails to hold my shattered carcass together and I finally die.

I don’t want to die. I want to live as long as I can do so in moderate dignity.

The current system actually kills me sooner than necessary – simply because I have to die at a time when I am still fit and modestly healthy to take a trip to Switzerland.

Changing the law will let some of us wait a bit longer – maybe a few weeks, maybe a few months – before taking the final option.

Yes, some people will be pressured into death, but that already happens and there are a lot of people who “die in their sleep”, who most certainly were assisted to do so. The law on murder covers those cases, so there is no need to worry that assisted suicide would change that.

Letting people choose when to die will mean more people living for longer, and when they die, they can do so at home, surrounded by comforts and not in an impersonal Swiss industrial estate.

Why is that a bad thing?

4 January 2012 10:56

I echo the question: Why is that a bad thing? Christians, like the man who styles himself “Archbishop Cranmer”, think that there are all sorts of dangers involved in the legalisation of assisted dying. In his post he says this:

Presently, only about 20-25 people jet out to Switzerland each year to end their lives. It is estimated that the legalisation of ‘assisted suicide’ and euthanasia would lead to 13000 deaths annually. The most vulnerable elderly and disabled would inevitably feel they were a burden on their families and society, and the terminally ill may view the option as preferable to months or years of treatment and palliative care. God alone knows how many teenagers might choose to end their lives over depression, family breakdown or unrequited love.

This just shows how the religious are reduced to empty fear-mongering over the issue of assisted dying. Sure, people can be put under pressure to die, but whether they have decided or not would be subject to review, and would have to be vetted by someone who could discern whether or not their decision was freely made. As to estimates of numbers, there is very little ground for making prognostications. The numbers in the Netherlands are only a very small fraction of deaths every year, and it is likely that this will be true of England and Wales as well. As to being a burden on their families, as Mary Warnock has repeatedly said, there is no reason why a person who feels a burden should not be able, for altruistic reasons, to decide to die, especially if other aspects of their situation seemed to make life no longer worthwhile for them. Besides, does it not happen now? Are persons never pressured into forgoing treatment or having treatment withdrawn? As for teenagers, any law legalising assisted dying would not include anyone with transient episodes of depression, as is the case in most instances of teenage suicide. People really must make some effort to be reasonable, as the person calling himself (rather pompously) ”Archbishop Cranmer” stoutly refuses to do.

Thanks to Mark Jones for the link.

Christians did this!

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The Guardian reported on 2 August 2011 that there is support for a change in the law regarding assisted dying. According to the report, aptly entitled “Assisted dying poll shows support for change in law“,

Three in four people said terminally ill adults who want to die should be able to ask their doctor for help, while only one in three said physically disabled adults who were not terminally ill should have the same right. [my italics]

Of course, this is old news. Polls in Britain have been almost uniformly in favour of assisted dying for the last ten or fifteen years. But, just see what Christians have wrought! Isn’t this good news, then? No, it’s not. It means that anyone who is paralysed or has locked-in syndrome — like ”Martin“, whom it would be cruelty to force to stay alive – anyone who is suffering from a degenerative disease which leaves them incapable of caring for themselves and in misery, anyone except those who are going to die — when? how long qualifies as terminal? — must put up with the pain, indignity, or what may be, to them, the sheer unrelieved boredom of being alive and in whatever condition it is that leads them to want to die, without any option.

[Thanks to Haggis for the following correction (and further below). Shows how anger can switch off your careful reading monitor. Note that it is still a disturbingly large majority who think we should make choices for others a critical points in their lives.]

Three Two out of three four people are prepared to say that they are qualified to rule about other people’s decisions about the value of their lives. Three Two out of three four are that confident!

This is important. It means that people like Sir Edward Downes, who went with his wife to Switzerland, where they both were assisted to die, would have been forced to go on living, even though, without his wife, who was terminally ill, he would have been left alone, without his life partner, in an increasingly silent, dark world, because of increasing deafness and blindness. It means that people like Daniel James, a young rugby player, who was completely paralysed and in pain, would have had to go on living, perhaps to live the full span of his life, possibly fifty years more, because he was not dying, instead of being allowed to die, as he chose to do (also at Dignitas). It might well mean that my wife Elizabeth would have been forced to live for several years in torture, paralysed, enduring constant spastic pain, unable to speak or to feed herself, until someone else decided that her condition was “terminal”.

It means that Christians, who’ve spent the last thirty years raising the anxiety level of the disabled and mentally challenged to explosive levels, have managed to force their will on the suffering, to satisfy their lust to force their will at least on some.

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Submission to Commission on Assisted Dying by Isobel McLachlan

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Stone of Morphie

[The following consists of two submissions to the Falconer Commission -- the UK Commission on Assisted Dying -- kindly submitted by a reader in Scotland. The first is Isobel McLachlan's submission, and the second is a brief submission from her husband Colin, which expresses his agreement with the submission that his wife Isobel made to the Commission. Together they constitute a very eloquent appeal for reason and choice in dying, instead of the present status quo which was established long ago by religious beliefs which many people do not now share -- and even, of those who share them, a majority support a change in the law to permit assisted dying. Isobel's and Colin's submissions are also passionate testimony to the situation in life that so many people face, and from which our present laws, except for very few places on earth, provide no appeal, and to which they offer no alternative. Despite the idiocies of people like Damian Thompson or Allison Pearson, the Archbishop of Canterbury or the Pope, choice in dying is, as Ludwig Minelli (the founder of the Swiss organisation Dignitas) justly says, our last right -- not, mind you, the only right that is in need of recognition, but the last right that each of us can have, since, once granted, will be, when and if claimed, the last right that we will exercise as free persons. I wish to thank Isobel and Colin for letting their words stand here as a testimony to their love, their humanity, their courage and their good sense.]

I am 54 years old and suffering from Stage IV Breast Cancer. Although I have great faith in, and admiration for, the scientists & doctors who work tirelessly and with incredible ingenuity to produce treatments which give people in my situation a good quality of life for as long as possible, the fact remains the condition is incurable. I have, therefore, had to come to terms with my death in the not too distant future. In this I am resigned, as I can do nothing to change the fact. The manner of my death, however, is another matter and, over this, I strongly feel I can and should be able to exert a degree of control.

If we accept we all have the right to live, then, surely, we must automatically also have the right to die. If suicide is legal, then it is illogical for the assisted suicide of a terminally ill person to be illegal! If a much-loved pet is “put to sleep” to avoid suffering, how can a civilised society countenance human beings having no choice but to suffer?

As an atheist, I find it a disgrace that the views of an unelected minority can be imposed on us all, as happened in the House of Lords in the vote on Lord Joffe’s Bill, defeated with the help of the Bishops. Why, in a secular democracy, should the beliefs of one sector of the population be given such disproportionate weight? We must keep making the point, after all, that what we are suggesting will not take away anyone’s right to a natural death, we are simply asking to be allowed a choice. In every survey I have ever seen, the majority of the people in the country want the law changed.

The legislation I want to see is physician-assisted suicide, i.e. Voluntary Euthanasia. The reason is simply that doctors have the expertise to ensure a peaceful end. I have heard too many horror stories of dreadfully distressing attempts by family members trying to help a loved one die. A doctor takes an oath “to do no harm”. This can be interpreted as prolonging life at all cost. Weight must also be given, however, to the principle of providing relief from pain and distress, even if this results in the end coming slightly sooner for a patient. Let’s be honest, even the BMA acknowledge that there are doctors who have helped patients at the end of life, on purely compassionate grounds, and if the act were not illegal, I have no doubt there would be many more. I can understand that some medical professionals would not wish to carry out assisted dying and so there must, of course, be a means of allowing doctors to “opt out” if it gives them a problem of conscience.

I have written an Advance Directive stating my wishes should I be unable to communicate. If the law were to be changed to allow physician-assisted suicide, I would suggest that the Advance Directive could be altered/expanded to incorporate the change and allow a person’s wishes at end of life to be clearly and formally stated. As it stands, however, I can only instruct in the negative, i.e. withdrawal of treatment or, indeed, food & water, but cannot ask for positive help to end my life. This leaves me with the prospect of possibly dying of dehydration or starvation. This is the very antithesis of care. Is this the way a civilised society should be leaving people to end their days? Surely a compassionate act would be to help people slip away peacefully. With a law in place such matters could be discussed openly and, if my medical attendant would not be prepared to fulfil my wishes for religious or ethical reasons, I would be able to arrange to be placed under the care of one who would. Removing the uncertainty for medical professionals and, thereby, allowing frank discussion, can only be an improvement for all parties.

Opponents of a change in legislation tell us that good palliative care, and not euthanasia, is the answer. Firstly, in spite of what they may say, assisted dying and palliative care are in no way mutually exclusive. It is accepted that a point will generally come in the dying process when nothing more can be done. Surely then assisted dying is, in fact, the natural extension of palliative care. Secondly, can a guarantee be given to every dying person that a good level of care will be given? I don’t see how this could be possible. Whether it was provided or not can only be assessed after the  event, which is of no use to the person on the receiving end. I, for one, want my final days to be, as far as possible, under my control, or that of my husband (who is of a like mind and supports me completely). Indeed, the assertion that pain can be controlled is a major worry for me. The World Health Organisation has developed a “Ladder of Pain”, which is a 3-step ladder for cancer pain relief. This goes from aspirin & paracetamol, through codeine, to strong opioids, such as morphine. On their website, it states that the regular administration of these will result in 80-90% of cancer patients being pain-free. This leaves 10-20% of us with the prospect of dying in severe,  uncontrollable pain. As I have found that non-opioids & mild opioids do nothing to relieve my pain, and strong opioids cause very distressing side-effects, this WHO statistic, rather than reassuring me, leaves me terrified.

The question of “dignity” can also be a point of contention. I once heard a Palliative Care Nurse say that human dignity cannot be lost. As the concept of dignity is entirely subjective, how can she possibly make such a statement? Only the dying person can judge if his/her dignity is lost. As a strongly independent and self-sufficient person, loss of dignity is another of my major fears. Poor care, which I have seen and suffered first-hand in hospital, brings on loss of dignity all the more quickly. I have had more than 30 operations over my life time, for various medical problems as well as  cancer. From this wide experience, I can say that it makes no difference what is in the Patients’ Charters, the reality is that hospital staff frequently fall short of the target always to treat patients with respect and ensure their dignity is maintained.

Another argument cited against the proposed change in the law is concern over the weak and vulnerable, where the elderly in particular may feel pressurised into taking this course of action. As well as there being no evidence whatsoever to show that this has happened in any of the parts of the world where assisted suicide is already allowed (indeed, the Oregon experience shows the opposite), any Law brought in here could, and most certainly,should incorporate the most robust safeguards to protect the weak & vulnerable. Anyone at this stage in their illness, however, will be well known to a number of medical professionals, so it seems highly unlikely that outside pressure  would not be picked up on.

Procedures such as two doctors being involved, psychiatric assessment, and “cooling off” periods, which have all been suggested, answer what to my mind is the most nonsensical argument against such  a law, which is that dying people can become depressed, and might just be having a bad day. Certainly for cancer, there is a well-recognised “dying trajectory”. I will be very aware, as will my palliative care doctor & nurses, when I have reached the final stage and will know that there will be no more “good days”. To deny us the right of choice on the basis we might just be “feeling a  bit low” is insulting and patronising!

As far as who should qualify for assisted dying, in my opinion it should go without saying that the first to qualify would be the terminally ill. In fact, to anyone who would want to deny it for people in that situation, I would ask “Where is your humanity? Where is your compassion?” It should also be allowed for people with incurable and/or degenerative conditions. I can also see an argument for allowing it for any competent adult who has shown a voluntary, settled, clear, and informed wish to die. A change in the law to allow such assistance (even if, ultimately, we did not feel the need to make use of it) would be of enormous comfort to those of us approaching the end of our lives, giving reassurance that we will be allowed to die at the point – which only we can decide – when we can take no more.

If a change in the law is not going to come in time for me, I have to consider what other options may be open to me if I find myself in a position where I can no longer bear my suffering. I will not travel to Dignitas, for so many reasons. I find the whole situation that dying people in Britain are put in just incredible! We are supposed to be a civilised society, but we would have them go through the trauma of a long journey to a foreign country in order to receive compassionate assistance.

The only remaining option open to me is to rely on my husband to help me, should the need arise. Although he does not want to lose me,he would find it unbearable to see me suffer and do nothing. Anyone who knows us is well aware of my views and would see his assistance as an act of love and  compassion. Under the DPP guidelines it is highly unlikely he would be prosecuted. Nonetheless, surely it is not unreasonable to expect legislation to formalise these guidelines and reflect the needs of the modern society in which we live.

Submission to Commission on Assisted Dying.

I wish to go on record as having read the submission of my wife Isobel McLachlan, with which I fully agree. I love her dearly, and when she dies shall miss her in ways I don’t even want to begin to imagine. Nonetheless, I will not see her suffer pain and indignity in her final days. It is internationally recognised that physical and mental torture is a major crime against humanity. It seems obvious to me that allowing a person to suffer while dying, when the means to alleviate that pain and distress are readily to hand, is tantamount to torture. I will not be a party to this torture, and will do what she wishes when the time comes.

Colin McLachlan