Margo Macdonald’s current proposals on assisted suicide go by the hard-to-argue with name of the End of Life Assistance (Scotland) Bill. Who wouldn’t want to be assisted at the end of their life? I know nothing scares me more than the thought of non-existence, nothing that is except inescapable pain or the loss of function in my body or my mind. Some assistance would be appreciated, thanks society.
Of course, it’s an ambiguous name, and what it’s really about is assisting people to end their lives. No doubt the decision was taken to find a less controversial name than the Euthanasia (Scotland) Bill or the Assisted Suicide (Scotland) Bill.
This is an issue normally phrased as a challenging moral debate, with newspapers feeling obliged to locate quotes for and against, the latter normally from the Catholic Church or similar. Sometimes it’s the supporters who don’t get a look in. For instance, the Daily Mail recently ran a virulently negative piece which suggested such legislation would lead, UK-wide, to 1,000 deaths.
I don’t get it. It’s a pure freedom issue to me, I have nothing but respect for Margo’s decision to bring the legislation forward, and I agree with her that there needs to be a set of robust safeguards. Personally, I cannot imagine what it would be like to suffer interminable pain and to be denied the choice to end it. If you’re against it, religious readers, simply don’t do it. Don’t take part. It’s absolutely your freedom, should you find yourself in the situation the Bill is intended to cover, to suffer on as long as you wish.
There’s a theme here we see in other areas: people seeking to project their own individual moral preferences onto society and make universal laws accordingly. It’s like the debate over decriminalising gay sex in the 60s. Just because you don’t want to do it yourself, fine, but that’s no reason why you should be allowed to limit the freedom of others to do so. I also wonder whether any of the small number of vociferous opponents ever find themselves in the situation they’ve speculated about later in life, and if that new feeling of powerlessness occasionally changes their mind.
That Daily Mail article can be read completely differently. The figure seems high, but if they’re right about it, there are 1,000 people in this country suffering unbearably and being denied the final relief, people whose freedoms must not be denied in their time of extraordinary need. Some of those thousand people would decide to ask for help to end their life, others may decide otherwise. Whatever the numbers, the choice should be theirs, and Scotland would surely be a better place if Margo’s Bill passes.
#1 by Indy on October 27, 2010 - 12:37 pm
I have no objection, moral or otherwise, to people taking their own lives. Everybody should be free to commit suicide.
But Margo’s bill is not about that. It is about doctors killing people.
Two different things.
#2 by James on October 27, 2010 - 12:38 pm
It’s about people who want to take their own lives and who are incapable of doing so having the assistance of a doctor to do so. What would you do where someone wants to die but is physically unable to take the pills or inject themselves?
#3 by Despairing on October 27, 2010 - 12:44 pm
I agree with absolutely everything James says on this. People should have the freedom to choose, and I’d rather the doctor ended my life humanely than have to put up with years of pain, suffering and humiliation – by both me and my carer.
#4 by BM on October 27, 2010 - 1:07 pm
When my aunt was lying on her death bed with cancer, fighting for every breath, was she humiliated? Do you go round the terminally ill ward at hospitals, look at those struggling bravely to take every day they’re sent, and think “Oh my god, they must be humiliated”? If so, then I do not find it surprising that you would favour ending someone’s life. After all, your embarrassment is much more important than the good friends you’ll leave behind, the grandchildren you’ll never see again, or the contribution you could make to society and the lives of other individuals.
You’re right to not be “humiliated” trumps all these, to be sure.
I really do consider it the hight of insult to frame this debate as “young, healthy, and proud” vs “old, ill, and humiliated”.
#5 by Despairing on October 27, 2010 - 1:46 pm
Firstly, I deliberately never mentioned age. It shouldn’t be a factor in this debate, otherwise we get into the realms of how old a person should be before we think it’s ok for them to make the decision to end their own lives.
Secondly, your aunt obviously didn’t want that. She was in a position to acknowledge that. But you can’t speak for all the others on the same ward. The debate is not about death panels or doctors choosing who should live or die, it’s about terminally ill people having the right to choose for themselves when the end should come.
And thirdly, I’d consider it humiliating to have someone change my colostomy bag or clean up my mess or carry me into a bath. I may be very grateful to them, but it would be humiliating nonetheless.
#6 by James on October 27, 2010 - 2:49 pm
I don’t favour ending anyone’s life unless they feel it’s the right option for them. If people want to fight through the pain for as long as doctors can keep them alive, I support that.
#7 by Jeff on October 27, 2010 - 1:44 pm
” It’s like the debate over decriminalising gay sex in the 60s. Just because you don’t want to do it yourself, fine, but that’s no reason why you should be allowed to limit the freedom of others to do so.”
It’s not quite that simple though is it James? What if one were to replace ‘gay sex’ with ‘murder’. An upping the ante of shock tactics – ‘if you don’t want to commit murder then don’t but please don’t get in the way of the freedoms of those who do’.
That said, I do want Margo’s Bill to pass and I trust the robust safeguards will mitigate the vast majority of risks. Some may say that if this Bill leads to one person having their life terminated against any reasonable free will (non comus mentus etc) then it is not worth it.
It may sound grisly, but I actually disagree. A nurse accidentally switched off a life support machine last week with a deeply regrettable result. Should we stop hiring nurses because they cause unwanted deaths?
I hope Margo’s Bill passes.
#8 by James on October 27, 2010 - 2:48 pm
If someone like Diane Pretty wants to be helped, why shouldn’t she be? There’d be no victim there. If two people want to have sex together there’s no victim. Whereas, with murder..
#9 by Paul Freeman on October 27, 2010 - 2:14 pm
Total respect for Margo to even try to bring this bill, and I too hope it passes.
For BM’s aunt above, if she chooses to fight then the Bill doesn’t cover her. It is assisted suicide. Some people do feel humiliated, some do have so much pain that they want to the pain to end.
btw, a title pun worthy of Jeff
#10 by Indy on October 27, 2010 - 2:16 pm
You’re still avoiding the issue saying that doctors would be providing assistance to people who want to end their own lives.
They would be providing assistance by killing them.
That’s what this Bill is about.
I would certainly be in favour of modernising the law regarding assisted suicide with regard to relatives/friends who help someone who wants to die.
But doctors killing their patients – even if those patients consent – is something else. It is a totally different thing and I don’t think it’s honest to frame the debate any other way.
#11 by Jeff on October 27, 2010 - 3:34 pm
Doesn’t legal “killing” already take place though? Can this legislation not be seen as protection for doctors who already do end lives?
I don’t know the difference between what this Bill would allow and what the limits of the current laws allow for but I do know, first hand, of two incidents where doctors put forward an option of ending a life before nature could.
I don’t see much difference between such circumstances and the person involved having a say in advance. Indeed, the latter is surely preferable?
#12 by Indy on October 27, 2010 - 4:04 pm
No legal killimg does not already take place. A doctor who intentionally killed a patient would be charged with murder the same as anyone else would be.
I agree there is a gray area around end of life care but Margo’s bill requires registered medical practicioners to approve the killing of patients who request that.
That’s why I cannot see it as “assisting” a suicide. With suicide a person takes responsibility for ending their own life. Under the provisions of this Bill responsibility for ending life is essentially passed to the doctor.
#13 by Jeff on October 27, 2010 - 5:27 pm
I’m going to continue to dispute the “legal killing” point you make Indy, but I’m not suggesting the boys in blue need sent in anywhere.
But when a doctor talks about switching a life support machine off, gains consent from the family and then acts on it, is that not strictly speaking a legal killing? Particularly so when there is still a chance of life but with no quality of life therein. I’m not saying such a scenario is exactly the same as what Margo is proposing but it is sufficiently similar to dilute your points. I think, at least.
#14 by James on October 27, 2010 - 5:27 pm
I see we agree: you do accept the right of someone to end their own life.
But if they’re simply physically incapable of doing so (which will tend to be disproportionately accompanied by additional pain and distress), then that right should effectively be withdrawn, no matter how clear their own opinion may be? How does that make sense?
#15 by Indy on October 27, 2010 - 6:48 pm
“When a doctor talks about switching a life support machine off, gains consent from the family and then acts on it, is that not strictly speaking a legal killing? ”
No of course it isn’t. When someone is on a life support system their life is, by definition, being artificially prolonged. Switch off the system and they will die. In many cases doctors may help them at that point by giving them drugs. But that is not the same as intentionally killing.
As regards James’ point, as I have said I have no moral objection to suicide but the individual needs to take responsibility for that. I just don’t think it is right to ask doctors to take that responsibility.
#16 by AB on October 27, 2010 - 11:33 pm
Having read the above comments – just some thoughts, and then turning to the article itself an the Bill itself. Hopefully, this might stimulate some further debate…
The issue of “legal killing” by doctors. Importantly, no doctor can ever (in any circumstances) chose that an individuals life is not worth living (due to terminal illness, pain suffering etc); he has neither the legal nor moral authority to make such a determination. That said, several legal caveats exist. (1) You can choose, by way of advance directive, also known as living will, not to be treated. You need not justify your decision and this can include denial of life saving treatment, (2) A doctor can by the doctrine of ‘double effect’ hasten death by administering drugs – however, only in circumstances where the shortening of life is not the primary aim of said actions, (3) When Indy and James talk about family consent this misses the point that all individuals are deemed competent to make decisions for themselves, regardless of family desires, unless they are deemed mentally incompetent. The starting point should always be the competent individual wishing to end life. Protections should be built in for the more exceptional cases of mental incompetence.
Regarding the analogy with the decriminalisation of homosexual activities/murder. The foundation of all laws in a liberal democracy should be the harm principle; we can do all things which do not harm others. To change the law to enable someone to assist suicide does not harm others so long as doctors who do not wish to act in such a manner have a full, unconditional opt-out clause. On my quick reading of the Bill, as it stands, no such provision exists. Without such a provision this Bill is utterly useless – otherwise a issue of harm to doctors would result.. Murder = harm to others (individuals and society as a whole).
Physical capacity to commit suicide vs mental competence to decide. The current law can surely be read in the following manner; if you have the capacity to commit suicide but do not posses the mental competence (ie. would be deemed mentally incompetent such that a proxy would make medical decisions for you if you were properly assessed) then you are free to commit suicide. However, if you lack the capacity but are of full competence then you are denied the same freedom to end your life by dint of physical incapacity.
Drawing on this, we would surely argue that the mental competence of the individual is of far greater importance than the mere luck of physical capacity. To take this ad extremis; we allow those physically incapacitated to vote but do not allow those mentally incompetent to vote. A crime (ie conspiracy to murder) can be committed by someone who plans a murder even if physically incapable of the actual act; however, someone without mental capacity (insanity) would be incapable of committing the same crime (not guilty by reason of insanity). We deem mental capacity as more important than physical capacity in all areas of the law and society yet the current law on suicide does not reflect this. .
While I appreciate the Bill is still in its drafting infancy I would suggest the following elements are of concern (provisions pasted below)
(a) In this Act “end of life assistance†means assistance, including the provision or
administration of appropriate means, to enable a person to die with dignity and a
minimum of distress.
The problem with a topic like this is the emotional nature of the language which enters the debate. People die every day without dignity and in considerable distress – if I want to die in such a manner then why not allow such a choice to be enabled (taking the liberty argument to its logical conclusion). Secondly, if end of life assistance is defined in the above terms, does this mean that should the assisted death not be dignified or with a minimum of distress would the ‘enablement’ therefore be illegal (murder or assisting suicide?). Thirdly, who defines a dignified death; the patient, the doctor, a medical panel or a judge? Do we essentially end up with a contract, determining the ways, means and results between Doctor and patient, the breach of which demands a remedy – some form of punitive sanction against the doctor?
(2) (a) has been diagnosed as terminally ill and finds life intolerable; or
(b) is permanently physically incapacitated to such an extent as not to be able to live independently and finds life intolerable.
Why are these the parameters? It seems incredibly strange, if we believe in freedom of choice based on mental capacity, that we must pass some hurdle of intolerability before our choice is accepted by society. Again, who makes this determination of intolerability. This indicates this Bill is not about freedom of choice; surely with the safeguards of mental competence (fully informed, voluntarily made decision) and the very fact someone makes an application for assisted suicide is enough. Consider also, ‘ability to live independently’ as a factor – can an individuals freely made decision be vitiated by social services modifying a house or providing assistance such that the individual is able to live independently? Taking this further, who actually lives ‘independently’ – we all rely on others – who the heck defines independently – is this a hermit or a fully socially interactive person?
(4) For the purposes of subsection (2)(a) a person is terminally ill if the person suffers from a progressive condition and if death within six months in consequence of that condition can reasonably be expected.
Again, another strange parameter.. If an individual is 25, terminally ill, finds life intolerable but has a prognosis of 20 years why should this individual be denied the assistance whereas someone in a merely temporally different position has different legal assistance.
Looking at this Bill as a whole, it does not represent the step change in the legal and social change which a fuller respect for voluntary choices demands. This is a Bill designed for the most limited of circumstances – I imagine even then it will be watered down even further or not pass at all.
The principle of sanctity of life is still vital. The principle that care shall always be provided free at the point of use for any person who wishes to utilise such services is still important. But perhaps the principle of freedom of choice demands elevation beyond the morally conservative benevolent paternalism which underpins the status quo.
#17 by James on October 27, 2010 - 11:44 pm
Fascinating, thanks so much for your contribution.
A couple of things that jump out at me there:
Exactly my view, but put more clearly.
And your concerns with the detail (timescales, the definition of dignity): I just hope Parliament gets the chance to debate them. I fear the Bill will get voted down at Stage One, sadly.
Also, I don’t know if you’re on Twitter..