02:06, March 22 146 0 theguardian.com

2019-03-22 02:06:03
Deciding how to end one’s life should be the ultimate human right

What is the principal cause of death in Britain? The answer is premeditated killing. And who are the killers? The answer is doctors. It’s said that over half of all deaths result from a specific medical decision, either to administer a knowingly lethal drug dose or to withdraw life-saving treatment. The better we get at keeping ourselves alive, the more cunning we must be in getting to die.

So a modest cheer for the Royal College of Physicians’ vote on Thursday to hold to a position of neutrality on so-called “assisted dying”, otherwise known as voluntary euthanasia. Only 43% now actively want the law to stay unchanged, the rest divided between reform and neutrality. It may at last nudge the debate in Britain towards humanity and common sense. In parliament at present, discussing assisted suicide remains, like abortion in Ireland until last year, taboo.

I regard the right to die as I choose – healthy or sick – as the obverse of my right to life. I may delegate it, as a soldier does to the army. I may hand it, if incapacitated, to someone I love. I may even command a doctor, as is my right, to stop the artificial prolonging of my life. But I do not grant the right over whether I be allowed to live or die to a doctor, a judge or a politician.

Britain continues to treat buying someone a ticket to Dignitas in Switzerland as conspiracy to murder. It is an attitude to common human decency that is stuck in the 19th century. Suicide is no longer a crime, though it took Britain until 1961 to say so. An average of 16 people a day take their own life in the UK, often woefully deprived of psychiatric care. Regulated help to those unable to kill themselves should be treated as an issue of disability, not of criminal law.

The most commonly expressed wish of the dying is to pass away at home, without pain and surrounded by those they love. Doctors should honour that desire for autonomy, not take refuge in the anachronistic dictates of Hippocrates. Most doctors do ultimately listen, but usually only in a hospital ward – the last place most people want to die. The NHS has nationalised death, and wants no one else muscling in on its territory.

The clearest head on this was the philosopher Mary Warnock, who sadly died on Thursday. Surely we can accept, she said, “how deeply we desire a good death, for ourselves, our friends and family; and how much we resent the assumption that death must be fended off at all costs, whatever our wishes”. Indeed, “The desire to escape the intolerable humiliations as well as the pains of incurable illness usually combines with the desire not to be a burden or a futile expense; this is a perfectly respectable motive, which should not be thought of as the outcome of undue pressure.”

The LSE’s expert on euthanasia law, Emily Jackson, struggles to disentangle sound argument from religion. Where does treatment end and become a “usurping [of] God’s monopoly on the power to give or take life”? When challenged, fundamentalists slither from religious dogma into “concerns” about regulation. To be sure, says Jackson, there are concerns, but regulation is the essence of medical ethics. Doctors already accede to the wishes of patients and family, for instance on withdrawing treatment in cases of persistent vegetative states. As Jackson put it in an unpublished lecture: “The lawful means that doctors use to shorten people’s lives are almost certainly more open to abuse than legalised euthanasia.”

Nothing to do with terminal healthcare is easy. I once asked a friend diagnosed with motor neurone disease how he wanted to die, adding that I would gladly help him in any way. We were walking in Snowdonia, and he said he wanted eventually to die on the mountain right where we then stood. His friends should carry him in his wheelchair, have a drink and push him off his favourite rock. I said I would rather hand him a couple of pills. He asked, what was the difference? Climbers, I gather, dream of dying on mountains.

This shows that hard cases make bad law. Euthanasia is bedevilled by cliches about slippery slopes, doctor executioners and “bumping off granny”. But there is now enough evidence from abroad that regulatory concerns can be answered. Debate is turning to whether dying in conditions of “intolerable suffering” might extend to psychological suffering, and whether assistance might be given to those not terminally ill. No one seeks to imitate the cruelty of the British law.

While other countries – Switzerland, the Netherlands, Belgium and various US states – are moving towards a more humane and respectful approach to the end of life, Britain is stuck in an age of superstition, its attitude reminiscent of 1960s views on abortion, divorce, homosexuality and the contraceptive pill (“only for married women on prescription”). As doctors are quietly conceding life-shortening measures, so judges are refusing to convict travellers to Dignitas in Switzerland. But even as practice makes an ass of the law, each judgment tends to refer back to parliament. As with drug laws and penal reform, Britain’s broken-backed politicians are the last refuge of social illiberalism.

The medical profession cannot be blind to the human implications of ever greater life expectancy. The implications are there to be tackled. It is not God but doctors who want to monopolise end-of-life decisions, hugging them close to their hospital empires. Suicide may be a sort of failure, but deciding how one wants to end one’s life must be the ultimate human right. If people need help to handle it with dignity, doctors should offer them help, not condemnation.

In the UK, Samaritans can be contacted on 116 123 or email jo@samaritans.org. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org

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