THE English author Jojo Moyes’ best-selling ode to assisted dying, Me Before You has probably done more to shape public opinion on euthanasia than any number of parliamentary debates and earnest reports. It made assisted suicide seem positively heroic.
Quadriplegic Will is a handsome, intelligent ubermensch; a go-getter who got what he wanted from life before his motorcycle accident and is determined to get what he wants to end it. It is an existential question; an assertion of free will. His carer, Lou, tries desperately to give him reasons to live, including her own body. But she ends up agreeing that he has the right to decide what to do with his. Next stop: Dignitas.
Will is selfish, of course. But in a secular age of rights and individualism it is becoming impossible to argue against this disabled man’s right to choose. He is not responsible for Lou’s love for him, nor the impact his suicide might have on his friends and family. Nor does he owe a debt to the disabled community, still less an obligation to some religious doctrine.
I similarly find it almost impossible to argue against Liam McArthur’s Assisted Dying Bill, consultation on which has just ended in Holyrood. I would expect to have the right to end my own life if I had a terminal illness and was experiencing unbearable pain. I suspect most MSPs will think similarly when they come to vote on this landmark legislation.
However, I am acutely aware that this is not just about me, me, me.
There is a raft of awkward ethical issues that will follow this profound change in society’s attitude to life and death. Legislators need to think about them now and not be seduced by the euphemistic slogans of campaigners or romantic fiction. The medical profession above all need to think what it means for their Hippocratic mission statement: do no harm.
The doctor’s trade union, the BMA, tried to duck the issue last year by announcing that it is now “neutral” on assisted dying – a moral cop-out. You can’t be neutral about killing people, however humanely. For we are not talking about palliative care here in which terminally ill patients are allowed to die after withdrawal of treatment or sustenance. Assisted dying, any way you look at it, involves active participation by doctors in the ending of life – euthanasia.
Would the BMA be neutral on ending the lives of people who are not terminally ill but have psychiatric conditions like depression? Would they be content for children to be given euthanasia, as in Belgium and Holland? Or old people who feel they are a burden on their families and on society? Probably not. But why not?
This is not some contrived “slippery slope” argument, but question of moral equivalence, of fairness. If I am allowed to take my own life how can I deny that right to others, whatever their condition? Why should anyone who is of sound mind be denied the right to end their own unbearable suffering? Why exclude the terminally depressed, the terminally old? When do you say No? Who is to say No?
Take 29-year old Aurelia Brouwers, the Dutch depressive who, in 2018, drank poison supplied by a doctor in a state-sanctioned act of assisted suicide. Around one per cent of assisted suicides in Holland are psychiatric cases, equivalent to around 200 people a year in the UK. The majority are women.
Euthanasia and assisted suicide have been legal in the Netherlands since 2002. As is proposed here, a patient’s request must be “informed”, “voluntary” and “well considered”. A doctor has to be satisfied that the patient has “unbearable suffering, without prospect of improvement”. Patients receive death by either lethal injection (euthanasia) or a self-administered prescription for lethal medication (assisted suicide). Numbers have tripled from 1,800 to more than 6,000 annually, the equivalent of 24,000 in the UK. Researchers say there are many other cases that go unreported.
The debate in Holland has moved on. Parliament is now considering euthanasia for people who are not terminally ill or even in unbearable suffering, but who are simply “tired of life”. A majority of Dutch voters apparently support the Dutch MP,Pia Dijkstra’s Completed Life Bill, including around 10,000 elderly baby boomers, who told researchers that they no longer saw any point in living. Many said they are “taking up resources”, “depriving families of housing”, “making life difficult for carers”.
Mr McArthur’s bill proposes nothing like this, being for terminally ill patients only. But I know that my mother often felt she was a burden. Many old people feel that way. She was in distressing personal circumstances, disabled and depressed, wanting to end it all.
She started hallucinating and ranting in a racist manner, despite having been a lifelong opponent of racism. We thought that this was it; she was too far gone. Then they discovered that she had a urinary tract infection and she was back to normal in two weeks. It was sobering.
Later, when she finally did succumb to old age she was in the expert hands of a Scottish NHS hospital which specialised in palliative care. I was surprised when the consultant signalled to me, months before she actually died, that she wasn’t going home. They knew she was dying, and were actively making her passing as pain-free as possible.
Supporters of assisted dying say that this palliative care is a distraction. Mr McArthur’s bill is about giving choice to rational people who’ve decided that their lives are not worth living. I fully accept that. I would expect nothing less were I to be experiencing unbearable suffering.
But why should dignity in dying only be available to the terminally ill? Why should the signature of two doctors make any difference? Why should a paraplegic like Will, who considers his life to be unbearable, not also be allowed to choose to end it?
He and many like him will continue to go to Switzerland or Oregon or wherever. The campaign for euthanasia will surely continue until everyone who sincerely wants to die is helped to die. Let us at least be honest about that.
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