The Right to Die is Wrong

by Michael Carberry

Last month, on 29 November, the British House of Commons, the lower house of the UK Parliament, passed a Private Members Bill* put forward by Kim Leadbeater MP proposing a change in the existing law to permit assisted dying i.e. permitting family members or professionals to assist a terminally ill person to take their own life.  This was only a first stage in the legislative process.  The Bill will have to go through a committee stage where it is debated clause by clause and then go to the House of Lords, the upper house, before going back to the Commons for final approval. At any stage the draft could be significantly altered or thrown out altogether.  This means that it could take up to three years before the Bill becomes law if at all.

I have considerable respect for Kim Leadbeater, who showed great courage and resilience in response to the brutal racist murder of her sister, Jo Cox MP, by taking over her seat in Parliament.  There are few matters on which we would disagree, but on this particular topic she is wrong. The issue is a very delicate one, touching as it does on people’s moral, ethical and religious convictions and often coloured, as in Kim Leadbeater’s case by their personal experiences. Several government ministers, including the Prime Minister, voted in favour, while both the Health Secretary, Wes Streeting, and the Justice Secretary, Shabana Mahmood, who would be the ministers principally concerned with any change in the law, vigorously opposed it. 

I have read much of the literature and listened with great interest to many arguments about this topic over several years but I personally remain strongly opposed to all forms of active euthanasia, or assisted suicide, even if voluntarily requested by the patient.  One of the distinguishing features of a civilised society is its respect for human life.   That respect is correspondingly one of the first things to disappear under tyrannical regimes or when civil society breaks down.   One aspect of the increasing respect for human life around the globe is the widespread abolition of the death penalty. This extends to more than half the countries in the world and is now even a condition of membership of the EU.  It seems to me bizarre that when we no longer terminate the lives of rapists, murderers and terrorists we should consider doing so for elderly or terminally ill people when in nearly all cases palliative care is possible.

Although many people think that assisted dying is about preventing prolonged and unnecessary suffering, campaigners for the Bill, like the writer and broadcaster Jonathan Dimbleby, acknowledge that that is not really an issue, since with proper palliative care, pain can be managed.  Rather they prefer to talk about the “right to die” – a bizarre phrase since, for the foreseeable future, everyone will die unless efforts are made to maintain them alive and such efforts can only be temporary.  Even the term ‘assisted dying’ is a misnomer. What it really means is ‘assisted suicide’ i.e. the ability to end one’s life at a time and place of one’s own choosing. It is a question of control or “autonomy” as campaigners prefer to call it. 

One cannot but be touched by many of the stories put forward by the assisted suicide lobby.  But the people who are most vociferous are those who find it hard to accept the loss of control in their lives and for whom the campaign does something to redress that balance.   I get particularly irritated by the phrase “dying with dignity”. Not that people should not be allowed to die with dignity but that the way the phrase is used implies a misguided and distorted idea of what dignity really means.     Dignity has two aspects.  First, the behaviour or comportment of the person themselves.  Many people, deliberately debased or put in humiliating circumstances, as in the Nazi concentration camps, were nevertheless able to conduct themselves with great dignity.  Dignity does not come from having control and to suggest that it does is to demean those, like the disabled, who do not always have that possibility.  At a time when we are increasingly recognising and celebrating the contribution of disabled people in all walks of life, to suggest that not having full autonomy is undignified is offensive.

The other and perhaps more important aspect is the dignity accorded to an individual by others.   In a civilized society, children, the elderly, physically or mentally disabled people, even prisoners, all have the right to be treated with dignity even though they are not in full control of their situation and in many cases never could be.  The danger is that if these individuals cannot decide for themselves, others will do it for them.  I understand that in Belgium, where assisted dying has been legal for some time, it is now possible, in certain cases, for relatives to terminate the lives of severely disabled children or people with dementia.   That has worrying echoes of the dystopian world of Nazi Germany where, apart from all the Jews, Gypsies, homosexuals and political opponents murdered in the concentration camps, many disabled children and people with mental health problems were forcibly removed from their families and quietly done to death.

Nor indeed is the process of assisted suicide particularly dignified.  There is nothing dignified about giving someone a lethal injection or a suicide pill.  Unless we think that what Americans do to condemned prisoners is dignified.  I do not buy into the idea, commonly presented, of family and friends sitting around playing nice music and smilingly waving goodbye. In 2009, a British TV drama – A Short Stay in Switzerland - starring Julie Walters, explored very sympathetically the reasons why a real-life person (a medical doctor) with a progressively debilitating terminal illness chose to go to Dignitas, the assisted suicide organisation in Switzerland.   But the programme also showed what a traumatic and harrowing experience it was for her three children who were effectively assisting at the execution of their mother.  It was certainly not dignified.

So how do we deal with these very difficult cases of people who no longer have any quality of life.   The 19th century poem The Latest Decalogue by Arthur Hugh Clough is a satirical re-working of the Ten Commandments.  The revised 6th Commandment reads, “Thou shalt not kill; but need’st not strive officiously to keep alive”. In reality, that is a sound principle which is not as cynical as it seems and has served well until now.  People with terminal illnesses should be allowed to die.  We should not seek to prolong their lives unnecessarily and we should help make their end of life as comfortable, pain-free and, yes, dignified, as possible.   In that sense, assisted dying already exists. That is what the Hospice movement is all about, as I know well: I recently lost two sisters to cancer. 

Some commentators have said they do not see any real difference between removing life support, or giving palliative care which may accelerate the dying process, or actively terminating someone’s life.  But there is in fact a huge difference. However much one sympathises with the hundreds, even thousands, who wish to take the path of assisted suicide I believe that to change the law would be to cross a line which poses serious dangers for millions of much more vulnerable people. Kim Leadbeater has made much of the safeguards built into the draft Bill.  But involving both doctors and Courts in these decisions is likely to suck medical professionals, concerned with saving lives, into prolonged, expensive and harrowing court battles over whether to deliberately do the opposite.  That is one reason why both Wes Streeting and Shabana Mahmood are both so opposed. 

Although there may appear to be more anecdotal evidence in favour of change than against it, that is simply because it has not hitherto been necessary – but it is not difficult to find anecdotes tending to favour the status quo. Another televised drama documentary - again some years ago – dealt with the real-life case of a middle-aged daughter who attempted, and almost succeeded, to persuade her elderly mother to commit suicide so that the daughter could have the inheritance.  Such cases may be rare but if the law is changed and the principle established that families can “help” an elderly or terminally ill person to end their life it risks opening the flood gates to abuse as many frail and vulnerable people will feel obliged to end their lives so as not “to be a burden”.

My own mother-in-law died at the age of 96.  She had always said that if she became too frail to look after herself then she did not want to linger on in a helpless state and that she would want someone to put her to sleep.  But when the time came and she was in that state, there was no longer any talk of wanting to be put to sleep.  Indeed, she felt very vulnerable and was clearly afraid of dying.  Had she a few years before her last illness made a ‘living will’ to the effect that she wanted to be “helped to die” she was the kind of person who would have felt morally obligated to go through with it.  I would not want anyone I loved to be put in that position.  Evidence from Canada, where assisted suicide is already legal, reveals that a major reason for old people registering for the service is that they “do not want to be a burden” to their families.  In the event, when the time comes, about a third of them, decline to go through with it.  Which suggests that there are many more who would rather not, but feel an obligation to their families to do so.   That is a terrible situation in which to put an old and vulnerable person.

That was not a problem in my mother-in-law ‘s case. But she had a friend – we will call her Eliza - a few years older.  Eliza, to put it kindly, was not the sharpest knife on the block but through no effort of her own had come into a substantial sum of money, shared with her brother.   Eliza was very suggestible to the extent that her brother persuaded her into a tontine arrangement where, if she died first, he would inherit her share of the estate, excluding Eliza’s own son, but if he died, his wife would inherit before Eliza!   In the event both the brother and his wife died and Eliza inherited the whole estate.  But Eliza’s son, a feckless alcoholic, had a conniving and gold-digging partner, Anne, who persuaded Eliza to part with large sums of money during her life and was waiting to collect her fortune when she died.  Fortunately, the son died first.  Eliza lived well into her 90s and much of her money was required for her care costs, especially after she developed Alzheimer’s.  Had it been possible, Anne would certainly have persuaded Eliza to sign a document allowing for her life to be terminated in order for Anna to get her hands on the money.

I believe there are far more Elizas in this world than the people who are campaigning for the “right to die”.  They are weak and vulnerable and they are the people we need to protect even if it means denying the minority the autonomy they want.

*A Private Members Bill is a draft law proposed by an individual Member of Parliament rather than the government and members may not be required to vote in line with their Party.