Kim Leadbeater, who introduced her assisted dying bill in the Commons yesterday, has said it’s all about the safeguards. Well, no, it’s not. It’s about a clash of irreconcilable principles. On the one hand, there’s Kim’s contention that “too many people have been condemned to die in misery and pain”. In other words, we’re talking personal autonomy which is in many respects a valuable aspiration.
On the other, there’s the contention that death should not be on the list of options that we offer people with terminal illness, or, come to that, degenerative conditions or mental illness or just loneliness and pain. By opening up the possibility that suicide is one of our life choices — or rather, end of life choices — we change fundamentally and forever our relationships with each other; between parent and child, between patient and physician, the individual and society. It’s not just about you, or you. It’s about us all.
If this bill is passed there will be an unspoken possibility behind the interaction between the elderly Parkinson’s patient and her daughter, the care home resident conscious that her care is costing her family £3,000 from her estate with every month in which she greedily hangs onto life, between the doctor and his geriatric, demanding patient with dementia. The possibility will be: there is another way, a way out…why not take it? And this is quite apart from the insidious question of coercive control, whereby unscrupulous relatives suggest, implicitly or overtly, that it’s going to be really difficult to pay for the heating this winter.
This is a bill to benefit the strong minded
The celebrity proponent of this bill, the PM’s favourite activist, is Esther Rantzen who suffers from cancer. And she is precisely the kind of person who is least likely to suffer the consequences if this bill is passed: articulate, feisty, financially secure, cared for. Ditto Sir Nicholas Mostyn, the retired judge suffering from Parkinson’s who already wants the bill extended to those suffering from incurable conditions like his.
This is a bill to benefit the strong minded, who’ve had autonomy in every other part of their lives and jolly well want choice about how to end it. Except, as I say, it’s not about them. In Oregon people are provided with drugs — barbiturates or cheaper alternatives — to take in their own time. And the rate of take-up is only a tenth of those cases where you have a medic coming to the house to administer a lethal injection or an overdose of pills (up to 100 for barbiturates), according to the palliative care professor and anti-assisted dying campaigner, Ilora Finlay.
In other words, people can be browbeaten by the process of assisted suicide into going along with it. You book your slot, you have a medic taking the trouble to visit your home…are you really going to turn round and say, nope, don’t fancy it now? The process has a momentum all of its own, which only the strong minded could resist. And talking of Oregon, since assisted suicide was introduced, there have been nine people who recovered from their self administered lethal dose, again, according to Ilora Finlay. And you know what? Not one of them tried again.
Let’s take the safeguards which Kim Leadbeater sets such store by. As presently envisaged, the Bill only applies to those with a prognosis of a limited life term. That sounds nice and scientific; say, six months to live. Except a prognosis is the least sure thing on earth. My colleague has just buried his father who was, at the beginning of February, given weeks, perhaps days, to live. He took a hasty holiday; he rushed home. And then his father was assigned Macmillan nurses to come to his house and cheer him up, make him exercise and encourage him to eat. The upshot was that he had another nine months. A friend of his mother’s told her that she had been in the same position, and her husband had had an extra eight years of life. The concept of certainty in terms of our span of life is a dud.
And if we’re talking about choice, make it about care
Then there’s the promise of the suicide order being signed off by two doctors and a judge. Sounds good, huh? Well, I attended last night an interesting debate at the Royal College of Psychiatrists on whether mental illness should be a criterion for assisted suicide and the questions were thrown open to online participants. The very top question asked was how on earth, given the broken (I refer you to the PM) condition of the NHS and especially mental health practice, it is actually conceivable that it could spare sufficient practitioners to monitor the cognitive and moral capacity of people looking to die. It’s not there. As for judges, where are they to come from for what could be thousands of applicants, given that the criminal justice service isn’t actually functioning? If we don’t have judges for serious assault cases, where are we to get them from for would-be suicides?
And if we’re talking about choice, make it about care. Most prudent MPs will preface their support for this bill with a commitment to palliative care. And this is one area where Britain leads the field — did you know? But even here, provision is patchy, the postcode lottery obtains. We simply don’t have the palliative care, the hospice provision at home and outside it, which would allow for genuine choice at the end of life. As Ilora Finlay, told me, “Palliative care is not like an antibiotics for a urinary tract infection. It’s care for the whole person, care and support. Some people don’t want support or help, but for those who do, we can say that you don’t have to take your own life; we will look after you right through to the end. That may mean seven days a week services that go at the person’s pace and are a rapid response to crises.
There should be uniform provision of palliative care; instead we have a patchwork. Suffering is a complex phenomenon; many people suffer with different things through their life. The question is whether doctors should be responding to that with lethal drugs or keep trying to relieve suffering. The healthcare system must give people real choice of being looked after.” And if palliative care is offered, much of the fear around cancer, around degenerative conditions dissipates. She says, and she knows: “it is not necessary to die in agony; it is not necessary to choke to death. We have instruments to manage symptoms.”
No one wants a terrible death, but with good hospice and palliative provision you don’t have to have it. If parliament wants choice, then give us choice. But make it about how to die well, cared for: the hard option, not the easy one.
