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Dignity in life, dignity in death: Laurie Penny on euthanasia

Theological dogma should not dictate policy when it comes to assisted suicide.

It's not easy watching a man commit suicide on camera. The public uproar over the BBC documentary Choosing To Die, in which the author and Alzheimer's sufferer Sir Terry Pratchett visits the Dignitas euthanasia clinic in Switzerland, has reopened the debate over whether or not sufferers from terminal and chronic illness should be allowed to end their own lives. In the film, we watch Peter Smedley, a British sufferer from motor neurone disease, as he swallows the killing draught; he coughs as he begins to fall asleep, and asks for water. The prim Dignitas "escort" refuses. His wife, the picture of pseudo-aristocratic dignity, holds his hand as his head begins to drop to his chest. Sir Terry sits opposite the Smedleys as they say goodbye, swallowing obvious tears. It is terribly hard to watch.

It is no harder, however, than it would be to watch a man die slowly and in pain, longing for release. Sir Terry, whose own encroaching mortality is a constant, ominous presence in the programme, concludes with wobbling lip that this was a good death -- "When we think of all the ways people can die, that would count as a result" -- and that the creepy little blue house on the Swiss industrial estate where so many come to die exists for a good reason. It is difficult not to take his point, especially when one sees how rigorous and exhausting are the checks for fitness of mind and non-coercion run by the clinic. With an ageing population suffering increasingly from protracted, agonising end-of-life conditions, now would seem precisely the time for an adult debate about assisted dying. It seems likely, however, that the debate will be messy, drawn-out and painful.

Talking about suicide has always been taboo, even in journalism, a profession not generally known for tact and discretion. It is only 50 years since the practice was decriminalised in this country, and parts of the 1961 suicide act provide that, while you can no longer be sent to jail for surviving a suicide attempt, your friends and family can be imprisoned for up to 14 years if they are suspected of assisting a suicide -- even just for offering, like brave Mrs Smedley, a loving hand to hold at the end. There is something about this subject that repels rational debate. It sticks in the craw, disgorging reason. You can't help but feel that the reason nobody wants to ask the important questions about chosen death is that nobody really wants to hear the answers.

There is a very real fear that if we talk about this properly, we might reach a conclusion that we might not want to face: that, in some cases, taking one's own life is a sane and sensible thing to do. The term that commenters keep returning to is "slippery slope": if we acknowledge that self-murder might be acceptable for the terminally ill, what about the chronically ill? What about the mentally ill? What about those who are in perfect physical health but, like a small minority of Dignitas clients, are simply "weary of life"? If everyone could die in a time and place of their choosing, might we not see the numbers of suicides rise from current averages of just over 5,000 a year to tens or hundreds of thousands, many of them young people with everything to live for?

This is a legitimate fear. At 24, I have lost several friends to suicide. I have seen many more young people with big lives ahead of them attempt to end those lives. I have intervened personally in three suicide attempts, all of them involving young adults under 22. Those incidents were frightening, painful and heartbreaking for everyone involved. Hundreds of children and young people commit suicide every year in Britain and, according to the Samaritans and Barnados, that number is rising. I believe, like the Dignitas director, Ludwig Minelli, that the "right to self-determination" includes the right to control the manner of your death as far as possible, but the thought that it might somehow become acceptable for anyone simply to give up on life genuinely chills me.

That is not, however, what a service like Dignitas is offering. Dignitas, in fact, appears to offer a civilised solution to a problem which has dogged society, not to mention the medical profession, for centuries -- injecting a merciful dose of procedural oversight into a shadowy world of unspoken pain and moral dilemma, providing one has the £10,000 to cover the clinic's costs.

The key statistic is that 70 per cent of those who make enquiries with Dignitas never call back. The knowledge that the option of a quick and painless end is there seems, in fact, to give many people the strength to carry on. There is cause to believe that oversight and legitimacy in the field of euthanasia might, in fact, reduce the number of tragic suicides, by giving desperate people back a sense of control over the end of their lives. As Nietzsche observed, the thought of suicide, considered rationally, may well be "a powerful solace: by means of it one gets through many a bad night."

We live, for now, in a society where theological dogma does not dictate policy, but the notion of suicide as a "sin" persists. The reasons behind religious proselytising against suicide -- which comes with the not insignificant metaphysical threat of hell -- are benign enough for anyone who believes that God and law can and should dictate the lives of human beings. There is, however, also a powerful argument that the "sanctity" of life is worth less if the individual living that life cannot determine its boundaries. There is an argument that a measure of formality, choice and control in death is no bad thing for a person living out their last days in pain and terror. These are arguments that, if we wish to live in a truly civilised society, we will soon collectively be obliged to consider.

Rather than consider them, however, much of the response to this documentary and the difficult issues it raises, particularly on the Christian right, has focused on the possibility of a second "slippery slope". The fear seems to be that if euthanasia were not taboo, the elderly and infirm might be encouraged to end their lives against their will, to spare their families and the state the burden of caring for them, despite the enormous bureaucracy already in place to prevent this from happening. The hypocrisy of this moral panic is unbelievable, when hospices and end-of-life care centres are facing funding cuts of 30 per cent, according to a report released in January.

The brutal truth is that we do not need to fear a world where the sick, disabled and terminally ill are denied support and treated as disposable. We are living in that world, right now.

On 10 June last year, Paul Reekie, a 48-year-old poet from Edinburgh, took his own life. Spread out on the table beside him, in place of a suicide note, were two letters: one informing him that his Incapacity Benefit had been stopped, and another informing him that his Housing Benefit had also been stopped. This government, expanding on the policies of the last, is currently forcing over a million sick and disabled people to undergo a work capability assessment performed by a private company, Atos Origin, with a £300m mandate to deny benefits to hundreds of thousands of claimants. As a result of these tests, patients in the final stages of cancer have been refused the pittance of state support that was supposed to make the end of their lives bearable.

This month, top mental health charities warned the government that the tests were already causing desperate claimants to take their own lives, and that more suicides can be expected if the scheme continues. Someone in government appears already to have accepted and made provisions for this eventuality, distributing handy suicide guidelines to staff at call-centres dealing with benefit claims. The callousness with which this is being done should shock us; it should shock us far more than as-yet-abstract idea of state-sanctioned euthanasia. Instead, we nod along as ministers and tabloid headlines inform us that these people are not worth the good money we could be pumping into tax relief for the banking system.

We need no longer fear a world where society and the state cannot be bothered to expend time and money looking after the sick, the dying and the unprofitable. We are already living in that world. We are halfway down the slippery slope, clutching for handholds of humanity. If we truly believe that all human life is precious, if we truly believe in dignity in life and in death, we should start by taking an honest look at the slow, unmerciful slaughter of a welfare state which, while ailing, has so much more to give - and considering what that says about all of us.

Laurie Penny is a contributing editor to the New Statesman. She is the author of five books, most recently Unspeakable Things.

Photo: Getty
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A good apprenticeship is about more than box-ticking

The political apprenticeships arms race, promising ever increasing numbers of apprenticeships but with little focus on quality, is helping nobody. 

The political apprenticeships arms race, promising ever increasing numbers of apprenticeships but with little focus on quality, is helping nobody. Playing a numbers game often means the quality and the personal touch that turns a placement into a career opportunity can be lost. The government has set a target of three million new apprenticeships by 2020. In London Boris Johnson set a target for 250,000 apprentice starts, but fell short by over 100,000. Both targets miss the point; any target should focus on outcomes, not just numbers through the door.

Policy makers need to step back from the rigid frameworks and see what works on the ground.  For me this involved eating a bacon sandwich, which is arguably a risky exercise for politicians.  I was seeing how the owner of the Bermondsey Community Kitchen and Café, Mike, has transformed the space above his café into a training kitchen teaching young unemployed people the skills they need to gain qualifications to work in restaurants.

The posters on the wall spell out the choices available to the young people. They make it explicitly clear that there is an alternative to a life in prison, which some of the trainee chefs have already experienced, with pictures of celebrity chefs including Jamie Oliver, Delia Smith and Gordon Ramsay outlining how they worked their way to where they are now. None of the young people have had an easy start in life. Barriers they face include autism, lack of literacy skills, insufficient funds to pay the fare to the café and criminal records. But Mike and the team running the kitchen are determined to give them the chances every young person deserves. From City & Guilds qualifications, work placements and ensuring they have a job at the end of the process, this is the type of grass roots project that the government could learn from. With two groups of eight students over three half days, this is skills training that is about as personal as it gets. The young people are enthusiastic about the course, the practical skills they are learning and optimistic about the future.

The project is funded partly through the café, but mainly through grants and donations (including pots and pans from Raymond Blanc and funding from trusts as well as the local council). Mike has plans to expand. He wants premises with space for a nursery so young mothers who might otherwise struggle to complete a course can attend, he has a vision for two or three more similar enterprises across Southwark. I have no doubt he will achieve this but the challenge for policy makers is making it easier for people like Mike who are delivering flexible qualifications and delivering better results. Bureaucratic processes, lengthy forms and refusals would have put less determined people off. As the funding for skills is devolved, there is both an opportunity and a challenge to look at how innovative models can be supported. Unless more is done to ensure groups that might be defined as ‘hard to reach’ get opportunities, there will always be significant numbers falling through the gaps in a sometimes impersonal system.

Over 60 per cent of the apprenticeships in London focus on low level qualifications with little prospect of employment upon completion. Many skills based apprenticeships fail to match demand, the booming construction industry for example is crying out for skilled workers and with all parties agreeing new homes are a priority its surprising to learn that in London only 3 per cent of apprenticeships are in construction.

Apprenticeships need to focus on leading to work, and work that is skilled and pays enough to live on. They should be about opportunity not opportunistic employers. In a report published in October 2015, Ofsted was critical of apprenticeships saying too many of them ‘do not provide sufficient training that stretches the apprentices and improves their capabilities. Instead they frequently are being used as a means of accrediting existing low-level skills, like making coffee and cleaning floors.’

The new apprenticeship levy charged to businesses with a wage bill over a certain amount could be a useful way of enhancing opportunities but the definition of apprenticeship needs to be refined. On a recent visit to the iconic Brompton Bikes factory, the London Assembly Economy Committee was told that although the firm has to pay the new levy as a result of its size, they have a bespoke way of training their apprenticeships so they have the skills to get jobs with Brompton Bikes at the end of the process. Because this tailored training doesn’t meet the narrow government criteria they aren’t formally accredited apprenticeships and thus Brompton are unable to claim any funding back from government despite their excellent work.

I am increasingly frustrated that the most exciting and inspiring projects I visit don’t always meet the criteria for funding. We are doing something wrong if people are asked to fit something that works into a form that meets criteria rather than rewarding their successes. Instead huge amounts of public money are being put into funding low quality low skilled apprenticeships that sometimes appear to be more about avoiding the minimum wage. This is not just a waste of money; it is a waste of the lives of the young people. As the Bermondsey fishmonger we bumped in to on the way out of the café told us, sometimes what works is smashing the box, not ticking the box.