Permitted assisted dying could increase protection for vulnerable people

The only person who can decide if a life is worth living is the one living it.

Tony Nicklinson may not have achieved his wish for doctors to be allowed to terminate his life at a place and time of his choosing, but he did manage to push the subject of assisted dying higher up the public agenda than it has been for a long time. And while he didn't convince the judges at the High Court, public opinion would seem to be firmly on his side. A YouGov poll conducted on behalf of the British Humanist Association last week found that a massive 81 per cent of adults (and two thirds of Roman Catholics) would support the right of "mentally competent individuals with incurable or terminal diseases" to access medical support to end their lives. Only 6 per cent were "strongly opposed". 

Support, too, has come from some leading politicians, such as the newly-appointed health minister Anna Soubry, who called the present state of the law "ridiculous and appalling".

Even so, opposition to any change remains entrenched and seemingly unmovable. Many MPs, almost all religious leaders and the official policy of the BMA are implacably opposed to legalising voluntary euthanasia, which the current BMA president has described as "a journey I just don't want us to even start out on".

For some, the question is forever out of bounds because life is sacred and can properly be terminated only by God. But there are more pragmatic arguments, too, that convince many that assisted dying is inherently dangerous. It's said that if the law were changed, vulnerable people would feel under pressure to end their lives in order to spare their families (or the taxpayer) the "burden" of their continued existence. That a system of planned death, timetabled according to personal or medical convenience, would cheapen life itself, would enshrine in law the idea that some lives were not worth living, and could potentially lead to a eugenic society in which the chronically sick, the elderly and the disabled were seen as disposable, by themselves or by others.

Such an argument may sound plausible. But can we be sure that we don't live in such a society already? Today we learned of the case of an unnamed man, aged 51, with Down's Syndrome and other disabilities, who spent some time in hospital last year. After "AWA" was discharged it emerged that without the knowledge of his family or carers doctors had placed a "do not resuscitate" (DNR) order on his file. The sole reason given for the notice - which would have resulted in his inevitable death had he suffered a cardiac arrest or encountered serious breathing difficulties - was apparently his disability. He does not seem to have been terminally ill.

We must, of course, be careful. It is only one case. The NHS trust concerned has declined to comment on the ongoing legal action and there may be significant facts that haven't been reported. AWA's solicitor, Merry Varney however, described it as "one of the most extreme cases we have seen" and declared that "to use Down's Syndrome and learning difficulties as a reason to withhold lifesaving treatment is nothing short of blatant prejudice."

"Extreme" this case may be, but problems relating to DNR notices are far from unheard of. In another case currently before the courts, David Tracey is suing Addenbrooke's hospital in Cambridge over a DNR issued in respect of his wife who died there last year, and which was apparently discussed neither with her nor with him. He was also being represented by Merry Varney, who argued that "a competent patient must surely know when a decision to withhold potentially life sustaining treatment has been made."

A survey of 100 hospitals carried out last year by the Care Quality Commission found that at least five were in breach of medical guidance regarding consultation with families before issuing a DNR notice. On one ward, as many as a third of such orders were issued without consultation. The charity Action on Elder Abuse described such practices as "euthanasia by the backdoor".

Even if such cases are not the norm, they might be seen as evidence of a callously utilitarian approach to questions of life and death even without legalised euthanasia. AWA's case in particular suggests that vulnerable patients might be especially, well, vulnerable to such an attitude. Yet others tell a different story, of elderly and vulnerable or terminally-ill people, sometimes in pain, past all hope of full recovery and who in an earlier age would have died peacefully, being artificially kept alive by well-meaning doctors and by the death-cheating power of modern medicine.

In today's legal and medical regime, it would appear, some people are allowed to die who would rather live, while others are unwillingly kept alive when they want to die.

These two undesirable situations in fact represent different sides of the same coin: the paternalist attitude that sees medical professionals, rather than individual patients, as the people best placed to make the decision about whether he lives or dies. Tony Nicklinson, intellectually fully competent and certain in his own mind, is not allowed to determine the manner of his death. Nor is the more obviously vulnerable AWA. A system supposedly concerned with protecting the vulnerable only succeeds in reinforcing the godlike power of doctors.

For that reason, I suspect legislation that permitted assisted dying would actually increase the protection currently afforded to vulnerable people, and increase respect for the value of life. There's no contradiction between saying that all lives are valuable and that some have become intolerably burdensome. Rather, knowledge that they would not be condemned, in extremis, to a lingering agony at the hands of modern medicine would free some patients to live. And those who chose for reasons of faith or optimism to cling to every last painful moment of life could do so without causing others to feel guilt for their plight, which is the real "burden" which people with severe disabilities or who are in the last stages of terminal illness impose on their loved-ones.

The only person capable of deciding whether a life is or is not worth living, ultimately, is the one who is living it.

There are fears that hospitals could be practising "euthanasia by the backdoor". Photograph: Getty Images
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John Prescott on Labour: “This must be the worst operation I’ve ever seen”

The Labour peer and former deputy prime minister laments his party’s “civil war status”, saying “I wish Momentum would go away”.

I’ve attended a thousand PLP meetings. This must be the worst operation I’ve ever seen. It is more about personality politics than in the past.

The [last] Labour government was successful in most of the issues that we always thought was important to Labour: in the growth of the hospitals, the education system, the economy, people at work. All that was a successful record.

Not that it’s ever mentioned now. It was soured largely by Iraq. That period is almost obliterated by that. So you find present government, or even present leadership, in no way refers to that period of the Labour government. So the real problem is, if you’re disowning the most successful three periods of a Labour government, then you’re in some difficulty as to what you’re replacing it with.

It’s never happened before – it’s open war, civil war, inside the PLP. Some members in the PLP sit there with their social media, already typing out the fight going on to the mass of reporters who are amassed outside and told to come along and report because there’s going to be a big row. All that means we can’t really have unity. The division now is the attack on the leadership. A core who sit in the same places, make the same accusations against the leadership, right or wrong, every bloody week. They do it by a death of a thousand cuts – keep on making the same complaints.

I just think that the PLP is in civil war status. It’s not carrying out what it should do – that is, project Labour’s policies and be supportive of our people in the field.

All this criticism is about removing him. And then what adds to that is when Tom Watson comes along and joins in with this criticism. He’s entitled to do so, but he is the Deputy Leader, for God’s sake – quite different from the way I saw the role as defined; to support the party in a positive way, right. Get out and increase his membership, etc.

And the Leader, he's faced with a really difficult position, because he was elected and had never been a minister before. My heart went out to him when he had to deal with PMQs. Even with my 50 years, I found it impossible and fell on my face a few times.

We have a shadow cabinet now – cor blimey, you can be in the shadow cabinet in 12 months! You do need to have a bit of experience. So that does affect it, without a doubt. Then you get people on one side who refuse to serve in the shadow cabinet criticising the shadow cabinet. If you join the shadow cabinet, you’re a traitor to one cause or the other.

It's how you manage that division. The leadership is critical – for Jeremy to go out and do all of these things when he’s not been a minister is difficult. I think he’s been improving in doing the job. But frankly, it gets into people’s minds in a very short period of time, whether they think you’re the leader or not. And we do have a dilemma. It’s difficult for him – he’s reaching out a bit now, but almost the list has been drawn. I can’t see these people coming across now and uniting in the name of the party, supporting our people out in the elections. If you can’t unite the party, how the hell can you carry the country?

There are problems on the left and problems on the right, but we’ve always managed them – especially in the PLP. Robust arguments. But now it’s the battlefield, and all that comes out is a divided party.

I’m an old Labour man, right, I’m Labour to the core. To sit and watch it waste away its great reputation, what it’s done for our people in the country, and then when our people start stopping to vote for us, you’ve got to ask what’s bloody going wrong.

What Jeremy does is his decision. But he’s made clear he wants to stay. Now, if that stays the same, and the others stay the same, we’re going to have a stalemate divided Labour party – it’s disastrous.

So on the one hand, the PLP could try to be a little bit more supportive, and to recognise the party’s elected a leader, or they can go through the same process come June and call for another election, put it to the vote. They’re the options given to us by our party.

Our bloody country is decimated and we’re talking about the fucking sponsorship rules for the election of leader! I wish Momentum would go away, they’ve given us the same problems we had with Militant. I don’t think they’re as powerful as Militant, but they’re dedicated to the same cause. Their debate is how you change the Labour party.

By Christ, we can't win like this! I’m an old-fashioned type, and I’m proud to have belonged to a team that did win three elections. There was no other leader who did that before. But I don’t put it down to leaders, I put it down to the nature of the party. We’re responsible, not the leaders.

John Prescott is a Labour peer and former deputy leader of the Labour Party.

As told to Anoosh Chakelian.

This article first appeared in the 30 March 2017 issue of the New Statesman, Wanted: an opposition