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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Jeremy Corbyn's opponents are going down a blind alley on tuition fees

The electoral pool they are fishing in is shallow – perhaps even non-existent. 

The press and Labour’s political opponents are hammering Jeremy Corbyn over his party's pledge/ambition/cruel lie to win an election (delete depending on your preference) to not only abolish tuition fees for new students, but to write off the existing debts of those who have already graduated.

Labour has conceded (or restated, again, depending on your preference) that this is merely an “ambition” – that the party had not pledged to wipe out existing tuition fee debt but merely to scrap fees.

The party’s manifesto and the accompanying costings document only included a commitment to scrap the fees of students already in the system. What the Conservatives and Liberal Democrats are claiming as a pledge is the following remark, made by Jeremy Corbyn in his Q&A with NME readers:

“First of all, we want to get rid of student fees altogether. We’ll do it as soon as we get in, and we’ll then introduce legislation to ensure that any student going from the 2017-18 academic year will not pay fees. They will pay them, but we’ll rebate them when we’ve got the legislation through – that’s fundamentally the principle behind it. Yes, there is a block of those that currently have a massive debt, and I’m looking at ways that we could reduce that, ameliorate that, lengthen the period of paying it off, or some other means of reducing that debt burden. I don’t have the simple answer for it at this stage – I don’t think anybody would expect me to, because this election was called unexpectedly; we had two weeks to prepare all of this – but I’m very well aware of that problem. And I don’t see why those that had the historical misfortune to be at university during the £9,000 period should be burdened excessively compared to those that went before or those that come after. I will deal with it.”

Is this a promise, an aspiration or a target? The answer probably depends on how you feel about Jeremy Corbyn or fees policy in general. (My reading, for what it’s worth, is that the full quote looks much more like an objective than a promise to my eyes but that the alternative explanation is fair enough, too.)

The more interesting question is whether or not there is an electoral prize to be had, whether from the Conservatives or the Liberal Democrats, for hammering Labour on this topic. On that one the answer is open and shut: there really isn’t one.

Why not? Because the evidence is clear: that pledging to abolish tuition fees largely moves two groups of voters: students who have yet to graduate and actually start paying back the fees, and their parents and grandparents, who are worried about the debt burden.

There is not a large caucus of fee-paying graduates – that is, people who have graduated and are earning enough to start paying back their tuition fees – who are opposed to the system. (We don’t have enough evidence but my expectation is that the parents of people who have already graduated are also less fussed. They can see that their children are not crippled by tuition fee debt, which forms a negligible part of a graduate’s tax and living expenses, as opposed to parents who are expecting a worrying future for their children who have yet to graduate.)

Put simply, there isn’t a large group of people aged 21 or above voting for Corbyn who are that concerned about a debt write-off. Of those that are, they tend to have an ideological stance on the value of a higher education system paid for out of general taxation – a stance that makes it much harder for the Conservatives or the Liberal Democrats to peel those votes off.

The whole thing is a bit of a blind alley for the parties of the centre and right. The Tory difficulty at this election wasn’t that they did badly among 18-21s, though they did do exceptionally badly. With the exception of the wave year of 1983, they have always tended to do badly with this group. Their problem is that they are doing badly with 30-45s, usually the time in life that some younger Labour voters begin to vote Conservative, largely but not exclusively because they have tended to get on the property ladder.

Nowadays of course, that cohort, particularly in the south of England, is not getting on the property ladder and as a result is not turning blue as it ages. And that’s both a bigger worry and a more lucrative electoral target for Labour’s opponents than litigating an NME interview.

Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to domestic and global politics.