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
Belief, disbelief and beyond belief
Photo: Getty
Show Hide image

Jess Phillips's Diary: Lazy attacks on “lazy MPs”, and how to tackle the trolls

The Labour MP for Birmingham Yardley takes us through her week.

As parliament kicked us out for the conference recess season on 14 September, several tabloids run the predictable story: “MPs go back on holiday today only NINE days after returning to parliament from a six-week summer break.” I imagine the journalist who churns it out hates doing the same tired “all MPs are lazy baddies” shtick as much as we hate having to rebut the nonsense idea that we are on holiday when we are working full-time in our constituencies.

Legislation is on holiday, not legislators. I have still yet to find an MP who thinks it reasonable that parliament shuts for three weeks for conference season. Why can we not have these conferences at the weekend? Or during the summer recess? Hell, why do we have to have them so regularly at all?

Is the nation screaming out for the politically minded to spend hundreds of pounds sleeping on the floor of an overcrowded Airbnb in a seaside town after a heavy night on warm wine and small food? I’ll wager that you cannot find me a person on the Clapham omnibus – or frankly any omnibus, whatever an omnibus even is – who thinks we should have a week off making laws so that the Lib Dems can do karaoke.

Her Maj

As well as time off for conference, it seems that the Tories will be scurrying home early every Wednesday as well. They appear to be on strike from voting on any opposition day motions as their governing partners, Northern Ireland’s Democratic Unionist Party, play fast and loose with their allegiances. (The DUP backed a Labour motion against raising tuition fees, which the government says is non-binding.)

I and other Labour MPs sat in parliament and watched ministerial cars speed off on 13 September as the whips told the great and good to go home. Her Majesty’s Most Loyal Opposition is a pretty important part of our democracy. If I were Her Maj I might be more than a little peeved that Mrs May cannot be arsed to turn up to fight for what she believes in, whatever that is. Presumably whatever Boris Johnson and his gang say it is this week.

Leave the kids alone

I spent the weekend at a local Labour Party fundraiser, at my surgery, and handing out certificates to hundreds of young people graduating from the National Citizen Service. I sat in front of a lively, wildly diverse group of young people and thought we should hand over managing geopolitics to them for a while. Even the naughty kid at the back (whom I had to scold) gave me more faith than what I see on the news.

Family life

At a debate about the abuse of MPs, the traditional Tory colonel Bob Stewart told the house that his son had been targeted and isolated by his schoolteacher because his father was a Conservative MP.

Now, I’ve had my run-in ins with the colonel in the past, but I was horrified by this – one of my sons is the same age as his. As a parent and an MP I dread the idea that my choices will cause my sons’ grief. I’ve got enough guilt about leaving them half the week without their being targeted and bullied. I once found my son and his mates watching videos about me on YouTube that had been made by men’s rights activists. The vicious content was unsettling enough, but the thought of his teacher joining in the hate is harrowing (and, I’m pleased to say, completely unthinkable at his school). Our families are conscripts to this life – some are conscientious objectors.

Troll detection

So, should we ban internet trolls who abuse MPs online from voting? This is the suggestion floated by the Electoral Commission. I can see the argument for trying to make people treat the electoral system with respect. I also think we have got to have a hard line and a punishment. I’m just not sure how we will decide what is abuse. People say sexist stuff to me all the time. Would a negative comment about my appearance count, or are we talking rape and death threats? (What a time to be alive, when I can give a traffic light system to my sexist online abuse.) To some, the idea of having your vote taken away would only provoke a shrug; but to me it seems too much.

Climb every mountain

I have nearly finished More in Common by my friend Brendan Cox. It is about his late wife, my friend Jo, and is brilliant, but I dip in and out because I want it to last. Reading it makes me feel so tired: maybe because I read it in bed, but also because Jo’s energy and adventures seem exhausting. I like mountains on a screen saver, but I wouldn’t climb one, especially not with a tropical disease or a baby in my belly.

I’m also exhausted because of the ridiculous late nights we seem to be adopting in parliament. Jo’s distaste for the silly hours is covered in the book. She couldn’t understand why we couldn’t start earlier than 11.30am and finish in time for people to see their kids. As I put down the story of her life (and, my god, what a life) I’ll gladly trek for her to the seemingly impassable peak of reforming the voting hours in parliament. 

This article first appeared in the 21 September 2017 issue of the New Statesman, The revenge of the left