A necessary fudge?

Assisted suicide should be illegal but tacitly permitted -- not legal under certain rigorously-enfor

An unofficial commission headed by the former Lord Chancellor, Lord Falconer, is proposing changes in the law to allow doctors to assist a terminally ill person to take their own life, provided that certain conditions are met. For example, that the dying person is mentally competent and has less than 12 months to live.

In response, a statement from the Church of England, by the Bishop of Carlisle, draws attention to the "self-appointed" nature of the commission and suggests that it "excluded from its membership anyone with a known objection to assisted suicide." And it supports the status quo.

The present law strikes an excellent balance between safeguarding hundreds of thousands of vulnerable people and treating with fairness and compassion those few people who, acting out of selfless motives, have assisted a loved one to die.

The law itself is quite clear, however: assisting a suicide is illegal, and punishable with up to 14 years in prison. In some cases relatives have faced prosecution not for assisted suicide but for murder, which carries a mandatory life sentence. Any "balance" is confined to an official statement, introduced last year in response to the Debbie Purdy case, of the circumstances under which the law might not be enforced.

From a logical point of view, this is indefensible. It also offers only quailifed protection to those who would assist a dying relative. It implies that they will probably not be prosecuted, but they still know that they are breaking the law and that they are running a risk, however remote, that the CPS might take a stricter view in their own case. And can it really be good in principle to keep a law on the statute book when there is a codified public policy of disregarding it?

Perhaps it's not too surprising to find the Church of England supporting an unprincipled and hypocritical fudge, especially when that fudge also represents the status quo. Unwilling to condemn assisted suicide outright on the grounds that it is for God alone to take away life, the bishop concentrates instead on the practical issue of whether more "vulnerable people" would be put under pressure by a change in the law to take their own lives. He claims that the commission has "singularly failed to demonstrate" that its proposals would not place vulnerable people at greater risk.

But that question was a major concern for Falconer's commission, which concluded (albeit with a dissenting opinion from a clergyman on the panel) that it would be possible to devise sufficient safeguards. Any new system, the report stressed, must have such considerations "at its heart."

So the debate hasn't really progressed. Everyone seems to agree that the sticking point is whether vulnerable people would be put under pressure by a change in the law. Everyone agrees that putting vulnerable people under pressure is a bad thing to do: at least, it's not being argued even by strong supporters of legalised assisted suicide or euthanasia that in some cases people ought to be put under pressure to end their own lives (to save scarce NHS resources, for example, or to help emotionally-burdened family members to move on with their own lives). Yet the implied pressure is present even in the suspicion that it might exist.

The present state of the law, on the other hand, might be said to place quite a different pressure on vulnerable people who are terminally ill and wish to end their own lives: the pressure not to ask for help and so expose their family members or medical staff to legal jeopardy.

It's assumed -- on what evidence? -- that if the law were changed, terminally ill patients might feel themselves under pressure to agree to be "suicided" by their relatives, or perhaps by their doctors and that safeguards must be put in place to counteract this. In other words, both sides in this debate show a marked suspicion of the motives of the very people most intimately concerned with the welfare of the terminally ill, their next of kin and those professionally charged with their care. Both sides would rather place their faith in a set of impersonal (and somewhat inflexible) laws and regulations, in the form either of statute or of the existing guidelines, which by their nature must give rise to anomalies and inconsistencies.

Indeed, the commission's proposals -- and this, I think, is a serious objection to them -- would replace the current fudge with a highly bureaucratic, box-ticking approach. Patients would have to prove that they were not depressed -- although someone in constant pain with only weeks to live might be said to have every reason to be depressed -- and be required to prove their resolution over a two-week cooling-off period. There would be forms to be filled in, monitoring systems to be implemented (and funded: OfDeath, anyone?), compulsory counselling to be provided.

Some doctors would not wish to co-operate with these procedures -- possibly not even some doctors who at present will surreptitiously up the morphine levels of dying patients. I can even foresee the emergence of a cadre of specialist death-doctors, whose adherence to the spirit of the Hippocratic oath is reflected in their daily violation of its cardinal principle to "first, do no harm".

So what is the answer? I must admit to being torn. I support autonomy for the individual, up to and including the right to take one's own life (even for people who are not terminally ill). But once you institutionalise the process of suicide it begins to seem routine, normalised, an option that presents itself, or is presented, to the dying as a matter of course. And that begins to subvert the basic principles of medicine as they are publicly professed and believed in. Transparency and logic are achieved at the expense of discretion, privacy and that sense of the numinous that should properly surround issues of life and death.

So in the end I'm with the fudge. But it should be a proper fudge. Assisted suicide should be illegal but tacitly permitted, not legal under certain rigorously-enforced (and somewhat arbitrary) conditions and banned under all others, as Falconer seems to want. That would be in the interests neither of those who want to preserve life, nor even of those who want to die.

Belief, disbelief and beyond belief
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The tale of Battersea power station shows how affordable housing is lost

Initially, the developers promised 636 affordable homes. Now, they have reduced the number to 386. 

It’s the most predictable trick in the big book of property development. A developer signs an agreement with a local council promising to provide a barely acceptable level of barely affordable housing, then slashes these commitments at the first, second and third signs of trouble. It’s happened all over the country, from Hastings to Cumbria. But it happens most often in London, and most recently of all at Battersea power station, the Thames landmark and long-time London ruin which I wrote about in my 2016 book, Up In Smoke: The Failed Dreams of Battersea Power Station. For decades, the power station was one of London’s most popular buildings but now it represents some of the most depressing aspects of the capital’s attempts at regeneration. Almost in shame, the building itself has started to disappear from view behind a curtain of ugly gold-and-glass apartments aimed squarely at the international rich. The Battersea power station development is costing around £9bn. There will be around 4,200 flats, an office for Apple and a new Tube station. But only 386 of the new flats will be considered affordable

What makes the Battersea power station development worse is the developer’s argument for why there are so few affordable homes, which runs something like this. The bottom is falling out of the luxury homes market because too many are being built, which means developers can no longer afford to build the sort of homes that people actually want. It’s yet another sign of the failure of the housing market to provide what is most needed. But it also highlights the delusion of politicians who still seem to believe that property developers are going to provide the answers to one of the most pressing problems in politics.

A Malaysian consortium acquired the power station in 2012 and initially promised to build 517 affordable units, which then rose to 636. This was pretty meagre, but with four developers having already failed to develop the site, it was enough to satisfy Wandsworth council. By the time I wrote Up In Smoke, this had been reduced back to 565 units – around 15 per cent of the total number of new flats. Now the developers want to build only 386 affordable homes – around 9 per cent of the final residential offering, which includes expensive flats bought by the likes of Sting and Bear Grylls. 

The developers say this is because of escalating costs and the technical challenges of restoring the power station – but it’s also the case that the entire Nine Elms area between Battersea and Vauxhall is experiencing a glut of similar property, which is driving down prices. They want to focus instead on paying for the new Northern Line extension that joins the power station to Kennington. The slashing of affordable housing can be done without need for a new planning application or public consultation by using a “deed of variation”. It also means Mayor Sadiq Khan can’t do much more than write to Wandsworth urging the council to reject the new scheme. There’s little chance of that. Conservative Wandsworth has been committed to a developer-led solution to the power station for three decades and in that time has perfected the art of rolling over, despite several excruciating, and occasionally hilarious, disappointments.

The Battersea power station situation also highlights the sophistry developers will use to excuse any decision. When I interviewed Rob Tincknell, the developer’s chief executive, in 2014, he boasted it was the developer’s commitment to paying for the Northern Line extension (NLE) that was allowing the already limited amount of affordable housing to be built in the first place. Without the NLE, he insisted, they would never be able to build this number of affordable units. “The important point to note is that the NLE project allows the development density in the district of Nine Elms to nearly double,” he said. “Therefore, without the NLE the density at Battersea would be about half and even if there was a higher level of affordable, say 30 per cent, it would be a percentage of a lower figure and therefore the city wouldn’t get any more affordable than they do now.”

Now the argument is reversed. Because the developer has to pay for the transport infrastructure, they can’t afford to build as much affordable housing. Smart hey?

It’s not entirely hopeless. Wandsworth may yet reject the plan, while the developers say they hope to restore the missing 250 units at the end of the build.

But I wouldn’t hold your breath.

This is a version of a blog post which originally appeared here.

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