Assisted dying isn't contested on religious grounds - it's about power, paternalism and control

A recent YouGov poll has shown that a majority of people - from almost all religious denominations - support doctor-assisted dying. It is our secular and spiritual leaders who are refusing to catch up.

Something striking is going on when the British Humanist Association articulates the instincts of religious believers better than their own spiritual leaders manage to do.

Yesterday the national debate on assisted dying reached the Court of Appeal. Paul Lamb, who was almost completely paralysed in a car accident, another man identified only as Martin and the widow of locked-in syndrome sufferer Tony Nicklinson, whose case hit the headlines last year, are arguing that doctors should be allowed to assist mentally competent patients to end their own lives.  As the law stands, such a doctor (or a relative) risks being charged with murder and the mandatory life sentence that follows conviction.  Some indication of the importance being attached to this case may be gleaned from the fact that the Lord Chief Justice and the Master of the Rolls - the most senior judges in the land - are both hearing it.

The appellants have high-powered support for their arguments: the British Humanist Association, which has intervened in the case, has assembled evidence from leading philosophers including Simon Blackburn and AC Grayling. They also have public opinion on their side.  A recent YouGov poll, commissioned by the organisers of the Westminster Faith Debate series, showed support for a change in the law now runs at 70 per cent.

Lord Judge was a bit sniffy about these figures yesterday.  The law can't be decided on the basis of opinion polls, he said and in any case, "the public may change its mind next week."  He's right about the legal principles, of course.  In a society that claims to be democratic, however, it seems rather paternalistic to ignore the clear views of the public on a matter that touches so deeply on individual rights.  But public opinion seems unlikely to change next week, or next year.  The most recent polling confirms what has been a consistent trend, as shown for example in the British Social Attitudes Survey

This is one case in which elitist moral philosophers, cogitating in their ivory towers, seem to be at tune with public opinion far more religious leaders, the majority of whom (though not all) continue to oppose any change.  It's an opposition not shared, it seems, by most of their congregations.  The YouGov showed unequivocally that the majority of people who associated themselves with a religion supported assisted dying.  This included 71 per cent of Anglicans (almost exactly the same as among the population as a whole), more than 60 per cent of Methodists and Presbyterians, 69 per cent of Jews and even 56 per cent of Roman Catholics.  Among Sikhs, support was as high as 73 per cent.  Only Muslims showed a majority against the proposed changes - 55 per cent.  It's true that support for assisted dying was lower among people who described themselves as "active participants" in their faiths, but even here support for a change in the law to allow assisted dying tended to be greater than opposition.

In other words, the most significant divide in this debate is not between the religious and the secular, but between public opinion as a whole and those in positions of power and authority, who tend to take a strongly paternalistic (indeed patronising) line.  However important it is to protect the vulnerable, it is surely equally important to uphold the right of people who are fully competent to decide their own destiny. 

Death comes to us all, and any one of us might find ourselves in the terrible position faced by Tony Nicklinson or Paul Lamb.  Faced with an inevitable and painful decline, prolonged as much as alleviated by medical science, some will respond with determination to bear the suffering, either out of a wish to hang on for as long as possible, or because of their religious belief in the sanctity of life.  But others will wish to die with dignity with a minimum at a time of their choosing.  Neither choice is right or wrong; or rather the rightness or wrongness of such an individual choice is not what really matters here.  The question is rather, why should a responsible adult not be allowed to make that choice?

Certainly, most people in this country now feel this way, as the YouGov poll revealed. The most popular argument in favour of changing the law was a simple appeal to personal autonomy: "An individual has the right to choose when and how to die" (82 per cent).  The common arguments that death can be preferable to long drawn-out suffering and that those assisting a freely-chosen suicide shouldn't be put at risk of prosecution were slightly less popular.  This is significant, it seems to me, because these (rather than the principle of autonomy) are the arguments most often made when the subject of assisted dying is made in Parliament or when the subject is debated in the media. 

The paternalistic impulse to do what is best for other people is the flip-side of the most commonly-made objection to assisted dying: that if it were allowed, people would feel pressurised not to "be a burden" to their loved ones.  Both arguments are ultimately based on feelings of compassion for others rather than respect for them as autonomous moral agents.

The debate about assisted suicide is made pressing by medical advances that can now keep people alive for much longer, and in much more reduced circumstances, than would previously have been the case.  Whether or not life is a gift from God, its perpetuation is often now a gift, or a curse, from the doctors.  But I don't think that's the only reason that the subject is so contested at the present time.  Rather, it's bound up with an increasing conviction that the "right to life" is much more than a simple right to exist: it's also the "right to a life", the right to make one's own decisions as far as one is able to do, and to have one's choices respected.  And at the same time, not imposing one's moral choices on other people.  I don't think it's a coincidence that public opinion now also favours same sex marriage for those who want it.

I don't think this is evidence of an increasingly secular society so much as of an increasingly horizontal one, in which people are less willing to defer to moral authority figures when it comes to decisions that affect their own lives.  This is as true of many religious people as it is of humanists and atheists.  That's why in matters of life and death, as well as questions of lifestyle, believers may find themselves scratching their heads when listening to priestly pontifications but nodding along with AC Grayling.

Paul Lamb and Jane Nicklinson at the Royal Courts for a hearing on legalising doctor-assisted dying. Photograph: Getty Images.
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A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear