Watching someone you love grow old is a bewildering experience. When they have Alzheimer’s or dementia you effectively begin the grieving process while they are still alive. Each day they are a little more translucent, a little less who they were. You grasp at the fragments of a personality you still recognise while, piece by piece, it slips away to another realm.
My step-grandfather had Alzheimer’s and my grandmother, aged 92, has dementia. Similar case studies are at the forefront of the debate on assisted dying. Under a new proposed UK Assisted Dying Bill, dementia patients would be unable to sanction their own demise due to their cognitive impairment. But adopting the bill would help others of sound mind to initiate that final step. We know some would choose this, because many are circumventing existing law. In 2019, 42 British people travelled to Dignitas in Switzerland to end their life, at an average cost of £10,000. This works out at one person around every eight or nine days.
The act of suicide was decriminalised in England and Wales by Harold MacMillan’s government in 1961. Yet by creating an offence of “assisting, aiding or abetting suicide”, the same law made it illegal to help a person do something that, were they to do it themselves, would not be a crime. Today, those who help a terminally ill loved one to take their life risk up to 14 years in prison.
A bill brought to the House of Lords by the crossbench peer Baroness Meacher, chair of the campaign group Dignity in Dying, seeks to change this. If successful, the bill would allow those “whose suffering is beyond the reach of palliative care to die well and on their own terms, should they choose it”.
The bill would bring the law into line with public opinion, which overwhelmingly supports assisted dying. According to a YouGov poll taken in August of last year, three-quarters of Britons think the law should allow doctor-assisted suicide for patients suffering from a terminal illness. Party affiliation is unimportant: 74 percent of Conservative voters and 76 percent of Labour voters back a change in the law. YouGov’s head of data journalism described assisted dying as “the nation’s most closely bipartisan view”.
Yet Baroness Meacher’s bill – as with previous similar attempts – will likely fail. It passed unopposed on 22 October 2021 following its second reading in the Lords. Yet as Lord Falconer, architect of a 2014 bill on assisted dying, writes, “the bill will die… choked by filibustering amendments”. So far there have been 200 such amendments from peers with – as Lord Falconer puts it – “longstanding and deep-rooted objections” to assisted dying. The government also seems unwilling to make time in the Commons for MPs to scrutinise the bill and vote on it.
Harold Shipman – “Doctor Death” – is often cited by opponents of assisted dying as a cautionary tale. Individuals like Shipman, it is argued, would take advantage of any change in the law to carry out their grisly deeds. Yet Shipman, who killed an estimated 250 patients, is rather an example of what can happen when power goes unchecked under the current system. As Dr Aneez Esmail, a medical adviser on the inquiry into the Shipman murders, told the Times in 2019, the best safeguard is “to have it all out in the open”. Esmail, who supports assisted dying, continued: “When you don’t talk about it the doctors end up having a huge amount of power and are able to abuse that power.”
This is why safeguards are at the forefront of Baroness Meacher’s bill. While it proposes giving terminally ill patients of sound mind the right to die by taking life-ending drugs, it does so on the condition that two doctors and a High Court judge agree. Furthermore, the request would only be approved if the individual in question had six or fewer months left to live.
Assisted dying is already legal in many parts of the world. As well as Switzerland it is legal in a number of American states including Oregon, Washington, Colorado and California, in the Netherlands, New Zealand, Belgium, Luxembourg, Colombia, and, since 2016, Canada. In Australia, assisted dying laws have been passed in five of six states. The Scottish Parliament will consider an Assisted Dying Bill during its next session. Last year the Royal College of Physicians changed its stance to become neutral on the issue after many years of opposition.
In the US state of Oregon, which implemented the world’s first assisted dying statute in 1997, there is no evidence of an inordinate impact on vulnerable populations. Since 1998, a total of 2,518 people have received prescriptions under the act, with a median age of 74. Ninety per cent were in a hospice at the time of death; 68 per cent had cancer; and the most commonly cited reason for ending life was a “decreasing ability to participate in activities that made life enjoyable” (90 per cent).
The former Archbishop of Canterbury Lord Carey and Rabbi Jonathan Romain wrote recently in a joint essay for the British Medical Journal, “Belief in the sanctity of life… does not mean believing in the sanctity of suffering or disregarding steps to avoid it. There is nothing holy about agony.” Both support a change in the law, as do many of their flock. A 2019 poll of 5,000 people found that 82 per cent of British Christians and 80 per cent of religious people support assisted dying for terminally ill, mentally competent patients.
Up to 650 terminally ill people take their own lives each year, while up to 6,500 attempt to do so. Those with sufficient funds can travel to Switzerland. Yet because patients are often fearful that they may lose the physical ability to make this journey, some end their life pre-emptively. Thus, a law that is ostensibly in place to preserve life ends up shortening it.
The debate on assisted dying hinges on a fundamental moral question: who does one’s life belong to? Does it belong to the individual, or to the state or some higher power? Opponents of assisted dying talk of life as an intrinsic good – the quality of the life in question treated almost as an afterthought.
Yet those of us who’ve witnessed a degenerative illness up close have had to accept that it’s not always like that: that there are times when the conclusion of a human life can happen long before the absolute end of “life”. The law should recognise that too.