DYING WITH DIGNITY

The Royal College of Physicians has been dragged into a vocal and undignified spat with its members over assisted dying, with some opposed, some supportive, and the rest uncommitted.  It’s like Brexit all over again, with a consensus as far away as ever.

It is quite extraordinary that the law regulating assisted suicide and every permutation in between goes back to 1961, when the Suicide Act was passed.  That Act served a very narrow purpose, which was to relax the law on suicide and attempted suicide, which, before the Act, was a criminal offence.

In days of yore, it was acknowledged, albeit reluctantly, that it was  a waste of time prosecuting a corpse, but the law, aided and abetted by the ‘caring’ Catholic and Apostolic Church, made sure that those who remained were punished instead.

Those who committed suicide were denied a Christian burial – and instead carried to a crossroads in the dead of night and dumped in a pit, a wooden stake hammered through the body pinning it in place. There were no clergy or mourners, and no prayers were offered.

But punishment did not end with death. The deceased’s family were stripped of their belongings and they were handed to the Crown. The suicide of an adult male could reduce his survivors to pauperism.  Suffice it to say suicides were rare indeed in the olden days, and with a generous massaging of the truth, the dear departed were presented as victims of foul play.  Plod would come along, take a few details with a well licked pencil in his pocket book and it would be an open and shut case.

But I digress.  It is a fact of life and death that we as a population are getting older and older.  Statistics tell us that on average, we are living 15 years longer than we did twenty years ago.  And with medical science keeping us going well past our sell by date, the issue of assisted suicide is becoming more and more relevant.

It is not so much our life span that is relevant, but our quality of life, and that is where assisted suicide comes into play.  Whilst we can debate ad nauseam the ethics, it is increasingly the case that some are being kept alive against their wishes simply because nobody will take reponsibility for ending it.

We all know of cases of our nearest and dearest suffering from a terminal illness, where medical science is keeping them alive against their wishes, and where they are pumped full of morphine and painkillers until an undignified death finally puts them out of their misery.  Far better to choose the order of our going, surrounded by our family and friends, and then quietly slipping away.

By way of safeguard, and to allay any fears about foul play,  I support the idea of two medical practitioners justifying the decision to withdraw life support, a decision to be endorsed by a senior judge who will also consult the immediate family.

 We don’t need well meaning but ignorant lobbyists shouting the odds about the right to life and waving placards.  It is none of their business.  Far better if they took voluntary employment in a care home where they could wipe bottoms and change soiled sheeets and feed the inmates and then, if they still felt the need to wave placards, they could see first hand the damage and distress they are causing.

There is absolutely nothing wrong about dying with dignity.

CROSSING THE RUBICON

Poor Ali Saunders, the much beleaguered Director of Public Prosecutions, damned if you do and damned if you don’t! Still smarting from the verbal spanking she received from many quarters after her decision not to prosecute Lord Janner, along comes Nikki Kenward the organ grinder’s monkey in the assisted suicide debate initiated by Lord Falconer, the former Lord Chancellor.

Ms. Nikki Kenward’s legal team, funded by us the taxpayers, has been granted a judicial review over Ms. Saunders’ decision not to prosecute doctors and nurses who help severely disabled or terminally ill people to take their own lives. Whilst Ms. Kenward is seriously disabled, she was never asked if she would like help in popping her clogs, so quite what she is doing in the frame is a mystery.

On review, these lawyers will argue that the DPP’s guidelines will enable healthcare professionals to offer their services to those wishing to commit suicide which, according to these well meaning but misguided advocates, is akin to “crossing the Rubicon”. With respect as we say but don’t mean in the legal profession, the services on offer are precisely the services most needed in these tragic circumstances. Ms. Kenward may have been put up to stir the pot, but this should in no way detract from  two very important issues, namely the right of any person of sound mind who wants  to end it all to do so but who cannot do so without help, and the courage and dedication of the doctors who will bring it about.

Assisted suicide is but one dimension of a debate that isn’t going away and will become more and more relevant over the next several years. Lord Falconer’s proposal is confined to those with terminal illnesses who have less than six months to live, so it is cast within fairly narrow parameters.  Of equal if not greater relevance is longevity itself.  When to call it a day?  And who calls the shots?  The advances in medical science help to keep us alive longer and longer, regardless of our state of health, and as we grow older and older, we are part of an environment ill equipped to provide us with the quality of life essential to enjoy our twilight years.  The argument that the Lord will decide has only limited appeal in our post Christian society, so some help may be needed to speed us on our way.

For my part, I am comforted in the knowledge that when I enter the final stretch, I can decide when it’s time to go, and to suggest that my nearest and dearest would connive with the medical profession to send me on my way before I am ready is as unattractive as it is implausible.

MERCY KILLING

The debate on mercy killing and assisted suicide continues unabated as the law struggles to find a way through the ethical morass.  The two terms and not synonymous.  Mercy killing requires intervention by a third party, almost always a doctor, where the sufferer is incapable of ending his life unaided.  Assisted suicide suggests the contrary, where the sufferer ends his own life unaided, although with the assistance of a third party, almost always a close relative or family friend.  This is not a distinction without a difference, but a fundamental difference, and one given prominence in the tragic case of Tony Nicklinson.  He has “locked in” syndrome, cannot move, and can only communicate by blinking his eyes. He wants to die, but as the law stands, he has no right to do so.

The debate on assisted suicide has moved on since Debbie Purdy’s case and the helpful ‘clarification’ by the Director of Public Prosecutions.  This ‘clarification’ suggests that relatives and friends of sufferers who take their own lives are unlikely to be prosecuted where it can be clearly shown that they were acting out of compassion and not in anticipation of an expected inheritance.

Mercy killing is far from resolved, and by all accounts, a proposed Bill to address this issue will fail to do so.  It will fail to help Tony Nicklinson, not simply because he is incapable of taking the necessary physical steps to end his own life, but also because he fails to meet the criteria.  These are that he has a terminal illness with a prognosis of only 12 months to live, and he must be able to take the lethal medication himself.  The ability to take the lethal dose unaided also applies to the Dignitas clinic in Switzerland.

Everybody with an opinion wants to ventilate it.  There is the Commission on Assisted Dying, the Care not Killing and the Right to Die lobbies, to name but three of the most vociferous, but surely to God it must be first and foremost the sufferer and his family and friends who should have the right to decide.

If the sufferer, like Tony Nicklinson, can communicate his wish to die, then in the name of humanity, let him die.  The idea that the doctor administering the lethal dose should be paraded in court and accused of murder is abhorrent to all right minded people in a civilised society.

By all means have safeguards and hoops to jump through to protect the interests of the sufferer, but once surmounted to the satisfaction of right minded people, and not lawyers or interest groups or lobbyists, let the suffering end.

Postscript  John Simpson, the distinguished World Affairs Editor of the BBC, is presenting a programme on BBC1 this coming Wednesday at 9pm, entitled “When I Get Older”.  It deals with many of the issues discussed in this article, and well worth tuning in.

AT DEATH’S DOOR

Assisted suicide, mercy killing, euthanasia, call it what you will, simply won’t go away, and it promises to run and run for years to come.

In the recent past, we have been treated to the outpourings of Martin Amis and Terry Pratchett on euthanasia and assisted suicide, and both merit our careful consideration.

Martin Amis, I suspect with tongue in cheek, advocates “euthanasia booths” on street corners where the elderly can end their lives with a martini and a medal. He predicts a “silver tsunami” of increasingly elderly and thoroughly useless people, stinking out the restaurants and cafés and shops, in constant conflict with the younger generation. He has a point, although not attractively made. More and more of our precious resources will have to be devoted to them, from the doctor’s surgery, to the hospitals, to the care homes and finally to the hospices. And as we all know, the state pension was devised to support the elderly into their mid seventies, not into their eighties and nineties.

I live in a retirement area, and although I am not in the first blush of youth, I find that the elderly can be unintentionally irritating on many levels. Driving behind them is an ordeal, queuing behind them at the checkout whilst they count out every penny, dodging their electric carts as they trundle down the pavement with a miserable expression fixed, rictus like, on their faces, all this and more is enough to test the patience of a saint. But beneath these petty irritations lies a deeper malaise. Medical science may well keep us going for longer and longer, but sadly, without the quality of life, it seems so terribly pointless. This is, or should be, the nub of the debate.

Terry Pratchett speaks with greater conviction, as he is in the early stages of Alzheimer’s disease, and in his opinion, a fate worse than death. He is probably right. His aim is for a good and rich life well lived, and at the end of it, in the comfort of his own home, and in the company of loved ones, to have a death worth dying for.

And finally, we now have yet another “clarification” of the law on assisted suicide by Keir Starmer, the Director of Public Prosecutions. It is not his fault, because he has been passed the poisoned chalice, but his “clarification” is meaningless. He simply repeats what we already know, that each case is unique, and each case must be considered on its own merits. We already know that Debbie Purdy’s husband will not be prosecuted if he assists in her suicide, and I like to think that all who fall into this category will also escape prosecution, but there is no guarantee. To put it bluntly, it is not a guarantee that any law officer can give.

All these are noble sentiments, expressed as they are against the backdrop of a society where old age is to be despised, not revered, and where elderly relatives are shipped out at the first sign of inconvenience, not to mention incontinence.

But back to the nub of the debate. It matters not to which God we address our prayers, there remains a fear of the unknown, and a fear of dying. It was Edward Fitzgerald who wrote:

“Strange, is it not? That of the myriads who before us have passed the door of darkness through, not one returns to tell us of the road, which to discover, we must travel too.”

But above all, and the strongest argument against euthanasia, or mercy killing, or assisted suicide, is to decide when the time is right, and most important of all, to decide who decides. Those suffering a terminal illness have been known to recover, as have those in a deep and apparently irreversible coma. Those, like Terry Pratchett, may still enjoy a quality of life, even in the advanced stages of Alzheimer’s, and once Terry gets there, and is presumably incapable of deciding when the time is right, who in the company of those he loves decides when to pull the plug? And is it ever possible to escape the suspicion, real or imagined, that this merciful release was not motivated by self interest on the part of those who remain behind? And how is it to be done? On a show of hands?

The same with Martin Amis’s euthanasia booths. If you are well enough to walk into such a booth under your own steam and of your own volition, you are presumably well enough to live another day.

There is no easy answer. I do not hold a torch for either side of the argument, as I can see the strengths and weaknesses of both. But we must ask ourselves one question. When we are old and frail, and perhaps lacking the quality of life we once enjoyed, is it not better to allow the forces of nature to decide our going, even if, to some, we should have gone a long time ago? I am not sure if I am ready to have my nearest and dearest circling my death bed like some carrion crow, ready to pick over the bones of my rotting corpse.

MERCIFUL RELEASE

The law on assisted suicide is now a complete shambles. Within the space of a week, one woman is convicted of murdering her terminally ill son, and has to serve at least nine years behind bars, the other woman is acquitted of attempted murder, to spontaneous applause, and the judge criticises the Crown Prosecution Service for bringing the charge in the first place. So why didn’t he stop it?

For those who had thought that Keir Starmer, the ‘quiet’ and all but invisible man in charge of the CPS, would shine his light into the dark recesses of the law on assisted suicide, there is a genuine sense of disappointment. His attempts at clarification have been anything but, leaving the CPS and the courts to square the circle and failing miserably.

The problem with this unholy mess is that nobody is willing to stand up and be counted. In the two most recent cases, the grief of caring mothers nursing their terminally ill children cannot be overstated, and yet they, and not the medical profession, must shoulder the burden of mixing the drugs and administering the fatal dose. Where is the qualified doctor when you need him? If recent events are anything to go by, he’s in Germany, in possession of a smattering of English and only three hours sleep. Why can’t they take the lead and actually help, instead of washing their hands?

The CPS also has to take its share of responsibility, and not shift the decision making to the judge and jury. In the case of the woman charged with attempted murder and gloriously acquitted, why didn’t the CPS heed the strictures of the judge? A classic case of buck passing, which simply shouldn’t happen. The responsibility for seeing that justice is done rests in the hands of twelve men and women who have no legal or medical knowledge, and who are as likely as not to reach their verdict with the toss of a coin.

And what about the judge? Another classic case of buck passing. The rules state that if there is a case to answer, then it must be answered by the jury. But there are weak cases which cry out for judicial intervention, so why not intervene? The trial judge was eminently placed to do so, and yet he fudged it. Why? He must have been aware of the criticisms of his learned colleague. In the name of humanity, stand up and be counted!

So this unholy mess is dumped back into the laps of the politicians, who have bigger fish to fry, and in the case of this dying government, plans to make when they are thrown out of office. If ever there was a case for assisted suicide, this government would come high on the wish list of most of the electorate. But with Jack Straw, the Minister for Justice, his silence is underwhelming.