A good question? Should assisted dying be legalised?
Each month we ask one question, and get four answers.
This month: Should assisted dying be legalised?
‘I worry about a change with unintended consequences that can never be undone’
Dave has been admitted to a hospice in the end stages of cancer. He has had enough. He says to the chaplain visiting him: “Why can’t the doctors give me something to end it all?”
Later that same morning, the chaplain encounters a family, desperately worried about their elderly mother. “She’s wasting away,” they say. “Why won’t they feed her?”
Anyone who works in palliative care has heard those anguished questions. They are both cries for help, yet asking for totally different things. They remind us that this is a complex area, where patients and families are often as fearful of death being hastened as of life prolonged.
Those who argue for assisted dying emphasise the importance of personal autonomy. They stress that there will be safeguards to ensure that those who ask for help to die are in the terminal stages of their illness, are suffering unbearably, and are certain of what they want. And this is, apparently, what the majority of the general public wants, too.
So why do I feel reluctant to go down this road? First, because I have seen too many people change their minds.It’s commonly thought that palliative care is just for people right at the end of their lives; but in reality good palliative care can make a difference to those who have months ahead of them and are struggling with pain or depression, or are fearful of what the dying process may be like. I’ve seen people who initially wanted to die find fresh reasons to live.
Second, because once this line is crossed, I believe that it will fundamentally change the relationship between doctor and patient. I think of the recent outcry over the Liverpool Care Pathway for the dying and imagine the fears that would be aroused if doctors were legally able to end their patients’ lives.
Finally, I fear what this will do to us as a society. I worry about a process of almost imperceptible drift: that what begins with carefully limited cases will not end there, that we will find it easier to make broader judgements about what constitutes a “worthwhile” life; and that such judgements will increase the anxieties of those who can feel most vulnerable, because they are frail, elderly or severely disabled.
I haven’t argued here from a specifically “Christian” viewpoint. There’s a common misconception that it’s just religious people who worry about a change in the law and who are seeking to impose their views on others. But I know many who don’t share my beliefs yet share my concerns about the implications of a change that, once embarked upon, may have unintended consequences that can never be undone.
Judy Davies is president for the Association of Hospice and Palliative Care Chaplains
‘We should show Christian compassion to those who ask for help’
I support assisted dying for “competent” people suffering unbearably in terminal illness who repeatedly ask for assistance to die. At present, a relative who assists a loved one to die is unlikely to be prosecuted but a health professional could face 14 years in prison. Lord Falconer thinks this “incoherent” and is proposing a change in the law so that dying people with fewer than six months to live can ask a doctor for life-ending medication.
Most people (80%) would welcome this, including a majority of churchgoers. However, most religious leaders are opposed. Some argue that only God should determine the hour of our death; but if they were consistent they would be equally opposed to medical intervention to prolong life. For some, “Thou shalt not kill” is decisive, but that commandment is better translated as a ban on murder. It is not relevant to hastening the death of someone who is already dying. Many argue that palliative care is a better response and in the majority of cases I agree. If such care were universally available, 95% of the pain in terminal illness could be controlled. That would be a huge improvement, but it would still leave one in 20 cases where pain could not be palliated. If I were in that 5% I would want help to hasten my end.
One common objection is that if assisted dying were legalised some old and ill people would feel pressurised to ask for it. However, this hasn’t happened in other countries. For example, Switzerland has had assisted dying for 70 years and on average they live 2.5 years longer than we do and they live longer with terminal illness. Some believe that palliative care and the hospice movement could be put at risk. This worried the Oregon Hospice Association and they fought hard against legalising assisted dying in their state. But after eight years’ experience, they changed their position, admitting: “Absolutely none of our dire predictions has been realised.” Instead, the percentage dying in hospices rose from 22% to 51%. Similarly, the European Association on Palliative Care found that in the Netherlands, Belgium and Luxembourg, palliative care improved since assisted dying was legalised. Why should the same not happen here? There is no slippery slope to fear and we should show Christian compassion to those who ask for help.
The Revd Dr Paul Badham is professor of theology at University of Wales Trinity St David (Lampeter campus)
‘Why should we artificially prolong life?’
If this question had easy answers there would have been legislation by now. People’s views are informed by their faith, lifestyle or experience, so no two will have the same answers. Recent pleas from the severely disabled to allow doctors to terminate their lives have forced us to face the question again.
As a Christian, I recognise life is sacred, God-given, that death is not the end but a new beginning. I also recognise the power of prayer, that healing can come in any situation and that for some, death is the ultimate healing and not a failure. I recognise too that there is a time for dying.
I know folk who are tortured by disability and severe terminal illness; I have seen those who cannot move or communicate after a severe stroke and have remained vegetative for years; I have known those who have been in the last stages of motor neurone disease; I have known their carers, who have loved their spouse/ partner/friend/family member and do everything possible to keep them alive by sacrificing their own health and quality of life. Part of me says we shouldn’t take a life – but if death is not the end, why should we artificially prolong life for advanced terminal patients close to death?
Having spent many years advocating healing ministry, I still believe that prayers are answered – but not always in the way we want or expect. Some of us through prayer ministry might have experienced terminal patients receiving a deep peace when previously they were troubled and anxious, or carers being able to draw on inner resources they didn’t know existed and receiving help from unexpected sources.
A letter in the The Sunday Telegraph in May succinctly answered the question for me. Terence English wrote: “The term ‘assisted dying’ is important because it will distinguish ‘assisted suicide’ for those who are not terminally ill (which will remain illegal) from those who are dying as defined by a terminal prognosis certified by two independent doctors. If assisted dying is legalised it will permit a very small group of very advanced terminally ill patients to obtain help from a doctor, within strictly legal safeguards, to choose the time and circumstances of a dignified death. That is very different from assisted suicide for the seriously disabled or mentally infirm who may have many years to live.”
Assisted dying can only be appropriate for a few severe terminal cases, including those where folk are being artificially kept alive, and it needs to be limited and very controlled. Living wills could be helpful. If doctors and relatives know the patients wishes in a particular situation, they can act on them when the patient is unable to communicate.
This needs to be balanced with improved palliative care and facilities for the terminally ill.
Delia Bond is a former United Reformed Church coordinator for the Synod Healing Ministry Advisors
‘The value of human life makes it incompatable with our faith’
Lord Falconer’s Bill to legalise assisted suicide means that we have the opportunity, responsibility and duty to advocate the value of human life, speak up for the vulnerable and expose the dangers of changing the law.
The closer individuals get to the issue of assisted suicide, the lower the level of support for a change in the law. Six out of 10 members of parliament oppose or strongly oppose legalising assisted suicide for mentally competent terminally ill people according to a ComRes poll published in September 2012. The vast majority of clinicians are opposed to legalising assisted suicide. The British Medical Association opposes assisted suicide and rejected motions to adopt a neutral stance on the issue in June 2012. They are joined in their opposition by the Royal College of General Practitioners, the Royal College of Physicians, the British Geriatric Society and the Association for Palliative Medicine.
Why should this be the case? Having thought long and hard about the issue following debates in the Commons in January and March of 2012, MPs remain unconvinced that public safety concerns have been dealt with. Even with the very best safeguards, the pressure on vulnerable people will remain. Ultimately, for MPs, the current law is clear and does not need to be meddled with. Assisted suicide is illegal and punishable by up to 14 years’ imprisonment and the director of public prosecution’s guidelines provide for discretion and the tempering of justice with mercy in particularly hard cases.
Any clinician will readily admit that diagnosis and prognosis is not an exact science and would recognise that it is incredibly difficult to determine how long a person has left to live. Additionally, whilst palliative medicine may not be a panacea able to alleviate all pain and suffering, it can effectively tackle many of the drivers for assisted suicide, namely: fear of dying badly, worries about a loss of control and concerns about quality of life.
Our point of departure as Christians is that the intrinsic value of human life makes support for assisted suicide incompatible with our faith. However, it is understandable – if not condonable – that, from a quick scan of the papers, the view of the public (some suggest even the Christian population) leans towards legalising assisted suicide. Yet Christian love extends beyond mere compassion for individual circumstance; we recognise a creator God who knit us together in his image and first loved us.
The Bill proposed by Lord Falconer is unnecessary and dangerous. Particularly in a time of recession, with an aging population and a stretched health service; it should be given short shrift ensuring that the vulnerable remain protected as they currently are.
Nola Leach is chief executive of the Christian charity CARE
These article was published in the July/August 2013 edition of Reform.