Saturday, 3 November 2012

Assisted Suicide: A Debate

This article first appeared on in April 2012. We reprint it here, entirely unabridged, to mark 10 years since the Dignitas clinic in Switzerland first opened its doors. With thanks to Dancing Giraffe and Peter McAllister, my collaborator and anti-AS opposite number on this piece.

Since this article was published, campaigner Tony Nicklinson has passed away. We have chosen to leave the article intact as a respectful tribute to the discussion that Mr. Nicklinson's efforts produced.

In March 2012, Tony Nicklinson approached the High Court seeking leave to pursue a clarification of the law surrounding assisted suicide. Mr Nicklinson had a massive stroke in 2005 while on holiday in Greece and was left paralysed save for slight movements of his head and eyes – a condition known as locked-in syndrome. His mind is unaffected and he is entirely conscious, but unable to move or communicate.

Since the stroke, Mr Nicklinson has been able to communicate only by using a voice synthesiser that interprets his blinking. When approached for comment following his appeal to the legal system, he has stated that he wishes the doctors in Athens had not saved his life. He described his current existence as, “dull, miserable, demeaning, undignified and intolerable”. The UK legal system is by now well-accustomed to such challenges.

In 2009, Debbie Purdy went through the courts in an effort to discover whether her husband would face prosecution if he accompanied her to a clinic such as Dignitas. The House of Lords agreed that it was a breach of her human rights not to know, particularly since this information was likely to play a large part in choosing when and how to end her life. The BBC reports the case of Tony Bland: “crushed in the Hillsborough disaster [...] allowed to die through the withdrawal of feeding tubes. He was in a persistent vegetative state after suffering severe brain damage and the judges said that it was in his best interests to be allowed to die.”
Yet despite these legal successes, and no shortage of discussion in debate amongst medical professionals and within the national press, little actual legal change has been effected. The consultation process for any change in the law is likely to be lengthy and complex, as befits such a weighty issue. Any change in the law, even a relatively minor one, will doubtless alter our society; our attitudes to disability will affect and be affected by the eventual outcome. To investigate the issue further, Peter McAllister and Christie Louise Tucker present a debate of the issues at hand.

Argument Against Assisted Suicide

Firstly I would like to make it clear, I am not an apologist for antediluvian values, nor is this a polemic discourse on the dangers to spirituality of assisted suicide. My intentions are as much a deep-seated personalisation as they are borne of any religious conviction. I do concede, however that religion has played its part in my disagreements to assisted suicide and indeed suicide, but not exclusively.
One of the most ardent opponents to assisted suicide is the Christian Faith. Suicide of any form is morally wrong because, having given life; God is the only one who has the right to take it away. The Fifth Commandment, 'Thou shalt not kill' (Exodus 20, verse 13), makes the point quite unequivocally. I have always found this particular Commandment non-negotiable.

There are arguments raising the point about serious concerns in legislating assisted suicide due to unsavoury family members and shifty doctors who would rather persuade a person to end their life, against the person’s will. Are there selfish reasons involved from particular family members? Do they stand to gain financially? Surely their motives are not borne out of a selfless empathy?
In free will there is another potential problem, that of capacity. Is the person contemplating assisted suicide competent to make such a decision? Are the drugs that people take for pain relief compromising their ability to make clear decisions? From experience, yes this is a factor. Psychiatric conditions may make someone desire suicide. Conditions such as Depression and Schizophrenia disorder can go undiagnosed; people who suffer such disorders could in fact choose to be unnecessarily supported to take their own lives?

Many people fear that assisted suicide will create a climate in which some people are pressured into it. The old, the poor, or minorities and other vulnerable groups might be persuaded to shorten their lives, rather than to "burden" their families. Will the definition stop short of a human’s ability to be productive?
People with severe and enduring disabilities may in turn have to justify staying alive. Is this a situation we really want to embrace? Writers such as The Times columnist, Melanie Reid use emotional tactics to further the cause for assisted suicide. But in my view this masks a very self-pitying nature, expounding their self-interested agenda and turning it into an exercise in scaremongering a civilised society.

Argument For Assisted Suicide

The distinction between suicide and physician-assisted dying is at times subtle, but always important. For a coroner to return a clear verdict of suicide, the Government’s legal definition states that it must be apparent that the deceased, “took their own life whilst the balance of their mind was disturbed.” But for a change of the laws surrounding assisted suicide to work, establishing sound mind prior to acting would be paramount.
This is already the case at the Dignitas clinic in Switzerland, where each client must consult an expert psychiatrist and submit medical records to an affiliated doctor before a prescription can be written, and there can be no doubting the value and importance of this requirement. Currently the only medical procedure in the UK to require the consent of two doctors is an elective termination; of course assisted suicide should be the same, and for the same reasons.

The loudest protests against changes to the law are usually from religious groups arguing the sanctity of life, or those concerned about potential misuse of the eventual act. But when retired American Episcopalian bishop, John Shelby Spong states that “the right to a good death is a basic human freedom”, it’s plain that the debate is a long way from conclusion.
Much is made of“valuing life”, the implication being that those who support assisted suicide lack this conviction. Nothing could be further from the truth. Valuing a worthwhile and fulfilling life is central to our argument; not wanting to continue a life shattered by absolute incapacity is merely a continuation of this.

It’s vital to make clear that it is severe incapacity that is under discussion here – the end stages of degenerative disease, or massive injuries caused by accident or injury. The argument is made best by the individuals attending court to challenge the law, and those close to them: the initiator of this current challenge, Tony Nicklinson, describes his life as “dull, miserable, demeaning, undignified and intolerable.” The parents of Daniel James, who ended his life at a Dignitas clinic in 2008, characterised their son as "an intelligent young man of sound mind" who was "not prepared to live what he felt was a second-class existence".
A southern African saying once related to the author of this article comes to mind; upon the death of a relative, the grieving family are reminded to give thanks to God for “a long life, well lived.” Even non-religious readers will acknowledge the truth and value in this. This is truly when assisted suicide should be considered; at the end of a long and full life, when all other options have been exhausted and the loss of faculty is too great for the individual to accommodate.

In Conclusion

The purpose of the assisted suicide debate is not to imply that the lives of disabled people, or anyone else, are in any way miserable or intolerable. Instead, the aim is to enable individuals to make their own decision about when, where and how to die, and to do so with dignity and comfort.
At present, someone seeking physician-assisted suicide must travel to the Dignitas clinic in Switzerland: previously an anonymous, nondescript concrete tower block just outside Zurich, now a pleasant house in a residential district of the city. Many opt to make the journey alone; to have a relative accompany them could expose their companion to prosecution for attempting to “aid, abet, counsel or procure” suicide, a charge that carries a 14-year sentence.

Both sides of the argument talk about dignity, quality of life, control, and ethics, but in the end, the decision is nothing more than a personal choice. What is needed now is discussion – in Parliament, between ministers and the sick and dying, between doctors, between couples and within families. The onus should not be on individuals to ask permission to be allowed to die peacefully.
Assisted suicide is an act of mercy, no less than the actions of a doctor or nurse on any other day in their career. The real enemy is silence and hypocrisy; wishing a dignified death for oneself and others isn’t selfish or unfeeling, it’s human. And our humanity is what necessitates the freedom to make our choice.

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