Fraser Nelson should stick to the facts about assisted suicide
Dear Fraser Nelson,
I’m usually an avid reader of your analysis and enjoy your TV and radio performances as well. However, on the issue of assisted suicide, I think you have got it wrong, very wrong. While your short article was far from the weakest view I have seen expressed on this hotly debated topic, I still believe that your logic and evidence are both flawed.
You made no attempt to hide your delight that Lord Falconer failed in his attempt to legalise assisted suicide for people sending friends and relatives to “Swiss death clinics” (a fairly loaded description, I might add). As you stated, Lord Falconer had ”proposed that any two doctors can be ‘of the opinion in good faith’ that someone is terminally ill, yet mentally coherent enough to make the decision to go to Switzerland for the lethal injection”, which sparked what you described as an “excellent” debate in the Lords. Even so, the evidence that you presented was limited to the following extract:
“…the doctors have said they want nothing to do with this. Perhaps because they know that diagnoses can be wrong. As we heard from the (excellent) Lords report: “The Royal College of Pathologists drew attention to ‘a 30% error rate in the medically-certified cause of death’, with ’significant errors (i.e. misdiagnosis of a terminal illness resulting in inappropriate treatment) in about 5% of cases.’” So one in 20 terminal illness is wrongly diagnosed – ergo, people could be sent to their deaths for no reason. And, even if the diagnoses were 100 percent correct, imagine what would happen if the principle were established. If we, as a society, decided that lives are disposable – that there was an officially sanctioned “off” switch – then how would that make our elderly feel? My concern is that it would plant in their heads a nagging question: should they do the decent thing, and ask to be sent to Switzerland so as not to be a burden?
This is a fairly weak argument. You claim that doctors want “nothing to do with” assisted suicide, but the Lords evidence included surveys of medical professionals that found over 10% of doctors claim to have assisted someone dying in the past, even though this is against the law. Your next point about the prognosis is relevant but not insurmountable. Without knowing which terminal illnesses were misdiagnosed, this point cannot be settled either way. Personally, I find it very hard to believe that someone with terminal cancer or motor neurone disease could ever misdiagnosed, so I would guess that this problem is confined to other disorders. The evidence from the Lords also raised the issue of it being very difficult to precisely determine when someone is at the point of death or even to determine when they have reached “unbearable suffering” (which can be physical or psychological) but, again, this will vary between disorders and diseases. Furthermore, there is no need to wait until the exact second before someone is going to die naturally to allow assisted suicide to take place because the final stages of several degenerative diseases will last for months, if not years before they become fatal – even though someone’s quality of life could have been destroyed a long time ago.
I admit that there are concerns about assisted suicide, even more so about voluntary euthanasia that is already legal in the Netherlands. That said, society has never and will never be able to stop people wanting to kill themselves. Trying to portray assisted suicide as a huge change in culture is questionable on the grounds that many doctors do it anyway and many patients who don’t have a helpful doctor will be forced to find someone else to help them instead – potentially leaving a family member or friend at risk of going to jail. Is that right? Is that the society you want? Everything hidden away and done in shadowy, dangerous circumstances away from the eyes of medical professionals? An elderly or disabled person may feel like a burden without assisted suicide being legal and that is still no reason to bury our heads in the sand and walk away from the issue. How assisted suicide affects the disabled and elderly is worthy of discussion, although there is no reason why the same safeguards that apply to everyone else should not apply to them. I would be in favour of people of sound mind being able to sign a legal document in the presence of medical professionals after a terminal illness has been diagnosed (but before their illness reaches a terminal state and only for a limited number of diseases), expressing their wish to be able to end their own life once their disease has reached an advanced stage.
Voluntary euthanasia for people who aren’t even ill opens up a whole world of problems that I have no desire to see appear in this country, but assisted suicide is humane and wholly justifiable on medical and moral grounds. Lord Falconer only lost the vote by 194 votes to 141 because it sounds like he left too much doubt over how, why and when assisted suicide could take place – but these questions can all be tackled one by one until the objections (bar the religious lobby who should be ignored as they have no right to tell me what to do) have all been addressed. It’s not often I say this about your articles, but this time I think you made the wrong call.
Yours sincerely,
A.Tory
Witanagemot Blogs
To me, it’s really simple:
Is Suicide legal? Yes it is in that it was expressly decriminalised in, I think, 1961.
Do we make provision for the disabled to make the same choices as the able bodied? Yes, we do.
So why do we not allow the disabled to kill themselves? Oh it’s legal but we prefer them to suffer if they lack the capacity to take their own lives.
In this country, a place that basically gave birth to the idea of fair-play, a place proud of its liberalism and equality, we have tied the right to commit suicide intrinsically to the physical capacity to carry out the act. This damns the disabled.
I disagree vehemently with Lady Campbell and note that the overt religious objections are taking a back seat to the ‘live long and suffer’ mob’s new approach – getting members of the disabled community to talk of their fears of being euthanised against their will, invoking shadows of the Nazis. This, I should say, is bunkum.
There are many people with a disability, myself included, who will want to end their lives when physical degeneration reaches a certain point. Like Debbie Purdy, I’d like to do it as late as possible and not as soon as I have to through the operation of a law that is supposed to protect me. Its all very well having someone who gets £250 a day for rocking up to the Lords, who can afford all manner of care and who’s income is not, in any sense, linked to the capacity to work, to argue that they don’t want to die. It’s something different when you are looking at losing the ability to work, at losing you home, at going bankrupt and then being bundled off to a
living dustbin‘care home’ to fester and suffer out of sight.‘If we, as a society, decided that lives are disposable – that there was an officially sanctioned “off” switch – then how would that make our elderly feel?’
How about thinking ‘if we as individuals’ – it changes the meaning of this entire sentence. And why shouldn’t we have the right to end our own lives. It is easy enough to do for those who aren’t disabled – it just takes a trip to Beachy Head. But as Shaun rightly points out it is the disabled and terminally ill that are completely disadvantaged as they would require help to take their lives and yet arguably they are the ones who should be allowed to end their own suffering if they so choose.
It seems to me that it is our current taboo of all things related to death. In the present day you will hear many people saying that a child should never die before it’s parents yet in Victorian Britain and present day Africa this was/is common place. We experience much less in the way of death than our ancestors did and as such we have become very sensitised to it. Which has led to us happily telling seriously suffering people that they must continue to suffer until a very painful end because as a society we don’t want to talk about/deal with death.
Shaun, I know that you speak from a very personal perspective on this. To condemn people to a truly horrible fate when their body gives up on them is inhumane – plain and simple.
Candid, I think the religious lobby are still keeping euthanasia off the table, while a faltering government also has no incentive to raise such a contentious issue.
Pathologists drew attention to ‘a 30% error rate in the medically-certified cause of death’, with ’significant errors (i.e. misdiagnosis of a terminal illness resulting in inappropriate treatment) in about 5% of cases.’”
Bloody hell. That many? I have to wonder about my mother now but I think she was ready to go anyway.
That does seem high, admittedly – but that is when determining the cause of death. No doubt many people have developed a number of conditions by the time they die. This is not that relevant for diagnosing conditions before people die when discussing assisted suicide.
Using the 30% CoD error rate as an argument is pure bunkum, as CoD can be difficult to ascertain – terminal illneses, and palliatives for them, come with complications, side-effects and secondary problems all of which can be terminal.
Someone had a heart attack due to the chemotherapy? Do you say it was cancer, the chemotherapy or a heart attack that killed them? That’s a basic one, there are more complex situations and all made worse by targets, demands for clarity.
Assisted suicide is a nonsense term. If you are not able to kill yourself then you can’t commit suicide. So the question comes down to under what circumstances are we happy to condone killing. Its a difficult question to answer, as your discourse highlights. Personally I would much prefer that the law continues to support the idea that killing is wrong, and let the courts deal with the exceptions. Its not perfect, but its the best option we have. So I guess I am with Fraser on this one. On the other hand, when you get to the end of your refining process, I would bet you will be too!
LFAT,
I don’t agree with legalising euthanasia as I think there are genuine areas of concern.
There are undoubtedly those who are clear in their own minds and who are sound of mind who will make this difficult decision.
There are also those who are in vulnerable situations where those meant to be looking after them do not hold their best interests at heart.
I fear the proposed system won’t give adequate protection to those who are vulnerable. I’m also wary at how this might become a different animal a number of years down the line.
Taking the abortion act as an example, the original intent was to protect woman from the dreadful results of back street abortionists. A good intention. Doctors checks were put in as part of the process (similar in concept to what is being proposed here). Fast forward 40 years and we have doctors rubber stamping what has largely become a contraceptive activity – a move away from the original intention (i think).
Should we go down this road, i think that in 40 years we will be rubber stamping euthanasia in the same way – a mere formality. I fear this opens up the opportunity for abuse..
I think that the current system or a tweak of the current system is best, whereby the Procurator Fiscal or the CPS can review the facts surrounding such events. Where there is some evidence or suspicion that mal intent is involved they pursue. Where there is none, they don’t.
I wouldn’t want to cause extra grief to those in the middle of a desperate situation, but neither do i want to see a situation where murderers can get their crimes rubber stamped.
~Former Labour Supporter
So then the *intention* doesn’t matter to you?
If someone trips and falls off a cliff, is that suicide to you or death by misadventure? If the latter, then what is the distinction other than mens rea – mental intent?
This is important as disability tends to leave intention and mental capacity broadly intact but deprives people of a physical capacity to act on that intent.
If I shot you with a loaded legally held shotgun by accident, say I tripped and fell (a happy side-effect of Multiple Sclerosis), then it would at worst be manslaughter since I did not *intend* to kill you. If, conversely, I wanted to kill you and punched you in the face and you lived, it would be assault. If I wanted to give you GBH (attack you with sufficient force to break your skin and produce bleeding and/or break your bones), say a good beating with a baseball bat, and you died, the law holds that the intention to commit GBH is equivalent to that required for murder so I’d be prosecuted for homicide. Other laws say that you *can* legally consent to say having your scrotum nailed to a chair while being filmed for p*rnographic purposes (R v Brown, Jaggert and others).
The theme, in case you’d missed it, is that intention is key. I would argue that if you are disabled and have the intention to end your own life, our society has as much of a duty to give effect to that intention as it does to enable me to access a public toilet with a wheelchair.
Then because you believe that we as human beings, free of heart and mind, are incapable of proposing adequate safeguards for the vulnerable and therefore should force people to ‘live’ against their will, to endure their existential suffering.
I have MS and may end up locked-in to an immobile body, not entirely able to swallow and subject to neuropathic pain solely treatable by cannabinoids such as Sativex, which (despite being manufactured at Porton Down – ahem) isn’t available on prescription in this country. I have yet to meet anyone, apart from people winding me up by pretending to be religious Jews, who will tell me to my face that I will have to live in that circumstance (should it arise) because they believe my suffering is in some way necessary. Perhaps you will have the courage to do that…
Mr LFAT, I like your new blog header, did you design it yourself?
I have looked at your manifesto. It is articulate, convincing and truly traditionalist and conservative.
This leads me to ask two things:
1) What the heck do you vote Tory for? and
2) Please could you and your readers vote in my poll?
http://theantipolitician.wordpress.com/2009/07/09/82/
Ob, I completely agree. The figure is a red herring.
Alistair, having to go to court to be allowed to end your suffering is an appalling solution.
FLS, there is always a danger that things change in future for the worse, but that is no excuse not to relieve the suffering of hundreds of people in the present.
Shaun, I concur that the challenge of creating safeguards is not sufficient reason to run away from this issue altogether.
TE, thanks for the compliments, I’m sure my readers can make up their own minds about whether or not they want to vote!
Alistair, having to go to court to be allowed to end your suffering is an appalling solution.
Actually, LFAT, I for one would be quite happy to apply to a court and a jury for permission to have my life ended and actually forms the basis of my preferred safeguard-solution which I have discussed with Dignity in Dying.
For people like me and Debbie Purdy and I, it is the *uncertainty* that people we love would be prosecuted for our deaths that is cruel. If it was banned and there was prosecutions, we could rail against the evident injustice. Instead we have a threatening, chilling, law in force that the DPP chooses, for reasons he will not reveal, not to prosecute. Without evidence to the contrary, it is clear that could change. And there’s no statute of limitations on crimes of killing so even if this DPP came and said he’d never do it, there’d be uncertaunty stretching into the future.
The problem, I contend, is the political cowardice of the DPP and his government masters. By refusing to state his criteria for prosecution while equally refusing to prosecute lest the caselaw start to ‘widen’ the availability of suicide, he just sits on the fence.
There is no question that the DDP have just stuck their head in the sands, which is by far the worst possible outcome – no certainty is given to anyone about anything. That said, I think being forced to use a court will rule out assisted suicide for those who cannot afford expensive legal cases – which is not a satisfactory outcome.
As they say at law school, “Lemonade is sweet, legal aid is sweeter”…
I think that voluntary euthanasia is acceptable as long as the person has, as you said a sound mind. Wether it´s a terminal disease or a person who had an accident and simply can´t move, and won´t move for the rest of her life, I think it´s not immoral. It´s simply suicide. It´s our choice..it´s the Right to die.
‘Then because you believe that we as human beings, free of heart and mind, are incapable of proposing adequate safeguards for the vulnerable and therefore should force people to ‘live’ against their will, to endure their existential suffering.’
Shaun, you’ve added 2+2 to get 5 based on what i’ve said. I never said that people should be forced to live against their will. See point about prosecutorial discretion.
‘…free of heart and mind, are incapable of proposing adequate safeguards for the vulnerable’
Frankly, yes.
‘I will have to live in that circumstance (should it arise) because they believe my suffering is in some way necessary. Perhaps you will have the courage to do that… ‘
I’m not sure how you’ve come to the conclusion that I think your suffering is in some way necessary. Be assured though, if i did think that, I would have no qualms about telling you straight.
However, if it comes down to a choice between protecting rights to take such action (made of free will) or protecting the rights of those unable to make such a choice (for whatever reason), then my choice is to favour the protection of those unable to do so.
As i said, i believe that prosecutorial discretion provides a framework that best balances the two competing rights.
Shaun, you’ve added 2+2 to get 5 based on what i’ve said. I never said that people should be forced to live against their will. See point about prosecutorial discretion
Sorry, FLS. If you don’t think people should be free to get an assisted death then you believe that people such as I should live on as an immobile husk in pain, suffering, because we cannot actively kill ourselves.
The ‘point’ about prosecutorial discretion only makes the whole matter more uncertain, increasing (for example) the stress on me in case my wife is prosecuted for travelling with me and wiping my bum/changing my colostomy bag. Since our Labour DPP lacks the courage to spell out the circumstances in which he would prosecute and equally lacks the courage to take a case to court lest the Judiciary decide those circumstances for him. In short, the status quo simply adds to my suffering through legal uncertainty.
However, if it comes down to a choice between protecting rights to take such action (made of free will) or protecting the rights of those unable to make such a choice (for whatever reason), then my choice is to favour the protection of those unable to do so.
OR, to put it another way, you are happy to put *hypothetical* (potential) suffering ahead of *actual* (happening now) suffering. Someone who actually wants to die but can’t do it on their own is, therefore, less important to you than a potential person who may not want to die but gets murdered. Real v potential. I get that, I just happen to put reality ahead of possibility and resent the fact that people with your point of view will make me endure suffering because of their fears of some other hypothetical person possibly suffering.
@Shaun Pilkington – If someone trips and falls off a cliff, that sounds like an accident to me. I think that if you are not capable of killing yourself you are unlikely to be in a position to fall off a cliff. If you are in the unfortunate position of tripping and causing someone else to fall off a cliff then I guess you have to live with the consequences. BUT I am struggling to see your point.
My point was about intention. You do in fact seem to differentiate between a suicide by jumping off a cliff and an accident where someone falls off a cliff. This means that you DO believe that intention is important.
Finding that out was my point.
So if in one case an intention can transform an accident into a suicide, why is a disabled person’s intention to die insufficient for you to consider giving effect to?
@LFAT – LFAT, the point I had in mind relates to the position of the assister rather than the assisted. I don’t subscribe to the view that it is appropriate for the court to validate (or otherwise) such an act in advance
LFAT – off the reservation here…
Both you and Fraser miss the fundamental point: the state simply does not have the right to take life or to approve the taking of life. That is the biggest single extension of executive power imaginable. (And yes, war is an exception to this rule).
The answer, as always, is simple (and pretty close to what we had in the past before the whole Dignitas unpleasantness).
If a patient wants to bring their life to an early end but is unable to do so without assistance they can communicate this to a doctor. Said doctor, if amenable, would typically administer a lethal dose of morphine. This was normal practice for decades. If, for whatever reason, it ends up as an issue then the state shows clemency.
Sure there is no legal certainty, but that’s what you get for operating in such a grey zone as this. This is a relgious/ethical question, and one that should be resolved by individuals. That said, the State simply cannot be seen to official condone the taking of life.