Killing people with kindness

I’ve spent a fair amount of time today being distracted by (and indulging in) debates on Twitter regarding the pros and cons of the Assisted Dying Bill.  Of most interest and challenge was my discussion with Dr Paul Teed who describes himself as a ‘A British junior A+E doctor and evidence based supporter of 

In response to my question ‘what would success look like?’ regarding the impact of the Assisted Dying Bill were it to become law Paul argued that it would bring ‘checks and balances’ to a situation that was and would in any case continue to happen with or without the law (i.e. people securing third party assistance to take their own life).  The law he argued was in the interests of patient safety and that ‘it would not lead to massive scale unchecked voluntary (+non voluntary) euthanasia (as it would reduce this practice) = improvement.’

I confess to finding this argument quite compelling.  It reminds me of the case that was made to legalise abortion law in the late 1960’s, or the case for needle exchanges for intravenous drug users to guard against HIV transmission.  It does not demand that one morally supports assisted dying (or abortion, or drug use); only that one might be inclined to put people’s safety above all other considerations.

Yet if one pursues this logic, why be confined to people who wish to take their own life because they have a terminal illness?  All suicides are presently unchecked.  All who seek to commit suicide may do so in a manner which involves avoidable pain or suffering (or which fails sometimes leaving a person with horrific injuries).  Why are we willing to help people who are terminally ill through medical intervention but not people with a ‘settled view’ that they wish to end their own life for other reasons?

We’re not willing to do so because we do not wish to be complicit in the suicide of people generally.  We may not be able to stop people taking their own lives, nor is doing so an illegal act, but we do not generally as society respect the choice to do so sufficient that we sanction physician assisted suicide on demand.  We discourage it.  We seek to prevent it happening in prisons or other closed institutions and investigate it when it does. We do not accept it.  Nor would we agree to a change in the law such that helping someone take their own life was generally deemed acceptable.

So ultimately we come back to the rationale of permitting assistance where a person has a terminal illness and is expected to die naturally within 6 months.  And whilst the Assisted Dying Bill does not employ the language of ‘suffering,’ the framing and narratives of campaigns for assisted dying are literally drenched in it.  Relieving ‘unnecessary suffering’ is the stated objective of those who support a change in the law.   I am quite certain that it – rather than a concern for ‘free will’ –  is also the basis for (widespread) public support as well.

And what may on the face of it seem like the most noble of objectives is I believe also why no matter what safeguards are included, or assurances given, the passing of this legislation would let the genie out of the bottle and place others who either do not seek assisted suicide, or whose circumstances the Bill as drafted excludes, at risk.

While at present the proposed Bill is restricted to adults with competence, considered to have reached a ‘settled decision….reached voluntarily, on an informed basis and without coercion or duress’ in two EU countries which already have such laws attention subsequently turned to those without competence, including children, on grounds of relieving suffering. In making the case for euthanasia for terminally ill children Belgian Senator Jean-Jacques De Gucht argued that ‘There is no age for suffering and, next to that, it’s very important that we have a legal framework for the doctors who are confronted with this demand today” (my emphasis).  If relieving suffering is the primary aim, it does seem somewhat counter-intuitive to require that children endure that which adults might be relieved of?  And if parents can give consent to medical treatment, or to its withdrawal, then why not to actively terminating a child’s life on grounds of unnecessary suffering?  It also seems entirely feasible that arguments should be made to relieve the suffering of people deemed to lack competence, as Doctors have done in Holland and I am quite sure will be argued in the UK.  The obvious risk is that should this Bill become law it will act to normalise the idea that the active ending of life is a legitimate method of ‘relieving suffering’ and as a consequence see euthanasia expand into other realms.

Paul and others have also argued that the Assisted Dying Bill poses no threat to disabled people generally given the strict limitations involved. Putting aside the fact that there are many people who be regarded as disabled who also have ‘terminal illnesses’, I believe this is to ignore the danger created by the social signal this legislation will send.

Disabled people are frequently described in the media and elsewhere as ‘suffering’ from their condition.  While recognising how Dignity in Dying has been careful to distinguish its current goals from high profile cases such as that of Tony Nicklinson – who despite seeking assisted suicide would not have been able to benefit from the proposed law – it seems clear to me that such cases have nevertheless helpfully rallied public support for assisted dying.  This is precisely because the public – and the media – sees ‘suffering’ in such cases and they do so not only because of the way his story was told, but because it confirms pre-existing ideas of what it means to be disabled.  The recent case involving a mother killing her three disabled children is a case in point – all newspaper reports focused attention on the nature of her children’s health condition and the degree of ‘suffering’ involved or life expectancy anticipated as if either would have justified her actions.   One must conclude therefore that a great deal of public support for this legislation arguably draws from the same well of misplaced compassion as that which underpins the continuing prejudice and discrimination faced by disabled people in all walks of life and that support is not confined to the constraints imposed by this Bill.

This is why the citing by Dignity in Dying and others of public opinion polling which finds widespread support for assisted dying should be regarded with caution.  For example, they quote the British Social Attitudes survey 2010 which found ‘82% of the general public believe that a doctor should probably or definitely be allowed to end the life of a patient with a painful incurable disease at the patient’s request.’ This data is presented at face value – the opinion of respondents taken as informed and unsullied by prejudice or stereotypes.  Contrast this with the finding of the BSA 2012 that ‘three out of four (75%) respondents advocate a reduction in immigration overall, a rise from 63% since 1995. 51% want a large reduction.’   Do we regard the opinion of these respondents regarding immigration as informed and unsullied by prejudice or stereotypes? No – we naturally suspect that opinion is shaped by various forces and worry about its significance.  So we should with respect to attitudes to assisted dying.

Perceptions regarding the suffering of people with impairments and health conditions are not only very often misplaced and grounded in stereotypes and prejudice – which devalue disabled people’s right to be included in and supported by society – they are sufficient to permit people to rationalise the very ending of a human life.

Paul and others may see no risk of a massive rise in ‘unchecked’ voluntary euthanasia, but he passes no comment on whether as a society we might reasonably be concerned by a significant rise in ‘checked’ voluntary euthanasia following the passing of the Bill into law. He and others also disregard the possibility if of it providing a stepping stone towards the expansion of euthanasia more generally.  I am unconvinced and my fear is that whatever the safeguards in this Bill, its passing could make for a much less safe and supportive society in which to be a disabled person.

 

 

 

 

 

 

 

 

 

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5 thoughts on “Killing people with kindness

  1. The comparison with attitudes to immigration is neat but misleading. What are the prejudices or stereotypes about “painful incurable disease” which you think render those public opinions about assisted dying untrustworthy? Have you read any of the research evidence about the way that people with Motor Neurone Disease or end stage cancer die? Are you familiar with the stated wishes of people with those terminal conditions? Are you saying that actually “painful incurable disease” is not something to be worried about?

  2. Hi Tom

    No I’m very clearly not saying that and yes I am familiar with the stated wishes of some of those people with those terminal conditions and have read about the pain people endure.

    I’m saying that I believe there are great risks to others of legislating to permit ‘assisted dying’ and that I do not have confidence in the assurances given by campaigners that these risks are unfounded for the reasons I outline. I think it is right that these risks are debated and addressed before we go down this route.

    A significant risk is a pervasive view in society that people ‘suffer’ from disabilities and I offer the example of the way the media sought to make sense of the recent killing of three disabled children by their mother on the basis of the severity and life expectancy of the children. I also highlight the confusion that exists between ‘assisted dying’ as defined in this Bill and ‘assisted suicide’ as pursued by Tony Nicklinson, or which has been the subject of various high profile legal; cases and media stories, including that involving Terry Pratchett (who also funded the Commission on Assisted Dying). Dignity in Dying’s campaign materials focus upon ‘relieving suffering’ (with little emphasis is placed on ‘pain’). ‘Suffering’ is a broader concept that ‘pain’ & given many presume disabled people to ‘suffer’ (a form of prejudice) it seems possible at least that some supposedly compassionate public opinion is in fact rooted in harmful prejudice and stereotypes regarding disabled people (irrespective of the specific question asked, given people do not answer such questions in a vacuum). Whatever the specific legal and procedural safeguards in this proposed legislation, it cannot safeguard against the social signal it may send, or the dangerous prejudices it may confirm.

    Best wishes, Neil

    • “I do not have confidence in the assurances given by campaigners that these risks are unfounded for the reasons I outline.”

      Hi Neil,

      What about Oregon, which wasn’t mentioned in your blog-post? An assisted dying law has been working there for over 15 years and has never been extended, nor had any calls for extension, in it’s criteria of terminal illness.

      Also it is worth pointing out that it is incorrect to state Belgium and Holland moved from assisted dying to a broader criteria (“EU countries which already have such laws turn attention…”) – they were always wider when first implemented, and one of the safeguards with assisted dying is that the life ending medication has to be self-administered, whereas both these countries have euthanasia when the doctor can perform the final action.

      Cheers,
      Mickey (i work at Dignity in Dying fyi)

      • Hi Mickey

        Thanks for your comments.

        While Belgium and the Netherlands may have started in a different place, both did so on grounds of relieving suffering and both did not plan to extend to non competent adults and children which both have either done or are debating. .

        With respect to Oregon, yes you;re right I didn’t make reference to it which was remiss of me as it is the template for the legislation now proposed here. And while there may never have been a call for an extension there, the annual reports make in my view quite disturbing reading with respect to the reasons given by patients to seek PAS. This is from 2001 for example:

        ‘Physicians were asked if, based on discussions with patients, any of six
        end-of-life concerns might have contributed to the patients’ requests for
        lethal medication (Table 3). In all cases, physicians reported multiple
        concerns contributing to the request. Eleven (41%) patients included at least
        four specific concerns: becoming a burden, losing autonomy, decreasing
        ability to participate in activities that make life enjoyable, and losing control
        of bodily functions. Another 15 (56%) patients included at least two or three
        of these concerns. Most frequently noted across all three years were loss of autonomy (2000, 93%; 1999, 78%; 1998, 75%) and participation in
        activities that make life enjoyable (2000, 78%; 1999, 81%; 1998, 69%). Patients have increasingly expressed concern about becoming a burden to
        family friends or caregivers (2000 63%,, 1999 26%, 1998, 12%)’

        Neil

  3. Pingback: .@neilmcrowther on assisted dying / voluntary euthanasia | arbitrary constant

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