Assisted suicide is not the way to go.
Suicide and killing people are two things that the Church has always declared to be wrong. It has therefore been of considerable interest in the UK this last week that a proposed law was put forward for debate which would authorize assistance with both.
Perhaps even more surprising was the intervention of Lord Carey, the former Archbishop of Canterbury, in support of the idea. In an article in the Daily Mail he announced a change of heart, reversing his previous stance, and breaking with the long-standing position of the Church of England on these matters.
In the background lay a number of difficult and very sad cases of which that of the late Tony Nicklinson was the most recent. He was paralyzed after a stroke and suffered from what is called “locked-in syndrome” for over nine years, which he found unbearable. So he wanted someone to kill him by injecting him with a lethal drug, (though, if necessary, he was prepared to kill himself by means of a machine invented by one Dr. Nitschke which, after being loaded with a lethal drug by a helper could have been digitally activated by Mr. Nicklinson, using a pass phrase via an eye-blink computer system).
Existing UK law forbids both killing people and assisting a suicide, but in practice a growing degree of forbearance in application of the law, in cases of medically assisted dying, has been introduced. But, Mr. Nicklinson sought to have the law changed outright upon the basis that it was in conflict with the European Convention on Human Rights of which Article 8 guarantees respect for private and family life. The right to a private life his lawyers contended meant respecting his “right” to commit suicide and more particularly have someone help him to do this without fear of subsequent prosecution.
His original case was rejected and in response, Mr. Nicklinson then refused all food and died of Pneumonia shortly thereafter. His widow then continued with an appeal to the Supreme Court, which, in June this year, again rejected the application. In a 7:2 majority decision, their Lordships declined the opportunity for judicial activism even though they indicated a strong sympathy with the case that had been made. Thus, they judged that the matters were within the discretion (or, more formally, the “margin of appreciation”) of the UK Parliament (whose capacity is itself now constrained by European law).
Nonetheless, they felt that the issues were better suited for Parliament to resolve than the Court, as they turned upon “important elements of social policy and a moral value-judgment,” together with “a choice between two fundamental but mutually inconsistent moral values, the sanctity of life and the principle of autonomy, which are sensitive to a society’s most fundamental collective moral and social values and upon which there is no consensus in our society.” The Parliamentary process they held “is a better way of resolving issues involving controversial and complex questions of fact arising out of moral and social dilemmas in a manner which allows all interests and opinions to be expressed and considered.”
While not directly making a decision compelling change, in reviewing the substantive issues, the judgment goes on to make a cumulative case for Parliament making changes to the applicable law. The judgment notes that the main justification for an absolute prohibition on assisted suicide “is the perceived risk to the lives of vulnerable individuals who might feel themselves a burden to their family, friends or society and might, if assisted suicide were permitted, be persuaded or convince themselves that they should undertake it, when they would not otherwise do so.”
Their Lordships then re-frame the core problem taking the “right-to-die” as a given, which then turns the whole matter into a contest of rights which consequently requires a judgment about “the relative importance of the right to commit suicide versus the right of the vulnerable, especially the old and sick, to be protected from direct or indirect pressure to do so.”
Having reframed things in this way, the question is no longer how to avoid any such pressure, since “It is unlikely that the risk of such pressure can ever be wholly eliminated. Therefore the real question is instead, according to the judgment, “how much risk to the vulnerable is acceptable in order to facilitate suicide by others who are free of such pressure or more resistant to it.”
With all this argued for, it is little wonder that they hint very heavily to Parliament that “A system whereby a judge or other independent assessor is satisfied in advance that someone has a voluntary, clear, settled and informed wish to die and for his or her suicide then to be organised in an open and professional way would arguably provide greater and more satisfactory protection for the vulnerable, than a system which involves a lawyer from the DPP’s office inquiring, after the event, whether the person who had killed himself or herself had such a wish.”
Perhaps the most curious irony in all this is that the terrible circumstances of Mr. Nicklinson would not in fact have met the new criteria. Thus, the person whose original case started this whole process would not have been eligible to apply it for the simple reason that he was not in fact terminally ill. While terrible, his condition was such that with sustained high level care his life could have continued for many more years, just as Stephen Hawking the celebrated physicist has lived on in to his seventies although medical experts confidently predicted he had “only months to live” in 1963.
All of which points to a serious disconnect between what is now being proposed and many of the issues put forward in support of it. For example, it is urged that medical science has led to excessive efforts to “keep people going at any price” and is “forcing people to live on for many months in unbearable pain.” Whether or not these claims are in fact true, in neither case would assisted suicide seem the optimal remedy. It is certainly not clear that the law as it stands, and still less Christian moral theology, obliges extraordinary measures that cause suffering to the patient. But references to the cost of treatment do hint at a worrying if otherwise concealed and logically separate concern about saving money. Encouraging suicide as a means to financial savings does not seem an especially attractive policy and is surely hard to present as necessarily in interest of the patient. The goals of relieving suffering and saving money are not issues that fit easily together.
Then it is frequently suggested that “It is quality of life that counts, not the number of days.” But this line of reasoning, when cited in the context of social policy must imply a mechanism for assessment. This in turn introduces an inexorable utilitarian line of analysis that can only erode the long-standing religious emphasis upon the intrinsic worth and sanctity of all human life. How can the “quality challenge” not eventually pose the question for all disabled people, on a continuing basis, of whether their quality of life is such as to warrant its continuation?
In fact, the question will be posed with a degree of force proportionate to the disability. The more disabled the person the more doubt it will create about the propriety of their continued existence, and the more urgency will be implied for their consideration of assisted suicide in the duly “organized open and professional way” we urged to embrace. It is not hard to think of historical instances where the disabled were targeted for elimination in a highly organised and professional way. Are we now to suppose that the only fault was a failure to be open about it and perhaps a certain murkiness about securing their consent, insofar as they had the capacity to provide it?
And that last is of course a further difficulty, at a time of so much emphasis upon equality of opportunity, why should the suicide option only be made available for those able to consent: given that those unable to provide it might be all the more in need of its alleged potential benefit of relieving their suffering? It is now often urged that the dying should “have a choice over how and when they wish their lives to end.” Perhaps this fittingly if tragically captures the final irony of our ever growing consumerist emphasis upon the individual’s right to choice — that it should now extend to maximizing choice in death.
No doubt the slogan “a life without choice is a life not worth living” will not be far behind. It would capture very neatly the sin of presumption which in the past informed the Christian objection to suicide: namely that it was an act of contumacy against God our Creator with whom alone should lie the ultimate time and hour of our death. This in turn points to a fundamental difference of perspective between secular and Christian views. For the Christian, death brings us before God and the life eternal, it is not simply a transition to nothingness.
But while such a difference of perspective is hugely important it is far from obvious that there is as much difference as many suppose in the assisted suicide debate over the propriety of relieving suffering. This surely suggests that in theory (if not in practice once the legitimacy of assisting suicide is conceded) all would agree that if pain and suffering can be relieved then there should be no need for suicide. Even now the proposed legislation would only offer support to those facing an imminent prospect of death (within six months) not to anyone just because they find life a burden. This means that the whole debate really turns upon the alleged impossibility, even if in only a very few cases, of relieving such suffering.
But in fact, it is open to doubt if palliative care is not progressing to the point where such pain relief is possible. In addition, the long standing Christian principle of “double effect” means that there is no reason to withhold pain relief even if it has the incidental (though not intended) further effect of shortening life. Accordingly, there is no real need to create the sinister specter of doctors authorized intentionally to kill their patients or “help them to die” in complete breach of the Hippocratic Oath (if they still affirm it) according to which they can “give no deadly medicine.”
Unfortunately however, it seems that prescribing deadly medicine is something to which lawyers and politicians are ever more inclined.
The Rev. Canon Alistair Macdonald-Radcliff is Director General of the World Dialogue Council.