The right to die – assisted death or assisted suicide?
Should we have the right to decide whether we live or die? Is it right to help a person end their life?
Since 1961 it has not been illegal to commit suicide. The State recognises we have the right to end our lives if we want to. It’s important though to draw a distinction between assisted suicide and assisted dying. The two terms are often treated as synonymous depending on which side of the argument you are on.
A person committing suicide may be in good physical health with a long life ahead of them. Due to various psychological conditions however the prospect of a long life fills them with dread and they choose to end it. With assisted dying, the person knows they have a terminal illness and is merely helping the inevitable along. A word of caution should be added here. It is notoriously difficult to predict how long someone has to live. There are many people who have been given only six months to live who have prove the doctors wrong. Having said that if your body is riddled with cancer, its a reasonable bet your life is going to be limited.
There are no certainties, but it is important to give people choices. We all have them when we are well, why should we lose them just because we are ill? The law recognises the right to self determination. In the words of Lord Justice Kennedy “It is a basic right to be able to manage your own property and affairs and no lawyer or court should rush to interfere with that right.” Masterman v Jewell 2003
But what of those people who through illness or other incapacity have lost the right to choose how they live their lives or if they live them at all? And how do we protect the ill and the incapacitated from undue pressure or exploitation when it comes to consider the treatment they receive and whether or not their life should continue? How do we protect people like Penny Pepper who is frightened that the right to die may devalue the lives of the disabled?
One of our greatest fears is dying in pain. Can modern drug treatment always provide relief? The Guardian reports its only effective in 60-70 per cent of cases. It may not be effective to prevent bone or neurological pain. We all want a good death, but this can be a lottery says clinical ethicists Ann Munro. Apart from pain, death can result in a loss of control and dignity. For example, bowel cancer can result in a patient vomiting excrement. The Guardian, today, tells the stories of four people and their desire to control how and when they die. we can do no better than give you a link to them.
For some people life is sacred and only God can decide when it ends. The courts have held however that life should not be sustained merely to satisfy religious belief, particularly if it is likely to only result in further pain and suffering NHS Foundation Trust v VT 2014. This case revolves around the kind of intensive care treatment that should be given, as opposed to actively ending a life.
The House of Lords is debating the Assisted Dying Bill. This proposes where two doctors certify a person has less than 6 months to live it would not be unlawful to assist them in dying. How do we prevent the weak and the vulnerable under this Bill feeling under an obligation to end their lives because they are a burden on others? It must be remembered it will only apply to people who have been diagnosed as terminally ill with less than 6 months to live.
There must however be adequate safeguards in place. Under the Mental Capacity Act 2005 you can place decisions over your future health and welfare in the hands of another. The scope of the powers you can grant are very wide and include giving someone the right to refuse life sustaining medical treatment on your behalf. A Health and Welfare power of attorney only applies when a person lacks mental capacity to make decisions for themselves. But it allows you to delegate the decision of whether you live or die to a third party. Is this not a golden opportunity for the exploitation of the weak and vulnerable? In the seven years the law has been in force nothing has come to light to suggest Health and Welfare Attorneys are exploiting their position.
Assisted dying is currently lawful in Holland, Belgium, Switzerland and Luxembourg and in Oregon, Washington, Vermont, New Mexico and Montana in the USA. While the dead tell no tales, no evidence has yet come to light of people being pressurised into killing themselves. The main safeguards under the power of attorney are that at least one person must be told you have created it and a further individual who knows you well or is a solicitor or other suitably qualified person must certify you understand the consequences of creating the power of attorney. Should we have a similar safeguard with assisted dying?
Some doctors can be accused of being more concerned with cure than care . When a person is diagnosed as incurable or dying they lose interest in them. If they are going to be involved in helping a patient end their life then this attitude will need to seriously change. They also need to be far more willing to discuss dying with their patients and not see death as a failure on their part. We all die one day and none of us come with any guarantee. As a geneticist said recently our DNA aims to get us to puberty and then tends to lose interest in what happens thereafter.
We should look at the role of none medical people. An independent certificate provider perhaps who either knows the person well and has nothing to gain from their death, or a professional person, such as a solicitor, who is well experienced in the manipulation of the elderly could a be asked to certify whether or not the decision to end life was that of the person concerned or someone else.
We all need to accept that life is finite and also beware that modern medicine can help maintain life long after the MOT has run out. When we are fit and healthy we can decide whether to live or die. Should we really be denied that right when we are ill and dying?
