Assisted dying: who's to decide when a life is not worth living?

...is the title of a disgusting article Andrew Brown has written on CIF Belief. Jumping off from a recent BHA poll on assisted dying, he poisons the well by comparing choice in dying legislation to abortion legislation. The subtitle says:

Changing interpretations of the Abortion Act show how little legal safeguards are worth when the sentiment behind them is lost

Brown is not really interested in a sober reflection on the ethics of assisted dying. Talking about the poll's support for even those who aren't terminally ill being granted the ability to end their lives, he says:

You may think that this kind of autonomy is unrealistic and that it can lead to a distorting egoism. I certainly do. 

Both I and Andrew Brown have this kind of autonomy, so is this leading to a distorting egoism in us? Perhaps this is a mea culpa from Brown, or a misanthropic confession, but I presume he must mean that the combination of autonomy and Tony Nicklinson's sort of disability is causing the egoism, since we have the autonomy he sought. But why in the world should this freedom be denied to those who find themselves in Tony Nicklinson's position, when surely that freedom with that sort of disability is what is most needed? And talking of Nicklinson, he says:

Just as important was the attitude of his family and those around him. I don't want to suggest for a moment that they were actuated by anything but love and the desire to help him realise the end he wanted for his life. The point, however, is that their decision and their support were very important. Had they opposed his wishes he would hardly have got anywhere.

But I think he does want to suggest something else; he's hinting at ulterior motives behind the Nicklinson family's support for Tony. It's not that they supported Tony's right to decide his own fate, but they somehow, unwittingly, wanted him dead? Despite the fact that all the evidence suggests that they would much rather he live, if only he wasn't suffering so much:

Standing by his side Jane calmly offers her support, albeit somewhat reluctantly as she admits that, despite everything, she doesn’t want to lose him. ‘But I can see how he suffers every day,’ she says, ‘trapped in a body that is little more than a shell.
‘So, however much I would like to have him stay with me, I love him too much to try to change his mind. This is his choice – it’s what he wants.’

And Brown makes the insinuation crystal clear:

Those who stand to benefit from someone's death are very likely, sincerely, to see the life they want to end as hardly worth living. This is a nasty fact about human nature, but any kind of humanism that isn't grounded in human nature is no more than ludicrous and sinister self-deception.

...

No wonder that the most recent piece of anti-euthanasia propaganda that I was sent highlighted a figure of 300,000 incidents of elder abuse every year. Supporters of assisted dying see this point. But it just makes them believe more firmly that the right kind of legislation, with the clearest possible safeguards, will stop unwanted grannies being liquidated for their asset value.

...and referencing abortion legislation:

If a mother has the right to dispose of an unwanted foetus, why doesn't a daughter have the right to dispose of an unwanted, incoherent and incontinent old person whose miserable life will only ever get worse? What could be easier than to propose to such a creature that its life is not in fact worth living? 

So the Nicklinsons, and anyone who wants their loved ones to determine their own fate, are, underneath it all, swayed by the 'benefit' that will accrue from the death of their loved one. Leaving aside for a moment the breathtaking idea that Tony's family were going to benefit in some way from his death, and that's why they supported him, this 'nasty fact about human nature', if it were so factual, could apply to everyone! Why, then, aren't there queues of old folk throwing themselves off Beachy Head like lemmings because their offspring will benefit from an inheritance? Maybe because Brown's misanthropy has got the better of him, and this 'nasty fact' isn't so true, or is true only in a few misguided individuals.

And because he thinks the practice of abortion has exceeded its brief, does he think that letting people decide their own fate will lead to daughters disposing of unwanted grannies? The sloppy thinking is objectionable, to say the least.

Reading about the Nicklinsons, I've always been struck by their concern for Tony. It was clear that they desperately wanted to keep him, but recognised that he didn't want to stay, and understanding his pain, supported him in his quest. Their humanity shines through; and not a nasty humanity either, but the best kind. I'm sorry that Andrew Brown is blinded to the truth of that by his prejudice against assisted dying.

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Melanie Reid on Assisted Dying

Melanie Reid has written a clear-sighted 'view from the wheelchair' on assisted dying, prompted by yesterday's commons debate on the DPP guidelines on assisted dying (MPs supported the guidelines, though no change to law was supported). Because it's behind The Times paywall, but is very good, I make no apologies for reproducing it here, because I think it deserves a wider circulation. Reid was a Times columnist, but broke her neck and back in a horse-riding accident in 2010, and has charted her progress since then in a series of moving pieces in the magazine, called Spinal Column. Anyway, here it is, entitled I choose, fiercely, to live - but only for now:

When asked about assisted suicide, I tend to pause and take a deep breath. You really want to know what I think? From the vantage point of a severely crippled body?

Honestly? You want the voice from the coalface? You don’t just want an opinion from some able-bodied moralist who presumes to know what’s best for me?

I find it ridiculous that an educated society, facing an unaffordable explosion in dementia and age-related illness, is prevaricating over this issue. It is, for me, almost inconceivable that the law lags so many decades behind modern realities; and is so out of step with the feelings of the vast majority of the population.

Where is the democracy surrounding death? The fact is simply this. Because of a religious minority, a few antediluvian pressure groups and the might of modern medicine, we are condemning growing numbers of elderly, terminally ill or disabled people to a terrible lingering twilight rather than a good death in the circumstances of their choosing.

And we are condemning the people who want to assist them to the threat of criminal prosecution. This is a scandal.

Today, apparently for the first time in nearly 40 years, MPs are to vote on assisted suicide (in 2006 a change in the law on assisted dying was defeated in the House of Lords by 148 votes to 100). Says it all, doesn’t it? The Conservative MP Richard Ottaway has secured a debate about the guidelines by the Director of Public Prosecutions on the issue, which have been in place since February 2010. The guidelines make it clear that prosecution is unlikely in cases of compassionate amateur assistance to die.

We must hope our MPs are bold enough to represent the nation’s views and support this stance. A recent poll found that 82 per cent of people believe that the DPP’s approach to prosecution is “sensible and humane”. Every single person I know is of the same general opinion: that there is no point keeping humans alive just for the sake of it, when they don’t want to be, in circumstances which we and they regard as intolerable. And if they need help to achieve a good death, in the comfort and peace of their own home, we should be able to give it to them.

Yet we are being held back by a tiny number, not even 18 per cent I bet, who either believe the Bible rules it out or are so blinded by the doctrine of palliative care (or perhaps both), that they remove choice from the majority.

Ironic, isn’t it, that we can buy 50 different types of pasta or ice cream? We can choose a million styles of hair, or clothes, holiday destination or car. Tidal waves of consumer choice lap against us every waking minute. Yet when we need help to effect a simple, primary decision to ease out of life; when we want to avoid becoming a living shell, stuck in bed, in pain, staring at the wall for months on end, and thereby condemning our relatives to a similar suffering, we are denied that choice. Or, if we are able, we must leave the country and go to a grotty Swiss suburb to find it. In an age wedded to the gospel of human rights, in other words, we are denied the most basic human right of all.

I will be very blunt. Most mornings I contemplate suicide, briefly examining the concept in a detached, intellectual way. It’s always during the hour when I am sitting on my shower chair over the loo, leaning forward over my purple, paralysed feet, fighting nausea and light-headedness, sore bones and paralysed bowels. This, without intending to sound self-pitying, is the worst bit in the day of a life as a tetraplegic — a cruel Japanese game show, full of repeated tortures.

And every day I stare at my toes and say to myself: “Nope, got to keep going, got to keep fighting.” Because I choose, fiercely, to live for the people who love me; and will continue to do so until such point as they understand I cannot carry on. I hope that moment, if or when it comes, is many years away.

But you know sometimes, just sometimes, I get angry enough to wish that a few bishops, palliative care specialists and those dedicated campaigners from Care Not Killing — ah! what amazing arrogance lurks in a name — were in my skin, sitting in my shower chair, facing my future.

Knowing that I have a choice is a huge comfort to me; it sustains me on the days when I make the mistake of looking too far in the future. But the point is, I am blessed precisely because I have a choice. I can talk, use my hands to a limited degree. I could, if I sought to, take my own life without implicating anyone else.

There are many other people who, because of their illness or their disability, do not have this possibility of self-determination. Their right to choose is denied to them. They need help to escape from their imprisonment; and they want to know that their family or friends will not be punished for assisting them to die.

The debate today is narrow in scope and only the beginning. It covers the terminally ill, which rules out spinal injuries and a host of other forms of chronic suffering. But it is an important start.

Humanity and economics demand that, eventually — and yes, yes, yes, with all proper safeguards — assisted dying is extended to become legally available to all those who seek it, and not just cancer patients. People like me, living with the consequences of an accident, who dread growing old and lonely. People like my mother, who in the early stages of dementia expressed a clear wish to end her life and not be a burden on us.

There will be a whole generation of ageing babyboomers, in fact, who will seek to go out of life in the same way they have successfully run it: in control, not in incontinence pads in a care home. This debate is not about other people. It is about every single one of us.

(© Melanie Reid, The Times etc)

Hear, hear. It's about autonomy and resisting the tyranny of a misbegotten authoritarianism.

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A Pitcher of Sneer

Pitcher - he's the one on the left

Eric MacDonald has posted a piece entitled The Emptiness of George Pitcher, pointing out the vacuity of Pitcher's slippery slope argument against assisted dying.

There is simply no logical connexion between my conviction that my life is intolerable in my condition, and the claim that anyone else in a similar condition must also be living in intolerable suffering. Yet every argument against assisted dying assumes that there is, and that, for that reason, we cannot permit people to make up their own minds about whether or not they should be allowed to receive assistance in dying. And so the suffering are forced to suffer.

I was listening to Raymond Tallis talking about the arguments against assisted dying, and I think he made a couple more pertinent points on the slippery slope:

When you're thinking about slippery slopes, you need to know how slippery they are, what the coefficient of friction is, and, indeed, what way they're pointing.

He then quoted John Harris's view that moving to assisted dying legislation would not apply skis, but crampons, to the issue, because informal procedures are more likely to be abused than formal ones. The crazy thing is that doctors are already on a slope, and there is no-one and nothing available to help them traverse it. The law can supply a foothold for these beleaguered professionals. For more on Tallis's views, see here.

On Wednesday night Pitcher pitched a loathsome performance on 10 O'clock Live, in a discussion which was supposed to cover the cultural and political relevance in Britain today of Christianity in light of the prayers offered by all and sundry for the stricken Bolton footballer Fabrice Muamba. Instead of discussing the subject he was more content to hurl brickbats at Evan Harris, to whom he has become something of a troll. He seemed to revel in trolling him face to face this time. 

Evan Harris made some eminently reasonable and far from strident comments that praying was 'a nice thing' if people were genuinely asking for help from god, but that fact didn't justify religious privilege in the public sphere. To which Pitcher replied, demonstrating the wit we've all come to expect from him, 

That's bollocks!

For some reason he didn't expand on this, presumably considering it a better argument than anything that theologians have come up with to counter secularism.

He did however ramble on about a 'folk faith' that people in this country have, that surfaces in times of extremis. Well, this is true, and not just in times of extremis. Cultural Christians often use religious language, and that would include Dawkins, as his recent "Oh god!" testifies when he was trying to remember the subtitle to On the Origin of Species. It's hardly surprising when we've been force-fed religion since we were 3 years old. Harris pointed out that this doesn't mean we must therefore be a 'Christian country'. 

Harris re-iterated that secularism was about removing religious privilege, not religious persecution, which won a round of applause from the audience. The needy Pitcher, feeling the warmth accorded to the sentiment, then said he 'sort of' agreed with that (really?!) so could he have a round of applause too? Harris then spoke out against self-censorship of criticism of religious extremists, sensibly, and how no-one had a right to be offended. Pitcher took offence at this, and accused Harris of being one of the easiest people in the world to offend, and said that that was why he was thrown out of parliament, for taking himself too seriously - *nice*, again with the personal attacks.

Mitchell challenged Harris's contention that atheists could not be offended (a claim that is surely too strong!), but Harris clarified the point, and it's pretty obvious; atheists are simply less likely to hold certain beliefs, rituals and objects as sacred, so are more difficult to offend. Pitcher then suggested that atheism was a religion (does George think that's bad?!), and trotted out the tired old saw that Dawkins is the 'high priest' of atheism, and made a weak joke alluding to Dawkins's recent memory lapse.

(Mitchell's performance in this discussion was surprisingly weak, based on past showings; I'll put that down to a momentary aberration, and hope it has nothing to do with his forthcoming nuptials with faitheist Victoria Coren. Congratulations to them both, anyway!)

So apart from one small interlude where the topic was discussed, Pitcher spent the discussion playing the man not the ball. I cannot believe that any Christians watching would want to be associated with a religion to which this irksome, quarrelsome and militant priest was connected.

UPDATE: Here is an audio of the talk discussed above:

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Rhyme or Reason?

Richard Dawkins suggests that Rowan Williams and other sophisticated theologians are being poetic about their beliefs - perhaps that they are metaphorical. I'm pretty sure that Williams thinks, however poetic he gets, that there is an underlying real truth behind what he says. And this is surely true of most senior Anglicans, despite the suspicion some have (or had, like Julian Baggini?) that they don't really believe in the unlikely things they say they believe in. Consider this, from Michael Nazir-Ali, the former Bishop of Rochester, in the Daily Telegraph:

The proper relation of religion to science is also vital. Young people must be taught to appreciate both the experimental methods of science and the ultimate values which religion offers. Such a conversation must take place in the classroom if we are not to continue being divided by “scientistic” and religious fundamentalists.

Mr Cameron reminded us that inalienable human dignity is founded on the biblical idea that we are made in the image of God. But to whom does this extend? And are there circumstances when a person might lose such dignity?

Nazir-Ali implies that we have sources of reliable knowledge other than science, with his false opposition between scientism and fundamentalism, then notes that human dignity is based on 'the biblical idea that we are made in the image of God'. This is very debatable, of course, but, further, is 'made in the image of God' a literal truth or a poetic metaphor? Science shows that we are inextricably a part of the animal kingdom with no need for such a notion, so should we not conclude a contradiction between science and religion here? I think we should, but liberal theists might say that I am being too scientistic and literal in my interpretation of the teaching; lacking poetry, perhaps? 

As an aside, read Russell Blackford's discussion of scientism, and other things, here, which explains well how the charge of scientism lacks teeth - anyone who appeals to a worldview based on reason and evidence  (practically everyone, I should think) is automatically not scientistic; but that does not allow anyone to claim truths in opposition to science.

Nevertheless, Nazir-Ali clearly wants public policy based on this 'idea', linking it to the 'special nature of the human embryo' which suggests he, at least, thinks it's a literal truth that we are created in the image of God, in opposition to the huge weight of scientific evidence:

It was for these reasons that the Human Fertilisation and Embryology Act recognised the special nature of the human embryo and established an authority to regulate scientific work involving embryos. I support the Coalition’s desire to trim the quangos, and the Human Fertilisation and Embryology Authority is not perfect. But we need a body, perhaps modelled on the US President’s Council, that can consider the moral implications of developments in bioethics.

If he doesn't think it's a literal truth, should we base such decisions on ancient metaphors? I think metaphors could be useful if they highlighted an underlying truth revealed by our explorations of reality, but the image of God and the special nature of the human embryo would need to be connected by something more than a biblical idea, since biblical ideas have a wretched record in the marketplace of ideas and, in any case, they should not be grounds for public policy in a secular, multi-cultural world, unless they can be supported by secular, multi-cultural arguments and evidence. Even good poetic reasons would not suffice, in my opinion.

The moral implications of developments in bioethics should be considered, but, like all morality, they should be considered by us all, in a mature group negotiation that considers all the facts as we understand them, in concert with mutually acceptable values.

Bizarrely, Nazir-Ali also says:

As Mr Cameron reminded us, the value of equality comes from the biblical teaching, confirmed by science, of the common origin of all humans.

He appears to blind himself to the evolutionary view which shows our common origin with other animals, and to ignore biblical teachings such as descent from Adam and Eve and the massacre of the Canaanites, which suggest that some humans are more equal than others.

The Commission on Assisted Dying will be reporting this week, and it has taken on board evidence from Robin Gill, an advisor to the Archbishop of Canterbury, that the current status quo should be maintained, preferring to limit patient choice to a denial of treatment, with all the potential for pain and suffering that that entails. This stems from another supposed truth (poetic or otherwise) that human life is a gift from God and thus not our own:

10. The sanctity of human life: This principle is crucial to Christians. It encapsulates their belief that life is in and of itself sacred because it is given by God. Life has an inherent value, not just a conditional one. The principle is enshrined in law in the form of an absolute prohibition on the intentional killing of innocent human beings. It is not normally taken to mean that any life ought to be preserved at all costs. But it does ‘protect each one of us impartially, embodying the belief that all are equal’ (quoted by the Archbishop and the Cardinal from the 1994 Select Committee’s report, included in Appendix I).
11. For a Christian, this principle also encapsulates the simple belief that God owns my life, not I, and I have, therefore, no right to end it.

(from the Church of England briefing paper to the Lords Select Committee on Assisted Dying)

The consequence of such literal beliefs is Anglican opposition to humane measures which recognise each individual's autonomy. But, it's a logical corollary to the view that our lives are not our own. Let us hope that the Commission recognises the evil nature of such warping ideas, poetic metaphor or not, since these beliefs have neither rhyme nor reason to my ears.

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