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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Empathy for the Poor Devil

UPDATE 22/8/12: Today Tony Nicklinson died. My thoughts are with his family and friends.

The High Court in Britain yesterday refused Tony Nicklinson and 'Martin' the means to end their lives without causing another to commit a crime. The judgement of Lord Justice Toulson concludes:

Tony’s and Martin’s circumstances are deeply moving. Their desire to have control over the ending of their lives demands the most careful and sympathetic consideration, but there are also other important issues to consider. A decision to allow their claims would have consequences far beyond the present cases. To do as Tony wants, the court would be making a major change in the law. To do as Martin wants, the court would be compelling the DPP to go beyond his established legal role.These are not things which the court should do. It is not for the court to decide whether the law about assisted dying should be changed and, if so, what safeguards should be put in place. Under our system of government these are matters for Parliament to decide, representing society as a whole, after Parliamentary scrutiny,and not for the court on the facts of an individual case or cases. For those reasons I would refuse these applications for judicial review.

Well, I have some sympathy with this: Parliament should be sorting this out. But gone are the days, it seems, when judges like Lord Denning made ground breaking but eminently sensible changes to common law. No doubt, though, that assisted dying has more import than obscure civil law. Mr Justice Royce agrees with Toulson:

Any change [to the law] would need the most carefully structured safeguards which only Parliament can deliver.

As does Mrs Justice Macur:

However, Mr Bowen QC does not succeed in persuading me that this process may reassure society that the development of common law for which he contends is merited by separate consideration of individual circumstances by individual tribunals of whatever stature and experience. The issues raised by Tony and Martin’s case are conspicuously matters which must be adjudicated upon by Parliament and not Judges or the DPP as unelected officers of state.

In his submission to the Court Tony wrote:

My life can be summed up as dull, miserable, demeaning, undignified and intolerable. …it is misery created by the accumulation of lots of things which are minor in themselves but, taken together, ruin what’s left of my life. Things like…constant dribbling; having to be hoisted everywhere; loss of independence, …particularly toileting and washing, in fact all bodily functions (by far the hardest thing to get used to); having to forgo favourite foods; … having to wait until 10.30 to go to the toilet…in extreme circumstances I have gone in the chair, and have sat there until the carers arrived at the normal time.

He is prepared to starve himself to death to end the tortured state in which he finds himself. His state, to remind everyone, is not of the terminally ill, but of the terminally locked-in. He faces up to half a century of this 'life' which he would rather not; or, at least, he would like the freedom to decide when he has had enough. We currently impose this sentence on some, because as a society we worry about the consequences of letting a very few people, like him, do what they want. The argument goes, it seems, that by allowing folk of right mind to determine their own destiny, we will allow an avalanche of abuse against certain folk who are not of right mind. Tony has to suffer in this real world for the putative premature termination of the lives of others. But individual autonomy, which is the goal of choice in dying advocates, empowers even those who think they would be at risk from such legislation.

Even if we were to allow this dubious premise, balancing current lives and future ones is notoriously difficult.  I'm currently reading Derek Parfit's Reasons and Persons which explores in excruciating detail a number of these questions for their moral implications, and I'm still not entirely clear what I think. However, I do not see how anyone, outside of those with religious reasons, could fail to support Tony in his quest. Most people appear to agree with me; apparently opinion polls have consistently shown a high percentage in favour of the right to die. Today's Independent leader says:

Few lawyers expect him to succeed. But concern at the dangers of a new precedent must come second to the inhumanity of condemning a person to so intolerable an existence. Mr Nicklinson must be allowed to make his choice.

However, the Daily Mail's Steve Doughty begs to differ, and bizarrely seems to suggest that a continuation of the campaign is good for Tony:

He can communicate by blinking at letters held up by his wife Jane on a perspex board. He has an eye-blink word processor he describes as ‘a ray of sunshine on an otherwise bleak horizon’. He is writing his memoirs.

... 

I should make it clear that I do not for a moment doubt Mr Nicklinson’s sincerity or his determination to end his own suffering. But it seems that what may be keeping him going, for now, despite affliction that would crush most others, is his campaign for the right to be killed.

Many have this idea that simple existence itself is an unalloyed good (often fuelled by religious doctrine). But we can see clearly that it is the right thing to put a family pet out of its misery when there is no quality of life to be had. Without defending some form of human exceptionalism, we should conclude the same for people in Tony's position. Now, I suppose, if I'm reading Steve Doughty charitably, he is suggesting that maybe humans are unique in having an inner mental life of contemplation, and that that life is worth living. Well perhaps, but just as the physical life can become unbearable, so too the mental life, and it can become even more unbearable for humans because of their inner mental life of contemplation. The decision to end it should still be Tony's to make, just as somebody able-bodied is free to make it.

How can we stand back and allow Tony to be treated like this? As Polly Toynbee writes:

Of all the various harms religions can do, their successful opposition to the right to a peaceful death is one of the most pernicious. Tony Nicklinson asks this: "The next stroke could affect you. Would you be happy to end up like me?"

If anything makes us human it's surely a deep empathy for his position. To see somebody suffering now demands our action.

Support Tony here.

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