Right To Die?

Euthanasia, Assisted Suicide And End-Of-Life Care

John Wyatt

• Publisher: IVP
• Year: 2015
• Print ISBN: 9781783593866
• eBook ISBN: 9781783593880
• Edition: 1
• Topic: Philosophy
• Subtopic: Utilitarianism

The case for assisted suicide can seem so compelling. Surely it can't be wrong to help desperate people to kill themselves? Don't we have a right to take our own lives in certain circumstances?




There are no trite or easy answers. John Wyatt helps us to navigate the arguments with hearts and heads engaged, and above all with our Bibles open. There are practical and compassionate alternatives to assisted suicide, and as many who have gone before us have found, the end of our lives on this earth may turn out to be a strange and wonderful opportunity for growth and internal healing.

1
Recent cases and media debates

There will be a population of demented very old people, like an invasion of terrible immigrants, stinking out the restaurants and cafés and shops. I can imagine a sort of civil war between the old and the young in 10 or 15 years’ time ... There should be a way out for rational people who have decided they are in the negative. That should be available and it should be easy ... There should be a booth on every corner where you could get a martini and a medal.

The words were mocking, cynical, deliberately provocative, but Martin Amis was deadly serious. He had seen the protracted death of loved ones at close quarters, and he didn’t want to go in the same way.

Martin Amis is just one of a chorus of celebrities, com­mentators, philosophers, distinguished doctors and others, calling for the legalization of medically assisted suicide. In this chapter we will look at some of the prominent cases that have influenced the current debates, including a small but highly publicized stream of despairing suicides who make the journey to end their lives at the Dignitas clinic in Zurich, Switzerland.

Recent cases

Edward and Joan Downes

The conductor Sir Edward Downes died at the Dignitas clinic, together with his wife Joan, a former ballerina. She had received a diagnosis of terminal liver and pancreatic cancer; he was elderly and frail, but there was no evidence of a terminal illness. They travelled to Zurich, where they were helped to commit suicide, the arrangements having been made for a fee of reportedly about £5,000 each. ‘After 54 happy years together, they decided to end their own lives rather than continue to struggle with serious health problems,’ reported their son Caractacus in a statement released to the press. ‘They drank a small quantity of clear liquid and then lay down on the beds next to each other ... They wanted to be next to each other when they died. It is a very civilized way to end your life, and I don’t understand why the legal position in this country doesn’t allow it.’

Although a person who ‘aids, abets, counsels or procures the suicide of another’ commits a serious criminal offence in the UK, the then Director of Public Prosecution, Keir Starmer, said that it would not be in the public interest to prosecute Caractacus Downes. This was despite evidence that he had booked the couple a hotel room in Switzerland and accompanied them on their final journey, and that he stood to gain financially from their deaths. Mr Starmer stated that

the available evidence indicates that Mr Downes’ parents had reached a voluntary, clear, settled and informed decision to take their own lives, and in assisting them, Mr Downes was wholly motivated by compassion ... Although his parents’ wills show that Mr Downes stood to gain substantial benefit upon the death of his parents, there is no evidence to indicate that he was motivated by this prospect.

Daniel James

Another case which caused great public sympathy was that of Daniel James, a promising young rugby player for the England youth squad. In 2007, at the age of twenty-two, he suffered a spinal cord injury while playing and was per­manently paralysed from the chest downwards. Daniel made an attempt on his life by swallowing an overdose while in the spinal injuries unit at Stoke Mandeville Hospital in October 2007, seven months after his injury. Six weeks later he was discharged home and took a second overdose in January 2008.

On that occasion he was taken to hospital, where a psych­iatrist noted he was ‘very angry and extremely hopeless’. He was also despondent that he had once again failed in his suicide bid. He refused any medical treatment, but two days later was ‘calm, rational and co-operative’. He still maintained that he wanted to die, and if he did not do so from his physical problems, he would continue to attempt suicide.

His parents, who up until then had done everything they could to dissuade him, told the psychiatrist they had come to accept his wish to die. They had bought thousands of pounds’ worth of equipment for their home to help with his rehabilitation, but he had shown no interest in using it. In March 2008 Daniel applied to go to Dignitas, telling his mother that if he were rejected, he intended to move out of the family home into assisted accommodation and starve himself, as ‘that was the only means of ending his life in a way that he was able to control’.

In September 2008, accompanied by his parents, he travelled to Dignitas where he took a lethal dose of barbiturates. His parents were quoted as saying,

His death was no doubt a welcome relief from the ‘prison’ he felt his body had become and the day-to-day fear and loathing of his living existence ... This is the last way that the family wanted Dan’s life to end, but he was, as those who know him are aware, an intelligent, strong-willed and some say determined young man.

The distinguished philosopher Baroness Mary Warnock, writing in the Observer newspaper, supported Daniel’s parents’ decision:

They decided to believe him when he said, after he was paralysed in a scrum, that his life was of no value to him, and that he would prefer death. It was not a sudden decision, but one taken over many months, during which he had shown, by attempting suicide, that he was in deadly earnest. They made a deliberate moral choice, and carried it out in what must have been an agonising journey to Switzerland. Their courage has been enormous ...

The number of British people who travel to Switzerland to commit suicide is tiny – between twenty and thirty a year, compared with approximately 500,000 deaths a year in the UK. But to many they represent the tip of an iceberg – the clearest manifestation of profound changes that are occurring in attitudes towards suicide and medical killing.

Tony Nicklinson

Tony Nicklinson was fifty-one when, on a business trip to Athens, a stroke left him paralysed from the neck down. The nature of the stroke led to ‘locked-in syndrome’, a rare condition in which conscious awareness and intelligence are unaffected, but the patient is almost totally paralysed. Tony was able to communicate only by interacting with a computer through blinking and moving his head. Nicklinson, who had lived an active life before his stroke, playing sport and travelling around the world, found it unbearable to have to be washed, dressed and fed by carers, and moved from bed to wheelchair by means of a sling. He described his life as ‘dull, miserable, demeaning, undignified and intolerable’.

After the stroke he was left dependent on round-the-clock care:

I cannot scratch if I itch. I cannot pick my nose if it is blocked, and I can only eat if I am fed like a baby – only I won’t grow out of it, unlike a baby. I have no privacy or dignity left. I am washed, dressed and put to bed by carers who are, after all, still strangers. I am fed up with my life and don’t want to spend the next 20 years or so like this.

It is estimated that at any one time there are up to 100 people in the UK with locked-in syndrome, yet the majority do not wish to die. They are clinging on to life, like the French editor Jean-Dominique Bauby, who gave a moving first-hand account of the experience of locked-in syndrome in his autobiography and subsequent film The Diving Bell and the Butterfly.

But Tony Nicklinson’s insistence on his human right to die (in reality, his right to be killed by a doctor) touched a nerve with the public and media. He took his case to the Ministry of Justice, arguing that when he decided he wanted to die, the doctors who killed him should be immune from prosecution. He stated that he wanted to establish the right to die with dignity at a time of his choosing.

After protracted legal argument, the case failed. The judges described Tony’s plight as ‘deeply moving’, demanding the most careful and sympathetic consideration. However, it was not for the High 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.’ Following the verdict, Nicklinson described himself as ‘devastated’. He started refusing food and deteriorated rapidly, dying from natural causes just six days after the court judgment.

Changing debates

It is striking how in the UK the public and media debate about euthanasia and assisted suicide has changed in the last twenty years. In the 1990s the debate was primarily about people who were dying in terrible and uncontrolled pain. The media was full of tragic stories of painful death. ‘You wouldn’t let a dog die in agony, so why do we let human beings die in this way?’ And it was death from cancer which was seen as the principal problem that had to be faced. But the debate has changed. Now it is not primarily about physical pain – it has become widely accepted by most people that, with expert palliative care, pain can be reduced and controlled, if not completely eliminated. Now the main issues are choice and control. And the diseases in focus are not cancer – they are neurological diseases, such as motor neurone disease, stroke and multiple sclerosis, which cause loss of control, and dependence on others. These issues – choice, control and the fear of dependence – are now central to the debate, as we will see in subsequent chapters.

Rational suicide

The obituary of Nan Maitland, the founder of a network for social housing, is another indication of an ongoing shift in social attitudes to suicide. At first glance it was unremarkable: ‘Nan Maitland died on 1 March. Her vision, energy and inspir­ation will be missed by all of us around the world who were captured by her warm personality and compelling charm.’

But after her death all her friends and colleagues received a letter:

By the time you read this, with the help of Friends At The End (FATE) and the good Swiss, I will have gone to sleep, never to wake. For some time, my life has consisted of more pain than pleasure and over the next months and years the pain will be more and the pleasure less. I have a great feeling of relief that I will have no further need to struggle through each day in dread of what further horrors may lie in wait. For many years, I have feared the long period of decline, sometimes called ‘prolonged dwindling’, that so many people unfortunately experience before they die. Please be happy for me that I have been able to escape from this, for me, unbearable future. I have had a wonderful life, and the great good fortune to die at a time of my choosing, and in the good company of two FATE colleagues. With my death, on March 1st, I feel I am fully accepting the concept of ‘old-age-rational suicide’ which I have been very pleased to promote, as a founder member of the Society for Old Age Rational Suicide in the past fifteen months.

Nan Maitland’s death represents a trend which is slowly growing in several countries. In the Netherlands a 2010 citizens’ initiative called ‘Out of Free Will’ demanded that all Dutch people over seventy who feel ‘tired of life’ (sometimes described as having a ‘completed life’) should have the right to professional help in ending it. A number of prominent Dutch citizens supported the initiative, including former ministers and artists, legal scholars and physicians.

Some euthanasia activists, including the Dignitas founder Ludwig Minelli, believe in death on demand. Minelli argues that autonomy is a human right that overrides all others: ‘If you accept the idea of personal autonomy, you can’t make conditions that only terminally ill people should have this right.’ Minelli highlights a deep division in the fundamental logic behind end-of-life legislation. Is it about autonomy and choice? Or is it about the prevention of suffering? Should assisted dying be restricted only to those with terminal illness? And is it possible to construct a law which has an internal logical consistency? These are issues to which we will return later in the book.

Human pain

These are much more than philosophical, legal or sociological issues. The brief stories above remind us of the personal tragedies and fears that lie behind the public debates. As so often, the ethical dilemmas start with human pain. With human beings who suffer and worry and weep and agonize over what will happen to them and to their loved ones. So we must never reduce these painful realities to cold philosophical or theological analysis. We are called to enter into the pain and despair of those who see no way out except suicide.

And of course the fears and anxieties raised by death and dying are not just issues ‘out there’ in society. They touch us all. In our darkest moments many of us have unspoken fears about what the process of dying might involve for us and for our loved ones. The prospect of an ‘easy way out’, a quick and painless death under our own control, may seem appealing, compassionate and humane.

Some, like Lord Carey (whom we met earlier), are arguing that we have a duty of Christian love to provide the option of a quick and painless suicide for those suffering at the end of life. Could this be an authentically Christian response? Later on I will argue that authentic Christ-like compassion leads not to medical killing and the accelerated destruction of life, but to practical caring – skilled, painstaking, costly and life-affirming.

But before that we must step back and look at the strange and murky history of mercy killing.

2
History of euthanasia and international scene

If you don’t know where you are going, it’s sometimes helpful to know where you have been ...

(William Temple)

There is a strong tendency in current debates about medical killing to ignore the historical perspective. The implication is that this is a new problem which requires new solutions. Yet the reality is that euthanasia has been actively discussed in the UK for almost 150 years, while the morality of suicide and mercy killing has been a matter of debate from the pre-Christian era.

This chapter provides a brief review of the history of euthanasia both in the UK and internationally. The content that follows is therefore somewhat academic. It is also disturb­ing. For those who wish to fast-forward to the present and come back to this later, chapter 3 focuses on recent developments in the UK. The precise definitions of ‘euthanasia’ and ‘assisted suicide’ in the current debate are critically important, and these are discussed in that chapter.

Early developments in the UK

In 1870 an English schoolteacher, Samuel Williams, published an essay entitled ‘Euthanasia’. He proposed that:

In all cases of hopeless and painful illness, it should be the recognised duty of the medical attendant, whenever so desired by the patient, to administer chloroform, or such other anaesthetic as may by and by supersede chloroform, so as to destroy consciousness at once, and put the sufferer to a quick and painless death; all needful precautions being adopted to prevent any possible abuse of such duty, and means taken to establish, beyond the possibility of doubt or question, that the remedy was applied at the express wish of the patient.

His essay was reprinted several times and contributed to a vigorous debate on the topic.

It is striking that right from the beginning mercy killing carried out by a doctor was christened with a euphemistic title, for euthanasia means simply ‘good death’: eu-thanatos. As we will see, the use of ambiguous and misleading termin­ology by campaigners has been a feature of the debate right up to the current time.

There seems little doubt that the remarkable advances in medical anaesthesia in the nineteenth century had stimulated Williams’s essay. Chloroform was a new, powerful (and potentially lethal) addition to medical practice, and was being used increasingly to abolish pain during childbirth and in surgical operations. Why should it not be used, under strict guidelines, to induce a painless death in cases of hopeless and painful illness? An editorial in The Spectator conceded that Williams’s argument was persuasive, but rejected it on practical and religious grounds: ‘Euthanasia would place an intolerable responsibility upon the patient, his physician and friends.’

Williams’s essay was also clearly influenced by recent evolutionary thought, encapsulated in the publication of Charles Darwin’s The Origin of Species eleven years earlier in 1859. Williams wrote,

A universal struggle for mastery and the universal preying on the weak by the strong is incessant; where conflict, cruelties, suffering and death are in full activity at every moment in every place ... And the only factor in all this scene of carnage that can be pointed to as significant of beneficent design, is the continuous victory of the strong, the continuous crushing out of the weak, and the consequent maintenance of what is called ‘the vigour of the race’, the preservation of the hardiest races and of the hardiest individuals.

Williams argued that humans already behaved in counter-evolutionary ways. Modern medicine, although commendable, effectively sponsored the survival of the ‘unfit’. If this was ethically justifiable, then human beings were similarly justi­fied in preventing the suffering which nature saw fit to impose at the end of life.

Five years later the prominent birth-control campaigner and socialist Annie Besant promoted the concept of ‘rational suicide’ (which we saw in the last chapter):

... when we have given all we can, when strength is sinking, and life is failing, when pain wracks our bodies, and the worst agony of seeing our dear ones suffer in our anguish tortures our enfeebled minds, when the only service we can render man is to relieve him of a useless and injurious burden ... we ask that we may be permitted to die voluntarily and painlessly, and so to crown a noble life with the laurel wreath of a self-sacrificing death.

Radical new ideas deriving from the Enlightenment were common among elite educated thinkers in Victorian Britain. There was the potent dream of building a better future for humanity based not on religious dogma, but on science and rationality alone. At the same time the new rational philosophy of utilitarianism highlighted the moral imperative of minimizing painful and negative experiences for humans and animals alike.

Several historians have pointed to the connection between the rise of interest in euthanasia and the development of eugenics in Victorian Britain. The new ‘scientific’ eugenics sought to prevent racial degeneration by restricting the reproduction of those who were called the ‘unfit’, those with identifiable hereditary abnormalities who ‘cluster to the extreme left of the distribution curve, and whose powers of reason and memory were even below those of dogs and other intelligent animals’.

In 1901 Dr Charles Goddard, a prominent supporter of both eugenics and voluntary euthanasia, and Medical Officer of Health in London, delivered a medical paper entitled ‘Suggestions in Favour of Terminating Absolutely Hopeless Cases of Injury or Disease’. In it he proposed offering euthan­asia both to ‘those poor creatures with inaccessible and therefore inoperable malignancy’, but also to mental defect­ives, referring to the large number of impaired individuals resident in the asylums, ‘for example, idiots, beings having only semblance to human form, incapable of improvement in education, and unable to feed themselves or perceiving when the natural functions are performed, unable to enjoy life or of serving any useful purpose in nature’.

Dr Goddard’s views were extreme, and were not supported by many in the overwhelmingly conservative medical profession. However, proposals for ‘eugenic euthanasia’ continued to be raised from time to time. Even George Bernard Shaw, in a speech to the Eugenics Education Society in 1910, was reported to have supported ‘the lethal chamber’ for those who wasted other people’s time because they needed looking after.

The eminent neurologist Dr Tredgold was a leadin...

Table of contents

• Contents
• Acknowledgments
• Introduction
• 1 Recent cases and media debates
• 2 History of euthanasia and international scene
• 3 United Kingdom experience
• 4 Underlying forces
• 5 The argument from compassion
• 6 The argument from autonomy
• 7 Christian responses and perspectives
• 8 Medical issues in the care of the dying person
• 9 Palliative care and legal frameworks
• 10 Dying well and dying faithfully
• Appendix 1 Example Statement of Wishes and Values for a Christian believer
• Appendix 2
• Appendix 3
• Appendix 4
• Notes and references
• Glossary of medical and technical terms
• Further reading and resources