Next week, on 7 November, the Assisted Dying Bill will return to
the Lords for scrutiny in committee. Lord Falconer's Bill to
legalise assisted suicide was given its second reading in the House
of Lords in June, and reports have it that opinion among their
lordships appeared quite evenly balanced. By conven-tion, no vote
was taken. Crucially, no wrecking amendment was intro-duced to
derail the Bill, since its opponents recognised that it ought to be
allowed a full airing in the lower, elected house - partly because
of the level of popular support, and partly at the urging of the
president of the Supreme Court.
While the Church of England is officially against legalisation,
opinion within the Church is divided. In the run-up to June's
debate, both Archbishop Desmond Tutu and Lord Carey came out in its
support.
What is the issue, and what is the controversy about? The issue
is whether terminally ill patients who want to end their lives may
be helped to commit suicide. As things now stand, it is not illegal
to commit suicide, but it is illegal to assist someone in so doing.
That might sound odd and inconsistent, but it is not.
Suicide was decriminalised in 1961, not because Parliament
decided that an individual's killing himself was a matter of public
indifference, but because it recog-nised that prosecution and
punish-ment were not the appropriate responses to a failed attempt
at suicide. The appropriate response is the provision of
psychiatric coun-selling. By declining to decrimin-alise assistance
in suicide, however, Parliament has continued to affirm the norm
that suicide is not to be encouraged.
Why is it controversial to make it legal to assist the suicide
of the terminally ill? According to some of those in favour of it,
the only reason it is controversial is because some people, most
notably religious leaders, are so lacking in com-passion for the
suffering of their fellow-humans that they are un- willing to
compromise their rigid adherence to the principle of the sacredness
(or absolute inviolability) of human life, claiming that only God
has the right to take life.
For sure, there are some Christians who think this way, but I am
not among them. If you are a pacifist, then you'll regard human
life as something that a human should never take, no matter what
the circumstances. But if you are not a pacifist (as I am not),
then you'll admit that, though taking human life is an evil, it may
sometimes be right - say, in self-defence, or in defence of the
innocent against grave injustice.
Some non-pacifist Christians, alongside philosophical Kantians,
nevertheless regard suicide as always and everywhere wrong, judging
it to be invariably an expression of self-pity or despair in God. I
don't agree. I can think of some cases of suicide that seem to me
to be noble: for example, that of Henning von Tresckow, who, after
learning of the failure of von Stauffenberg's plot to assassinate
Hitler in July 1944, took himself out to no man's land on the
Eastern Front, and blew himself up with hand grenades. Why? Because
he feared that he would not be able to withstand the Gestapo's
torture, and wanted to avoid betraying his fellow-conspirators. I
find myself quite unable to condemn him for that. On the contrary,
I admire him.
So while I do think that we are responsible for the handling of
our lives before God, that our handling of them should be governed
by moral law, and that we may not do with them exactly what we
please, nevertheless I don't think that only God has the right to
take human life. I think that we may take it responsibly.
Am I saying, therefore, that the case against the legalisation
of assisted suicide has no grounds? Not at all. First, opposition
does not come just from religious people; plenty of non-Christian
parliament-arians and healthcare professionals oppose it. If that
were not so, legalisation would have commanded majority support in
the Royal Colleges of the medical professions and in Parliament a
long time ago.
WHAT are the grounds for objecting? I see three main ones. First,
there is reason to doubt the practical effectiveness of the
safeguards that Lord Falconer's Bill proposes, in order to ensure
that no one would suffer undue pressure from another person to
choose an assisted death. The problem is that many vulnerable
people live, make their choices, and exercise their "autonomy" in
an environment that is hostile, not supportive.
In 2008 - before the full implications of the current financial
and economic crisis had dawned on us - Julia Neuberger, writing in
her book Not Dead Yet about the treatment of the elderly,
reported that at any one time in the UK 500,000 elderly people are
being abused, two-thirds of them at home by someone in a position
of trust. Judging by the current home-page Action on Elder Abuse,
nothing much has changed since. Moreover, in 2009 the
Mid-Staffordshire Healthcare Trust scandal revealed that abuse of
vulnerable patients extended to healthcare professionals.
Given such an actual social context, there is good reason to
doubt that any set of procedures implemented by fallible and sinful
human beings will suffice to ensure protection against hostile
manipulation.
The second objection is that the legalisation of assisted
suicide will enshrine in law the implicit endorsement of the
principle that some life is not worth living, and is not to be
borne. Once that is established, reasonable questions will then be
raised about why the benefit of lethal relief should be confined to
those capable of administering it themselves. Why deny it to those
who need someone else to do it for them? Why not move from assisted
suicide to voluntary euthanasia? And then, why restrict relief to
the terminally ill? Indeed, why only to the physically ill? What
about the chronically ill and the severely dis-abled? What about
the chronically grief-stricken, those enduring the slow torture of
life imprisonment, and the philosophically desperate?
It is notable that the Bill currently before Parliament, which
would restrict eligibility to the terminally ill, would make no
difference at all to most of the cases recently publicised by the
media - not to Alzheimer's patients such as Terry Pratchett; nor to
sufferers of multiple sclerosis such as Debbie Purdy; nor to
quadriplegics such as the late Daniel James; nor to those subject
to locked-in syndrome, such as the late Tony Nicklinson; nor to
those unwilling to endure bereavement, such as the late Sir Edward
Downes.
So the third objection follows from the second: once the
principle is established in law that some life is not worth living
and may be terminated, political momentum will gather for the
extension of eligibility. We will move down the road taken by the
Netherlands, where controversy continues over whether "unbearable
suffering'" should include existential and psychological suffering
as well as physical, and whether it should include those who are
merely "tired of life".
Similar debates are being held in Belgium and Switzerland. Last
year, for example, a Brussels doctor legally acceded to a request
for a lethal injection by a 44-year-old whose sex-change operation
to become a man had been botched. The same doctor had also overseen
the euthanasia of 45-year-old congenitally deaf twins, who feared
that they were going blind. Last summer in Switzerland, the Swiss
Medical Association criticised the legal move by the organisation
Exit to extend its assistance in suicide to elderly people who were
not terminally ill, but were suffering from old age. And, in
September, Belgium's justice minister approved the request for
euthanasia of a convicted killer and rapist on the grounds that he
was "suffering unbearably" from an incurable psychiatric
condition.
SO THERE are three objections to the legalisation of assisted
suicide for the terminally ill. Not the inviolability of human
life, nor God's monopoly of the right to take it. Rather, the
improbability of successfully ensuring the protection of those
vulnerable to hostile manipulation; the logical implications of
enshrining in law the principle that some life is not worth living;
and the likely political momentum for the progressive relaxation of
the conditions of eligibility.
But, if we don't allow assisted suicide, what can be done for
those who are suffering grievously? In brief, three things. First,
we can work to extend and deepen the national provision of
palliative medicine and care, which continues to be very patchy.
Second, in extreme cases we can offer palliative sedation to render
a patient unconscious. And third, we can encourage doctors to
administer whatever dose of pain-relieving drug is necessary, even
at the risk of abbreviating life, by emphasising that there is no
moral or legal objection, provided that the intention is to
palliate, not to kill.
None of this, of course, will relieve those kinds of human
suffering which don't consist of physical pain. It will do nothing
for the deep weariness of the elderly, the chronic grief of the
bereaved, or the profound frustrations of the life prisoner and the
severely disabled.
The hard implication of this is that some kinds of suffering
ought to be borne. But when suffering is borne for the sake of
protecting fellow-citizens against the hostile manipulation that
would arise from the legalisation of assisted suicide, then
suffering is no longer mean-ingless for it becomes an act of love.
And meaningful suffering is some-times easier to bear.
Professor Biggar is Regius Professor of Moral and Pastoral
Theology, and Director of the McDonald Centre for Theology, Ethics,
and Public Life, in the University of Oxford. He is the author
of Aiming to Kill: The Ethics of Suicide and Euthanasia
(DLT, 2004) and "The Road to Death on Demand", Standpoint
magazine, March 2010:
http://standpointmag.co.uk/text-march-10-the-road-to-death-on-demand-nigel-biggar-assisted-suicide