doctors and dignity

Just seen this link – ‘UK doctors consistently oppose euthanasia and assisted suicide‘. It describes a literature review of doctors’ attitudes to assisted suicide over the last 20 years, confirming that the medical profession as a whole remains reassuringly unconvinced of the value of modifying a doctor’s role to include intentionally ending their patients’ lives.

It jumped out as I’ve just recently read Against Physician Assisted Suicide: A Palliative Care Perspective, by David Jeffrey (2009).  (Amazon)

Jeffrey points out that palliative care and physician assisted suicide are fundamentally incompatible, and the perceived need for the latter arises only in the absence of the former. The UK is currently the world leader in palliative care, the approach which seeks to improve the patient’s quality of life through the prevention and relief of suffering.

It’s only a short book (120 page paperback)  but it covers a huge amount of ground – ethical, legal, and practical issues surrounding the care of the dying, with a helpful analysis of the failed Joffe Bill and the situation in Oregon and the Netherlands, where forms of assisted suicide have been legalised.

Most usefully of all, it calmly, gently, and thoroughly dismantles the myth that dying can only be dignified if it happens at a time and in a way under your own control. The ‘suffering’ component of any illness is much more of a psychological and social problem than medical, and once patients have their pain controlled, if they are assisted to address their fears and feelings of hopelessness, whatever attractiveness they had seen in ending their life prematurely seems to quietly disappear.

Scaring people about the horrors of old age and illness is a great way of instilling the idea that life is not worth living unless you’re young and fit, but it’s really just an unrealistic and defeatist attitude which treats human life with vastly less of the dignity it pretends to – as untold numbers of disabled and older people can testify.

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a conversation event

On Tuesday evening I went with a couple of friends to hear Margo MacDonald (the Independent MSP) and Ewan Aitken (Labour councillor and Church of Scotland minister) discuss the “right to die” proposals which Margo is putting forward in Holyrood at the moment.

The format of the evening wasn’t so much a debate, as whatever you might be forgiven for expecting from a “conversation event.” Ewan Aitken conversationally lobbed things at Margo MacDonald, who responded in a conversational manner, and from time to time they opened it up to the floor and a roving microphone allowed the other people present to participate, conversationally. So it was all awfully chummy – with the advantage, of course, that things stayed civil and courteous throughout, but it did leave me wondering if the seriousness of the issues was perhaps clouded over, and the public debate which everyone agreed was absolutely vital maybe wasn’t conducted as robustly as it could have been.

Margo MacDonald spoke calmly, firmly, and with clear conviction about what she sees as the need to give individuals such autonomy that their wish to truncate their end of life suffering would be acted upon. Her guiding principle seems to be the right of the individual to choose when their life should end, in situations where they felt their life was intolerable. According to her proposals, if someone conveys to a suitable doctor a wish to be assisted in dying (where suitable is defined in part as not someone with a moral code which wouldn’t allow it), then that wish should be respected.

Ewan Aitken was clearly uncomfortable with what Margo MacDonald was saying. From time to time he offered some broad-brush considerations which gently nudged at Margo’s position at key points. He was keen, for example, on the idea of sacrificial love – that a person’s family and friends should never cease reaching out with care, and should never allow them to develop unchallenged such a negative view of themselves that they see themselves as a burden and their death as the only solution.

But unfortunately I can’t say that Aitken was fired by the same degree of passion or conviction as Margo MacDonald. Whether he was constrained by the chatty atmosphere of the evening – or afraid that without the personal perspective of having a diagnosis of a debilitating illness his views weren’t so worthwhile – or hampered by his dual role as both the challenger to the ‘assisted dying’ proposals and the chairperson for the evening – it’s hard to say, but I did come away with the feeling that the assisted dying proposals got much more of an airing than the opposite view, and with much less scrutiny.

The consultation on Margo’s bill is to open next week, and the signatures of 18 MSPs are required for it to make progress. There was some scepticism on Tuesday as to whether this many MSPs could be persuaded to support it, but in any case it is indeed essential to have a public debate.

What adds to the necessity of discussing these proposals is of course the ongoing consultation for the SNP MSP Roseanna Cunningham’s bill, which proposes to “require needs-based palliative care to be available on demand.” Margo MacDonald on Tuesday evening was very dismissive of these proposals (perhaps just because she didn’t see how they could be funded? surely she can’t be opposed to more and better provision of palliative care on a Scotland-wide basis). But the two bills side by side do expose a fundamental difference in principle. While both sets of proposals agree that suffering at the end of life is something that should be avoided if at all possible, under Cunningham’s proposals, the suggestion is that we should tackle the immediate cause of the suffering, and MacDonald’s proposals offer it as a solution that life itself should be ended.

And it’s the intentional ending of life that makes the issue so serious. As a sense of the value of human life fades from public and personal consciousness, we lose the imperative to care for one another in all the difficulties of living – old people with terrible dementia in all their desperate physical frailty are still our grannies and grandads, people with Downs and cystic fybrosis are our brothers and sisters … If they’re a burden, why are they not a burden we can shoulder? And on the other hand, it’s also a failure to give due respect to the value of human life when people come to be unconcerned about disposing of their own life. There’s no instinct for deliberate self-destruction in our natural constitution – coming to regard your own life as easily disposable is the product of an unwholesome atmosphere which shirks to some extent or another our responsibilities towards ourselves (strange as it might seem to say so in our otherwise narcissistic society, although narcissism itself is a perversion in the opposite extreme). If people in Scotland are routinely finding themselves in situations where the care and support that’s available to them is so poor that they can only see the hasty end of their own life as the way out, this is a shameful black mark against those who could be caring and supporting and aren’t. But the way forward is not to allow the lack of support to flourish, but to supply that lack so that people can live, and live out their days, with as much of the dignity that should be afforded to a human being as possible.