The terminal spin of 'assisted dying'
Published in: Daily Mail
Professor Raymond Tallis is a distinguished emeritus professor of geriatric medicine, philosopher, poet, novelist and cultural critic. He is also a patron of the pressure group Dignity in Dying, previously known as the Voluntary Euthanasia Society. He is additionally chairman of Healthcare Professionals for Assisted Dying (HPAD) which aims to change the law, medical culture and medical practice ‘so that needless suffering at the end of life becomes a thing of the past’.
In today’s Times (£), Professor Tallis argues passionately in support of ‘assisted dying’, which he claims is all about
‘...permitting physicians to assist the death of mentally competent, terminally ill patients, who are suffering unbearably despite receiving optimal palliative care, at their request.’
The phrase ‘assisted dying’ or ‘assisted death’ is, however, deeply disingenuous. Indeed, in the context of this whole argument the word ‘dying’ has turned into what one might classify as a piece of terminal spin. It is used to avoid spelling out that what is actually being proposed by Dignity in Dying is killing -- either helping people to kill themselves, which is what assisted dying is, or causing them to be killed either by a positive action (for example, a lethal injection) or the absence of life-sustaining action (for example, depriving them of food or water).
HPAD says on its website:
‘We recognise that dying is inevitable and is part of life. For those with terminal conditions, the dying process is not a failure of the healthcare team or the patient – but it does become a failure if the patient suffers an undignified death. Moreover since dying in these circumstances is not a failure, help in dying should be thought of as assisting dying and not assisting suicide (my emphasis).
But even terminally ill people may well not be dying when they ask to die. If so, the person assisting them with this request is not helping them to die -- because they are not dying – but to kill themselves. The reason that last sentence in the HPAD paragraph above makes no logical sense whatever is surely because what lies behind it – and what it is trying to conceal -- is actually the recognition that, in terms of winning hearts and minds, ‘dying’ sounds good while ‘killing’ sounds bad.
What is so deeply shocking about Professor Tallis’s article, however, is not that he supports ‘assisted dying’. There are indeed powerful and compassionate arguments on his side to do with the relief of suffering which deserve respect. But there are also powerful and compassionate arguments – in my view, much more powerful – on the other side, to do with the harm that would be done both to the most vulnerable and to society in general if the law were to allow the line prohibiting intentional killing to be breached .
Assisted dying may sound humane. But suppose hypothetically you saw someone about to hurl themselves off the cliffs at Beachy Head. What would be the natural and humane instinct of any decent person? Would it be to try desperately to prevent them from doing so? Or would it be to give them a helpful push over the edge? The latter would surely be abhorrent to any decent person. Yet what is the moral difference between that scenario and helping someone drink chemicals that will kill them?
But Professor Tallis writes:
‘That anyone could object to such a humane ambition may seem astonishing.‘
He has no respect whatever for any such objections. Indeed, he finds it as incomprehensible as it is objectionable that anyone can believe that helping people to kill themselves is wrong. To Professor Tallis, it seems there can only be one reasonable view on this issue – his own. He is accordingly highly indignant that there has been
‘highly organised opposition to a change in the law’.
He contemptuously dismisses arguments about ‘the sanctity of life’ or ‘the slippery slope’, down which would slide people with disabilities who would be pressurised to choose death against their wishes and ‘burdensome’ older people told they were surplus to requirements. He writes:
‘These “arguments”, intended to instil fear, are often reinforced by factoids misrepresenting the impact of liberalisation of the law on medical practice and society in places such as the American state of Oregon.’
But the slippery slope argument is all too real. ‘Assisted dying’ or ‘mercy killing’ open up the route to intolerable abuse of deeply vulnerable people, who may be put under pressure by greedy or uncaring relatives to end their lives. Or the person in question may simply not wish to ‘be a burden’ on their loved ones.
There are certainly claims of such abuses in Oregon. But the reality of the ‘slippery slope’ has been demonstrated most devastatingly in the Netherlands – the global pioneer of euthanasia -- where almost one third of such procedures have been carried out without the patient’s explicit request, where the criteria for ending someone’s life have shifted from terminal to chronic illness and where people have had their lives ended simply because they were depressed.
It can never be in society’s best interests that anyone should be killed because they are ill, or that the health service should be turned into a death service. Yet Professor Tallis is incensed that
‘... there seems also to be strong opposition from the medical profession: the leading medical royal colleges, such as the Royal College of Physicians and the Royal College of GPs, are currently against assisted dying, as is the British Medical Association.
‘... HPAD challenges the medical profession’s illegitimate extension of its authority to matters that are for society as a whole to decide. Individual doctors are, of course, entitled to express their views on the ethical case for, and the potential social impact of, liberalising the law. The role of their representative bodies, however, should be confined to speaking on those areas where they have special expertise: for example, the safeguards and codes of practice necessary should any law be implemented and, more explicitly, medical matters such as determining prognosis and setting guidelines for optimal end-of-life care.
‘For the profession to go beyond this is a gross example of paternalism — particularly since it is at odds with the view of the vast majority of patients (82 per cent of the general population and 71 per cent of those with religious beliefs as detailed in the 2010 British Social Attitudes Survey).’
This seems perilously close to saying that doctors are entitled to express views on ‘assisted dying’ when they are in favour, as they do through HPAD -- but not when they are opposed! True, HPAD is merely a pressure group while Professor Tallis is objecting to doctors’ representative bodies taking such a stand. But we can be sure that if the BMA and the Royal Colleges came out in support of ‘assisted dying’, he would not then be inveighing against
‘the medical profession’s illegitimate extension of its authority to matters that are for society as a whole to decide.’
Even more alarming is his core assertion that doctors must not go against majority opinion. But first of all, it is not easy to decide what that opinion actually is – the answers people give to surveys depend on how the question to them is phrased. Moreover, public opinion is easily swayed by the kind of terrifying and skewed propaganda routinely produced by the pro-euthanasia lobby.
Take for example Diane Pretty, the motor neurone disease sufferer who was used by Dignity in Dying to push for a change in the law. She campaigned for the right to be helped to end her life because she feared her illness would cause her to choke or suffocate to death.
When she died in 2002, she did not choke to death. She died after having been in a coma for two days. Her husband said she suffered breathing difficulties for several days previously. But breathlessness is not the same as choking or suffocating to death.
No-one minimises the distress caused by the symptoms of motor neurone and other dreadful diseases. But studies of hundreds of motor neurone sufferers have shown that none of them died of choking or suffocation. According to Dr Nigel Sykes, a leading specialist in motor neurone disease, with proper care these symptoms can be alleviated. Yet such cases are ruthlessly exploited by the pro-euthanasia lobby to terrify the public into supporting the legalisation of assisted suicide, carefully sanitised as ‘assisted dying’.
In any event, whatever public opinion may say doctors have an overriding duty to an ethical code that says ‘first do no harm’. And that means never killing someone or helping them kill themselves. Death can never be a therapeutic remedy, and doctors must never turn themselves into executioners. What if public opinion were to demand, for example, that mentally handicapped people should be killed? In such circumstances, doctors’ ethics provide vital protection against tyranny for the most vulnerable.
Doctors have an overriding duty to uphold those ethical principles that bind them, whatever public opinion purports to be. For someone of the stature of Professor Tallis to damn such a stand by the medical profession as ‘illegitimate’ should chill us all to the marrow.