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Building a compassionate society

17 May 2013

Brendan McCarthy explains why the C of E supports the law against assisting suicide


In court: Paul Lamb arrives at the High Court in London on Monday for his case about assisted dying

In court: Paul Lamb arrives at the High Court in London on Monday for his case about assisted dying

In the debate in the General Synod last year, the Church of England affirmed that the current law on assisted suicide, and the Director of Public Prosecutions' guidelines for its administration provide a fair, balanced, and compassionate approach (News, 17 February 2012).

As a nationwide community organisation, the Church has the same rights, duties, and obligations as other socially aware organisations to participate in the continuing debate on assisted suicide. Its approach is based on the following four main considerations:

: for the good of society and individuals, it is essential that both the law and medical practice embrace a presumption in favour of life. The current debate is not only about an individual's wish to die; it is also about the limits that ought to be placed on one person actively participating in bringing about another person's death. To allow such participation would be to introduce a novel and dangerous concept into British law, with potentially unforeseen consequences.

The right to life is universally recognised as a fundamental right in domestic and international human-rights legislation, placing an obligation on governments to protect and promote it. This right is based on the belief that every human being is of intrinsic value. This belief is central not only to the law, but also to medical, nursing, and social care.

Arguments in favour of assisted suicide often favour an evaluation of human life based either on "quality of life" or on an individual's sense of personal worth. While these are important considerations, they ought not to undermine the central importance of the intrinsic value of every person's life. Eroding this principle would inevitably have a corrosive effect on many aspects of our communal life.

CARING for the vulnerable
: individuals seeking assistance in ending their lives are often vulnerable, but this must be placed alongside the vulnerability of very many others. Many people, especially elderly people, are already vulnerable to malicious actions by others. Each year in England and Wales, more than 300,000 people suffer elder-abuse, and at least another 100,000 suffer neglect. The majority of this abuse is perpetrated by carers or by family members, often with financial gain as a motive.

It would be negligent to believe that such people would not seek to exploit a change in the law in order to pursue their goals. Similarly, many elderly, infirm, or even disabled people would feel under pressure to "do the decent thing" and remove themselves from "being a burden". We know that this is the case, because many individuals have said so.

It would not be possible to put into place effective safeguards against such abuse or pressure if the law were to be changed. The Francis Report into events at the Mid Staffordshire NHS Trust serves as a warning: the NHS's high motives and rigorous monitoring policies did not prevent individuals' acting inappropriately. It is, of course, too late to try to remedy matters after the event. A change in the law on assisted suicide would provide additional scope for further individual and systemic abuses.

The key consideration is whether a change in the law would put increased numbers of vulnerable people at greater risk of harm; it is untenable to think that it would not.

BUILDING a caring and cohesive society
: the aspirations of individuals are important, but it is not possible to view these in isolation from the effects that they might have on others and on society in general. When viewing legislative change, we must ask ourselves what sort of society we are building.

A change in the law on assisted suicide would give, at the very least, mixed health-care signals. We rightly expend resources on suicide-prevention initiatives, and we encourage individuals who are ill or struggling with life to believe that their lives are worth living. Permitting assisted suicide clouds this message.

It would also create a number of problems for health-care professionals. There are real difficulties in obtaining an accurate prognosis of how long any individual might live, beyond an estimation of "hours or days" towards the very end of life. It would be wrong to place doctors in the position of having to estimate a person's life-expectancy for the purposes of their gaining access to any proposed assisted-suicide services.

It also takes time to ensure that an individual is not suffering from depression or other mental illness - much more time than even a tentative prognosis of "days or weeks" would allow. In addition, any involvement, however indirect, in assisted suicide by health-care professionals would irrevocably change the understanding of health care in the UK. The professional patient/client relationship would be altered detrimentally.

RESPECTING individuals: while assisted suicide is contrary to the principles outlined above, other end-of-life decisions ought to be respected. This means respecting the decisions of patients who choose not to receive treatment, besides respecting the wishes of those who do.

It is also essential that high-quality end-of-life care is available throughout the country, and hospices and palliative-care units are adequately resourced. The excellent care pioneered by the hospice movement has demonstrated that holistic palliative care, which treats every individual with respect and dignity, is a viable, life-affirming alternative to assisted suicide.

QUESTIONS about the end of life are complex: it is not appropriate to address them through the blunt instruments of opinion polls and online surveys. Respecting individuals necessitates careful consideration of all the issues; the process cannot be telescoped into a few short questions and answers.

The Church of England accepts that a range of opinion is held both by its members and by others in society. None the less, because of the considerations outlined here, the Church, through its bishops and through its elected representatives in the General Synod, continues to support the current law on assisted suicide.

The Revd Dr Brendan McCarthy is the National Adviser on Medical Ethics and Health and Social Care Policy for the Archbishops' Council.

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