AS I write this, my girlfriend’s cat is dying of kidney failure in the vet’s across the road. There is nothing to do but give him fluids and wait. If he appears to be in pain, I suppose they’ll kill him.
Meanwhile, in a nursing home a few miles away, my mother sits, confused, on the edge of her bed, and tries to come to terms with the loss of almost all her remaining sight. Her conversation rambles around social chitchat, asking whether she is really in Russia, and puzzlement at the repeated discovery that her husband has not left her, but died 20 years ago. Suddenly, she comes entirely to herself, and looks me fiercely in the eye. “I want to die,” she says.
I don’t doubt her. I won’t kill her, either. I don’t think that I would want my taxes to go to people who would kill her if she wanted it, either, but I am honestly not sure. The debate on assisted dying is conducted somewhere between those two dilemmas, and the publication of the report of the inquiry into more than 450 deaths at Gosport hospital, chaired by Bishop James Jones (News, 22 June), brought a lot of the muck that underlies it roiling to the surface in comment pieces.
Dominic Lawson, in The Sunday Times, saw the whole thing was the fault of the authority of doctors and the willingness of staff to accept this: “The ones most likely to get the treatment appeared to be not the sickest, but the most ‘difficult’. As the stepson of one of the victims remarked: ‘If a nurse didnt like you, you were a goner.’ This was clear from the testimony of Pauline Spilka, an auxiliary nurse . . . [she] was especially troubled by the fate of an 80-year-old patient (his name is redacted) whom she described as ‘mentally alert and capable of long conversations . . . able to walk . . . and to wash himself’. He was, however, ‘difficult’. She told the policeman that this patient was ‘always making demands’ and that ‘I remember having a conversation with one of the other auxiliaries [Marion]. . . we agreed that if he wasn’t careful he would “talk himself onto a syringe driver.”’”
Against this, Polly Toynbee, in The Guardian, thought that the answer was proper voluntary euthanasia: “Those who, mainly for religious reasons, claim it would be a slippery slope to Gosport-style dangers, deliberately ignore how a law would prevent another Gosport, with proper regulation bringing transparency to end-of-life treatment. Legislation advocated by the organisation Dignity in Dying would allow terminally ill patients in their final months, and mentally competent, to choose — with the oversight of two independent doctors and a high court judge — a quicker death. Personally, I would go further and legislate for a living will to end our lives if dementia takes hold, so our competent selves can act as custodian for our future incompetent selves: a guarantee to avoid humiliating mental collapse.”
The trouble with this policy prescription is that what happened in Gosport seems to be entirely legally clear, even if the law has not yet got round to dealing with Dr Jane Barton, the GP who oversaw the care of the patients. Yet it did happen, and probably still does in some corners of the system. Even without access to lethal drugs, there are all kinds of ways in which awkward patients can be persecuted in badly run hospitals. As a teenager, I worked for a while in a Cheshire home where troublesome inmates found knots tied in their catheters.
In that sense, the debate about assisted dying is an irrelevance. It presupposes a virtue that may not be present in parts of the system at all. What matters is the degree to which both nurses and the patients themselves believe that even useless lives have value, and whether they agree about what this value arises from.
I’d be more confident of Polly’s prescription if it weren’t the case that children expect to inherit from their parents, a situation that raises entirely different questions about the value of any given life. So, of course, does the political difficulty of raising taxes to pay for the expansion of social care, which everyone agrees is essential if the NHS hospitals are to keep functioning properly. The Bible is full of exhortations to care for the widows and orphans, who are the people who have no value in a subsistence economy. But a historian would ask why these injunctions had to be so often repeated. It is a sound general rule that laws are passed only against widespread and persistent abuses.
JOURNALISTS often “simplify, then exaggerate” to make the public sit up and care. Sir Roger Singleton, in his review of the adequacy of the Past Cases Review of 2007-09, complicates and then understates in search of the opposite effect. Sir Humphrey Appleby himself could not improve on this quote from The Times: “[The church] rather failed to give a comprehensive picture of the concerns that existed. It narrowed down the definitions of who had actually been responsible for abuse . . . reducing the numbers from probably nearer 100 to just two which appeared in the public statements.”
Yet all this happens, he said, without any conscious attempt at a cover-up.