TODAY, a Private Member’s Bill comes before the House of Lords, in the name of Baroness Meacher, to legalise assisted dying. It is just the latest such Bill in a persistent campaign to bring about a change in the law. Based on the model in Oregon, and closely related to the one that Lord Falconer brought forward in 2014 (News, 15 July 2014), it allows anyone with mental capacity who has an incurable disease, and less than six months to live, to request drugs, which have to be self-administered, which they could use to kill themselves. Two doctors have to give their consent.
If I was in a wilderness with a dying friend in extreme pain, days away from any help, and he begged me to shoot him, it might be morally right to agree to do so. But what that example highlights is that we are not dealing with an individual extreme case isolated from the rest of society. We are dealing with a change in the law, a fundamental change, with huge implications not just for our own time but for society as a whole over succeeding generations. The heart of the issue is what the long-term effect be of such a change will be. But first, what is happening in Oregon?
The stories that appear regularly in the press about someone with a totally debilitating illness who goes to Switzerland to get help with dying are often very moving. We ask ourselves — certainly, I do — what would I do in such circumstances? But the people in Oregon who ask to die do so not primarily because of unbearable physical suffering. The main reason is not wanting to be a burden on other people, followed by such reasons as a feeling of loneliness, or a life too constricted.
Between 1998 and 2020, concern about being or becoming a burden on family, friends, and caregivers ranked significantly higher (47.5 per cent) than inadequate pain control, or concern about inadequate pain control (27.4 per cent). The same pattern emerges in Canada, which has a much more libertarian law. The most common reasons for requesting medical assistance with dying there are an inability to engage in meaningful activities or to manage day-to-day tasks.
These are factors that can and should be addressed by their fellow human beings. Ever since the pioneering work of Dame Cicely Saunders, in which the right doses of the right drugs were administered at the right times in a caring community, we now have wonderful hospices in most parts of the country. One of my oldest, closest friends has just died of cancer in one such hospice, surrounded by love and laughter and prayer by staff and friends alike. Although the last weeks were not easy, the experience was a profoundly moving one for those involved. The issues revealed by the experience of Oregon can and should be addressed by other means than death by a self-administered drug.
BUT the main issue is what will be the effect of a change of the law on generations yet unborn.
Fundamental to our society now is respect for the individual worth and dignity of every human being, however ill in body or mind they might be. I cannot help thinking that, in a society in which there will be one million people suffering from dementia in 2025, and two million in 2050, and, as result of a much lower birth rate, a seriously reduced work force to support them both financially and with the care that they need, the question will arise in people’s minds whether they ought to ask to die rather than be left in that state to be cared for by others.
It is a legitimate question to raise. After all, someone might very well take the view that totally losing one’s reason is a worse fate than surviving six months of even extreme constriction. In 2020, the Dutch Supreme Court ruled that doctors can end the life of patients with dementia who had previously asked for the procedure. In Canada, in 2021, a waiver of final consent permits people to make a written arrangement with a physician or nurse for assisted dying for a future time, if they lose their decision-making capacity (that is, if they have dementia).
In those cases, the person concerned chooses, but, at some point in the future, relatives, upset at seeing their loved ones who no longer have the mental capacity so changed with dementia, might very well say that it would be in that person’s best interest not to continue a life with no quality in it.
THERE are also other areas where slippage is a real possibility.
In Belgium, people do not have to be dying or even suffering from a severe physical illness. Fatigue has been added to the list of legitimate reasons, and doctors can offer euthanasia by diagnosing a “polypathology” (that is, multiple ailments such as hearing loss, chronic pain, or rheumatism). In 2019, polypathology represented 17.4 per cent of all reported euthanasia cases. People can even ask, at a young age, to die because of psychological problems such as depression.
That is not what we have in the Bill at present before Parliament. But, in the decades ahead, there would be a real temptation to bring about a Bill along the lines of those in Canada, Belgium, or the Netherlands, allowing people to kill themselves if diagnosed with dementia, or if they are severely depressed.
I do not want to go down that path. Supporters of this Bill might very well say that they don’t, either. But the pressure to do so will, in time, inevitably build up.
At the moment, we have a fundamental bulwark in place: the worth and dignity of every human life, whatever state the person is in, physical or mental. We should keep it.
The Rt Revd Lord Harries of Pentregarth is a former Bishop of Oxford.