A COLLECTION of essays published last year, The Reality of Assisted Dying: Understanding the issue offers the facts and figures that ought to have been at the centre of the parliamentary debate on assisted dying. Gathering 34 short essays, by a broad range of experts and academics from palliative care, ethics, and the law, it manages to explore the issue in a comprehensive manner.
The editors, Dr Julian Hughes and Baroness Finlay of Llandaff, are to be praised for the clarity and concision of the essays, not to mention the fairly reasonable price tag, which make the book suitable for the layperson — and for the busy MP.
There are essays covering what has happened in countries that pioneered assisted dying, such as the Netherlands, Canada, New Zealand, and Australia. There are essays about the misuse of polling data, the effectiveness of legal safeguards, the consequences for palliative care and suicide prevention, and the accuracy of terminal diagnoses. There are philosophical essays about autonomy, dignity, and the moral imperative to prevent suicide.
Church Times readers may be especially interested in the piece by Nigel Biggar about the place of religion in the public debate on this issue, which is followed by essays making the case against assisted dying from Islamic, Jewish, and humanist perspectives, by Abdul-Azim Ahmed, Alexandra Wright, and Kevin Yuill.
Baroness Butler-Sloss writes in the preface: “What is most striking and original in this book . . . is the view . . . from the perspectives of those who have lived with legislative change in their own countries. Here we can read . . . how the expansion of eligibility criteria is a reality, and also of the pressure — from individuals and from institutions.”
Scott Kim’s chapter on what makes the eligibility criteria unstable — and likely to be relaxed over time — is particularly persuasive. The instability is caused, he argues, by the criteria’s vulnerability to our worries about discrimination and equality, i.e. if assisted suicide is justified to relieve suffering for some, then why not others? Why only for the terminally ill, and not for the chronically ill, or those suffering only from mental illness? Why only for adults, not minors? Any boundary seems like an arbitrary line drawn in the sand, privileging the relief of some forms of suffering, while ignoring others.
One chapter struck me more than any other with a sense of the chasm opening beneath us. Baroness Hollins (a crossbench peer and emeritus professor of psychiatry of intellectual disability) and Alice Firth’s chapter discusses the high vulnerability of those with autism and intellectual disabilities to seeking assisted dying out of despair. They are rarely supported adequately to live independently, let alone to advocate for themselves or to make decisions without pressure from others.
Earlier this year, the media widely reported the case of Zoraya ter Beek, an autistic woman from the Netherlands, who was one of many who wanted to be euthanised for the main or sole reason of being unable to cope with their intellectual disability. As the father of a child suspected of having learning difficulties, I cannot help but think, when I look at him, that he will grow up in a world less likely to treat him as someone worthy of being accepted, accommodated, and helped to live.
Dr Mehmet Çiftçi is a Public Bioethics Fellow at the Anscombe Bioethics Centre, Oxford.
The Reality of Assisted Dying: Understanding the issues
Julian Hughes and Ilora Finlay, editors
Open University Press £25.99
(978-0-335-25317-3)