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Dr Alistair Brown | Associate lecturer in English Literature; researching video games and literature

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Through exploring the psychopathology of Capgras syndrome, in which a patient mistakes a loved one for an imposter, The Echo Maker offers a sustained meditation on the ways in which we project our own problems onto other people. As a reflection on the mysteries of consciousness, the novel offers some interesting if not especially new insights into the fuzzy boundaries between scientific and literary interpretations of the mind. Read more

Choosing to Die

Tuesday, June 14, 2011

Terry Pratchett's controversial film on assisted suicide, which featured the death of a British man, Peter Smedley, at the Dignitas clinic in Switzerland, has only confirmed my belief that legalising such supported deaths would be a moral and humane thing to do.

As was invoked often in the film, the European Convention on Human Rights enshrines both the right to life, and the right to liberty and self-determination. Fundamental human rights do not act independently of each other, but intertwine, often in complex - sometimes conflicted - ways; witness the recent tension between those celebrities who claim a right to privacy, and those in the press who claim the right to free expression in publicising their affairs. In a similar way, campaigners against assisted suicide argue that legalising it would infringe upon the individual's right to life by encouraging people to take their own lives because the option of a "good death" is available, when they might ordinarily continue to want to live, perhaps in comfortable hospice care or supported by loving families. But surely the right to life also entails the right to a certain quality of life, something implied by the coexistence of other rights such as the right to liberty or freedom of thought. It is not enough simply to live, biologically; one also has the right to live a good life, emotionally. As part of this, the right to express oneself and act freely as an individual surely includes the right of the individual to choose when to die.

Looking at the rigorous manner in which assisted suicide is carried out in the Swiss system, it seems clear which is the worse scenario. With numerous legal checks and the opportunity for the individual to pull out of the process of assisted dying at every stage, the risk that legalising assisted dying would encourage suicide seems slim. This is something borne out by the Swiss case, where there was no evident increase in the suicide rate, whether conducted by the self or in clinics, after the legalisation of assisted dying. Indeed, one of the most telling statistics in the programme was that 70 percent of those who register in preparation for a death with Dignitas ultimately do not choose to pursue assisted suicide; it seems that the very existence of this option allows many people to go on living happily in the knowledge that, if it their feelings change, they may also end their own life in a guaranteed, humane way.

Currently, whilst the lack of legal assisted suicide in the UK is said mainly to protect the right to life, its absence seems more seriously to infringe upon the right to life which is powerfully intertwined with the right to liberty of conscience and action. Whilst the risks of legalising it upon the right to life seem slim and not substantiated by the Swiss case, the humanitarian inadequacies caused by not legalising it are evident. In Pratchett's programme, we witnessed two men paying £10 000 to travel to Switzerland in order to receive a gentle death of their own choosing. This expensive option is not available to those who are less wealthy, and a democracy surely has to embrace a democracy of dying, as well as of life choices, and allow anyone regardless of income or character, to have that opportunity available. If our National Health Service embodies the right to universal care, those same values of universality - regardless of social status - ought to be extended to the right to death as well. Indeed, it is precisely because we have a supportive, public health system in which individuals will be treated as long as possible, regardless of their predicted outcome or their ability to pay, that their decision to opt out of that healthcare support can be made freely. Their decision to die will be determined not by a guilty feeling that the state is unwilling to continue to treat them, but by their overwhelming wish to die despite knowing the healthcare opportunities that are available for them.

Again, I understand those campaigners who argue that the state should not imply that it would like actively to help the terminally sick or disabled to die, because this suggests to the disabled or sick person that they are an unvalued nuisance, that the state would prefer to kill those whose ongoing burden is too costly. Those who invoke Nazi genocide as the logical extension of state-sanctioned dying are clearly going too far, but I can appreciate the principle behind such views.

Nevertheless, again on balance it is preferable for the state to protect the individual's right to self determination. In Pratchett's programme last night, both the men who killed themselves did so against the wishes of their families. The pressure on the suffering self to live through that suffering in the hopes of a cure or continued happiness, is immense, deriving from deep-rooted - and admirable - cultural values of heroism against the odds. There is also a selfish aspect for families, a fear of seeing their loved ones go peacefully with themselves left behind to cope with the more difficult bereavement and loss. But these external pressures, which the two charismatic men in the programme happened to be able to resist, are again why the state needs to make available the possibility of assisted dying. The fact that families, quite naturally, may tend to pressure the individual not to die, ought to be balanced by alternatives which enshrine the right of the individual to stick to their own view against the wishes or opinions of the majority immediately around them. Such an alternative can only exist at a dispassionate, non-familial, state level.

The worst case I can imagine is where someone is no longer in a position to kill themselves, but the family refuses to assist them in their desire to die. The state regulates how families must behave after the death of someone who can quite literally no longer speak for themselves; families must respect the wishes, will, financial settlements of the dead person. But the state does not at present protect the right of an individual who is similarly voiceless and helpless in the immediate run up to their death. The moment one is dead, paradoxically one has more state-protected rights to exercise their free will than in the moment before.

This knowledge is what leads to the dissatisfying scenario we have at present, where individuals with degenerative neurological diseases - such as Pratchett's own Alzheimer's - are forced to enact their own deaths before they might ordinarily be ready, whilst they are still cognitively and physically capable of doing so. Fearing that there may be no family members or doctors willing and permitted to help them die after they become too ill to express their own desires, people take their own lives before it may be their ideal time. All deaths which end early, in car accidents or illness, in degenerative diseases or in suicide, offend our sense of the natural time to die. By legalising assisted dying, the state does have the opportunity to step in and prevent one type of premature death. Ensuring that people can choose when and how to die will help to ensure they will only go when the time is right for them.

People should be able to choose when and how they die, regardless of their ability to pay; they should be free to choose between ongoing, free healthcare leading to a natural death, or the immediate release of assisted suicide. In the twentieth century, the maturing humanitarianism of the British state developed universal welfare and healthcare; in the twenty-first century, it is time to recognise that the state is sophisticated and adult enough to facilitate a democracy of dying, as well as of life.

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Posted by Alistair at 8:05 am


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