I have been listening with interest to the recent debate about the current Assisted Dying for the Terminally Ill Bill.

There is an idea that this bill is dangerous, in the sense that it may result in patients being assisted to die who do not really really want to go. Some suggest that it might enable people to proclaim willy-nilly that they cannot bear to go on, and then be taken literally when in fact they do not really mean it. Others suggest that it will enable euthanasia-minded or even budget-minded doctors to unduly and inappropriately influence patients in their decisions.

In fact, the bill is very modest in its offer of assistance to the dying. The dying person must, in particular, persuade both his own doctor and a consultant that he fulfils a list of conditions including that he is suffering unbearably as a result of a terminal illness, that he is of sound mind and is fully versed on all the alternatives to assisted dying, and that he makes his choice entirely voluntarily. In some cases, he may need to persuade a psychiatrist as well. He will then need to execute, by signing, a legal declaration witnessed by two people. One witness must be a solicitor who has also come to a view upon the patient’s soundness of mind (among other things). The other need not be a solicitor but cannot be a doctor, patient, relative or anyone else of the kind likely to be at hand in circumstances where assisted dying is under consideration. Even then, there is a two-week “cooling-off” period before the assisting physician (which must be either the attending physician or the consultant) can take any action. Finally, the assisting physician must double check that the patient does not wish to revoke his declaration and the patient must give further positive assent to the assistance being provided.

All the above is, of course, a sensible set of safeguards to prevent the kind of abuses that people would otherwise naturally fear. (The kind of abuses indeed that some will fear regardless of what safeguards are put in place.) But they do also mean that there will be limits on the kinds of patient who are allowed to be assisted. Patients who suffer from a terminal illness resulting in mental incapacity will be ineligible even if – before they got to the “suffering unbearably” phase where they were incapacitated – they expressed in the clearest terms their desire to be assisted and the stage at which they wished this to happen. Children or mentally handicapped adults will be ineligible. Patients whose terminal illness means that, by the time they come to be “suffering unbearably”, they are not physically capable of expressing their wishes by, for example, persistently requesting assistance and physically signing the declaration, will not be eligible. Finally, because even where there is assisted dying the lethal dose must be self-administered, no patient who is for any reason incapable of self-administering the prescription will be eligible.

All of that leads me to say that this is a modest offering to those who demand the right to die with dignity. But more importantly, to my mind, is the principle of “dying with dignity”, as it is put. Should patients really be allowed to demand this? Is it right?

One concern that has been repeatedly raised is the concern that doctors will find themselves compelled to assist other to die. Life, and life choices, bring responsibility, they say. There is a responsibility not to put physicians in such difficult situations. Doctors should not be obliged to facilitate death – their job is to heal, to preserve life, not to kill.

For one thing, this argument is misleading. The bill expressly states that no person – no doctor, no nurse, no hospital, nobody – is obliged to offer assistance with dying, or even information about assisted dying. There is a clear and comprehensive conscientious objection clause in the bill. A person is not even required to tell the patient that he has such an objection.

For another, it confuses the question whether a doctor should have the right not to be involved in assisted dying with the question whether a patient should have the right to ask for and, if he can find a person willing to give it, to receive assistance. Some argue that the first question should be answered “yes” and that therefore the second question must be answered “no”. That, however, is nonsense. I can ask for help, you can say No. I can ask someone else, they can say Yes. I cannot force you to help me, but nor can you prevent someone else from doing so if they are willing where you are not. Nothing here interferes with the doctor’s freedom to refuse help to a patient asking for assisted death.

The more interesting argument against assisted dying revolves around the claim that human life is sacred. It is said that life is somehow intrinsically valuable so that, even if the person whose life it is does not want it any more, it is still incumbent on others to preserve it.

I find this argument strangely compelling, in the way that road traffic accidents are compelling. It is both a good argument, and a horrifically bad one. I won’t say more than that here, because this is a discussion which deserves its own post!

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