The progressive case for ‘dignity in dying’

Assisted dying is not just about patient rights at the end of life but about how society as a whole approaches death and dying, and Lord Falconer’s Bill does not champion rampant individualism but rather it challenges paternalism and the imposition of unshared principles. It is a progressive cause of our time, and an issue that will affect us all. It is time for change.

Charlie Faulner

James Harris is director of campaigns and communications at Dignity in Dying

Tomorrow, the former Lord chancellor Lord Falconer will table a Private Members’ Bill in the House of Lords to legalise and safeguard doctor assisted dying for terminally ill, mentally competent adults.

If enacted, it will prevent dying Britons from having to travel abroad to die, and prevent others who are either unwilling or physically or financially unable to make the journey from having to take matters into their own hands domestically.

To that end the Bill is about compassion, and compassion is not wholly exclusive to the left or the right. A new opinion poll by YouGov, commissioned by Dignity in Dying, finds that the Bill is supported by over three quarters of the population – with near equal levels of support amongst Labour, Liberal Democrat and Conservative voters. To that extent the Bill can be argued to transcend traditional political allegiances. Nevertheless, assisted dying is still an intensely political issue. 

For all the heat that this debate can create, there is one area where supporters and opponents of change agree: dying people should be able to access good quality end-of-life care, but that such care cannot alleviate all the suffering the dying process can cause for some people. Where the fault line emerges is whether such people should have to suffer against their wishes in order to protect others from potential harm.

The law as it stands

At present, the law prohibits medical assistance to die – under the Suicide Act 1961 a healthcare professional could be imprisoned for up to 14 years if they prescribed a life-ending medication to a terminally ill patient who they knew wanted to control their death. However, guidelines published by the Director of Public Prosecutions (DPP) in 2010 set out the factors for and against prosecution in the public interest. These guidelines have effectively decriminalised amateur compassionate assistance to die, such as accompanying a loved one who travels abroad to die. However, the guidelines also make it clear that healthcare professionals are more likely to be prosecuted for helping.

The utilitarian argument in favour of the status quo, made on the whole by social conservatives, is attractive to a minority on both the traditional left and the traditional right. They believe that the status quo provides the best of both worlds. Preventing medical assistance to die protects the majority, with a minority of genuine compassionate assisters ultimately forgiven by the legal system. Pushed to its extremes some see the desire to avoid suffering at the end of life as the ultimate act of consumerism in a world that values the rights of the individual above the collective good.

This utilitarian argument is false on two grounds.

First, as much as compassion isn’t universally owned by the left or the right, neither is choice. A dying person who seeks to avoid suffering through medical help to control the time of their death isn’t necessarily making a statement about individualism. They just don’t want to suffer. Secondly and critically, we as a society do not need to oblige a minority to suffer in order to protect the majority. Lord Falconer’s Bill would better protect us all.

Bad intentions

Some legislators, when creating laws, view the process not through the prism of how it impacts on the best of us, but rather on the worst of us. Surely, they will argue, an assisted dying law would make it easier for scheming relatives to get hold of inheritances through malign coercion?

On the contrary it would make it significantly harder. The DPP’s guidelines retrospectively investigate assistance to die. Lord Falconer’s Bill puts in place upfront safeguards to determine diagnosis, competence, that the patient is making the decision of their free will and is aware of all their care and treatment options. These upfront safeguards are more likely to detect malign coercion than a retrospective investigation of someone’s death, when the main witness is beyond questioning.

In reality if there is a pressure put on dying people by friends and family the opposite is true: predominately people want their loved ones to hang on indefinitely.

Assisted dying is not just about patient rights at the end of life but about how society as a whole approaches death and dying, and Lord Falconer’s Bill does not champion rampant individualism but rather it challenges paternalism and the imposition of unshared principles. It is a progressive cause of our time, and an issue that will affect us all. It is time for change.

One Response to “The progressive case for ‘dignity in dying’”

  1. OldLb

    Liverpool Care Pathway.

    Dignity in death.

    We will deny you water, because the NHS has decided its to expensive to treat you. Not that we will tell you.

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