Should the law on assisted dying be changed? NoBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1883 (Published 21 April 2011) Cite this as: BMJ 2011;342:d1883
Patient safety is at the heart of good clinical governance: not having the confidence to seek medical intervention early poses a threat to the lives of all patients, regardless of impairment. Disabled people, like others, and often with more reason, need to feel safe. Thus eroding what may already be a shaky sense of safety in medical care poses a further threat to disabled people’s wellbeing, continuing care, and life itself.
Impairment is already directly associated with an immediate threat to life during medical care. When Baroness Campbell, founder of Not Dead Yet UK and born with spinal muscular atrophy, was being treated for life threatening pneumonia two doctors told her they presumed that if she experienced respiratory failure, she wouldn’t want to be resuscitated: “You wouldn’t want to live on a ventilator.” No ventilation and no resuscitation meant she would die. Very scared, she stayed awake in hospital for more than 48 hours.1
Crucially, the doctors’ judgment, based on the idea of a “life not worth living,” is a moral judgment not of facts (medical or otherwise). It comes to: “I wouldn’t, couldn’t live like that,” a judgment of the value of another, disabled person’s life; it is not one doctors are generally entitled to make.
A law permitting euthanasia would reinforce this position, further clearing the ground to take away lives based on a moral judgment rather than medical fact. The threat will extend to the lives of older, disabled people too. Lord McColl, a surgeon, said:
“When a Dutch doctor was asked what his first case of euthanasia was like he said, ‘it was dreadful. We agonised all day. But the second case was much easier and the third case was a piece of cake.’ Many elderly people in the Netherlands are so fearful of euthanasia that they carry cards around with them saying that they do not want it.”2
This is not a “slippery slope” argument: these are existing practices that show real and present dangers in the UK as well as around the world.
A degree of suffering, intolerable suffering, is at the heart of the judgment that the life of the sufferer must end. But there is no safe measurement when relying on subjective reporting; people with severe symptoms, or who have had operations, are more likely, as a direct result, to categorise their experience as intolerable. People’s views change over time with relief of symptoms or pain.3 Furthermore, what one person describes as intolerable is not necessarily intolerable to another.
Why is any suffering thought to be intolerable? That is, at least partly because of lack of provision of services. If the fear of (future) suffering could be removed, if palliative care is as good as it can be and widely available, is there still a need to change the law?
Some disabled people share the moral judgment: “I don’t want to live like this.” I make no judgment of their position. This is not to ignore it. Nor does it mean that those who fear what a change in law will bring, lack compassion. It is entirely consistent with deep compassion for the suffering of another, to still think clearly and want to resist the threats inherent in legalising intentional, “medicalised” killing.
Since suicide was decriminalised in 1961, we might be said to have a right to end our own lives, but more recent arguments have transformed into the nonsensical idea that we have a “right to die.” Death is inevitable and is “not an event in life”4: it is the end of our experience of living in the world, including holding rights. It makes no sense to speak of a “right” to die. What is usually being claimed here is a right to have help to end your life, a right to a premature death, which is not inevitable.
Arguments for voluntary euthanasia are variously based on other fatal flaws: utilitarianism is a morally bankrupt philosophy, purporting to “measure” human happiness as a way of determining moral behaviour. This feeds the spurious notion that quality of life can be measured too. Human motivations are impossible to unpack entirely, which makes it impossible to find wholly autonomous patients and wholly compassionate assisters. Thus framing with “a few safeguards” just cannot suffice—it is impossible to draft a law to cover all cases.5 The move from the particular to the general case is fallacious (“this person wants it and should have it, so all people in their situation want or should have it”); the phrase “we own our own bodies” is empty. It is impossible to cover all these confused matters here. But they are lined up to threaten the lives of disabled people, whether that is anyone’s intention or not.
These discussions are complex, involving deep moral questions that cannot and must not be treated as though they were merely matters of fact with clear and obvious answers that everyone must share, as though logic dictated it. The lives of many disabled people depend on resisting attempts to introduce a law legalising the intentional act of killing.
Cite this as: BMJ 2011;342:d1883
Competing interests: The author has completed the unified competing interest form at www.icmje.org/coi_disclosure.pdf (available on request from him) and declares no support from any organisation for the submitted work; KF was commissioner for Wales on the Disability Rights Commission. He is director of Inclusion21 and associate of the Welsh Institute for Health and Social Care. He is on the board of the Welsh Ambulance Trust and Consumer Focus Wales.
Provenance and peer review: Commissioned; not externally peer reviewed.
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