A civilised society should enable people to end their lifeBMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3541 (Published 21 July 2017) Cite this as: BMJ 2017;358:j3541
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Dr Pearce’s recent letter (1) in response to the article by Dr Oliver (2) highlights a modern paradox. On the one hand we promote longevity, and medicine is rightly reluctant to abandon its commitment to curing illness, extending life and maintaining wellbeing. On the other we encounter a feeling that ageing is a problem. Pearce appears to hold that old age is a harm to be avoided by shortening life. We all know the importance of choice; but you can’t foster choice by promoting a decision that will end all choice.
We have found that this attitude is part of what makes patients fearful of age and illness. It contributes to a belief that an induced death is the only dignified escape from otherwise inevitable and intractable distress. No one is helped by medical collusion in that erroneous and nihilistic message.
The patients we meet, all of them survivors of one sort or another, remind us that functional impairment needn’t mean impaired quality of life. Perhaps there are still some doctors doing ‘little to deal with dreadful pain’ and the other problems that aging and illness might bring. But none of us should tolerate that disregard. Most of us have moved on. The best responses are imperfect and time-consuming but effective. Their effectiveness in alleviating distress, maintaining quality of life, and opening up new opportunity in the face of progressive illness is shown both by the evidence and by our patients’ experience. All of us are enriched by these people’s lives just as they are by the care they receive.
The refreshing thing about Dr Pearce’s letter is its honesty. Very often we are told that the scope of a change in the law would be limited to assisted suicide in terminal illness. But what we see here, as in some of the jurisdictions that allow doctors to end life, is a shift to lethal acts in a much wider population. The direction of the intent is clear and it is not the answer to the problem Dr Oliver identifies. Far from it: patients who have premature deaths sanctified by medical intervention don’t get to keep on aging well or living well in the face of life shortening illness. There’s nothing progressive about that curtailment. We need a better way.
1 Pearce J A civilised society should enable people to end their life BMJ 2017 358
2 Oliver.D How can we plan for old age if we don't discuss it honestly? BMJ 2017:358:j2759
Competing interests: No competing interests
Human life is not the same as animal life as some people have suggested. Most people would agree that human life is a higher order of being. It is based on the unique status of the person being a rational free and mostly independent being. It also pertains to the physical psychological social and spiritual aspects of a person. These are way beyond the parameters of quality control or flat earth style thinking. A person is also a loving being with hopes and beliefs and an impact factor on all who encounter him or her. Their lives influence the lives of many others. They may be role models and the glue that sticks other lives together. As such what a person does is never done in isolation. People need to see other people struggling with adversity and winning, and getting up after a fall and dusting themselves down and going at it again with renewed determination. We are not hapless beings that decide "to call it a day" when we find the going tough. We are made for more than clinically calculated exits at our own discretion. The tentative beginnings of human life and its faltering closing chapters are not ours to excise. They are the beginning and ending of a personal legend that we should admire and respect. They are more than the Mona Lisa or Pieta ...and imagine someone damaging these works of art!
Human life is untouchable, be it Charlie Gard or an elderly person with dementia or a film star. Killing human life by ones own hand or with "help" from those who think they are helping always was a criminal offence because it was considered a violation of a person. Has our ethical code "advanced" to the stage now where human life is dispensable but the lives of endangered species and art troves is sacrosanct?
Competing interests: No competing interests