I am full of admiration for Joe Magro, an ALS sufferer, and Louise Vella, who suffers from motor neurone disease. Their courageous pleas to be allowed to die with dignity at a time of their own choosing are both inspiring and moving.
As an advocate of, and signatory to, a (UK) living will, I wrote about assisted dying – “the last human right” – a year ago, giving an impartial assessment of the arguments.
Campaigns to let doctors help the suffering and terminally ill to die are increasing. The idea that doctors should be allowed to prescribe lethal medication for some patients who are at death’s door or in agony is gathering support.
Doctors have long quietly eased terminal agonies by increasing pain relief to, in effect, life-shortening doses. Under the doctrine of double effect, as long as the intention is to relieve suffering rather than hasten death, no crime is committed since what the doctor really intends is hard for anyone else to know, let alone prove.
Huge advances in modern medicine mean that dying is much more often prolonged. Most countries around the world now accept that patients or, if they are incapacitated, their relatives, may insist that unwanted life-sustaining treatment be withdrawn. Someone who needs a ventilator to breathe, for example, can demand that it be removed.
But what if there is no life-sustaining treatment to withdraw? For a long time Switzerland, whose countrymen cherish freedom, self-determination and the rule of law – including the right to choose the timing and manner of one’s death – was the only place where it was legal to help people to die, rather than simply passively allow them to do so.
After centuries in which suicide was a crime, most countries have removed such laws from their statute books. Some have only done so recently. Suicide was decriminalised in Ireland in 1993 and in India only last year. In Malta, it is still a crime.
While most countries removed suicide as a criminal offence – meaning that those who tried and failed to kill themselves risked prosecution or their possessions being forfeited – most kept in place the penalties for assisted suicide. Switzerland’s law, which was passed in 1942, barred it only if the motives were self-serving, for example to obtain an inheritance.
Each year, several hundred Swiss residents die with a doctor’s help, most of them at EXIT, the largest clinic. About 2,000 people from more than 40 countries have ended their lives at Dignitas.
Fifty-two years later, voters in Oregon in the US passed the Death with Dignity Bill, which came into force in 1997. This obliges two doctors to agree that the person requesting help to die has less than six months to live and is of sound mind. It is Oregon’s more restrictive rules than Switzerland’s – which exclude people with serious but not fatal illnesses – that are likely to be copied elsewhere.
Patients have the right to life. But they also have the right to personal autonomy and dignity
In 2002, the Netherlands, which for decades had turned a blind eye to doctors who agreed to prescribe lethal medicine for the terminally ill, legalised the practice and also extended it to those who, though not close to death, found their suffering unbearable. Belgium followed the Dutch soon afterwards.
The Netherlands and Belgium allow doctor-assisted dying in many more circumstances than Oregon. In Holland, it is available for people experiencing “unbearable suffering with no prospect of improvement” and, with parental consent, for terminally ill children over the age of 12 years.
A year ago, British members of Parliament rejected a Bill modelled on Oregon’s law by 330 to 118 votes. At about the same time, by narrower margins, the state assembly and senate of California, the United States’ most populous state, passed a similar measure which is now law.
In most countries, Malta included, the medical establishment is opposed to laws on doctor-assisted dying. That opposition has deep roots. The Hippocratic Oath, written 2,500 years ago, states: “Nor shall any man’s entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so.”
Doctor-assisted dying in countries where it has been introduced, however, seems not to undermine trust and public faith in the medical profession. A more subtle fear is that when it is legal, patients may feel under pressure to ask for it.
The arguments for and against the introduction of assisted dying legislation are finely balanced.
Despite the views of the self-righteous and intolerant religious right in Malta, traditional religious beliefs should play no part in the debate on whether or not there should be a law on assisted dying. Those whose religion tells them they should not support it are wholly entitled to hold that position – and not to participate.
Helping the terminally ill to die peacefully at a time of their own choosing is not “anti-Christian”. On the contrary, in the right circumstances and within tightly- drawn laws, it represents the Christianvalues of charity, compassion, mercy, dignity and kindness.
It cannot be right that those who need our support most, at the end of their lives, live in fear and uncertainty of how, or where, their last moments will be. One should be able to die with dignity. The law should accommodate this.
The heart of the debate centres on one question: to whom does a person’s life belong? Does it belong to the individual or to the doctor keeping them alive?
Patients have the right to life. But they also have the right to personal autonomy and dignity. When a patient’s condition has no cure and death is an imminent certainty, there must come a point where the individual has a right to end his suffering.
A tightly-drawn law containing clear conditions and safeguards would create a more defined pathway that gives choice and certainty back to those who want to die on their own terms. To keep someone alive against their wishes is the ultimate cruelty.
On the other hand, the arguments against the introduction of such a law are also compelling.
The principal argument adduced is that it would constitute the start of a slippery slope. Why should we help terminally ill people, but not others, to take their lives? After all, if it is thought assisting suicide is a proper way of relieving pain and suffering, why offer it to people expected to die shortly but withhold it from others with long-lasting illnesses?
Many are worried that, if there were a law like this, elderly people would opt for suicide because they felt a burden on others. It is argued that the introduction of such a law – even one which is restricted to terminally-ill patients with only months to live – is no more than a means to get a legal foot in the door to introduce assisted dying for anybody desiring it.
Assisted dying is not a novel desire. As a moral impulse, the idea that one might hasten one’s death because one gained no pleasure from living and had become a burden on family and friends and the State has been with us since the dawn of man.
Today, there is cultural disapproval. But altering the law may yet be a social reaction whose moment is coming.