These covid months have brought death closer to the lived experience of many of us. More friends and relatives have died. More have died at home. The circumstances of death have been dreadfully changed by the social isolation and distancing rules.
In amongst this, a campaign to change the law to allow or require doctors to end the lives of people before their natural death when they are faced with no prospect of recovery but ongoing extreme and intolerable pain, has gained ground.
The BMJ of September 11th carried several articles reviewing the situation. September 14th – The BMA changed its policy on this issue to one of neutrality from that of opposing a change in the law.
During my lifetime there have been changes in law in this country which reflect very marked modifications of views and beliefs on basic life values: the suicide act 1961, capital punishment 1965, Abortion act 1967, Sexual offences act 1967. I was young when these matters were being decided on. At the times and since, I have been comfortable with the spirit and details of the new legislation.
A change of law now, to make assisted suicide/assisted dying legal in this country and for it to become part of medical practice causes me hesitate.
Is it necessary? Those in favour of a change cite dreadful scenarios of people experiencing unresolved pain and distress for weeks and more, despite the attentions of the best of medical practice and palliative care. Yet doctors involved with hospices and palliative care are amongst those most surely against a change of law. They know that a proper use of existing law and available medical expertise means that almost everyone can be assured of a reasonable experience of dying – Dying is something which many people have dreaded throughout their lives, so it may never be easy or comfortable – but it can be helped to an objectively acceptable passing, Palliative Care doctors would say. My own limited experience of work within a hospice leads me to agree with them.
Polls of the general public 2015, 2019 and 2021 have found at least 70% in favour of assisted dying for those who are within 6 months of death and suffering intractable pain
Some high-profile religious leaders declare they find nothing in scriptures which rule against assisting death in such circumstances. Among the BMJ articles September 11th Archbishop George Carey and Rabi Jonathan Romain take this position and cite Desmond Tutu and Reverend Canon Rosie Harper as sharing their view. They provide quotations from Ecclesiasticus 30.17 and Ecclesiastes 3.2 which can be interpreted as supporting their view.
A 2019 survey found 82% of Christians and 80% of religious people of all faiths supported a change to legalise Assisted Deaths by doctors. As things stand the Roman Catholic Church, Anglican churches, Greek Orthodox Churches and Muslims are against a change. Liberal Judaism, Unitarians, and The Religious Alliance for Dignity in Dying want the law to be changed. Religious Alliance for Dignity in Dying – Dignity in Dying
Proposals for change and all discussion about the possibility would require that the person requesting help to die must have mental capacity and not be suffering from a mental disorder that would change their appreciation of their condition and prospects (such as depression). Their decision should be made with a free will and not subject to pressure or expectations from others.
There is very little discussion about people with dementia. I have real concerns that a combination of a law to allow Assisted Dying and Advanced Directives might push us toward a situation where people feel obliged to request their death be brought forward if/when they require care because of advanced dementia. This might be because an individual finds the prospect of life changed by dementia to be abhorrent, or to reduce the prospect of being a burden in a number of ways to their family or society, or to avoid costs. Any and all of these reflect prejudices within our society which would eliminate people who have or who develop such characteristics. Such a tenet is unacceptable – a slippery slope.
It is the case than Assisted Dying is accepted in Spain, New Zealand, Tasmania, Western Australia, Canada, Switzerland, Belgium, Luxenberg, The Netherlands, and other countries. It has been legal in Oregon for 25 years. The BMJ reports that there has been no misuse of the facility. Yet there are troubling stories of people who have been killed in keeping with their Advance Directive even though in their altered state with dementia they would resist a lethal injection. Struggling woman with dementia euthanised in Netherlands » MercatorNet
The rights and views of people with dementia when they lose capacity should surely be respected