Seen by many commentators as the most consequential legislative measure concerning a social reform and its associated ethics since the 1967 Abortion Act, the vote to legalise assisted dying applies to England and Wales only (the Isle of Man and Jersey are already ahead of the curve of UK jurisdictions in having legalised it). Just as with the Abortion Act, reform was initiated not by government but by a Private Member’s Bill which had been successfully drawn in a ballot and the members voted entirely by conscience. The debate was consequently in a passionate but respectful manner with no applause from the winning side after the vote. Voting preferences were expressed on a cross-party basis. The bill must pass several more hurdles and will not return to the House before April. The government is likely to assign a minister to help with deliberations on the bill without formally declaring its support for it. After that it must be voted on again by MPs and pass through the Lords. Should it become law there would be a two-year implementation period.
I must state my position on Assisted Dying at the outset. I support the principles behind the Bill on two philosophical grounds The first is the proposition by the late Professor Ronald Dworkin that there is no absolute sanctity of biological life either at its beginning or end. The second is the absolute human right to property in one’s person or bodily integrity. Regarding the first precept, an absolute belief in the sanctity of human life at the point of fertilisation, conception or at any point in the gestation process thereafter cannot automatically trump the rights and interests of the pregnant woman, not least her health. Likewise, a dogmatic insistence on the sanctity of life at its very end should not veto the choice of a mentally competent, terminally ill adult in pain to manage the manner of their death by hastening it in order to avoid the indignity, squalor and sheer agony of, for example, dying in their own bodily waste as Ms Leadbeater graphically testified to the case of Tom who had “vomited faecal matter for five hours before he ultimately inhaled the faeces” all the time remaining conscious while his family pleaded with doctors to help.[1]
That an intervention by Tom’s family in this situation could have resulted in prosecution and a 14-year jail sentence for coercion is reason enough for Parliament to have, in the words of Polly Toynbee, “have finally caught up with the public who have long been firmly and unwaveringly in support of assisted dying, since the first polls were carried out on the issue, more than forty years ago”[2]. She further notes that around the globe, scores of countries including many of greater religiosity than Britain have long had dignity in dying legislation – Spain, Australia, and New Zealand among many examples. Seven times since 2010, Conservative dominated parliaments had voted down bills on the right to die, regardless of public opinion until this ‘landmark’; this ‘enduring symbol and humane legacy of this Labour government’[3].
On bodily integrity arguments, it is a basic human right not to be subjected to coercive medical treatment be it enforced pregnancy, birth control, sterilisation, ECT for mental illness or forced feeding (think of the horrific manner in which forcible feeding was inflicted on the Price sisters during their imprisonment as depicted in Say Nothing the nine part adaptation on Disney + of Patrick Radden’s book of the same name). Every mentally competent person has the right to informed consent over medical decisions taken at every stage of the life cycle; be it the transition to adulthood, pregnancy, menopause, or the ageing process. Why should it be any different for the end of lie or, to put in the stark terms that society is so reluctant to acknowledge, death. For death is part of the life cycle and the part that none of us can avoid. It is a basic human instinct to avoid pain and a basic human right to avoid unnecessary pain and sufferings. Anaesthetics relieve pain in operative care; epidurals relieve pain in childbirth; vaccines are a universally proven, almost pain free means of avoiding infectious diseases. Why can the last few months of one’s natural life span not be similarly pain free or minimally painful? Does the sole means of pain relief in our last moments have to be the shot of morphine administered 24 hours before death? BTW, arguments, usually from the theologically dogmatic or from “natural health” ideologues, get short shrift here.
Much heartfelt and genuine opposition to the bill came from palliative care doctors and from those who convincingly argued that individual empathy was not the sole prerogative of parliamentarians. There were equal obligations to consider the risks to the vulnerable not just our end-of-life choices as individuals. For opponents of the Bill there was the looming spectre of the “slippery slope” whereby the bill could enable pressure being brought to bear on dementia sufferers or those affected by severe disabilities to prematurely end their lives by impatient or exploitative relatives. Such concerns were forcefully expressed by the Health Secretary, Wes Streeting, who unhelpfully complained of the “resource implications” of the bill as well as by the Justice Secretary, Sabina Mahmood.
Religious and ethical opposition to the bill take issue with the centrality of “compassion” in the arguments of its proponents. For Richard Harries, former Anglican Bishop of Oxford and cross bench peer, compassion, as a rational ethical principle may simply place the “good” of the person suffering at the front of our minds but it does not measure up the good of one individual, in terms of their suffering, to the loss of a major good for society, by undermining a sense of the essential worth and dignity of every human being, regardless of their suffering.[4] He warns of the danger of, in the event of the bill’s passage into law, of pressure to extend its scope in the manner of the legislation in place in Canada, Belgium and the Netherlands. As evidence, he cites the statistic of 138 assisted deaths in the Netherlands last year of people with mental illness, most of them single women under sixty suffering from depression (one was under 20).
A humanist reply to Richard Harries would be that unnecessary suffering at the end of life is an affront to the essential worth and dignity of humanity as a whole. According to Trevor More, chair of My Death, My Decision twenty people every day in the UK suffer unbearable pain at the end of their lives despite the receiving the best possible care. In his words “These people deserve better. They deserve the dignity of choice at the end of their lives, and we are relieved to see MPs acknowledge this.”[5]
Yet the voices and concerns of people with disabilities can never be dismissed in this debate. Labour MP Marie Tindall born with a disability affecting all four limbs recalled the extreme pain of having major surgery aged six, covered in body plaster from chest to ankles, in so much pain and requiring so much morphine that her skin began to itch and saying to her parents “Please let me die”. For her, “That moment also gave me a glimpse of how I would want to live my death just as I have lived my life” For “So often control is taken away from disabled people in all sorts of circumstances.”[6]
In the same vein another Labour MP, Jess Asato, while speculating that one day she may desire assisted dying for herself, “protection for vulnerable people should be paramount”, pointing out that there is no mandatory training for judges on coercive and controlling behaviour, nor is there for medical professionals raising the question as to “who will raise the alarm” in the absence of an obligation to tell one’s family and friends should one opt for assisted dying.[7]
But there is no inherent contradiction in advocating for assisted dying as well as lobbying for the rights of disabled adults and campaigning for better palliative care. As it stands, the bill places the decision to permit assisted dying in the hands of two medical professionals who must certify that the person seeking the assisted death is a mentally competent adult who has a maximum of six months to live. Any acts of coercion are punishable by a 14-year prison sentence. It is to be hoped that the deliberative process ahead will encompass the concerns that many legitimately feel around assisted dying while in the medium to long term reaches the broad consensus that exists around abortion, divorce, and same-sex marriage. The maturity of the Commons debate does augur well for these prospects.
Refeences
[1] Polly Toynbee A truly historic vote, and a new era of dignity. Guardian 30th November 2024
[2]Ibid
[3] Ibid
[4] Richard Harries. Another Voice. Assisted Dying is not solely about autonomy – it’s also about the value we place upon life. The New Statesman 29 November – 5 December 2024 p.27
[5] Jessica Elgot How the vote was won. From pubs to libraries, MPs were swayed by the stories of constituents. Guardian 30th November 2024.
[6] Historic vote paves wat for assisted dying to be legalised in England and Wales. Guardian 30th November 2024.
[7] Ibid
I must state my position on Assisted Dying at the outset. I support the principles behind the Bill on two philosophical grounds The first is the proposition by the late Professor Ronald Dworkin that there is no absolute sanctity of biological life either at its beginning or end. The second is the absolute human right to property in one’s person or bodily integrity. Regarding the first precept, an absolute belief in the sanctity of human life at the point of fertilisation, conception or at any point in the gestation process thereafter cannot automatically trump the rights and interests of the pregnant woman, not least her health. Likewise, a dogmatic insistence on the sanctity of life at its very end should not veto the choice of a mentally competent, terminally ill adult in pain to manage the manner of their death by hastening it in order to avoid the indignity, squalor and sheer agony of, for example, dying in their own bodily waste as Ms Leadbeater graphically testified to the case of Tom who had “vomited faecal matter for five hours before he ultimately inhaled the faeces” all the time remaining conscious while his family pleaded with doctors to help.[1]
That an intervention by Tom’s family in this situation could have resulted in prosecution and a 14-year jail sentence for coercion is reason enough for Parliament to have, in the words of Polly Toynbee, “have finally caught up with the public who have long been firmly and unwaveringly in support of assisted dying, since the first polls were carried out on the issue, more than forty years ago”[2]. She further notes that around the globe, scores of countries including many of greater religiosity than Britain have long had dignity in dying legislation – Spain, Australia, and New Zealand among many examples. Seven times since 2010, Conservative dominated parliaments had voted down bills on the right to die, regardless of public opinion until this ‘landmark’; this ‘enduring symbol and humane legacy of this Labour government’[3].
On bodily integrity arguments, it is a basic human right not to be subjected to coercive medical treatment be it enforced pregnancy, birth control, sterilisation, ECT for mental illness or forced feeding (think of the horrific manner in which forcible feeding was inflicted on the Price sisters during their imprisonment as depicted in Say Nothing the nine part adaptation on Disney + of Patrick Radden’s book of the same name). Every mentally competent person has the right to informed consent over medical decisions taken at every stage of the life cycle; be it the transition to adulthood, pregnancy, menopause, or the ageing process. Why should it be any different for the end of lie or, to put in the stark terms that society is so reluctant to acknowledge, death. For death is part of the life cycle and the part that none of us can avoid. It is a basic human instinct to avoid pain and a basic human right to avoid unnecessary pain and sufferings. Anaesthetics relieve pain in operative care; epidurals relieve pain in childbirth; vaccines are a universally proven, almost pain free means of avoiding infectious diseases. Why can the last few months of one’s natural life span not be similarly pain free or minimally painful? Does the sole means of pain relief in our last moments have to be the shot of morphine administered 24 hours before death? BTW, arguments, usually from the theologically dogmatic or from “natural health” ideologues, get short shrift here.
Much heartfelt and genuine opposition to the bill came from palliative care doctors and from those who convincingly argued that individual empathy was not the sole prerogative of parliamentarians. There were equal obligations to consider the risks to the vulnerable not just our end-of-life choices as individuals. For opponents of the Bill there was the looming spectre of the “slippery slope” whereby the bill could enable pressure being brought to bear on dementia sufferers or those affected by severe disabilities to prematurely end their lives by impatient or exploitative relatives. Such concerns were forcefully expressed by the Health Secretary, Wes Streeting, who unhelpfully complained of the “resource implications” of the bill as well as by the Justice Secretary, Sabina Mahmood.
Religious and ethical opposition to the bill take issue with the centrality of “compassion” in the arguments of its proponents. For Richard Harries, former Anglican Bishop of Oxford and cross bench peer, compassion, as a rational ethical principle may simply place the “good” of the person suffering at the front of our minds but it does not measure up the good of one individual, in terms of their suffering, to the loss of a major good for society, by undermining a sense of the essential worth and dignity of every human being, regardless of their suffering.[4] He warns of the danger of, in the event of the bill’s passage into law, of pressure to extend its scope in the manner of the legislation in place in Canada, Belgium and the Netherlands. As evidence, he cites the statistic of 138 assisted deaths in the Netherlands last year of people with mental illness, most of them single women under sixty suffering from depression (one was under 20).
A humanist reply to Richard Harries would be that unnecessary suffering at the end of life is an affront to the essential worth and dignity of humanity as a whole. According to Trevor More, chair of My Death, My Decision twenty people every day in the UK suffer unbearable pain at the end of their lives despite the receiving the best possible care. In his words “These people deserve better. They deserve the dignity of choice at the end of their lives, and we are relieved to see MPs acknowledge this.”[5]
Yet the voices and concerns of people with disabilities can never be dismissed in this debate. Labour MP Marie Tindall born with a disability affecting all four limbs recalled the extreme pain of having major surgery aged six, covered in body plaster from chest to ankles, in so much pain and requiring so much morphine that her skin began to itch and saying to her parents “Please let me die”. For her, “That moment also gave me a glimpse of how I would want to live my death just as I have lived my life” For “So often control is taken away from disabled people in all sorts of circumstances.”[6]
In the same vein another Labour MP, Jess Asato, while speculating that one day she may desire assisted dying for herself, “protection for vulnerable people should be paramount”, pointing out that there is no mandatory training for judges on coercive and controlling behaviour, nor is there for medical professionals raising the question as to “who will raise the alarm” in the absence of an obligation to tell one’s family and friends should one opt for assisted dying.[7]
But there is no inherent contradiction in advocating for assisted dying as well as lobbying for the rights of disabled adults and campaigning for better palliative care. As it stands, the bill places the decision to permit assisted dying in the hands of two medical professionals who must certify that the person seeking the assisted death is a mentally competent adult who has a maximum of six months to live. Any acts of coercion are punishable by a 14-year prison sentence. It is to be hoped that the deliberative process ahead will encompass the concerns that many legitimately feel around assisted dying while in the medium to long term reaches the broad consensus that exists around abortion, divorce, and same-sex marriage. The maturity of the Commons debate does augur well for these prospects.
Refeences
[1] Polly Toynbee A truly historic vote, and a new era of dignity. Guardian 30th November 2024
[2]Ibid
[3] Ibid
[4] Richard Harries. Another Voice. Assisted Dying is not solely about autonomy – it’s also about the value we place upon life. The New Statesman 29 November – 5 December 2024 p.27
[5] Jessica Elgot How the vote was won. From pubs to libraries, MPs were swayed by the stories of constituents. Guardian 30th November 2024.
[6] Historic vote paves wat for assisted dying to be legalised in England and Wales. Guardian 30th November 2024.
[7] Ibid
⏩Barry Gilheany is a freelance writer, qualified counsellor and aspirant artist resident in Colchester where he took his PhD at the University of Essex. He is also a lifelong Leeds United supporter.
Good piece Barry. I hope this legislation becomes law soon. The bishops opposing it will help get it over the line.
ReplyDelete