By Peter D. Williams
In early June this year, in answer to a question from a Parliamentary colleague, the Prime Minister made clear his opposition to the practice of assisted suicide.
Just a week later, Labour MP Rob Marris came top of the Private Members Ballot, and went on to propose a Bill that would introduce that very practice into the UK. Like the PM, many oppose this Bill, if not the very concept of assisted suicide itself. And quite rightly so, for a sound conservative analysis of the issue reveals it to violate a fundamental element of British life that conservatives wish to conserve: freedom under the law.
Ironically, given tomorrow’s debate in the Commons, today is World Suicide Prevention Day. That there exists such a place in the international calendar tells us something about the concern that our society expresses towards those who are so distressed that they wish to take their own lives. We rightly lionise the Samaritans and other groups who work to help such people, and we have entire strategies in place to prevent this tragedy.
Of course, conservatives realise that the over-extension of Government is pernicious, and causes more problems than it solves, but we also believe that when law is used in a judicious and limited way, it can help secure the common good. This latter reality is precisely what we see when we look at our law against assisted suicide. The admirably pithy Suicide Act 1961 managed to rightly remove the cruel imprisonment of those who attempt and fail to commit suicide – who need help, not punishment – but in prohibiting assisted suicide it also reiterated protections for those who might find themselves coerced into ending their own lives by unscrupulous relatives or others who might benefit from an inheritance of wealth or removal of a personal burden.
The concern that forms the basis for this protection, rightly expressed by the Prime Minister, that pressure might be put on people to end their lives when this might not be something they would otherwise want to do, is well-founded. Not only on a wise intuition of human failure, but the experience of foreign jurisdictions.
The Marri proposals are based on the system utilised in the U.S. state of Oregon. There, between 1998 (when the ‘Death With Dignity’ Act came into effect), 13% of patients applying for assisted suicide cited fear of being a burden on their family as a reason driving them. In 2014, that figure had inflated three-fold to 40%. Washington State, which uses the same system, found 59% of assisted suicide patients cited that reason. We might well ask whether ‘choosing’ to commit suicide based on the effect of your existence on others can be said to be ‘autonomous’ one.
Most Oregon patients requesting assistance in suicide do so due to some form of worry or psychological distress, rather than physical symptoms such as pain or nausea. A 2008 research paper in the British Medical Journal examined fifty-eight Oregonians who sought information on assisted suicide. The authors found that of these, 26% met the criteria for depression, and 22% for anxiety, with three of the applicants for assisted suicide receiving the lethal drugs, ingesting them, and dying within two months of being interviewed. The study’s authors concluded that Oregon’s law “may not adequately protect all mentally ill patients”. This can hardly be surprising, given the rate of psychiatric evaluation: only three of the one hundred and five patients who committed assisted suicide in 2014 were referred for such an examination.
Worse, the system has led to increasing numbers of such deaths each year. The latest Oregon figures show that the numbers of people enabled to end their own lives have risen from 24 in 1998, to 155 in 2014. That is an increase of over 600%. In 2013 alone, these numbers rose by 44%. It is worth noting that if the Oregon death rate were replicated in the UK, this would mean over 1,500 assisted suicide deaths per year. You might think that these numbers are small in relative terms, but the point is that many of these deaths could be the result of coercion or subtle pressure on vulnerable people, and this runs contrary to the efforts we make precisely to prevent the phenomenon of suicide.
To fight against this, Marris Bill proposes a system of assisted suicide that would include a number of alleged ‘safeguards’. Chiefly, the idea of two doctors being satisfied that the patient presenting for assisted suicide is making a ‘clear, settled, voluntary, and informed’ decision. It makes no attempt to suggest how this might be achieved by those doctors, but leaves details up to regulation after the legislative fact by Whitehall bureaucrats.
This so-called ‘safeguard’ is actually the same as that which exists in the Abortion Act 1967. The outcome of which was that what was meant to be – and at least on paper, is – a tight law allowed only few abortions, became one which is so effectively and routinely disregarded that we now have de facto abortion on demand. Whatever you think about the issue of abortion, this illustration of the divorce that can occur between the intended letter of the law and its practical application, gives us no grounds for confidence that the same procedure prescribed by this new legislation would not be similarly abused, to the detriment of adult patients.
By contrast, the law as it stands actually allows for the best possible balance of compassion and protection. If one person helps another to commit suicide, they are doing so for either altruistic or nefarious reasons. The law mandates that when this happens an investigation takes place, and whilst badly-motivated actions can be punished (and in the future deterred), kindly-meant ones can be forgiven either by the Crown Prosecution Service choosing not to prosecute, or by a Court deciding not to find a defendant guilty. We have a hard law, but it has a kind face.
This also allows our medical system, though it is by no means perfect, to develop truly caring options for patients. Despite some scare-mongering claims to the contrary, physical pain is not a justification for assisted suicide because palliative care, of which the UK has the best in the world, can take that away through morphine titration. Medical abuses, including of this facility, are irrelevant: if some medical staff are withdrawing food and fluids to kill their patients, then this is murder, and should be prosecuted and prevented.
Similarly, the idea that doctors may choose to overdose a patient on morphine in order to shorten their life – which is, incidentally, contrary to palliative care practice – is highly unlikely now that doctors work in teams, as indeed Sir Graeme Catto, Chair of ‘Dignity in Dying’ (the former ‘Voluntary Euthanasia Society’) stated in a Parliamentary meeting to launch the Marris Bill in July. In fact, independent research has overt hastening of deaths of patients by doctors in the UK is “rare or non-existent”. This is a very good thing: we euthanise family pets, and not humans, because the former are things treated essentially as objects and the latter are persons which we must treat as subjects. We recognise human dignity not by ending discomfort at all costs, but by healing and palliating at the same time as upholding the right to life. Palliative care can develop because of this concentration of relieving the suffering of patients, but not ending their lives.
You might think that all this is an imperfect system, and you would undoubtedly be right. Yet Conservatives of every stripe disbelieve even in the possibility of a man-made utopia. What we do believe in is a legal system that best protects the freedom and right to life of the individual against lethal coercion. This, happily, is precisely what we have.
The advocates of legislation like the Marris Bill are undoubtedly well-intentioned, but their motives are based in a false understanding of the current situation, and a naïvely wrong-headed appreciation of what the so-called ‘right to die’ would look like in practice. In order to gloss over the evident abuses of assisted suicide and euthanasia, and ignore the Law of Unintended Consequences, the advocates of such a system must put their trust in the benevolence of human nature and bureaucratic Government structures. Going by the historical precedent of such an approach, their proposals can be counted as among the chiefest contemporary examples of odious and disastrous things that have been motivated by good intention.
Ultimately, our choice is between a Government-run system of assisted suicide that cannot but fail to discern the autonomous will of the individual, even to their ultimate and irreversible harm, or a law that reactively mandates investigations of assisted suicides, and has the flexibility to not prosecute those who do so out of genuine compassion. It is the latter, and not the former, that truly safeguards freedom under the law.
Historic conservative principle, as well as common sense (but I repeat myself), tells us that we should not knock down a fence until we know its purpose. In the case of our law against assisted suicide, knowing the purpose of the fence should convince us it should never be taken down. It is an expression of the principle organic to human society that we do not involve ourselves in the death of others, and an important safeguard of the human right to life, especially for those whose personal autonomy is most compromised.
A right concern for the welfare of the vulnerable, as well as compassion for those suffering terminal illness, should lead conservatives to reject the Marris Bill proposals, and focus instead on improving the provision of palliative care services. Doing so would affirm the balance our statutes provide, and ensure that all Britons remain truly free under, and through, our law.
Follow Peter on Twitter
