Until 1961, attempting suicide in the UK was illegal and punishable by a fine or a short jail term. England was one of the last countries in Europe to decriminalise suicide, but the stigma remains in the minds of many, and I know from recent topical conversations that some people still believe suicide to be illegal, or just plain wrong. So, change happens slowly in Merrie Olde Englande, and confusion abounds.
In view of the outcome of Tony Nicklinson’s court case earlier this month, it seems that UK law is just as slow to change now as it was half a century ago. Why are our MPs and lawmakers so unwilling to discuss the notion of assisted suicide? For Tony, and for the other locked-in syndrome sufferer known only as ‘Martin’, the answer was obviously cowardice – politicians and judges both unwilling to confront real issues, such as the right to die when you are physically unable to take your own life. I would, however, like to add doctors to this short but telling list of the squeamish.
There is, understandably, fear that a change in the law would put vulnerable people at risk (disabled people who have no desire to die, for example), and perhaps images of naughty doctors creeping around care homes with syringes full of barbiturates did dance through the judges’ minds when they concluded that no doctor assisting non-terminally ill patients to die would be immune from prosecution. Of course new laws are vulnerable to abuse, but there is no reason why safeguards could not be implemented when legislating for assisted suicide. Just because you make something legal doesn’t mean you also make it easy. In the case of assisted suicide, the person seeking assistance should be assessed by several doctors independently and each case judged on its own merits with the maximum amount of information and professional advice available. It should be a lengthy process (at the very least, it isn’t one of those snap decisions that you’d be able to renege on at a later date), but the option should exist.
To a certain extent I can excuse the squeamishness of politicians and judges to deal with such an issue (perhaps because I have a lower opinion of them to begin with), but the Royal College of Physicians and the British Medical Association have keenly disappointed me with their views on assisted suicide. In the course of my research for this article I have found myself reading quote after quote in which doctors have asserted their duty to “look after” their patients and provide “good care” for them, but these are fluffy notions that do not entertain the idea that, for a very small minority of patients, death would be “in the patient’s best interests”. Ignoring this as an option is, in my opinion, the mark of a physician not doing their job properly. Perhaps some doctors have lost sight of the extent of the remit of their profession. Sometimes a situation becomes so intolerable for a person that it is not actually in their best interests to keep them alive.
How many times have you heard someone, speaking of a recently departed loved one, comment that their sadness at losing them is somewhat tempered by the knowledge that they are no longer suffering? Surely this is the more humane response – yet as a society we seem more attuned to the suffering of the family pet than a fellow human being. For how long have doctors been terminating pregnancies, switching off life support machines, engaging in passive euthanasia through DNR (“Do Not Resuscitate”) orders, and (in the case of veterinary doctors) putting animals down to end their suffering? Why do they have less problem ending the life of a being that cannot give its opinion on the matter than of one who can actually communicate their desire to die? It makes no sense. Where is the compassion for the human being who is suffering mentally, not just physically?
Despite the great increase in our understanding of mental illness, doctors still seem to prioritise health of the body over health of the mind. They are confident when dealing with conditions of all kinds from which a patient wishes to recover, and even respect a patient’s decision to refuse treatment, but when death is actively sought, they balk. The BMA’s reasons for continuing to oppose a change in the law on assisted suicide amount to little more than the protection of doctors against having to make tough moral decisions and to face up to what HPAD (Healthcare Professionals for Assisted Dying) calls the “clinical reality” – that however small the minority, there do exist patients who wish to end their lives but are unable to do so without outside help. Surely acting in the best interests of a patient should include choosing to assist in their wanted death rather than putting them into a position where, for example, they must resort to starving themselves as a means of ending their life.
We have to learn where to draw a line under our efforts to preserve human life. Do not take this statement out of context – doctors should always do their utmost to prevent death where death is not desired. But to preside over the death of a patient is not a failure or dereliction of duty when not even the patient believes in the worth of such efforts. We just need to make sure that any laws facilitating assisted suicide will never allow someone to “be murdered” without their express desire. And if there is consent, ought it even really to be called “murder”?