Tutors (in order of appearance):
Steve (S),
Linda (L)
Pupils:
Patricia (P),
Alexis (A),
Viki (V),
Colin (C),
Ray (R)
Scribe:
Gavin (G)
Apologies:
John (J),
Margie (M),
David (D),
Howard (H),
The homework set
The next meeting is on the topic of assisted dying or, as some suggest it should be called, assisted suicide. On BBC One there was a programme on this matter, Better Off Dead?, presenting an alternative case to the highly publicised recent views of such campaigners as Esther Rantzen. It is well worth watching.
It's certainly topical, with debates occurring around the UK— in the Scottish Parliament, Isle of Man, Channel Islands, and in Westminster—based on the Health and Social Care Committee. In a briefing note issued by the Committee, Assisted Dying is defined as follows:
'Assisted dying refers here to the involvement of healthcare professionals in the provision of lethal drugs intended to end a patient’s life at their voluntary request, subject to eligibility criteria and safeguards. It includes healthcare professionals prescribing lethal drugs for the patient to self-administer (‘physician-assisted suicide’) and healthcare professionals administering lethal drugs (‘euthanasia’). It is an offence (in England and Wales) to assist or encourage another person’s suicide under section 2(1) of the Suicide Act 1961. Euthanasia is illegal across the UK under the Homicide Act 1957 and could be prosecuted as murder or manslaughter.'
Of course it can be defined in lots of other ways, and this prompts debate and no little confusion. So as philosophers we need constantly to define our terms, especially when debating what safeguards are required to minimise the potential for abuse of any new law.
The majority of people, in surveys, say that they favour a law which enables people to end their lives if they feel their suffering is unbearable. Bodies such as the Royal College of Surgeons of England also support changes in the law. Charities like The Campaign for Dying with Dignity—which has a useful website—champion people's ability to end their lives (if suffering is unbearable) as a simple human right, thereby avoiding undignified and expensive travel to places such as Switzerland. 350 UK citizens have ended their lives at Dignitas in Zurich.
But is it that simple? There is devil in the detail of what controls need to be imposed to prevent abuse and coercive control. And the very act of making the law more 'liberal' could itself have potentially undesirable effects, for example: fuelling prejudice against people with disabilities, and reducing pressure on the NHS/Government to provide effective, compassionate, palliative care for all who need it.
On controls, we could consider:
Life expectancy: is it a necessary consideration per se? If so, how long? Six months or less, as advocated by Dying with Dignity?
Who should be in control? The person who wishes to end their life, or doctors and lawyers, or some combination of this.
Who should physically administer the means of dying? The mechanics of the final moments.
The pressures on doctors to provide assistance when it could conflict with their moral beliefs.
An enforced 'cooling off' period, after a decision has been made, to reflect.
The need to define 'unbearable suffering'…the potential for palliative care…again, who should decide?
In many parts of the world assisted dying is a legal right. Oregon has had a law since 1997, and there has been no apparent big need felt to reform this. Many other US and Canadian states have followed suit. However, particularly in the context of the growing number of authoritarian regimes around the world, is there a danger of a 'slippery slope' here? Lives of disabled, suffering, people being made so miserable that life-ending measures become the only way out, as society is 'purified'. Nazism looms....
In the mean time there are many online resources you might look at. The Royal College of Surgeons site is particularly informative. And there is an NHS site which deals with the topic. Dignity in Dying has a clear list of controls that support their campaign for a change in the law.
Plenary Session
Introduction(S)
The subject acquires different connotations, particularly from a legal viewpoint, once you refer to assisted dying as 'assisted suicide'.
It is very topical, for instance in France where a citizens assembly in 2023 has led the government to draft legislation.[1]
Polls indicate the majority wants assisted dying. Many states have had laws permitting it for some years. Most people want the option of assisted dying for themselves. It’s just allowing this possibility for the rest of society that poses the problem.
Discussion
Legally, a doctor in the UK cannot help you commit suicide; but if you contract a terminal illness, that doctor has to accept your wishes not to receive treatment.(P)
Philosophically but not legally, an omission is no better than an action.(S)
Slippery Slopes
When the Abortion Act came into effect in 1968, the requirements for a legal abortion were quite stringent. Now it's pretty much abortion on demand.(V)
How can society prevent people from being pressurised to end their lives—for example, by their family's financial concerns, or by a future government wishing to cut care costs?
In the countries where assisted dying is permitted, there have been almost no cases of abuse so far.(C)
The recently reported case of the young Dutch woman requesting assisted suicide because she is depressed[4] invites the question "Why does she have to involve the State in this matter? Why doesn't she just commit suicide?"(V)
The Problem of Suffering
Whether you are in favour of assisted dying depends on where you stand on the rights of the individual over their own body and the (often religious) viewpoint that suffering can be a good thing.(R)
Palliative care has limits. The suffering can continue in your head.(R)
Is pain good for you? If you don’t feel pain, it’s dangerous.
Chronic pain can make you short-tempered.
Creating the Legislation
Rules will be needed. The clauses should be drafted by the legal profession rather than politicians.(R)
The people in most pain may have 5-10 years of life ahead of them. A six-month limit on legally assistable dying is not enough.
How much should the wishes of the individual be respected? It depends on their state of mind, and their age. Those under 12 would have to abide by their parents' decision.
But even the very elderly who said they wanted to die can be surprised by their joy in unexpected future events, such as the appearance of a great-grandchild.(V)
Do we have an innate sense of when it is our time to go?
Should we consider the rights of the people surrounding those who want to die?
If taking out a health-oriented Power of Attorney, you need to let your intended attorneys know and consult with them. Consultation.(A)
How to define quality of life
Level of pain, inability to communicate, and loss of intellectual capacity.(C)
Is a termination contract possible?
People’s views of what they want when near death may change. Do-Not-Attempt-to-Resuscitate statements need to be reviewed frequently.(V)
Completing a living will[5] can be complicated.(P)
But tickboxes don’t allow you to describe the intensity of your feelings.(S)
Dying as an opportunity to Bond
In our post-modern society, we are distanced from death, and perhaps frightened by it.(R)
Unlike the past, we have outsourced care of the dying.(V)
We have an instinct to care for others, as did the Neanderthals.[3] They cared for their kin with disabilities for a long time.(C)
A recent book[9], written by the people running the longitudinal Harvard project on what contributes to happiness, suggests that when people show empathy, they can get an enormous buzz from helping each other.(S)
The book With the End in Mind…[8] is recommended; she advises the terminally ill to talk to relatives while they still can.(V)
And finally (as always)…AI
Could AI be used to pick up mental health problems?(S)
The problem is that AI can pick up loads of possible diagnoses.(C)
Other topics touched on
David Cameron's complacency as a factor in the Brexit vote.
