How to Die in England

‘Beware the slippery slope’: the logical fallacy

In Washington a large lumpy doctor rubs his large lumpy hands together at the thought of the money his company will make.

Yes, he hisses across the table at the depressed creature opposite him.

Yes, you should die.

Above him are degrees from various prestigious institutions. They had been stupid enough to think he wanted to be a doctor because he was compassionate and wanted to help people… well THANK GOD the law is now on his side. He doesn’t have to hide his lack of compassion anymore, the law has changed.

Do no harm? Do all harm.

***

In Oregon hoards of people in wheelchairs are being carried out of their homes, they struggle as hard as they can, faces wretched as though possessed.

In their loved ones’ eyes glee froths up. Don’t worry, we’re assisting you.

No check-ups, no safeguards — fast tracked like cattle going to the slaughter.

Oh man, we’re finally rid of them, an able-bodied woman screams, her hands on her head as if it might explode from joy. The state sanctioned public gathering hums. They gather at every culling to remember what a hoot this is.

We won’t stop until they’re all done in.

***

In Switzerland the sign that once read ‘Dignitas’ has been scorched off. In its place is another phrase beginning with D.

DO ALL HARM.

Three syllables as well.

We should have known.


The Assisted Dying Bill underwent the House of Lords last September. It was overwhelmingly rejected, deflated and probably won’t be spoken about again for the next few years. While it is a bill that has split Parliament opinion, a reported 80% of the British public support assisted dying. This is now a symbol of how ‘out of touch’ MPs truly are, and a call to Parliament to make this a referendum issue.

In a religious studies class in secondary school we were shown the film A Short Stay in Switzerland and that was my first introduction to the idea of assisted dying. It provoked serious questions — should doctors have the ability to allow patients to end their lives? Why didn’t Dr Anne Turner (real life retired medical doctor who was diagnosed with Progressive Supranuclear Palsy, portrayed by Julie Walters) want to spend more time with her family? Wasn’t this a disregard for the sanctity of life? The slippery slope argument. I was left undecided on the issue.

It took another film to change my mind decisively. Praised at the 2011 Sundance Festival, How to Die in Oregon is an extremely intimate and at times hard to watch documentary following a group of terminally ill people in Oregon. Oregon is currently one of five states in America to have passed a right to die law. While the film has an agenda, it also respects those filmed and offers a cross-sectional look at all the choices that can be made by terminally ill patients. The film’s message is simple: assisted dying is about giving back choice and, for many people, control.

From what I can see from the responses to the Bill, there are two prominent arguments people have used against a right to die law. First is that slippery slope — what will stop the relaxation or readjusting of safeguards to include disabled or mentally ill people, how can we truly ensure that doctors and medical corporations won’t condone deaths just because they cannot be bothered to look after those they swore to help? The second argument, not as strongly pronounced in the debates, is based on religion and questions whether we have the right to kill ourselves when some God above has apparently given us a path to follow.

The thing about slippery slopes is it offers this baseless consequence that takes away from the very real problem of private suicides and those already travelling miles to Switzerland for assistance. An estimate of more than 300 people a year are committing suicide because of terminal illness, and there is a large possibility that these suicides are lonely, unpredictable acts, much like the one Sheffield MP Paul Blomfield spoke passionately about at the MPs debate.

As it stands in the UK, anyone, be it doctors or family members, who assists with suicide can face up to 14 years imprisonment. However, if an assisted dying law is introduced, those who undergo the procedure will have the time to, not only get their affairs in order, but also to spend those moments with their family — assured of the control and knowledge they have over the rest of their lives. While people tend to see assisted dying as a death-only route, the treatment is not mutually exclusive from palliative care, where end of life support is given through pain management and other holistic treatments. A common argument is one cannot exist with the other, but the two are ultimately about patient care and comfort, and while it’s a preferred choice for some, it’s an unreasonable choice for others. In the ten years since the Death with Dignity Act was introduced, palliative care and use of hospices have increased in Oregon.

British patients constitute the second biggest clients at Dignitas, and that also raises huge inequality issues. It might sound morbid to say, as this whole piece has been, but only those who can afford the flights and the medicine are able to get out to Dignitas. This only really adds onto the rise of ‘amateur suicides’ here in the UK. People have already starved themselves to death to avoid any more pain. Everyone in this country, regardless of wealth, should have the right to die, safely in their own home, surrounded by the people they love and who care about them.

In terms of the potential relaxation of safeguards and protection towards the vulnerable, the practice has been going on for 18 years in Oregon as well as the Netherlands, Belgium and Switzerland. The slippery slope has yet to be seen in any of those places, and there has been no evidence of abuse. Rob Marris MP, who tabled the reading of the Assisted Dying Bill has set a number of improvements from Lord Falconer’s more euthanasia centred Bill (where euthanasia does not stress that the fatal medicine be self-administrated) that draws from the Oregon experience — including self-administration, being assessed by a High Court judge and two independent doctors to show mental capacity, and must be proven to have six months to live. Those who have a disability or suffer from mental illness would therefore exempt them from. In addition, those who request an assisted death can back out at any time — again, it’s about choice, not about glorifying death.

Religion and ethics is also a very critical and nuanced argument against assisted dying. What kind of society will we be once we start condoning suicide? Well, considering the pain and torture that a terminally ill person’s dying days can be — completely dependent and hurting — complying with someone’s wishes NOT to go through with that is very, very compassionate. Religion argues for the sanctity of life — as actually, must sections of society do! — but what is equally as important is, as former Church of England Archbishop Desmond Tutu has stated, the quality of life. In the build up to the Assisted Dying Bill debate, he recalled how Nelson Mandela was ‘prolonged artificially’ through a ‘long and painful illness’, being forced to take publicity photos. That’s not to say that Nelson Mandela would have wanted an assisted death, but it does highlight how people’s suffering are needlessly and perhaps insensitively prolonged.

Of course, the introduction of assisted dying would be a momentous, life-changing event in UK history. Not just for patients, but for the medical profession as well. If the Bill were to be enacted, there is a real and palpable concern over the emotional, mental realities doctors themselves will have to face. Doctors shouldn’t be desensitised from the debate, but quite literally, in the end, shouldn’t it be about what the patient needs? Are we really a place where we will listen to patients except when they are going to die?

Debating it shouldn’t be brushed aside lightly, but it needs to be given to the public. Death is such a personal thing. Many people have major anxieties over it – over our lack of control and fear for it. Maybe what we should be talking about is our relationship with death as a society, how we should be dealing with it emotionally and in a more stable way… but that is a post for another time. What we need right now, at the very least, is a choice. And it’s only right and fitting and fair that death should be a matter left to us.

Originally posted on The Banderola (Dec 2015)