Assisted dying: Is it really so merciful?

|PIC1|In the face of the very real suffering endured by people in pain, some commentators have called assisted dying an act of mercy. But is it really the most humane response to suffering and where will it lead in future generations?

This week, the respected BBC Panorama programme looks into the vexed question of whether or not an individual should have a legally sanctioned right to choose the moment of their death.

The programme will look in particular at the experience and views of Margo MacDonald, a Scottish politician who has a personal interest in assisted dying.

Ms MacDonald is described by the BBC as 'one of Scotland's most popular public figures - a firebrand, independent politician and forthright media commentator.'

Sadly, this gifted woman has Parkinson's disease, a degenerative condition of the brain, and she would like to be given the right to choose the time and place in which she dies.

In a BBC interview on Tuesday, Ms MacDonald talked openly about a visit to the Netherlands where, she said, people who'd requested help to die were treated humanely and were able to change their minds right up to the last minute.

Current assisted dying bills in countries like the Netherlands incorporate a "duty of care" clause. Doctors must be sure, they say, that a patient's request is voluntary and "well considered" and that the patient is suffering in an unbearable way, with no prospect of future improvement.

This sounds all very humane. Yet, if we look a little deeper, we find some very real moral and social time bombs waiting to explode.

For one thing, such laws are filled with terms that can be interpreted very subjectively. For example, how do we define "unbearable" suffering? How do we know when that limit's been reached? Surely, what one person will call "unbearable" another may call tolerable, at least for a while.

These laws also stipulate that there must be "no other reasonable solution" aside from death; but on what criteria is that decision based?

Palliative care is available in many cases, to ease or at least manage the pain. And who can judge whether a person's request to die is "well considered"? How can anyone possibly tell whether or not another human being is ready to die, or that they may not change their mind later if given the chance?

I do not wish for a moment to try to minimize the suffering undergone by many people, whether it is physical, emotional and psychological. In the developed world, we have seen remarkable leaps forward in the management of pain and in some cases cures for debilitating conditions may not be far away. However, this is of little comfort to those who suffer right now.

Yet there are thousands of stories about people who've tried to end their lives and failed. They've gone on to lead very fulfilling and significant lives, often serving their fellow human beings with a renewed sense of destiny and even vocation.

Looking back, they've expressed relief that their attempt to die didn't succeed.

In the same way, people who may feel like dying today may go on to find new purpose in life and in the process change the world for others. They should not be denied that opportunity.

Of course, part of the problem is that we're all living longer. Whilst life expectancies are generally on the rise in the developed world, the emotional or psychological quality of a longer life may not be increasing.

Medical technology may keep people alive longer, but it can't always offer them any quality of life to sustain them.

But this is not the role of medicos alone - it is up to family members, friends and others in the community to help people find reasons to go on living. We should be encouraging their resolve to go on, not removing it.

And by "we" I don't simply mean the legislators or the medicos; I mean each of us, taking it upon ourselves to try to help others find constructive purpose for their lives.

Supporters of assisted dying often say that it is an individual choice. That may or may not be, but it is all too often made in the midst of great loneliness, by people who feel that the world has ceased to care and that nobody treats them with the dignity they deserve.

It was Victor Frankl, the psychotherapist who survived the nightmare of the Nazi POW camps, who noted that people can endure a great deal of pain, so long as they see a purpose in their pain.

My own mother, whom I love dearly, has Alzheimer's disease. She has always been a remarkable woman, in her own quiet yet strong-willed way. Having raised seven children and several foster children, she is still finding ways to serve others in her care facility.

She would never consider asking to end her life, despite the confusion and uncertainty she faces at times. In fact, she has found in her situation as sense of vocation - an opportunity to serve others in the care facility where she lives. Along with medication, I'm sure this is helping to keep the effects of the disease at bay.

There's a potential for tragic mistakes with assisted dying laws. If people are unable to speak for themselves, if they're in a coma or incapacitated in some other way, how can there be a "well considered" request to die?

According to the Dutch government's own statistics 913 people had their lives terminated in 1995 without their express consent. Sometimes, the decision is being taken out of the hands of the patient.

Even when it seems the person's request is well considered, it may be based more on emotional trauma and fear than it is on physical suffering.

In another Dutch study, only five percent of patients who decided to go through with doctor-assisted suicide listed physical pain as the biggest factor in their decision. The most prominent factor was the fear of suffering, or shame.

In an age where, thankfully, emotional problems including depression and anxiety disorders are now openly discussed, surely we can find constructive ways to help people through these times of emotional upheaval.

There is at least one other reason for avoiding assisted dying legislation.

What one generation finds tolerable the next may treat as normal. We simply can't tell right now how assisted dying laws will impact upon or be interpreted by coming generations.

The next step from assisted dying may be "designer death" where consumers can choose from a catalogue of options how and when they want to die. Death may even become a marketable commodity.

The suffering of terminally ill people is very real, but, as the old saying goes, "two wrongs don't make a right". For all their good intentions, I think, advocates of assisted dying may be leading us slowly toward a culture of death, where human life is even more expendable than it is today.


About Mal Fletcher:
Mal Fletcher is an author, social commentator, global conference speaker, leadership consultant and TV and radio broadcaster based in London.


Copyright Mal Fletcher 2008, Next Wave International, www.malfletcher.net Printed with permission