End of Life (aka Death)

I was pleased this week that the vote in the Scottish Parliament to change the law on so-called assisted dying didn’t manage to make any further progress. Parliamentarians have now had a number of chances to think about this and vote on it and it still failed comprehensively to get anywhere near a majority of parliamentarians supporting it.

Yet in survey after survey we are told that people support it.

What’s going on?

It seems to me that any of us would be frightened of finding ourselves in a situation where we were left alone and in pain. People do die bad deaths alone and in pain in Scotland. Somehow many people then manage to make a jump in their heads to saying that the law should be changed to allow people to request help to end their lives.

I can’t make that jump myself. The current situation seems to me to be the right one. I have no problem with the idea that a doctor might give a treatment that improved the quality of someone’s life whilst knowing that the life itself might be shortened by doing so. I do have a problem with a drug being given or withheld where the very purpose is to hasten life.

To put it bluntly, if people are frightened of the idea of individuals dying alone and in pain then there are things we can do about that that fall a long way short of killing people off.

I don’t want to see the law changed but I do want to see a lot of things surrounding death to be changed.

I want hospices to be better funded.
I want more palliative care consultants to be trained.
I want money to be put into pain clinics.
I want more research to be put into pain relief.
And I want us to talk a bit more honestly about who should be with the dying if we don’t want dying people to die alone. Who would actually benefit from lives being shortened at will? The patient is not the only person affected by a death, nor the only possible person to derive any “benefit” from life being cut short.

These are so sensitive things to talk about and there are far more issues involved in decisions about end of life care than could ever be resolved in a bill in parliament.

It is good that people are talking about this more. The “death cafe” movement seems to me to be a good thing. Allowing people who are living to talk about the business of dying has to be positive. Sometimes we get into those kind of issues when I’m doing my “Plan your own funeral” workshop – which I’ve just been asked to do in other parts of the diocese too.

I recently conducted the funeral of someone who had had that kind of conversation about his funeral just a couple of weeks before he actually died. It was the most profound thing to have happened, and in the end one of the most profound and beautiful funerals that left me completely in awe of the person who had died and the plans he had made.

Parliamentarians have difficult decisions to make here. We all do. But the priority must be to protect the vulnerable. My judgement is different to the judgement of many and even maybe the majority. I don’t think the vulnerable would be best served by changing the law.

Doctors need to be able to make informed decisions and help others to make informed decisions but we are in an area where sometimes decisions will be tested hard. I’m not alone in thinking that things have become harder for many doctors since Harold Shipman’s crimes were revealed. No doctor wants to be accused to acting too swiftly. No health authority wants to risk harbouring someone who simply wants to kill. But we must be wary of restrictions on care that might prevent doctors taking action which relieves pain where that might be possible.

If I were dying and in terrible pain, would I not want my life to be ended more quickly and more intentionally and more humanely? Well maybe I would. But I’m not the only person in the world and that description of someone dying doesn’t come close to the complexity of what really happens when someone’s life is drawing to a close. There are far more people to think about – not just relatives but those who will die after we do.

So yes, I want pain to be relieved. Yes, I can imagine situations where I’d prefer to die than to live. But no, for the good of those who are vulnerable, for the good of those whose deaths would be a relief to others, for the good of those who are vulnerable and often least able to make autonomous choices, for all their sakes, I don’t think that the law should be changed.

Comments

  1. Kelvin, as always, you’ve made some important comments here, particularly given your high-profile stance on marriage equality and related issues. Some ultraconservative types try to convey the impression that all issues related to sex, marriage, families, and bioethics are a “package deal”. One either takes a conservative stance on the lot, or a progressive stance on the lot. Your ability to discern here on an issue-by-issue basis is refreshing.

    Another important thing is your question of “Who would actually benefit from lives being shortened at will? The patient is not the only person affected by a death, nor the only possible person to derive any “benefit” from life being cut short.” I honestly believe that it’s not only in Agatha Christie novels where a desperate person may be led to shorten the life of a old, ill family member for their own material gain.

  2. I have no problem with the idea that a doctor might give a treatment that improved the quality of someone’s life whilst knowing that the life itself might be shortened by doing so.

    In medical ethics this is called the Doctrine of Double Effect and is a recognised thing.

  3. John O'Leary says:

    You show both profound good sense and Christian sensibility here, Kelvin. I hope that attempt at a seat in the British parliament won’t be your last. There is such a great need for your voice in a much more public arena than a blog, or a microphone in a church.

  4. Anne O'Connell says:

    A beautifully nuanced, and well constructed piece on a vexed argument. Thank you.

  5. “I have no problem with the idea that a doctor might give a treatment that improved the quality of someone’s life whilst knowing that the life itself might be shortened by doing so.”

    It is all about intent. If the drugs are given to relieve pain, then it is the correct thing to do. If the drugs are given to shorten life, then it is the wrong thing to do.

    At no time should medical people feel compelled to keep a person alive simply to avoid a lawsuit or a criminal charge. There are examples of this happening in the US.

    At no time should treatment be given against the patient’s wishes.

    And, you can’t expect a one-size-fit-all approach to always be satisfying here.

  6. This is a sensitive subject. I can understand that people facing a terminal illness and in great pain may want to have control over their predicament. I agree that better quality palliative care would relieve much anxiety over this issue.

    Life is precious and should be treated as such. There’s too much potential for a lessening of the sacredness of life if euthanasia is legalised.

    Agree with your take on this issue Kelvin.

  7. Rosemary Sloan says:

    It isn’t just about not dying in pain. It is also about living in pain. And about living with no dignity or control or choice. That bothers me just as much.

    • And can you imagine that it might be better to tackle the problem of living in pain directly rather than presuming that battle will always be lost and instead giving people the opportunity to die, Rosemary?

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