• 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.

8 responses to “Assisted Dying – Why I’ve changed my mind”

  1. BobS Avatar
    BobS

    You lucidly illustrated an example of a family seeking to pressurise someone to influence the process of death. But what was possibly missing was the voice of the person nearing death. Where was their perspective, their reasoning? Assisted Dying starts and driven by the person dying. They are the ones who, with mental capacity, take those steps, if necessary, to expedite death at that final stage. They, together with medical experts, make those decisions.
    The examples cited refer to a family desperate for a skiing holiday and your concern of funeral directors making money through direct cremations.
    I fully agree with your desire for a better palliative care system. Having witnessed their work it is amazing. But that is another argument. To conflate the two dismisses the voice of those seeking assisted dying.
    Your concern over assisted dying seems to be interwoven by a call for improved palliative care and a demise in direct cremations.

    1. Rev Owain Jones Avatar

      Respectfully, Bob S, I think you’re overlooking the one thing that struck me very forcefully from this incident. I’ve always felt profoundly uneasy at the likelihood – I’d say ‘moral certainty’ – that the voice of the dying will in some cases be influenced, even swayed, by the dying person’s assumptions, inferences or intuitions (correct or not) about the needs of those closest to them, and even their desires. These desires might not be articulated, or even correctly guessed – but they might, and as soon as the dying person is subject to them, they are, by definition, influenced in their decision. At that point, Assisted Dying can no longer be said “to start and driven by the person dying.” I’ve been there for a long time – but what I suddenly realized reading Kelvin Holdsworth’s post, was that there’s a much darker issue here, and it relates to a fundamental principle to which I’ve always adhered. Please bear with me, and entertain for a moment an analogy which you might consider to be extreme, and which I’d be appalled to hear deployed by the religiously fanatical opponents of Assisted Dying. It’s this. I have always been opposed to the death penalty for a number of reasons, but very prominent among them is that it takes to an extreme the testing of a fundamental principle of justice (which I know I’m modifyng here to make the analogy a better fit, and of course, you’re free to take issue with that): “It is better that a hundred guilty men go free than that one innocent person be punished unjustly.” I’m aware that there’s a very significant separation between that and this, but I don’t believe it amounts to ‘clear blue water’. Let me try and articulate my conviction in a reasonable way, for you to consider, even if you reject it. I think that there’s a huge danger inscribed in legislation which will, of a moral certainty, permit circumstances in which unwilling dying individuals give assent under pressure to the active premature termination of their lives. This holds true even if a hundred times as many individuals assent freely, and even actively seek, such termination. One of the things that always made me uneasy about the Vulcans was the assertion that “The needs of the many outweigh the needs of the few”. There seems to me to be no way in any legislation to protect the needs and rights of the few in this issue. At the very least, I think that needs to be acknowledged openly by proponents of Assisted Dying. If we’re about to be taken across a Rubicon, I believe that everyone, on both sides of the decision, need to acknowledge that. (Incidentally, I completely agree with Kevin Holdsworth’s horror (I hope I’m expressing that fairly) at ‘Direct Cremations’ and the way they’re advertised. They seem to me to be open profiteering from the death-phobic culture in which we’re immersed. I fear that the impulses behind Assisted Dying as currently advocated may be a good-faith manifestation of the inability of society to look at the full actuality of human mortality and the relationship between life and death. I may be deluding myself, but I think I’d say that even if I were an atheist.

      1. BobS Avatar
        BobS

        Rev Owain, thank you for your response. I fear your analogy was stretched to fit your argument, and, apologies if my education lacked in this quarter, where the reference to Vulcans was applicable.
        If we are concerned that a very small percentage will be wronged, then many practices today should be stopped. The statistical error you describe will always be possible, albeit minimised as much as possible.
        The proposed law tries to cater for such concerns. What appears to be the argument against assisted dying is that it is not error proof.
        If a person who is deemed to have mental capacity with less than six months to live, with suitable medical provision, seeks to alleviate their suffering, and is capable of themselves administering the medication to ultimately ease that pain, then their voice has been heard.
        I also would hope that palliative care continues to improve but that is a separate argument, as are direct cremations, and now the cost of the funeral to families. These arguments are all used to conflate the underlying issue of assisted dying.

    2. Val Dobson Avatar
      Val Dobson

      You are wrong to connect funeral companies’ promotion of Direct Cremation with the push for assisted dying. Nowadays, many families simply cannot afford a “proper” funeral / cremation, and funeral grants come nowhere to covering the the costs. The funeral companies are simply responding to customer needs.

      1. Kelvin Avatar

        I’m happy to speak out about funerals being too expensive. However, it is manifestly not the case taht funeral companies are simply responding to customer needs. If they did they would promote these as being about price. They don’t – they promote them as being about not causing a fuss, which is the point I’m making here.

  2. Nigel Kenny Avatar
    Nigel Kenny

    Thank you for your wise and persuasive words – may they influence MSPs to vote against the Bill.

  3. Chriatine McIntosh Avatar
    Chriatine McIntosh

    Thanks for this, Kelvin – I’ve been thinking more about this as contemporaries begin to vanish from this life.

  4. Helen Leslie Avatar
    Helen Leslie

    Thank you Kelvin. I am someone who has spent the majority of my working life caring for people at the end of their lives. You said exactly what I would want to.

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