Assisted Suicide

This topic has been much debated on the Letters page of The Times this week, though I have not followed much of it. I did notice a letter on Friday, from the Consultant in Palliative Medicine, Newcastle upon Tyne Hospitals and Marie Curie Hospice, Newcastle.

This seemed to me a well balanced letter, recognising the need for a care that extends beyond just the physical care (relief of symptoms and pain) to include care for the emotional response of patients and a recognition that patients experience is not just a physical experience but also a spiritual (which, in some cases means religious) one. Some patients have significant resources of their own with which to cope with these challenges; but other patients need support and help from others in some or all of them. I was particularly struck by the following paragraph.

... this is just real life. Some people appear to get by easily and meet few difficulties; others encounter difficulties and meet them with success; others need help to manage their difficulties and a few get stuck. As a society, we have developed resources to assist people in difficulty. We have not previously proposed that a useful response to being stuck in a difficult position is to offer premature death as an alternative.

It appears that our advanced, very technological society creates an expectation that no-one should have to face any difficulty or challenge in life at all; whereas, in real life, difficulties may in some situations be eliminated but in others they have to be faced up to and managed.

In parallel with these issues, each person is on a spiritual journey through which they interpret the meaning of their lives. For some this is a religiously based belief, while for others it is about personal worth and contribution to ideals they hold dear, such as family life, care for the environment or world justice. In palliative care we seek to support them in reaching their own inner peace as they measure their triumphs and failings against their own set of ideals.

This paragraph raises another point of interest. If someone does not have a positive valuing of life, or an understanding of life that gives it a positive meaning, then abandoning life for death seems quite natural when presented with a serious difficulty in continuing with life. But a positive meaning for life needs to be proposed before patients become terminally ill, before even they become ill enough to be "patients". This is a general question of culture and life, not just one for during a terminal illness. When they become ill, a patient is then able to live out the meaning that they already recognise in life rather than needing to be educated to give life meaning "at the last moment".

Two aspects were perhaps not fully addressed by the letter. One is that of religious care, which was left to be seen as a particular case of spiritual care. The second is that of basic hydration and nutrition as the end of life approaches and a patient becomes unable to eat or drink themselves.

Today's edition of The Times is dominated by coverage of the Royal College of Nursing's decision to change its opposition to assisted suicide into a position of neutrality. The coverage is almost totally in favour of assisted suicide. Part of that coverage is a case study of a cancer patient. The caption (in the print edition, not used in the online version) to an accompanying photograph reads:

Bob Michell at home in Oxfordshire with a sculpture of his wife Pauline. He believes Pauline, right, craved the peaceful ending they had given her pet dog, Dodger.

So, the measure of how we treat the human person is to be the same as that which we use for an animal. And, though Professor Michell may want us to see it as the animal being treated better, the objective situation is one of reducing human life to the same value as animal life.

Reading the full text of the case study, the following questions come to mind:

How does Professor Michell really know that assisted suicide was "what she craved for herself", and how far is he just guessing?

"But it was still ghastly": how much does this observation exrpess Professor Michell's own experience, and the difficulty that he faced in coming to terms with it, rather than it being his wife's experience (though, of course, she may have found it very difficult too)?

And, very strikingly, notice how significant the present legal position banning assisted suicide was in the decision of Bob Michell and his wife not to undertake an action of assisted suicide; and an action of joint suicide appears to have been deterred by consideration of its family/societal consequences. There should be no illusions here - if the law is changed, those in situations like Mrs Michell's situation will be vulnerable to the wishes of others ...