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A Simple Act of kindness?

more: Medical Opinion, Opinion, Medical Opinion/Opinion

6th April 2009

Baroness Ilora Finlay, Professor of Palliative Medicine, disagrees with A C Grayling's reasons for assisted suicide...

There has been a clash of ideas in the columns of The Times this week. On the one side, A C Grayling, Professor of Applied Philosophy at Birkbeck College London, set out the reasons why he thought 'assisted dying' should be legalised. On the other, Baroness Ilora Finlay, Professor of Palliative Medicine at the University of Cardiff, explained why legalisation would put vulnerable people at serious risk of collateral harm.

Professor Grayling describes legalisation as "allowing people to arrange their deaths", and he called this "a simple act of kindness". We don't need to change the law to allow us to 'arrange our deaths': it's not illegal to decide when we want to die and to commit suicide. What is illegal is to implicate someone else in the process. What Professor Grayling means by the euphemism "allowing people to arrange their deaths" is authorising doctors to give lethal drugs to patients so that they can kill themselves. Is that 'a simple act of kindness'?

The law forbids assistance with suicide for good reasons. If it were legal, it would be all too easy for vulnerable people, such as those who are seriously ill, to be pressured into suicide either by others or, more likely, by undisclosed feelings of guilt at the burden, real or imagined, that they are imposing on their families. Professor Grayling is thinking of a small number of highly self-possessed individuals when he talks about assisting suicide as an act of kindness; but he is overlooking the collateral harm that could well come as a result to the majority of seriously ill people.

Professor Grayling describes legalised assisted suicide as "a release from suffering that the sufferers themselves earnestly desire and request" and he adds that "refusing them denies their autonomy". Indeed, he claims later in his article that having the option of physician-assisted suicide is "a human right that ought to be respected". People 'earnestly desire and request' all kinds of things, some that are in their best interests and others that aren't. Is Professor Grayling seriously suggesting that to deny something that we earnestly desire constitutes a denial of our autonomy? As Professor Finlay herself points out, the law doesn't give us the option of carrying guns or other offensive weapons. Are we to regard that too as a denial of our autonomy and as an infringement of our human rights? The implications of Professor Grayling's argument are breathtaking.

Professor Grayling recognises that most doctors wouldn't have anything to do with 'assisted dying', were it ever to be legalised. So he suggests the creation of "a medical specialism devoted to assisted dying, either a subsidiary part of anaesthetics or of terminal palliative care". But he has not asked himself why most doctors find 'assisted dying' abhorrent. It is because there is a basic incompatibility between providing health care and ending, or helping to end, the lives of sick people. And to suggest that palliative care physicians might be willing to take on the task borders on the absurd: the highest percentage of opposition to 'assisted dying' (over 90%) comes from this branch of medicine. The plain fact is that 'assisted dying' has nothing to do with clinical practice. We are constantly told by advocates of a change in the law that the suffering for which they see 'assisted dying' as a solution comes from loss of autonomy and personal control rather than from pain or other symptomatic distress. So why is it seen as something to be placed within health care?

Professor Grayling describes as "a kindly gesture, and a generous one" a recent proposal in Parliament by Patricia Hewitt MP that it should be legal to assist anyone to go abroad to commit suicide. He cannot, surely, have seen the text of the amendment that Mrs Hewitt put down for this purpose. It contained no conditions whatever. Had it become law, it would have allowed assistance to be given to any British citizen - whether or not they were ill or mentally competent or under duress - to go abroad and seek suicide. It would have amounted to Parliament washing its hands of the safety of any Briton who chose it or was coerced into it. Patricia Hewitt clearly had in mind Switzerland and the Dignitas suicide facility, misleadingly referred to in the media as a "clinic". Yet hardly was the ink dry on Professor Grayling's article than Dignitas's founder and manager, Ludwig Minelli, surfaced and told the BBC that he saw suicide in general as "a marvellous possibility". Is Professor Grayling seriously suggesting that it is kindly and generous to encourage British people to make use of this service?

There is much more about Professor Grayling's article that is open to question. Do read it and form your own judgement. And, if you also read Professor Finlay's explanation of why she regards 'assisted dying' as "a dangerous step too far", you may well feel that it makes more sense to listen to someone who has spent a lifetime caring for seriously ill and dying people and understanding their problems.

Assisted suicide is fine in a perfect world
A simple act of kindness

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