In light of recent events it would appear that satire has the capacity to expose our nation’s enthusiasm for a good, indignant sense of humour failure, and encourage us to consider wider issues.
I am of course thinking of that bastion of forthright, slightly pompous declarations, Martin Amis. In particular his recently expressed views on the elderly and assisted suicide. Agree with him or not, he has struck a potent iron at its absolute hottest. Scotland’s proposals for legalisation of the practice, more Brits heading to Dignitas in Switzerland, more ‘mercy killings’ being conducted by anxious, pressurised carers; it’s all pushing the assisted suicide debate further into the public eye and screaming out to the powers-that-be that the manner in which death and dying is dealt with in this country seriously needs to be addressed. Beloved author (and Alzheimer’s sufferer) Terry Pratchett has even gone so far as to say he would be a test case for assisted suicide ‘tribunals’ which would give people legal permission to end their lives.
Amis’s now infamous “euthanasia booths on street corners” quote may have been taken ridiculously out of proportion by many (apparently poised at the start line of righteous outraged objection, they sprung forward in determination to be riled up by a dystopian idea Amis wasn’t seriously proposing, d’oh…) but the accompanying sincere beliefs do raise sincere questions. When we hear of people who are terminally ill, utterly incapacitated, in intolerable pain and wanting to end their lives peacefully, I think most of us would empathise. Add to this the fact that without the legal option, thousands resort to violent, often botched, suicide attempts of their own – or persuade others to assist them in this – and many would agree that in severe cases legal assisted suicide should be available from medical practitioners. For the most part I would join them, but in the same way I disagree with the notion of extending abortion rights I worry about the manner in which it could develop; both need to be options, but it is vital that we don’t lose sight of what a big deal they are.
The assertion that we should be allowed to choose how we die sits comfortably with Amis and pretty much all pro-assisted suicide critics. When discussing mentally-sound patients, that is. A key part of Dying with Dignity’s conditions for permissible assisted suicide is the need for the person in question to be “mentally competent.” But this self-empowering element becomes decidedly more complicated when the person is mentally disabled and/or physically unable to express such a choice. It is an awkward, grey area that Amis and a lot of others commenting on the subject seem to have conveniently sailed past. Are we to assume that someone in such a position has less of a right to a peaceful death? They can still experience pain and shouldn’t this be taken into account?
It all invokes the potential for suggested regulations surrounding assisted suicide to be tweaked indefinitely, and the ProLife Alliance fear this would gradually result in the slide from voluntary to involuntary. The “unspoken standards” drawn over at what stage life can be deemed “unliveable” in the Netherlands – and Els Borst’s subsequent admission that these standards were wrong – have highlighted such potential. But coupled with this is the suggestion that most GPs would, understandably, have great difficulty with the responsibility of essentially killing someone, however bleak their prognosis.
It has to be certified that any hope for living comfortably until natural death is realised wherever possible. The emphasis, therefore, surely has to be on providing quality palliative care first and foremost. There are currently problems with this system; big problems, that probably accentuate assisted suicide as a preferable option by contrast. The most crucial of these being that far too many people simply aren’t getting it – as Dr Mark Porter observed in The Times, palliative care teams only get to meet a minority of people who are ill and dying, and the majority of those are cancer patients. This leaves sufferers of heart and lung disease, Alzheimer’s and other degenerative diseases in a position of secondary importance.
So, where do hospices stand in all this? They are widely regarded as the ideal option for dying people, but they need to be matched by all places of palliative care. Currently there aren’t enough hospices to cope with demand, and because of this a huge number of patients rely on palliative care units in hospitals and other centres, and judging by testimonials the standard across the country is highly inconsistent. As Porter points out “you don’t see many palliative care doctors walking the corridors of local nursing homes full of people with advanced dementia.” Before we push ahead with any assisted suicide legislation, surely the focus should be on ensuring that everyone can reliably expect high quality care, treatment and support in their last months, weeks and days.
For some patients, however, no amount of palliative care can address their anxieties regarding their loss of autonomy, dignity and control. If assisted suicide is legalised it needs to be very thoroughly regulated and not come to be regarded as a malleable system. But if people could feel that they were guaranteed a dignified, comfortable final period in their lives, the numbers looking elsewhere would lessen significantly.
February 9th, 2010 at 00:22
Ms. Glass makes a very cogent point: people who are receiving appropriate palliative care and pain medication are significantly less likely to seek a hastened death. On the other hand, it is a well-researched fact the primary reason that rational adult people seek hastened death not chiefly because of unrelieved pain. Rather, they say it is the loss of dignity, ability, and autonomy that comes from severe declines in health that drives them to self-deliverance. Such were the motives for conductor Sir Edward Downes, 85, who traveled last summer to the Dignitas facility near Zurich to die together with his wife Joan, 74, who had terminal liver and pancreatic cancer. He was virtually blind and increasingly deaf, but not himself terminally ill. — Richard N. Côté, author of “In Search of Gentle Death: The Fight for Your Right to Die With Dignity” (to press in 2011).