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The right to die

July 29th, 2009

The Royal College of Nursing has become the only major medical institution to withdraw its opposition to assisted dying and to adopt a neutral position, meaning that it will neither support nor oppose a change in the law. The College, which represents 400,000 members, arrived at this position after a three-month consultation.

The deaths of Sir Edward Downes, and his wife, Lady Downes at Dignitas clinic in Switzerland reignited the debate over the so-called “right-to-die”. The case was particularly controversial since although Lady Downes, 74, was suffering from terminal illness, Sir Edward, 85, was not.

In July an amendment to the Coroners and Justice Bill proposed by Lord Falconer to allow people to help a terminally ill person travel abroad to a country where assisted suicide is legal was defeated by the House of Lords.

Currently aiding and abetting suicide is a crime punishable by up to 14 years’ imprisonment. Figures show that at least 115 people from the UK have travelled abroad to die since 2002 with the rate increasing every year.

This issue of the “right to die” raises massive issues for both believers and unbelievers. How should Christians respond to this trend?

The Sixth Commandment is clear: “Thou shalt not murder.” It prohibits any act that would intentionally, or through carelessness, take the life of another human being. There are exceptions with regard to killing in war, self-defence, and some would argue, capital punishment. But the thrust of the commandment is that we should take all steps to preserve the lives of all human beings, including the unborn, the elderly, and even those who wish to die.

It is important to maintain a clear distinction between killing a person and letting someone die. Killing in the wrongful sense is murder, and it means actively doing something to a patient that hastens or causes his or her death. But “letting someone die” means allowing someone to die without interfering with the process that is already taking place. In cases where it is clearly known to be the patient’s wish to be allowed to die, and where there is no reasonable hope of recovery, and where death seems imminent, then it does not seem wrong to allow the person to die rather than prolonging the natural dying process by artificial means.

But where the matter becomes complicated and worrying is when people claim that it is their right to determine the time and circumstances of their death.

Baroness Finlay

Baroness Finlay

Baroness Finlay is Professor of Palliative Medicine at Cardiff University School of Medicine and chair of the All Party Parliamentary Group on Dying Well. She says,

“It is easy to talk glibly about more choice at the end of life but ‘medically-assisted death’ cannot be regarded as just another end-of-life choice, like choosing to die at home rather than in hospital. It poses very real risks to the safety of the overwhelming majority of terminally ill people. The question to be asked is whether Parliament can safely allow, for the convenience of a small minority of resolute individuals, an exception to the law on killing which flies in the face of medical ethics and which could easily create subtle and unwanted pressures on the great majority of terminally ill people to take their own lives. This serious issue cannot be brushed aside simply by categorising ‘medically-assisted death’ as just another end-of-life choice.”

The heart of Baroness Finlay’s argument is that proposals to allow “assisted dying”, while undoubtedly well intended, have an air of unreality about them that is worrying to anyone who works with seriously ill people.

They assume the existence of a perfect world, a world in which all terminally ill people are entirely clear-headed and make life-or-death decisions on completely rational grounds; and a world in which all doctors know their patients well and have limitless time and skill to assess requests for euthanasia.

As Baroness Finlay explains, seriously ill patients often alternate between deep depression and times of hope. During the bouts of depression, some may ask for assisted suicide. If given time, many will emerge from the depression with renewed hope.

Dr. Finlay also understands that many patients increasingly see themselves as burdens on their loved ones and then feel “hidden pressures” to end their lives in order to free their families from the burdens of care and cost. Doctors who care for terminally ill people sometimes have the subject of assisted dying raised by patients. In most cases they want assurance that they won’t be abandoned and will have care that maintains dignity and addresses their deepest fears. To respond by processing a request for assisted suicide risks sending a signal that the doctor agrees that the patient would be better off dead.

We rely on our doctors to act at all times in our best interests. That inevitably gives them a degree of influence, however unintended, over the choices we make about our health. This is an important point that a sensitive and caring physician will uniquely understand. An offer of assisted suicide can be interpreted as a duty to commit assisted suicide. It is also a fact that some patients who are thought to be nearing an inevitable death actually survive. The risk of getting it wrong is just far too high.

Baroness Finlay says that most doctors don’t believe that “assisted dying” is something they can square with the ethics of good medicine. And for good reason. Her experience as a palliative care physician is invaluable to this debate, as is her moral insight.

She is right to point to the imperfection of this world as sufficient reason to oppose arguments for assisted suicide. Nevertheless, the Christian worldview offers a stronger argument. This world is not just imperfect; it is fallen.

The reality of human sinfulness explains why no human agent is morally equipped to determine who should live and who should die. But human sinfulness also explains why we will try to act as if we are God, even in seeking our own death. The culture of death seems to be making significant advances in our society and it must be recognised for what it is, a frightening assault upon human dignity.

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