I will admit to being quite surprised that the Assisted Dying Bill passed its second reading.
Of course, much of that surprise can be put down to the ever-shrinking social media bubbles we all inhabit – mine, for example, seemed full of MPs saying that whilst they might support the principle, they couldn’t support the Bill as it stands. Yet parliament has spoken, and whilst there is still a long way for this Bill to go, it should make us at least recognise that we are in a new place culturally when it comes to matters of life and medicine. It looks, at the very least, like it is now a case of when and not if, when it comes to assisted dying.
Plenty of ink has been spilt on this debate, with some of the arguments being put forward more charitable than others. There has seemed, at times, to be a wilful refusal to hear – and rather to simply dismiss – the concerns raised by large numbers of disabled people, and in addition the voting figures (and associated speeches) from UKME MPs might also get us thinking. The professionally religious have, in the main, been opposed (with some notable exceptions), but there is interestingly no neat left-right distinction in this debate. The religious opposition has not always erred on the side of kindness, and yet perhaps this is best interpreted as a sign of how concerned many religious people are about the threat this Bill poses to something so central to how many people of faith understand human life to be. It is worth our all remembering that very few people – if any – are coming at this issue with bad intentions, even if their failure to see the consequences (from whichever direction) of their opinions is frustrating!
It’s not an original thought, but it is worth repeating that there are already grey areas in this debate that we have all learned to tolerate. Whilst the so-called doctrine of double effect – where a death-inducing dose of medication can be given if the intention is to relieve pain not induce death – really doesn’t have much (if any) actual use in contemporary medical practice (because the reality is that such high dosing is vanishingly rarely, if ever, required), nonetheless we know that patients can quite competently refuse treatment if they have decided that enough is enough. Similarly, we don’t simply go ahead and invasively treat patients when the treatment appears futile or actively harmful – there are decisions to be made on the what, where, when, and how in contemporary medical practice that cannot fit into simplistic binary choices. Yet what is being proposed here really is something new, in my mind, because – I think – it changes what it means to be a doctor, and hence what it means to have a doctor. It changes what choices doctors can legitimately be involved in – and what associated actions they can take.
I think that’s the angle that I’m approaching this debate from, although I am aware that not only am I a psychiatrist – and hence someone who deals in matters of capacity, competence, suicidal thinking, life and death on a fairly regular basis – I’m also a priest. There have been rather silly suggestions that those with faith cannot objectively talk about this stuff – silly because the truth is that none of us, with or without faith, can talk objectively. We’re all caught up in our different (and sometimes internally contradictory) worldviews, and so whatever we have to say about this is going to impact us differently. What I would like to do, though, is offer some reflections on how this whole debate hit me as a practitioner of medicine – one with faith, sure, but primarily one thinking through how my medical life might change in this new cultural landscape.
The first thing is how many MPs of various stripes, including some of those who were vocally opposed to the Bill, stated that they didn’t like this Bill but that they did agree ‘in principle’ (often in the stated context of poor palliative care provision). I’m not totally convinced that in matters of assisted dying, it’s quite so easy to separate principle and practice (as many disabled campaigners have made clear in their contributions to the debate), but putting that aside for a moment, it’s evident that more people are now willing to say that they think that there is a genuine choice possible between death and life. This is new, and significant, if it is indeed true (that is, unless the ‘agree in principle but not practice’ argument was simply being used because it was easier than to be seen to disagree in principle too). Assisted dying is, in the main, seen as a liberal, progressive cause – an assertion not without possible challenge, but an assertion that seems to have taken on a widely accepted status. Those arguing against assisted dying are doing so on the back foot.
Which makes me wonder what precisely the principle is that MPs (and the wider public) agree with. One of the difficulties with all this is the strange bedfellows each of us might find ourselves with, where the thing we agree or disagree on is not actually the same in substance even if it is in effect. Definitions throughout this debate have been shaky and unclear – we might think of the word ‘intolerable’, for example, of which more below – and so the grounds on which we agree or disagree can themselves feel shaky and unclear too. The Church of England has felt a little limited in what it has had to offer on all this – something I found when writing a book on despair and dying – which means that much of the official public output, such as it is, has felt rather last minute, unprepared, and shallow. In the church, we’ve forgotten that a vast number of people don’t speak our language, and our words have lost shared meaning.
Which brings me back to how words in general have lost that shared meaning in society. We have heard a lot about ‘intolerable’ pain during debates, but what exactly does that mean? When life is ‘not worth living’, again, what does that mean? Just as importantly, who makes the decisions about what those words mean, and against what are these meanings measured? As a medic, I feel uncomfortable with saying that some pain is inevitably intolerable, but who am I to determine what that means?
As a psychiatrist, too, I wonder about exactly what doctors are being asked to make a judgement on. Historically – in medicine and in law – we haven’t really accepted the idea that living vs dying is a legitimate choice for an individual to make for themselves. The Mental Health Act, and various other bits of medical legislation, make that clear – and our practice mirrors that. Meeting someone who is suicidal in clinic or in an emergency situation, I would inevitably err on the side of caution and see this risk as something that is at least an indicator that a deprivation of liberty is appropriate. Yet whilst it is only in very particular circumstances, this proposed Bill changes that, in a way that fundamentally changes the way doctors and patients interact. For all the talk on the content of the Bill, its safeguards and so on, this aspect seems not to have featured nearly enough.
Yet that also makes me wonder something else about this Bill specifically, which is whether it actually addresses the question its proponents state it aims to. For all the talk of slippery slopes, this Bill claims to only address those with a likely six-month time limit – ignoring, for a moment, the imprecise nature of any such prediction. In my experience, anecdotal though it is, I have infrequently met people with such a limited lime left on this Earth wishing for less – most, in fact, have wanted more. I can think of situations where ‘intolerable’ might make most sense to me – locked-in syndrome, for example, or degenerative diseases, which might be someone else’s tolerable but might be my intolerable – yet these are not included in this legislation. In other words, the arguments around assisted dying might be more palatable when addressing people in the last six months of life, but are they actually practical or necessary in this group of people? If the answer is, in fact, no, then that opens up a lot more questions.
This debate is not going to go away, and nor is it going to become much easier or clearer. Those of us who have serious and deep concerns about what this does to medical care – where on the one hand I am expected to see all suicidal thinking as suggestive of disorder, whilst on the other hand can now determine someone to be entirely of sound mind despite this thinking – have a duty to engage carefully and thoughtfully with the debate as it progresses, whilst drawing attention to the realities that underpin it. For all the talk of this being one of parliament’s finer hours, I am not convinced – by the principle, or the practical workings out.
This article was originally posted by Helen King on ViaMedia.News on 10 December 2024.
You can find the article here.
