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Assistance and Force: Different Things

5 Jun, 10 | by Iain Brassington

Imagine a world in which egg sandwiches are illegal.

Given that I really don’t like eggs and that I particularly hate the smell of them, I have no desire ever to eat one; this world is fine by me.  However, I’m aware that some people might, on occasion, express a desire for egg sandwiches.  Some might lobby for their decriminalisation.  Still, I think that the ban is just fine and dandy; and besides, if the ban on egg sandwiches for those who want them were to be lifted, we’d be only a small step from a world in which some people would be forced to eat egg sandwiches, and in which, gradually, Tescbury’s supermarket would remove from the shelves anything that  wasn’t an egg sandwich.  As far as I’m concerned, both of these would be terrible eventualities, and that’s why I’m minded to start a campaign to ensure that egg sandwiches are never legalised.

Absurd?

Well, yes.  Obviously – though I really do hate eggs.  However, it’s not that much more absurd than the Not Dead Yet “resistance” campaign, which describes itself as “a UK campaign for equality of access to healthcare and against proposed Assisted Dying legislation”, as though you can’t have the latter and the former at the same time.  (Yes, it really does call itself a resistance movement.)

It’s even got a “resistance charter“, which it’s asking all MPs to sign.  It’s carried by a whole army of straw men and Aunt Sallies, though.  Here’s what it says:

1. Disabled and terminally ill people deserve and are entitled to the same protection in law as everyone else.

2. I value the lives of all disabled and terminally ill people and the contributions they make to society.

3. I will seek opportunities to ensure disabled and terminally ill people in my constituency have access to the health, social care and other services they need to live with dignity.

4. I believe that disabled and terminally ill people seeking assistance to end their lives should receive the same support provided to any other person with suicidal thoughts and be encouraged to live.

5. I will support palliative care and independent living services in my constituency and work with those seeking to ensure they are available to all who would benefit from them.

6. I am willing to meet with disabled and terminally ill people in my constituency who are fearful of any change in the law on assisted suicide and to take account of their views.

7. I will seek to maintain the legal protection offered by the current law, which is that assisted suicide is illegal.

Most of these ought to be perfectly acceptable to anyone, regardless of their position on assisted dying.  Number 7, obviously, wouldn’t – but it has nothing at all to do with the other six anyway.  It’s trivially true that disabled and terminally ill people have the same moral status as the non-disabled and are therefore entitled to the same legal protection; it’s trivially true that disability tells us nothing about the value of your life or the contribution you make to society; it’s trivially true that the disabled and terminally ill ought to have access to the resources to guarantee the highest possible standard of living if that’s what they want; palliative care is great.

The problem comes with points 4 and 6.

Let’s start with 4.  There’re two components to it: the first has to do with the support offered to the suicidal; the second has to do with encouragement to live.  One  of the premises of the campaign’s argument is that, if an able-bodied person displayed a suicidal attitude, we’d think it right to intervene; therefore it’s perverse to make suicide easier for the disabled.  But this really does miss the point that the pro-assisted dying (AD) crowd is making.  Of course it’s admirable for a second person to be concerned for the welfare of others, and it’s possible that a suicidal orientation is only transitory.  But, of course, noone has ever suggested that assisted death should be as easy to obtain as your groceries.  Every single piece of legislation that I can recall makes provision for psychiatric evaluation, and, of course, the right to assisted dying could only ever mean a right provided a suitably qualified person is willing to provide it: it’s hard to see how it could ever be used to mandate assistance.

The point is that there’ll plenty of safeguards built into any plausible assisted dying scheme to ensure that it’s still fairly difficult to access – though, as I’ve argued elsewhere, I’m not sure that the difficulty has to be as high as all that.  So this brings us to people – able-bodied or disabled – whose desire no longer to be alive isn’t transient.  For whatever reason, they’ve had enough.  They don’t want palliative care, if that’s the alternative.  They don’t want counselling.  They just want it over.  Well, in that case: isn’t it up to them?  There’s a very long tradition of thinkers saying that there are some decisions that may be silly – but as long as they’re taken with a clear head and harm noone else, then that’s all there is on the matter.  To make a point of trying to encourage them to live seems to display a strange kind of contempt for the value they ascribe to their lives, and thereby to them.

There’s two possible responses to this.  First, we could deny that anyone ever decides to die with a clear head.  But there’s no reason to believe that this is true.  Even if – mirabile dictu – every single person who’s sought to end their lives so far has done so based on a mistake about their own life’s value, it doesn’t follow that there’s a necessary link between suicidal thoughts and that mistake.  Second, we could say that, irrespective of how a person values his own life, how others value it is also important, and could potentially be a trump consideration.  But now we aren’t talking about encouraging a person to live, but mandating them to do so; moreover, if that’s the attitude we’re going to take, it looks as though it might be possible that, if enough people hate you, you’d have an obligation to do away with yourself.

So much for point 4.  What about point 6?  Well, one thing to note is that no mention is made of the disabled and terminally ill who don’t fear a change in the law on assisted suicide.  But that’s perhaps a side-issue (albeit one that the campaign doesn’t, and ought to, address).

The idea that an MP should take account of the views of constituents is hardly Earth-shattering.  But the interesting point has to do with the fear that’s talked about.  Whence comes it?  It’s certainly not from AD supporters; by definition, assisted dying is just that – assisted - and no more.  AD ought not to make anyone afraid; the evidence from Oregon, where the availability of life-ending drugs has apparently brought a fall in the suicide rate, would seem to suggest the opposite: that people are less scared when they know they have a way out.  No: the fear seems to be generated by the anti-AD campaigners, who’ve created the chimera that AD is indistinguishable from forcing death on people.  That’s nothing short of a calumny.

The campaign’s spokesperson is Baroness Campbell of Surbiton, who told the BBC that

disabled people need help and support to live, not to die.

“We cannot allow others to speak for us – especially those who seek to offer us the choice of a premature death: it is not a choice, it is to abandon us.”

Well, yes to the first part, about support to live – but that’s wholly compatible with assisted dying.  It’s simply not a zero-sum game; Campbell is trading on a false dichotomy.  And the idea that “we cannot allow others to speak for us” is deeply ironic, given that the whole point of the campaign is to speak on behalf of the terminally ill and disabled, including those who’ve publicly supported and sought assisted dying.

Writing in The Guardian, Campbell says that

If they can make it legal for the life of a single person to be prematurely ended, they will then seek to broaden the criteria. Once early death becomes an “option”, it will gain a respectability that will erode the resolve of many people experiencing personal difficulties. Not only will it enter our heads, it will also enter the heads of our families and friends, those who provide us with health and social care support and, ultimately, those holding the purse strings.

How much more convenient for all if turkeys see voting for Christmas as exercising personal choice. No wonder disabled and terminally ill people are fearful of all attempts to weaken the current law. For any change would fundamentally alter not only how we are seen but also how we are treated and the care that we receive.

Campaigning to keep things as they are, to keep us safe, is not easy to do or explain.

And this seems to provide ammunition for my claim that the fear comes from the anti- campaign.  Let’s ignore the fact that her article runs together euthanasia with assisted suicide as though they’re completely the same thing – a neat but misleading rhetorical trick; note instead the trick whereby the important qualification built into AD arguments about availability is ignored – or possibly just buried under the hints, implications, and baseless fear that’s been sent cascading down the slippery slope.  Campbell makes vague accusations about the motives of unnamed people who – it would appear – just won’t be able to stop themselves killing once they’ve got a taste for it.  Does she really trust her family and friends that little?

Baroness Campbell: we know you’re not dead yet.  You’re missing the point.  If services for the disabled, terminally ill, or anyone else are under threat, then that’s one thing, and I’ll happily go along with a campaign for everyone meriting just consideration irrespective of their health or physical ability.  But it’s utterly different from allowing someone who has freely decided that they don’t want to be alive any more assistance in helping themselves out of the door.

Posted in In the News, Life and Death, Politics.
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  • Iain

    I’m happy that you have made concessions on the reductio and the ‘intemperate’ tone of your opening, so thank you for that.

    Regarding the trivial truth that disabled people have ‘the same status, rights and entitlements simply by virtue of being persons’ I don’t dispute the self-evidence of that to you or to me. The difficulty, as you go some way to acknowledging, is that their manifestation raises the further question: what use is a right if no-one affords it to you? This is the core problem: the rights of disabled people to live without fear and life-threatening interference or withdrawal of treatment based on someone else’s judgement of the value of our lives, are trampled on, ignored, dismissed, flouted, on a daily basis. So being aware of our rights does not remove the need to continue to fight for their implementation, sadly.

    I agree that every human being deserves dignity and respect in virtue of being human but the important rider (as Simone Weil pointed out so clearly) is that each deserves them in the same measure. That is what is lacking here. We are given to believe we are respected by others as human beings but that turns, in their hands, to dismissal as beings worth preserving, and to downright contempt for us and our lives by some.

    Weil makes another important point here: along with the fact that we deserve equal respect/dignity and in the same amount as everyone else, she is clear that this equality consists in ‘a recognition, at once public, general, effective and genuinely expressed in customs and institutions’. That is what the campaign seeks to make clear is not presently available, never mind endorsing a new law which would further damage access to protection of lives deemed by others as ‘not worth living’.

    You make the distinction between the impact – I would say lack of it - and the general truth, and that is what I am doing too. The general truth notwithstanding, the impact of the trivially true, where a just society would indeed afford and protect the rights of all human beings, is starkly absent. That’s the problem: and it’s a life-threatening problem. It goes to the heart of how a disabled life is not only not valued, but is dismissed by so many who believe they have the power to decide on our lives, just because they deem them not worth living in their terms. It is almost (I say almost) tautologous that they are not themselves disabled people.

    I have no difficulty describing the fact of the right’s existence as trivially true but recognise this as restricted philosophical phrasing, and it misleads a wider public which is why I would resist its use in this debate.

    The problem with changing the law is that the status of individual persons does not afford a general right to assist someone to die – such a change does erode the rights of other disabled individuals, does attack and deepen the sense that this (individual) life is not worth living in the minds of many. Who says that everyone who is dying from motor neurone disease will want to end their lives, will not believe their live is worth living to the natural end? Yet, the assumption being fed here is that no-one (in their right minds!) would want this. So not only do we all want to die sooner rather than later but we’re mad and crazy if we don’t. The reactionary arguments of the unconsidered are littered with this kind of ad hominem approach. We cannot even be treated with dignity for holding our position in the debate: what chance have we later, at death’s door?

    Frighteningly, it is a very short slide in some people’s minds (maybe not yours) to extend the notion that a disabled life is not worth living to ‘this and this and these lives are not worth living’; or are too ‘costly’ for others to ‘allow’. Not only might there be institutional pressures, there are already and then we have to factor in family,etc etc, and certain practitioner attitudes and pressures, which is why Shipman, Allitt and now Grigg-Booth are exactly relevant. So too is Staffordshire Hospital, when targets drove practices which compromised patient safety to death.

    Good clinical governance is first and foremost about patient safety, but the case of Staffs shows how easy it is to slide the slope which is not so much slippery as a vertical greasy pole with an immense force pushing people down it.

    I don’t deny the differences between assisted suicide and euthanasia – it would be hard to do so, when one is (currently) an individual case taken on its own merits, the other a program for eradication whether we try to say it’s about relief of pain or not. But Ilora Finlay shows clearly that no-one should have to die in pain or discomfort. If that is the case then surely the moral imperative should be to provide the most pain-free, comfortable, dignified death to all, rather than reacting to the fears of some and implementing laws which would allow a creep, gradual or swift, to a point at which euthanasia becomes acceptable by default.

    Neither will I deny that terminally ill people have real fears: that is precisely why I mention the savage practice of starvation and thirst-induced deaths that go unnoticed more often than they are resisted publicly. Of course this isn’t assisted dying in the sense of the lobbyist – it’s exactly the kind of horror they have learned to fear because of the lack of value placed on the lives and deaths of ‘lesser’ people by the general attitudes of others.

    My point about the foetus, like the point about the withdrawal of food and water, is to highlight the practices that already underpin the moves to assisted dying – there are different complex questions, for example about the rights of the mother as you say, but these are not resolvable in a general way. The difficulty is that the ‘I’ always enters moral decision-making; moral decision-making is always personal.

    Additionally, in the moment of taking a life for someone, which is what the assistant is asked to do, the rights of the one wanting to die may very well trample of the rights of the one doing the killing. This is not explicit in the lobbying but it is certainly not unimportant, and needs a deal more discussion. It is not just pressure on one person to die we must consider, but pressure on another to take the life of that person. Even if the motive could be separated out as pure love, and I don’t think that’s possible, all sorts of imponderable questions remain. Again, this is something the campaign wishes to point out – it is not a simple matter of compassion which everyone shares for the one who is dying.

    In the end my defence is this: the place and status of disabled people is already so undermined, that the formal recognition of their rights amount to very little or nothing at all. That is the lived experience of many disabled people, and what we cannot risk to be undermined any further.
  • Kevin –
    The question of lives worth living is a toughie, but I think you’re skipping too many steps to substantiate your worry about not allowing others to live – and in drafting this reply, I’ve kind of decided that it merits a blog post of its own, which I’ll formulate over the next couple of days if I get the chance.

    But there’s some stuff that I can address here. First, I don’t agree that the disabled (or anyone else) has dignity by virtue of being human; that would be species chauvinism. What counts is personhood: not all humans are persons, and not all persons have to be human. (That’s at least a big part of the comment about the foetus, by the way.) It makes a big difference to the shape of the debate, though, when we’re talking about how we ought to think about the value of life and of a given life.

    Second, the fact that certain philosophical terms might mislead those who aren’t familiar with their use isn’t much of an objection. Technical terms are a handy way of getting to the core of any debate, and to forbid them on the basis that they’re unfamiliar to some would mean that all debates are at risk of being bogged down in endless explanation – and I do mean endless, since you couldn’t be sure that your explanation of term A wouldn’t require an explanation of its own.

    Third, I don’t know whether your “euthanasia by default” comment is meant to indicate a worry that it’d become a first-line option – a worry that I think massively overblown – or to indicate a worry that it will be considered acceptable. If the latter, I’ve got no problem with that. I think that euthanasia is – or, at least can be – perfectly acceptable. Of course, there can be unacceptable instances of euthanasia as well – but I stand by the claim that it can be a defensible option.

    It’s certainly not the case that euthanasia is a programme of eradication. That’s just crazy. (At risk of falling foul of Godwin’s law, I know that there’ve been awful things done under the title of euthanasia during the past couple of centuries. But they weren’t, in the end, euthanasia. There is, as far as I can see, no such thing as involuntary euthanasia; and the meaning of non-voluntary euthanasia is quite tightly limited. Any death caused that isn’t motivated by a concern for the interests of the person about to die just ain’t euthanasia.)

    Of course, the elimination of the risk of dying in pain or discomfort is devoutly to be wished for. But that’s perfectly with allowing assisted death or euthanasia for those who want it. And, of course, there may be people who’d say that, of course they appreciate the value and merit of palliative care, but, all the same, they just don’t want it.

    Now, I think you’ve hit on something with your distinction between the (arguable) rights of the patient to assisted death and the rights of the HCP not to administer it. I’d happily accept that there “right” to AD is a right purely in the sense of “permission” – it’s not an entitlement. But the same applies to this as to any other instance of medical intervention: noone thinks that patient requests are or ought to be the whole story from an ethical point of view – and since Burke that’s been clear from a legal point of view as well.

    In sum, while your general point about the place of the disabled may well have a great deal of mileage to it, it doesn’t really tell us all that much about assisted dying. Many of the points you make are perfectly sound, and just about anyone ought to agree with them. But they’re also distractions, and they obscure the fact that, at least in relation to AD, there’re too many things that you’re taking for granted, and too many leaps in your reasoning.
  • Iain

    I’m happy that you have made concessions on the reductio and the ‘intemperate’ tone of your opening, so thank you for that.

    Regarding the trivial truth that disabled people have ‘the same status, rights and entitlements simply by virtue of being persons’ I don’t dispute the self-evidence of that to you or to me. The difficulty, as you go some way to acknowledging, is that their manifestation raises the further question: what use is a right if no-one affords it to you? This is the core problem: the rights of disabled people to live without fear and life-threatening interference or withdrawal of treatment based on someone else’s judgement of the value of our lives, are trampled on, ignored, dismissed, flouted, on a daily basis. So being aware of our rights does not remove the need to continue to fight for their implementation, sadly.

    I agree that every human being deserves dignity and respect in virtue of being human but the important rider (as Simone Weil pointed out so clearly) is that each deserves them in the same measure. That is what is lacking here. We are given to believe we are respected by others as human beings but that turns, in their hands, to dismissal as beings worth preserving, and to downright contempt for us and our lives by some.

    Weil makes another important point here: along with the fact that we deserve equal respect/dignity and in the same amount as everyone else, she is clear that this equality consists in ‘a recognition, at once public, general, effective and genuinely expressed in customs and institutions’. That is what the campaign seeks to make clear is not presently available, never mind endorsing a new law which would further damage access to protection of lives deemed by others as ‘not worth living’.

    You make the distinction between the impact – I would say lack of it - and the general truth, and that is what I am doing too. The general truth notwithstanding, the impact of the trivially true, where a just society would indeed afford and protect the rights of all human beings, is starkly absent. That’s the problem: and it’s a life-threatening problem. It goes to the heart of how a disabled life is not only not valued, but is dismissed by so many who believe they have the power to decide on our lives, just because they deem them not worth living in their terms. It is almost (I say almost) tautologous that they are not themselves disabled people.

    I have no difficulty describing the fact of the right’s existence as trivially true but recognise this as restricted philosophical phrasing, and it misleads a wider public which is why I would resist its use in this debate.

    The problem with changing the law is that the status of individual persons does not afford a general right to assist someone to die – such a change does erode the rights of other disabled individuals, does attack and deepen the sense that this (individual) life is not worth living in the minds of many. Who says that everyone who is dying from motor neurone disease will want to end their lives, will not believe their live is worth living to the natural end? Yet, the assumption being fed here is that no-one (in their right minds!) would want this. So not only do we all want to die sooner rather than later but we’re mad and crazy if we don’t. The reactionary arguments of the unconsidered are littered with this kind of ad hominem approach. We cannot even be treated with dignity for holding our position in the debate: what chance have we later, at death’s door?

    Frighteningly, it is a very short slide in some people’s minds (maybe not yours) to extend the notion that a disabled life is not worth living to ‘this and this and these lives are not worth living’; or are too ‘costly’ for others to ‘allow’. Not only might there be institutional pressures, there are already and then we have to factor in family,etc etc, and certain practitioner attitudes and pressures, which is why Shipman, Allitt and now Grigg-Booth are exactly relevant. So too is Staffordshire Hospital, when targets drove practices which compromised patient safety to death.

    Good clinical governance is first and foremost about patient safety, but the case of Staffs shows how easy it is to slide the slope which is not so much slippery as a vertical greasy pole with an immense force pushing people down it.

    I don’t deny the differences between assisted suicide and euthanasia – it would be hard to do so, when one is (currently) an individual case taken on its own merits, the other a program for eradication whether we try to say it’s about relief of pain or not. But Ilora Finlay shows clearly that no-one should have to die in pain or discomfort. If that is the case then surely the moral imperative should be to provide the most pain-free, comfortable, dignified death to all, rather than reacting to the fears of some and implementing laws which would allow a creep, gradual or swift, to a point at which euthanasia becomes acceptable by default.

    Neither will I deny that terminally ill people have real fears: that is precisely why I mention the savage practice of starvation and thirst-induced deaths that go unnoticed more often than they are resisted publicly. Of course this isn’t assisted dying in the sense of the lobbyist – it’s exactly the kind of horror they have learned to fear because of the lack of value placed on the lives and deaths of ‘lesser’ people by the general attitudes of others.

    My point about the foetus, like the point about the withdrawal of food and water, is to highlight the practices that already underpin the moves to assisted dying – there are different complex questions, for example about the rights of the mother as you say, but these are not resolvable in a general way. The difficulty is that the ‘I’ always enters moral decision-making; moral decision-making is always personal.

    Additionally, in the moment of taking a life for someone, which is what the assistant is asked to do, the rights of the one wanting to die may very well trample of the rights of the one doing the killing. This is not explicit in the lobbying but it is certainly not unimportant, and needs a deal more discussion. It is not just pressure on one person to die we must consider, but pressure on another to take the life of that person. Even if the motive could be separated out as pure love, and I don’t think that’s possible, all sorts of imponderable questions remain. Again, this is something the campaign wishes to point out – it is not a simple matter of compassion which everyone shares for the one who is dying.

    In the end my defence is this: the place and status of disabled people is already so undermined, that the formal recognition of their rights amount to very little or nothing at all. That is the lived experience of many disabled people, and what we cannot risk to be undermined any further.
  • @Kevin -
    Thanks for that: it's far more comprehensive a post than I can do justice to right now, but it's probably worth making a couple of quick points all the same. I’m not going to give you an account on whom I’ve read or heard speak, or when, though.

    First up, I’ll make a concession. Perhaps the “absurdity” claim is a bit strong, and maybe the reductio doesn’t quite work. I happen to think that it’s not all that wide of the mark, but I’ll happily concede that my tone in the opening salvo is (ahem) a touch on the abrasive or intemperate side. I’m not going to alter it – if I made a mistake there, then I’m happy for it to remain in the public record just so subsequent readers know what’s going on.

    I stand by the "trivial truth" point: that disabled and non-disabled persons have the same status, rights and entitlements simply by virtue of being persons I take to be about as close to self-evident as you can get in moral debate. Of course, how that status and those rights and entitlements manifest themselves might alter depending on circumstance; and it might be that there are practices, policies and instances of brute bad luck that (sometimes inadvertently) limit the extent to which a person can claim those rights (and I'll use the word "rights" as a catch-all from now on for the sake of ease). But, formally, those rights would be there all the same. Quite plausibly, it's the function of a just society to ensure that those rights - whatever they turn out to be - are underwritten to the greatest extent possible. A society in which some people are accorded a second-class status simply because of some quirk of physiology or illness falls, to that extent, short of being a just society. There ought to be nothing controversial at all about this; that's why I take it to be trivially true - not because of the impact, but because it's a very straightforward argument.

    Flowing from the claims about the status of persons, we might well find the right not to have your life deliberately ended without your explicit request. Assisted suicide does not have to impact on this right. In a reasonably well-written law, all its legalisation would do would be to give those who positively want to end their lives a degree of freedom to seek assistance.

    Naturally, I agree that a situation in which Smith tried to encourage Jones that his life was not worth living would be wholly morally different. I also agree that there might be institutional pressures that amount to something like that kind of encouragement, and that they ought to be removed – see my earlier point about just societies here. Still, that's compatible with providing assistance to those who want assistance, if there is any such person.

    As for the distinction between assisted dying and euthanasia - well, I agree that there are elements that they have in common (though I think that there are significant differences too); and it’s obviously true that there are people who are supportive of the legalisation of both. For example, I think that allowing assisted dying without making provision for those who can't actually administer the procedure themselves would be paradoxical; hence I think that, if we allow AD without also allowing people to request that others administer it, we'd have fallen foul of that paradox. If that's euthanasia, then so be it. But I don't agree with the slippery slope analysis: first, because I don't think that there's much of a slope; second, because I don't think it's necessarily all that slippery.

    You mention the withdrawal of food and water, and how I say nothing about it here. That's certainly something that raises a whole load of ethical (and legal) questions. However, they aren't clearly questions about assisted dying; that's why I don't pursue that particular line. Very quickly, though: if we're talking about withdrawal of nutrition and hydration from someone who has not refused them - say, someone in a coma whose condition the medical staff think will never improve, or for whom the continued administration of such is judged to be burdensome - they we aren't talking about assisted dying in the sense that AD proponents mean the term. If, on the other hand, we're talking about someone who positively refuses them - well, here we might be talking about AD if the reason they've refused them is so that they will die – though I do have a couple of misgivings about using the term in such circumstances. More importantly, though, I think that a situation in which a person wants to die and needs help, but the only help available is that someone can remove the feeding tube to allow a slow death from thirst or hunger – well, I think that that’s pretty grotesque. This takes us back to the euthanasia question, though – I’m not alone in thinking that it ought to be permissible to administer something to speed death to those who request it in those situations.

    Your point about the killing of the foetus seems to me to miss the target – not least because the rights of the woman to decide what happens with her body also need to be taken into account. Even if you think that a decision to terminate a Downs foetus just because it’s a Downs foetus is morally flawed (and I can see how that argument would be perfectly coherent), you still have to account for the fact that the mother is a fully-fledged person, and a foetus simply isn’t; irrespective of its physical quirks, there’s a non-crazy argument to be made that its claims are always going to lose out to its mother’s. (On this, see my “Brazil Nuts?” post, just below this one.)

    Generally, my defence is simply this: that questions about the place and status of the disabled are one thing, and – at least formally – questions about the permissibility of assisted dying are quite another. I think that ethics is done much better if we keep these formal distinctions in mind. It’s possible to speak on behalf of a desire for parity of esteem for all persons on one day, and on behalf of making it possible for those who want to end their lives to get help to do so on another. There need be no tension here, and the latter claim has nothing inherently to do with disability or illness, since it applies to all persons equally. And that’s what underpins my claim that, whatever fears the disabled or terminally ill have about assisted dying, they aren’t warranted by anything that any plausible defender of AD has said; all the powerful defences of AD I’ve seen have been scrupulous in pointing out that they aren’t making any claim about the value of the life of any person or group of people. Nor are AD defenders, as far as I can tell, making positive claims or assertions about particular individuals’ motivations; aren’t the arguments much more along the lines that if there is a person with such-and-such desires, and they are genuinely held, and a number of other conditions are met, then they should be able to access whatever it is they desire?

    (Incidentally, I don’t get the thrust of your Shipman or Allitt comment; neither of them has much to do with assisted dying, and if the illegality of their wrongdoing didn’t stop them doing it anyway, it’s not easy to see why they’re mentioned here. Ditto the BBC link.)

    I doubt that this has met your objections – as I said, your post contains a great deal, and merits serious thought – but I hope that it’s gone at least some of the way.
  • Ian Brassington’s response (5 June 2010) is unfortunately all too typical and displays some breathtaking insensitivity along the way.

    His attempt to defeat the campaign against assisted suicide by reductio ad absurdam might have been ok if it were not allied to a flippant turn of phrase and remarks like ‘it’s trivially true that disabled and terminally ill people have the same moral status as the non-disabled (sic)…’ [as though any group of human beings was or could be viewed as a homogenous whole…]

    It might be trivially true to Brassington – but the whole point here is that if it were trivially true to everybody then disabled and terminally ill people would not have to face the problems that the campaign seeks to highlight and defeat.

    This demonstrates one of the most fundamental and attritional struggles that disabled people must face in educating their non-disabled peers – non-disabled people may kid themselves that they ‘understand’ the lives and positions of disabled people, but really they don’t. It’s not a question of can’t understand. (Solipsism is nonsensical.) It’s rather a matter of won’t understand, either through laziness or simple mauvaise foi.

    Unless Brassington is willing to really get to understand the lived experience of disabled people (and by that I clearly do not mean being/becoming disabled – see the comment about solipsism) then he should not stoop to compare those people’s lives to egg sandwiches, for any reason.

    Brassington falls into the same old trap that has dogged policy thinking for as long back as I can see: it is a fatal flaw in logic known as the fallacy of moving from particular to general case.

    One person, who is disabled or terminally ill, says I would like to end my life: therefore we must immediately accept that it is the right of all. Even a group, large or otherwise, crying out ‘this is how things should be’, is no guarantee that this group is right. Socrates knew that (but we don’t seem to learn and look the parallel with his death.) We don’t have to go so far back in history to see the huge and disastrous consequences of following a group mentality for hundreds of millions of lives.

    The scathing nature of the remark in parentheses – the arrogant dismissal of putting it in brackets in the first place – ‘Yes, it really does call itself a resistance movement’ – again misses the reality that many disabled and terminally ill people face and will face more acutely should legislative change come about. Yes, Mr Brassington, this really is about our lives. I hazard that if you faced a similar threat to your life or the lives of your family members or friends you too would want to resist, with all your might. And that you call us ‘straw men and Aunt Sallies’ speaks to who you are and not who we are.

    We are many things but we are not stupid. Oh and yes, we are perfectly well aware of the debate in Brian Clark’s ‘Whose life is it anyway?’.

    I can pretty much guarantee that Brassington has never heard Baroness Ilora Finlay speak about palliative care, from her point of view as one of the most experienced consultants in the field.

    Reductio ad absurdam can be a powerful tool in logic to expose fatal flaws in arguments but in case anyone is impressed by its deployment here, please be aware that it has not be used to good effect. Jane Campbell’s protest that we cannot allow others to speak for us is not ‘ironic’ – it is part of her/our lived experience that people who make judgements, especially in clinical settings, about the ‘quality’ of a person’s life are most often not the person whose life it is. But we have for too long afforded doctors this status of being the ones whose judgement takes precedence over all others when making assessments about ‘quality’ of life.

    Brassington has nothing to say about the savage treatment of terminally ill people by withdrawal of food and water. Nor does he speak about the rights of an unborn child with Downs Syndrome for example.

    Striving to protect anyone who becomes vulnerable to this kind of ‘attack’ is not somehow specious, because it attempts to protect us all (and here I include Brassington too). And it is not a ‘neat but misleading rhetorical trick’ to speak about assisted suicide and euthanasia in the same breath. If Brassington had understood the point better he would be able to see that one of the core beliefs of The Resistance is that there is a slide between the two (not so far apart) positions. If he wants to challenge that slide then at least treat the fear with due consideration and respect, and cite evidence from the Netherlands that shows the rise in the actual numbers of deaths reported as ‘assisted suicide’ since the legislation was introduced.

    Anyone who becomes a patient, let alone a disabled or terminally ill patient, can become ‘vulnerable’ no matter what their station in life. Intelligent articulate successful people can become naturally destabilised in the shock of understanding that their lives will soon end. There are so many complexities in even one such situation and the campaign seeks to make it clear that because there are so many complexities we cannot ever have a blanket prescription enabling people to take a life in these or any circumstances. This is not a fear of ‘unnamed people’ (Shipman and Allitt already spring to mind) but it is a protest that the ‘AD crowd’ do not have a simple straightforward argument or clear ground. And the truth is, they never will because human behaviours and motivations are just not open to that kind of analysis.

    I could continue to argue every point in this blog, but I have better things to do than argue with a closed mind and sloppy thinking.

    But to be clear, it’s not her friends or family that Jane fears – after all they have protected her life every time she needed it since she was born. It is people like Iain Brassington that Jane fears and when people like him can and still do assume positions of absolute power over the lives and deaths of others, can you blame Jane and us for wanting all the protection we can get?

    In that way, thank you Mr Brassington – you make our point neatly for us.

    Addendum: If you still remain unconvinced, see this news today about Anne Grigg-Booth – another one with a ‘god complex’….and if I was religious I’d shout ‘God help us all!’ http://news.bbc.co.uk/1/hi/eng...
  • Honestly, I don't see how anyone can be opposed to letting a mentally competent adult choose how they die. Given the choice between a drawn-out, painful death, and one that's quick and relatively painless, occurring in the time and place of my choosing, with some measure of my dignity left intact, I know what I'd choose.

    The basic question is whether or not my life belongs to me, or if it belongs to someone else. If my life belongs to me, it's mine to end, if I so choose.
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