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Assisted Dying for the non-Terminal

14 Apr, 11 | by Iain Brassington

I’m a bit behind the curve with this, but I thought it worth noting the story of Nan Maitland, who recently travelled to Dignitas* at the start of March.  She was suffering from arthritis – which, though painful, is a long way short of a terminal illness.  (Her story is reminiscent of Robert and Jennifer Stokes.)

Maitland’s decision was – predictably – not supported by Care not Killing, whom The Guardian reported as saying that

the case demonstrated “a shifting of the goalposts” by pro-rights campaigners and would place pressure on vulnerable people to end their lives if they felt they were a burden. “It’s a very scary situation that not very severely disabled people could, at the drop of a hat, opt to kill themselves, and [Maitland’s case] shows a ramping-up by campaigners,” said a spokesman. “Many people have to live with arthritis. It does expose the lie that only people who are terminally ill will be affected by changes in the law.”

Perhaps more suprisingly, Dignity in Dying also spoke against Maitland’s decision:

“We don’t think that you could faithfully have in law assistance for someone who wasn’t terminally ill. Then you’re making judgements about quality of life, not quality of death.” She said their work was to improve the experience of death for those “where it was an inevitability”.

I think that both organisations are wrong.Essentially, this is because I think that the most powerful prop for arguments for assisted dying comes from appeals to autonomy, self-determination, or other concepts of that ilk.  Plainly put, if there’s no independent moral argument against the permissibility of self-killing – and there isn’t, as far as I can see** – then it’s your business and yours alone.  Nor can I see much problem with helping those whose decision is authentic.  The big worry that’s articulated against the legalisation of assisted dying is that people might be coerced into it; and that’s legitimate – but tells us nothing about those who aren’t coerced.

This always seemed to me to suggest a problem with the Joffe Bill (and I’ve written about it here): though, for understandable reasons, it would only have allowed AD for those suffering unbearably from a terminal illness, my hunch is that it’s going to be much easier to coerce someone who fits these criteria than someone who doesn’t.  If someone is neither terminally ill, nor ill at all, and is not suffering intolerably (whatever that means), then their decision to die would seem to be fairly reliable.

Maitland’s story gives no reason to suppose that there was any coercion, or that her decision was anything other than authentic.  For sure, she was suffering, and that might give us pause to worry about the authenticity of her request for AD – but the circumstances of her death suggest that she knew exactly what she was doing.

Dignity in Dying’s statement becomes more puzzling the more I think about it, actually.  I mean: death is an inevitability for all of us, and it’s not clear that you can separate quality of death decisions from quality of life ones, since the dying process is something that happens within your life.  Nor is anyone except the person whose life and death it is to begin with being asked to make any judgements when it comes to AD – remember that we’re thinking about assistance: it is the would-be dead person who is in the driving seat.  (To this extent, DiD seem to have accepted CnK’s hidden premise that people are generally untrustworthy and will happily nudge others towards death given the opportunity.)  Maybe DiD is just being a bit vanilla for political reasons.

Whatever: the question is this.  If you’re serious about the right to assistance in dying, is there any reason why you should forbid it to the non-terminal?

*Interesting how the phrase “travel to Dignitas” has acquired such a powerful euphemistic aspect…

**OK – a slight modification is in order here.  One possible argument against the permissibility of self killing might be that your death would place a burden on others.  But I don’t think that anti-euthanasia people would want to place too much weight on that, because there could conceivably be times when the same works the other way, and your continued survival would be a burden.

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  • Keith Tayler

    I do place a great deal of weight on what you describe as the 'burden to others' argument. If you think it works the other way round you would appear not to understnad the argument. It is not of course because it is a just 'burden', if by that you mean unwanted and unpleasant tack.

    Have spent too long explaining the problem in other postings. Please do not try to 'think' for the 'anti-euthanasia people' – best to listen (I disagree with most anti-euthanasia arguements). Of course I agree with you that 'self-killing… it’s your business and yours alone'. But you do not really mean that and that is the problem.

  • James Harris

    Iain,

    Dignity in Dying’s position on the death of Nan Maitland and the questions it raises is set out in detail in the following blog post:

    http://dignityindying.blogspot

    Although I appreciate that our campaign will not win favour with both those who oppose any change in the law on principle and those who support a wider change in the law (on principle?), I can assure you that it is not based on political expediency.

    Dignity in Dying aims to deal with a specific problem, which is that despite access to good quality end of life care some people will still suffer against their wishes in the last days or weeks of life. As a society we permit the hastening of death, via the withdrawal of treatment and/or the principle of ‘double effect’, however we do not enable non-dying people to end their lives. We think that this balance should be retained, whilst allowing for greater individual control over the dying process for those that are terminally ill via an assisted dying law.

    This is not to say that we don’t respect the decisions of non-dying people to end their lives, we do in line with other organisations like the Samaritans, but there is a difference between this and actively supporting a new law which would enable them to die.

    As our blog post states:

    “Prominent opponent of a change in the law on assisted dying, Baroness Finlay, said in response to Nan Maitland’s death “where do you stop?” Precisely. If there is a slippery slope, we are already on it – Dignity in Dying believes it’s time to act, both to alleviate suffering at the end of life and to better safeguard patient safety.”

    Best wishes

    James (Harris)
    Dignity in Dying

  • James Harris

    Iain,

    Dignity in Dying’s position on the death of Nan Maitland and the questions it raises is set out in detail on our blog (The Campaign for Dignity in Dying).

    Although I appreciate that our campaign will not win favour with both those who oppose any change in the law on principle and those who support a wider change in the law (on principle?), I can assure you that it is not based on political expediency.

    Dignity in Dying aims to deal with a specific problem, which is that despite access to good quality end of life care some people will still suffer against their wishes in the last days or weeks of life. As a society we permit the hastening of death, via the withdrawal of treatment and/or the principle of ‘double effect’, however we do not enable non-dying people to end their lives. We think that this balance should be retained, whilst allowing for greater individual control over the dying process for those that are terminally ill via an assisted dying law.

    This is not to say that we don’t respect the decisions of non-dying people to end their lives, we do in line with other organisations like the Samaritans, but there is a difference between this and actively supporting a new law which would enable them to die.

    As our blog post states “prominent opponent of a change in the law on assisted dying, Baroness Finlay, said in response to Nan Maitland’s death “where do you stop?” Precisely. If there is a slippery slope, we are already on it – Dignity in Dying believes it’s time to act, both to alleviate suffering at the end of life and to better safeguard patient safety.”

    Best wishes

    James (Harris)
    Dignity in Dying

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