There’s an essay by Diego Gracia called “Palliative Care and the Historical Background” that I frequently use in classes about Care ethics, and there’s a passage in it that always gets a fascinating reaction from students.  In this passage, Gracia claims that

the true goal of medicine has always been curing, rather than taking care of the patient. Caring has never been the goal of medicine.

In fact, in the context of palliative care, he takes this one step further:

Thus, if the type of care specific to medicine is curing, then palliative care has nothing to do with medicine…

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Doubtless many of you will have heard by now of Kerrie Wooltorton, who, apparently depressed by her fertility problems, drank anti-freeze, called an ambulance, and handed a living will to staff at A&E. Her story is reported by the Telegraph under the headline “Suicide woman allowed to die because doctors feared saving her would be assault” more…

In the wake of the DPP’s publication on Wednesday of guidance about assisted suicide, the Telegraph is reporting that the Christian Legal Centre is considering launching legal action to halt the implementation of that guidance.  The nub of their claim is that Lord Phillips, who had ruled in the summer that clearer guidance ought to be provided, showed in a newspaper interview in September that he was unsuitable to preside - he’d said that he felt “enormous sympathy” for terminally ill people who wanted to end their lives.  Thus the CLC’s claim is that:

these remarks showed that Lord Phillips had allowed his personal views to colour his judgement in the Purdy case.

This, the CLC insists, is in violation of Article 6 of the ECHR, which guarantees a fair trial.

There’s a range of things that the CLC has not noticed.  The first is that the human right to a fair trial is designed to protect… er… humans.  It’s not entirely clear to me that anyone’s rights were infringed, not least because it’s not clear that there’s anyone involved in the Purdy ruling who was in a position to have had any rights infringed to begin with.  Second, there’s no reason at all why being sympathetic to people in Purdy’s position would have to make any difference to a judge’s ability to interpret and apply the law, any more than why sympathy for a victim of mugging makes it less possible to try a suspect fairly.  His comments certainly do not show that his judgement was clouded; they don’t even give a reason to worry that they might have been clouded.  Note that Phillips didn’t say that he was sympathetic or well-disposed to Purdy’s suit; he said he felt sympathy for her and people in her position.  That’s very different, and you’d have to be quite a monomaniac to miss that point.

Oh, wait.  This is the CLC.  Hmmm.

Third, Andrea Williams, director of the CLC, says that

[j]ustice must be seen to be done. He [Lord Phillips] should be showing a clear lack of impartiality. These are fundamental issues that affect life. They are a matter of life and death.

I suspect the idea that judges should be showing a lack of impartiality is a typo, but it’s quite an amusing one.  Now, that justice should be seen to be done is is a long-standing principle of law: not only is it important that everyone has access to justice, but it’s also important that the justice system be transparent.  Impoprtantly, the DPP’s guidlines contribute to this clarificatory process.  My slight worry, though, is that the CLC has interpreted “seen to be done” as meaning that a criterion of justice is that it accord with expectations, which is simply not the case.

It’s also striking that a Christian group - hell, any reasonably decent person at all - should object to a judge because he’s expressed sympathy for people in difficult circumstances.  If your objection to a judge’s ruling is that he has elsewhere proved himself to have human feelings, then it’s not really much of an objection.

(Have a look at the CLC’s website.  It’s quite odd - note how, when the CLC wins a case, they thank God for it.  I’m willing to guess that they don’t blame him when they lose, though, which seems a bit unfair…)

The Director of Public Prosecutions has today published interim guidelines on prosecutions for assisted suicide in England and Wales - they’re available here (and Northern Ireland will get its own consultation process).  I’ve not had time to consider them in full, but there’s a number of things that stand out to me as worthy of comment. more…

Astute readers are no doubt already following the story of Debbie Purdy who is seeking to have the law of assisted suicide in the UK clarified, given that historically those who have traveled overseas and provided assistance have not been prosecuted in the past, despite it appearing that they are breaking the law.

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Lord Falconer’s amendment to the Coroners Bill, which would have made specific legal provision for those helping others to travel to places like Dignitas, was rejected by the House of Lords last night.

Oh, well.  As Falconer admits, it’s not obvious that it’ll make all that much difference on the ground, because few, if any, have the stomach to prosecute in such cases, and it’s not a given that the public interest’d be served anyway.  So the limbo continues.

Rowan Williams, Vincent Nichols and Jonathan Sacks wrote to the Telegraph on Tuesday to voice opposition to the Coroners and Justice Bill currently making its way through Parliament.  They allege that the amendment dealing with assisted suicide introduced by Lord Falconer (and reproduced here, on the Dignity in Dying website) is a step on the road to legalisation of euthanasia:

Now, by way of an amendment to the Coroners and Justice Bill, the legality of assisting people to end their own lives is once again to be debated. The proposed amendment seeks to protect from prosecution those who help friends or relatives to go abroad to commit suicide in one of the few countries where the practice is legal.

It would surely put vulnerable people at serious risk, especially sick people who are anxious about the burden their illness may be placing on others. Moreover, our hospice movement, an almost unique gift of this country to wider humankind, is the profound and tangible sign of another and better way to cope with the challenges faced by those who are terminally ill, by their loved ones and by those who care for them.

This amendment would mark a shift in British law towards legalising euthanasia. We do not believe that such a fundamental change in the law should be sought by way of an amendment to an already complex Bill. It should be rejected.

I’m not backwards in coming forwards in my support for the legalisation of euthanasia - but the C&J Bill, if it really is a step in that direction, is a very small one indeed.  So, while the Bill is very compex - “sprawling” would be a better word - that the amendment concerning assisted suicide is really not nearly as big a deal as I think the trio makes out.  Nor is it clear to me that there would be any greater risk to the vulnerable generated by the Bill than there is already.

On top of that, it’s curious how these men of the cloth have very little regard for the plight of those who are not vulnerable - for those, that is, who have simply had enough and would like help in bringing about an end to a life that is no longer worth the fight.

Little regard?  What about the reference to hospices?  Well, that’s just it.  Hospices are great things - but the letter commits the fallacy of thinking that hospices count as a cure-all for the distress of the dying.  They aren’t.  Some people have just had enough, and pointing out how great the hospice movement is misses the point, because for them, hospice treatment would not be the better option.  Worse, to shunt people towards hospices when hospice care is not what they want is good neither for the patient nor the hospice - and it ignores the distinct possibility that the people who are being so shunted are, by the letter’s own lights, likely to be vulnerable.  If it’s the unwelcome pressure that is the backbone of the Archbishops’ and Rabbi’s concern, then pressuring the ill into a care pathway that they do not want seems like a very strange way of going about things indeed.

Just as a point about the rhetorical strategy adopted, I’d add to these points that using the word “Surely” is frequently a shorthand for “I have this gut feeling but I can’t be bothered trying to present an argument for its plausibility” - and the use of the word in the letter here strikes me as conforming to the rule.  And the patriotic appeal to the “almost unique gift of this country to wider humankind” (is that “almost unique” as in “not unique”, then?) is simply nauseating.

Incidentally, a letter to The Times from a number of members of the House of Lords deals with the possible legal and jurisprudential implications of the amendments.  It’s still against the amendments - but it is so in a much more considered manner.

Debbie Purdy goes to the House of Lords today to seek assurance that her husband won’t be prosecuted for assisting suicide should he accompany her to the Dignitas clinic.  It’s hard not to sympathise with her request - but, speaking on the Today programme this morning, former DPP Sir Ken MacDonald said that he hoped her bid failed.  And, at least from a legal point of view, I think he might be right.  In essence, his point is that there’s something wrong with going to court to get permission in advance to break the law.

He added, though - also correctly - that there’s a very good reason to review the law.  MacDonald came over as thoughtful and insightful - and a whole lot more impressive than George Pitcher, who had spoken on the same topic a little over an hour earlier.  Quite why he should have been given airtime is beyond me - his qualifications seem simply to be that (a) he’s religious affairs editor of the Telegraph and (b) the BBC seems to think that you can’t have ethics without a large slice of religion (just have a look at this page to see what I mean).  Still - there he was.  And, lordy, did he talk some bollocks - which is appropriate enough.  Worse, it was tired, hackneyed, and false bollocks.

There were several claims: that allowing PAS or euthanasia is socially harmful and undermines the “social fabric” - whatever that is; that it diminishes the importance of death as a part of human life; that it undermines palliative care; that this point can be proved by looking at Holland and its non-existent palliative care system; and that allowing PAS or euthanasia for the ill will inevitably lead to its being available to the healthy.

Let’s deal with the last point first.  more…

The BBC is reporting that families may be able to request that post-mortems be carried out by MRI rather than invasively under new proposals.  The qualification here is that

[c]oroners [would] make the decision on a case-by-case basis as MRI scans may not always be the appropriate means to determining a cause of death, the government said.

This looks fairly reasonable in many ways.  The point of a post-mortem is to discover the cause of death; opening up a few corpses has been, up until recently, the most efficient way to do this; but there’s nothing special about opening them up.  If we can learn the same non-invasively - and, sometimes, we can - then there is no need to be invasive.  Indeed, it might be a less efficient way to go about things, in which case an invasive procedure would perhaps be a waste of resources and therefore (on the assumption that waste is wrong) morally problematic.

However, I do have a residual worry about the family being able to request an MRI examination instead of evisceration.  The decision to pursue a post-mortem has to do with questions of justice and of public health - and, to this extent, it’s unclear why the family has any privileged position.  If I objected to invasive post-mortems as a rule, then the fact that I am (or was) related to the corpse doesn’t seem to add much; and if it would be strange for me to request an MRI examination on a non-relative, and stranger yet to have that request granted - and it would - then it’s not clear why familial relationships should be any different.

There’s another problem:

A spokesman for the Ministry of Justice said that “justice and establishing the cause of death will always come first” but the new system will allow some flexibility “if it is a straightforward case”.

But how do we know in advance what is straightforward?  The recent case of the death of Ian Tomlinson is a salutary warning: quite aside from questions surrounding the circumstances of his death, his is a case in which it was thought to be reasonably straightforward… and we’re now onto our third PM.  His is a graphic example, but the point stands that even “traditional” PMs do not always give clear results, and we don’t always know whether we ought to be looking for something non-straightforward until the knives have come out.

A curious story from the Irish Times: a lecture by Len Doyal on euthanasia had to be cancelled after disruption from protesters: he’s now complained to the President.  The protesters apparently shouted obscenities and, er, the Rosary.

There are more details here.  In the meantime, I just can’t help myself:

 Thanks to Richard Ashcroft and Sorcha Uí Chonnachtaigh for the pointer.

UPDATE: The HSE - that’s the Irish version of the NHS - has issued a statement on the incident, available here.