Vulnerable people may request assisted suicide because they think they are a burden, and the limits of any new law could be expanded, writes Mark Pickering
“Many of those prominent in the [assisted suicide] debate have strong religious beliefs… it is essential that people participating in the public debate declare their religious beliefs. This is partly because their beliefs will influence their views but also because their religion may require them to take a particular view,’ so wrote Richard Smith, former BMJ editor. [1]
But why consider only religious beliefs? Why not political or philosophical beliefs, or the entrenched views of social circles or pressure groups? These affect the way many of us think, and may limit our ability to speak freely (or to change our minds) through peer pressure or fear of censure.
The truth is, we all have deeply held beliefs and affiliations that influence our views. Religious beliefs may be easier to identify (and dismiss), but they are not the only relevant ones. The General Medical Council acknowledges that “all doctors have personal values that affect their day-to-day practice.” [2]
Some of the arguments frequently used against assisted suicide are common among many groups, including legislators, disabled people, and many doctors, regardless of any religious affiliation. For example:
- Protection of vulnerable patients who may feel a burden (a reason given by 55.2% (79/143) of the patients recorded as dying by assisted suicide in Oregon in 2017). [3]
- Likelihood of incremental extension—as many of the patients in recent high profile assisted suicide court cases were not close to death, the six month prognosis clause often included in proposed legislation would be immediately ripe for legal challenge.
The rejection of Rob Marris MP’s bill in 2015 by 330 to 118 votes was decisive. The House of Commons is not known for its religious faith, and MPs are surely capable of discerning when an argument against assisted suicide depends on a religious worldview, and when it does not, regardless of who makes it.
It is reasonable to suggest that people with a religious worldview may on balance be more receptive to some arguments against assisted suicide than non-religious people. Many religions teach the value of caring for, and protecting, the vulnerable in society, for example. But ethical values themselves do not depend on adherence to any religion. This is why liberal atheist academic Kevin Yuill can state that deriding opposition to assisted suicide as religious in nature is “easier than confronting hard questions or inconvenient truths.” [4]
“Dignity” is routinely mentioned in debates about assisted suicide, yet rarely defined: I was unable to find any definition on the website of the pro-assisted dying organisation Dignity in Dying. [5] Proponents of assisted suicide frequently advocate for “a dignified death,” often referring to autonomy in end of life choices. But this is somewhat different to dignity, which the Oxford dictionary says is “the state or quality of being worthy of honour or respect.” [6] Dignity is much more about how a person is treated by those around them; it might be paraphrased as “you have value because of who you are, not what you can do.”
Treating dying patients with dignity was one of the driving visions of Cicely Saunders, the founder of the modern palliative care movement. Her own Christian faith shaped the development of person centred care at St Christopher’s, the hospice that she began. [7] And yet those principles of palliative care—including intending neither to hasten or postpone death—could easily be expressed in terms that doctors and nurses could identify with, regardless of worldview. [8]
Arguments against assisted suicide may tend to resonate more with people who have a religious worldview. But the main ethical objections stand regardless. We must not make the error of confusing the two.
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Proponents and opponents of assisted dying do not all agree on the terminology used to describe the process.
Assisted dying—Proponents of the Assisted Dying Bill 2015 in England and Wales argue that this term best describes prescribing life ending drugs for terminally ill, mentally competent adults to administer themselves after meeting strict legal safeguards. Assisted dying, as defined like this, is legal and regulated in the US states of Oregon, Vermont, Washington, Montana, Hawaii, California, and Colorado, and in Washington, DC. In 2017, similar legislation was passed in Victoria, Australia.
Assisted suicide—This term is often intended to describe giving assistance to die to people with long term progressive conditions and other people who are not dying, in addition to patients with a terminal illness. The drugs are self administered. Some opponents of assisted dying do not accept that it is different from assisted suicide. Assisted suicide, as defined like this, is permitted in Switzerland.
Voluntary euthanasia—This term describes a doctor directly administering life ending drugs to a patient who has given consent. Voluntary euthanasia is permitted in the Netherlands, Belgium, and Luxembourg. In 2016, Canada legalised both voluntary euthanasia and assisted dying for people whose death is “reasonably foreseeable,” in what it calls “medical assistance in dying” (MAID).
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Read more of our coverage of the assisted dying debate.
Mark Pickering is a prison GP in Yorkshire and the incoming chief executive of the Christian Medical Fellowship.
Competing interests: I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: Mark Pickering is a Christian and the incoming chief executive of the Christian Medical Fellowship.
References:
1. BMJ 2018;361:k1456
2. GMC 2013. Personal Beliefs in Medical Practice: Para 3.
3. Oregon Death with Dignity Act, 2017 Data Summary: 10
4. www.economist.com/open-future/2018/08/22/liberals-and-atheists-can-also-oppose-assisted-dying
5. www.dignityindying.org.uk
6. https://en.oxforddictionaries.com/definition/dignity
7. www.bmj.com/content/suppl/2005/07/18/331.7509.DC1
8. www.who.int/cancer/palliative/definition/en/