Robin Downie
Keep the doctors out of it

Margo MacDonald's Bill, now presented to Holyrood, raises several issues. I want to examine one of these – the phrase often used in discussions of assisted suicide – a right to die.
     The language of rights is used in discussions of this problem for the simple reason that most moral problems are nowadays presented in the language of rights. On the face of it however it does not seem very appropriate to speak of a 'right' to die, for the obvious reason that we do not need a right to die – we are all going to die anyway whether we like it or not.
     Dying is a matter of bodily causality, not of rights. Perhaps however what people may (sometimes) mean by a 'right to die', is a right to be allowed to die. It is sometimes argued that doctors prolong treatment when it is no longer doing much good. For example, a patient may be offered, and perhaps pressured by doctors (and relatives) to accept, yet another course of chemotherapy with a 15% chance of prolonging life for six months. But treatment with an 85% chance of failure coupled with toxic side-effects may not be a good option. It is in this kind of context that patients may say that they have a right (to be allowed) to die. But such a right already exists. Patients may lawfully refuse or withdraw their consent for even life-sustaining treatment. This should be more widely known.
     Again, if what is meant is a right to be assisted in dying then this is what those in palliative care try to do. Just as obstetricians and midwives assist in birth, the skills of palliative care assist in making the process of dying as humane as possible. Perhaps skilled palliative care should be more widely available but there is already a right to it under the NHS.
     But the core intention of those who use the misleading phrase 'a right to die' is to claim that there should be a right to be assisted in committing suicide. What kind of a right would this be? There is already a right to commit suicide, in the sense that it is no longer a criminal offence to take your own life. The Voluntary Euthanasia Society (or Exit) and similar bodies have publications suggesting effective ways of doing this with minimum unpleasantness to self and others. This kind of right is what we might call a 'right of action' or a freedom; it is a right in the sense that it is not wrong to commit suicide. But a right to assisted suicide cannot be of this kind because, in the nature of the case, others must be involved to assist. We might think of this as a 'right of recipience', in the sense that others have a reciprocal duty to assist with the implementation of the right. Who would be the 'others' in the case of assisted suicide?
     The widespread assumption is that it must be doctors who will assist. The assumption could be defended on the grounds that doctors are involved in treating the patient, and will know the prognosis. Assisting with suicide could be seen as the final terminus of end of life care. But there are real problems with this argument.
     Firstly, the transition from treatment to provide a health benefit to supplying or administering a lethal medication seems a switch to something of a different order. The BMA and GMC in their guidelines to doctors say that all treatments must aim at a health benefit, and death is regarded as an 'adverse incident'. An 'adverse incident' could hardly be the aim of any treatment.
     Secondly, most doctors in recent nationwide surveys are in fact (and for many reasons) against involving themselves in assisting suicide, so legislation may founder on this.
     Thirdly, reports from soldiers sometimes say that killing the first enemy is difficult, but it gets easier once the inhibition against killing is broken. Do we want our doctors to break their inhibitions?
     If these points are accepted does it follow that any legislation to decriminalise assisted suicide must (perhaps ought to) founder? It will founder only on the assumption that doctors must be the ones assisting. But why make that assumption? Administering a lethal dose is not a difficult procedure. It could easily be carried out by a technician with a short training. The assessment of the competence of a patient to make the decision, and to probe into the risks of pressure or financial benefit by the family, are more for lawyers than doctors. Indeed, if we are speaking of a right to assistance, lawyers more than doctors are the ones to investigate and defend rights.
     The main argument for legalising assisted suicide is now not mainly the 'unbearable pain' argument (if there is unbearable pain, something has gone wrong with the medical treatment) but the 'control' argument. People, especially those with degenerative diseases, very reasonably want to control when and how they die. As it seems to me this raises a public policy issue which need not involve doctors at all; two lawyers and a technician seem more appropriate.

Robin Downie is emeritus professor of moral philosophy at
Glasgow University