Robin Downie
The right to choose?

Recently I had to chair a well-attended public meeting at Glasgow University on assisted suicide. The actual title was 'Do patients have a right to choose an assisted death?'. The term 'assisted death' is a euphemism; it is assisted suicide and voluntary euthanasia which is the real issue.
     The meeting was originally to be a lecture by Margo MacDonald on her Bill, but she was indisposed so the meeting took the form of a debate. The debaters were Edward Turner, who had accompanied his mother Dr Ann Turner to the Swiss clinic Dignitas, and Dr Sheila McGettrick, medical director of the Prince and Princess of Wales Hospice in Glasgow. Mr Turner described cases where patients had benefited from attendance at the Swiss clinic, or who would benefit if assisted suicide were legalised in the UK, and Dr McGettrick described ways in which palliative care can support patients in their last days, and dispelled the widespread view that most patients die in pain. Thereafter there was almost an hour of discussion from the large audience. I'd like to make some comments on the two talks and the contributions from the audience.
     Both speakers appealed to the idea of dignity in dying. Mr Turner is on the board of a pressure group entitled Dignity in Dying. The idea of dignity involved is that of controlling when and how one dies, of not being at the mercy of disease-processes, and not being dependent on family and professional carers. And of course control, being self-governing, is one central aspect of dignity, so it is appropriate that Mr Turner and others of his persuasion should appeal to the concept of dignity. But control of this kind is not the only aspect of dignity.
     Dignity can be shown also in fortitude in the face of adversity. Death notices in newspapers often say: 'Peacefully, after a long illness bravely borne'. This too is dignity. One function of palliative medicine is to alleviate the symptoms of painful or degenerative illness and to give support to enable this aspect of dignity to be shown. The two aspects of dignity are expressed in Hamlet's well-known soliloquy in which he wonders whether 'tis nobler in the mind (ie more dignified) to suffer outrageous fortune or to take arms against it'. The point in all this is that since both sides can reasonably appeal to the concept of dignity nothing can be settled by that appeal.
     Many of the comments from the audience used the concept of choice. 'It is up to individuals to choose whether or not to end their lives'. If the idea is that doctors should offer suicide as a treatment option – 'We could ease your pain with morphine, or we could make you sleepy with some sedation, or we could assist you in killing yourself' – this is surely a bizarre proposal which doctors would reject. It is to be hoped that death consumerism is not the idea that dominates debate in Holyrood and elsewhere.
     As I see it, the key issue is not whether we are a Christian society or even whether suicide and assisting it are morally right or wrong – there would be no end to such discussions. The key issue is one of public policy. Do our politicians think that the alleged social benefits of legalising assisted suicide outweigh the alleged harms?
     The alleged benefits are: allowing those patients whose pain cannot be controlled – and those are extremely rare cases – to seek relief in death; allowing patients in general, but especially those with degenerative diseases, to choose when and how they wish to die. The alleged harms are: weakening society's belief in the sanctity of life; exposing patients to subtle pressure from relatives (or even health care managers) to opt for a speedier end than would happen naturally; exposing relatives and doctors to pressure from patients to take steps they would not otherwise have taken; placing society at the top of a slippery slope, where informed consent is no longer necessary. As one contributor to a TV programme put it, perhaps not realising the chilling implications: 'I just know what my loved one would have wanted'.
     Finally, it should be noted that even if there is no actual pressure on patients, relatives, managers or doctors the fact that the possibility of assisted suicide exists might create a tension in relationships. It is to be hoped that our representatives can debate the issues with full awareness of their implications and that they are not swayed by celebrity anecdotes.

Robin Downie is emeritus professor of moral philosophy at
Glasgow University