“Medicine Most Foul”: How Assisted Suicide Could Unravel Our Culture | Georgia L. Gilholy

On October 22nd Lady Meacher’s Assisted Dying Bill will receive its second reading in the House of Lords. It aims to legalise physician assisted suicide for patients with a terminal illness and who can be ‘reasonably’ expected to die in less than six months.

As is the case with a sizeable chunk of modern predilections—atheism, adultery, abortion—nothing much is new about euthanasia. Even the word itself derives from the ancient Greek term εὐθανασία meaning ‘good death’. However, in jurisdictions where the procedure has recently been legalised, it has hardly resulted in the ‘good’ ends implied by its etymological roots. 

There are two main categories of assisted death, and those that end the lives of those experiencing ‘pain and suffering’ are categorised as euthanasia. Assisted dying, usually describes the ending of a patient’s life by a medical professional. Assisted suicide, though technically a form of assisted dying, involves a medical professional handing a patient the chemical toolkit to end their own life. The prevailing narrative of mercy that accompanies the campaign to legalise both these procedures deceptively airbrush their grim reality. 

The physician Dr Joel Zivot, who researched the autopsies of more than 200 executed US prisoners, has emphasised how the common option method of ingesting pills can be “horrendous” and may lead to a paralysing injection being administered “because many individuals are not able to swallow”. In a process Zivot has described as akin to drowning or being strangled, the patient can no longer move or breathe but is not blocked from potential awareness. This gives the false impression of a patient’s ease and ongoing consent, while the final moments of their time on earth are characterised by excruciating pain without being able to speak or move to signal their distress, or even express final thoughts to a loved one. 

This terrifying step has already been banned as part of capital punishment inmost US states that still permit the penalty, due its blatant cruelty, yet it remains a staple of assisted dying in the ‘liberal’ state of Oregon, whose framework the Meacher Bill proudly models itself on. While the Meacher Bill itself does not acknowledge a role for doctors to step in and end the life when complications occur- as they do in many cases- how long until it is suggested that the law expand to facilitate this role? How many doctors will do so without fear of an autopsy revealing their criminality, given that the cause of death will be predetermined?

While the Bill’s supporters are insistent that the procedure only be legal when consent is given, how can consent be truly secured when so many patients are entirely deprived of their senses while the method of death is set in motion? 

In any case, we are wrong to assume that consent and choice are free-floating values, magically disconnected from social realities. Almost all of our choices, from which milk to buy to what career we choose, to who we marry, are influenced by external factors, including the people we surround ourselves with, and these influences are almost always exaggerated depending on the gravity of the decision we face.

A report published this year by the Oregon Health Authority evidenced just this point. The study examined their policy of medical assisted death from its introduction in 1998 to 2020, and found that out of all patients who underwent an assisted suicide in 2020, over half were motivated by concerns that they were a “burden on family, friends/caregivers”. Is it hardly a leap therefore, to assume that stresses over social and economic support are an overwhelming factor in the majority of assisted deaths, and that introducing the policy as simply another ‘form of treatment’ doctors are obliged to offer the terminally ill at a time of increasing financial and cultural chaos would open the door to certain disaster?

On the darker edge of this factor is the threat of pressuring vulnerable people to end their lives, and the inadequacy of busy doctors to detect social manipulation and coercion that families and partners wishing for a death they think will play in their financial or social favour, or even doctors who themselves come to see it as merciful to kill. As Professor John Keown, of Georgetown University highlighted over a decade ago, Dutch courts already hold that just as the ‘relief of suffering’ can justify voluntary requests for euthanasia, it can equally justify the termination of those who are in no position to give voluntary consent.

There are also plenty of patients who may simply see it as their duty to end their life as they become ‘too’ old, ill or depressed, and will take the route to an assisted death due to an internal sense of guilt and obligation, and it will be this new legal path to do just that which will be to blame. While the Meacher Bill would not permit such an individual a voluntary death unless a doctor could estimate that they were in six months of death, and given that such legislation has been expanded in every jurisdiction where it has been permitted, the Meacher Bill, if passed, would surely be no exception.

Although, unlike in the Netherlands, Belgium and elswehere, the Meacher Bill outlines strict preconditions for assisted suicide which do not include ‘suffering’, it is obvious that the might of the euthanasia campaign is based on the premise that this is the reason why we must legalise the practice. Ask the average campaigner why they support the procedure, and their answer will likely revolve around helping people escape pain. Even the article in which The Sunday Times announced it would henceforth be campaigning on behalf of the Meacher Bill, in May, led with the claim that it “aims to stop ‘unbearable suffering’. 

Either pro-assisted suicide campaigners are suggesting—quite irrationally—that mental and physical anguish are only ‘unbearable’ when a patient has a terminal illness likely to kill them within six months, and whom can give ‘voluntary consent’—the conditions for assisted suicide the Bill sets out—or these more moderate plans are geared toward getting their foot in the door by ensuring we firstly accept that assisted death is legally and morally permissible, before they can then argue that it ought to be expanded. It is fairly self-evident which is the case, and whether naive or dishonesty is to blame, they must be stopped.

By granting assisted suicide our seal of approval, we undoubtedly risk dragging ourselves into an intellectally disjointed civilisational territory in which we are bombarded with messages about the importance of mental health, and told there ought to be no shame in seeking help for such struggles, while we simultaously  greenlight a legal framework in which suicidal thoughts are indulged rather than mitigated. While no such expanded version of euthanasia is proposed by the Meacher Bill,  why would this extension be impossible once the legal premise that ‘suffering’ is justification for medically sanctioned voluntary death is accepted? What makes the UK more averse to this possibility than the so-called progressive paradises of Oregon, Canada and the Benelux?

Moreover, any measurement of suffering and pain is hugely arbitrary and subjective. How can one comfortably say that the anguish of grief or clinical depression for example, is less painful than an injury or physical disease? These sensations cannot be measured empirically , and every person reacts differently to them. It follows that the natural result of permitting state-sanctioned suicide due to ‘suffering’ is the extension of the permission for any person who judges themself to be suffering sufficiently to feel suicidal, whether it be a ninety-nine year old with terminal cancer, or a fourteen year old girl starving herself due to an eating disorder. The question of obtaining ‘clear’ consent also persists in both cases. Is it even possible for a person with clinical depression, or say, a depression wrought on by a serious illness, to make a rational choice to pursue death?

This is already a reality in some parts of the world. In October 2020, a healthy 90-year-old woman named Nancy Russell ended her life by euthanasia in Canada, saying that she wished to die rather than endure another lockdown. Bill C-7, passed in March by the Canadian Parliament, further extended euthanasia legislation to people of any age who have disabilities or mental health conditions. Belgian law allows euthanasia if the patient is in a state of constant physical or psychological pain. In the Netherlands doctors can secretly sedate patients who have dementia before euthanising them, and euthanasia for anyone over the age of 16 is legal.

While many have praised Britain’s national response to Covid-19 as a shining example of how a society can pull together to prevent death and prioritise the needs of the most clinically vulnerable, this is not the full story. Throughout the pandemic, elements of the health system in particular have demonstrably betrayed the dignity and right to life of persons with disabilities or mental conditions by issuing ‘do not resuscitate’ orders without consulting patients or their families. These decisions were not just likely to have been unlawful, but we know they led to a number of deaths, including that of a 58 year old woman with schizophrenia and a deaf man in his sixties. If the situation has already deteriorated this considerably while healthcare professionals are still legally required to preserve life, what will be the knock on impact of further cheapening the regard for human life, and the hippocratic oath, by legalising assisted death.

While many euthanasia campaigners are motivated by a genuine desire to reduce suffering, they are misled about what the true impact of this legal and cultural watershed would be. There are, of course, a small number of compelling cases that make it easy for people to support the theoretical autonomy of voluntary death, however, it is in fact right that a small fraction of individuals in exceptional cases not be permitted to legally access assisted suicide if by doing so we would put vast swathes of vulnerable people at  risk of unwanted and unwarranted deaths. The hypothetical liberties of a select few cannot be permitted to trump all other considerations.

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