Controversy always follows those who suggest that terminally ill or incurably suffering people should be allowed to ask for and receive help to die if they so wish. The same set of arguments is standardly urged in opposition: that life is sacred, that legalising physician-assisted suicide would lead to abuses, that a majority of the medical profession do not approve of legalising voluntary euthanasia.
These arguments so far carry the day with our legislators, even though polling shows now, and has done so consistently for many years, that more than 80 per cent of the public want physician-assisted suicide to be available to them as an option if they should find themselves in circumstances where their lives have become unbearable without hope of remedy.
The motive behind efforts made by those such as Lord Joffe, Patricia Hewitt, Baroness Warnock and the organisation Dignity in Dying to have physician-assisted suicide legalised is a simple one: it is a humane impulse of kindness, based on the realisation that we are gentler to our pets than to our fellow humans in facilitating an ultimate release from suffering when it is needed. In the case of our fellow humans we are talking about a release from suffering that the sufferers themselves earnestly desire and request; refusing them denies their autonomy, and is at least unkind and at worst cruel.
The spectacle of sufferers having to go to Switzerland to get the easeful death they want, instead of being able to leave life in their own homes, with their family and friends around them and at a time of their own choosing, is a scandal. A civilised and mature society should allow the few - they will always be a very small minority - who desire this option to be granted the right to take it; the coercive paternalism that denies it is wholly unjustified.
Those who talk of the “sanctity of life” make a fundamental mistake: it is not mere quantity of life that matters, but its quality; and since dying is a living act, the quality of experience at the end of life, or in conditions of incurable distress, is the overriding consideration. To believe that mere length of existence, however unbearable and painful, trumps the kindness of granting someone's request for help to end their suffering easily and quickly, is to have one's priorities utterly wrong.
The argument about the possible abuse of legalised physician-assisted suicide turns mainly on the fear that ill or elderly people might be coerced into it against their wishes by unscrupulous relatives. Alas, abuse is possible in all walks of life, but a carefully drafted law, such as the one Lord Joffe introduced in the House of Lords, would provide careful protections and checks, while allowing those in unbearable distress the sanctuary of an easeful end to suffering.
Polling data about medical attitudes to physician-assisted suicide suggest a third of doctors in favour and two thirds against. Two somewhat inconsistent reasons are offered: the first, that the primary aims of medical practice are curing or at least palliating, never killing; and second, that practitioners already help patients to die but would prefer the grey area of unspoken discretion to remain, fearing that a definite law would make matters more rather than less difficult.
A solution to the large difference between what the public want and what the medical profession wants is to have a medical specialism devoted to assisted dying, either a subsidiary part of anaesthetics or of terminal palliative care. If each NHS trust had one or two consultants in this specialty, who would help patients who had formally requested assistance to die and been granted it by the Trust ethics committee, all the rest of the staff would be exempt from the obligation, and for them the dilemma - which must frequently enough arise now, but without benefit of legal guidance - would not arise.
It is important to emphasise two things. The first is that the option of having help to die when in an unbearable and irremediable situation - suffering pain, suffocation because of inability to swallow, the indignity of incontinence, utter helplessness, reliance on selfhood-diminishing drugs, and the like - and when one has requested that help while mentally competent and with a settled resolution, is a human right that ought to be respected.
The second is that very few of us will ever ask for help to die, because most of us will prefer to live as long as possible, and to fight the diseases and incapacities that come with age. Physician-assisted suicide, if made law along the lines of Lord Joffe's bill, will require a settled determination by the sufferer, properly checked and verified.
Much misinformation is put out about the situation in the Netherlands, where granted requests for physician-assisted death result in less than 0.8 per cent of all deaths annually, mainly in terminally ill or permanently and unbearably disabled people under 65 (thus rebutting the “coerced elderly” concern). More than 90 per cent of these assisted deaths shorten life by less than a month - indeed most of them by less than a week. The number of physician-assisted deaths in the Netherlands has decreased since it was first made legal, and has stabilised at a very low level.
In Britain, to achieve a dignified and chosen end to one's sufferings requires the trouble, difficulty and expense of going to Switzerland. Patricia Hewitt wished to make that task, in the absence of a humane and civilised law in our own country, easier for all concerned. It is a kindly gesture, and a generous one, which I think puts to shame the minority in our country who stand in the way of a mature approach to individual rights over how we end our lives.
One hopes that the debate, ill-informed and retrogressive as much of it is, will continue, and eventually enable the majority opinion to prevail, thus ending unnecessary suffering, and allowing those who so choose to die in dignity and peace.
A.C.Grayling, Professor of Applied Philosophy at Birkbeck, University of London.