Open Future

Accurate language matters in this life-and-death debate

In her second piece, Ilora Finlay responds to the other essays in our assisted-dying series

This is the second week of essays in our assisted-dying series. All of the first week’s articles can be found here

I have been struck by the use of language in the various articles advocating a change in the law. For example, Steven Fletcher writes that “those who wish to live should be given the opportunity to do so.” Given the opportunity? They have that already. Mr Fletcher tells us that “assisted dying” (the current campaigning euphemism) is about “empathy, compassion, choice, hope and common sense”. Of course it is. But these are qualities that are common currency to both sides of the debate. I can, and do, argue against changing the law on precisely these grounds as well as on others.

Bernhard Sutter writes that “as soon as you officially tell the staff to hasten death, it gets complicated”, the implication being that a doctor who increases a dose of analgesia to relieve pain is unofficially hastening death. This sort of thing may possibly have happened many years ago when the science of analgesia was in its infancy, but it is certainly not the case today. With modern palliative medicine it is possible to relieve most of the physiological distress of the dying process, although Ellen Wiebe’s worrying description of distress in Canada’s hospices suggests they could learn from Britain’s.

Charles Falconer misrepresents the prosecution guidelines on acts of assisting suicide as offering dying people a choice between going to Switzerland for legalised assisted suicide or staying at home and seeking “amateur assistance”. The guidelines do no such thing. They make clear that assistance with suicide given by a doctor to a patient under his or her care raises issues in regard to doctor-patient trust and, as such, must be regarded as an aggravating factor. But they do not encourage any kind of assistance with suicide.

Nor does legalising “assisted dying” reduce other suicides.In the Netherlands unassisted suicides rose by over 20% from 2002 to 2016, despite downward trends in some of its neighbouring countries. Oregon’s unassisted suicides rose by over 28% from 1996 to 2016.

There are some important issues raised in these articles. Ms Wiebe writes of a 102-year-old lady who approached her for “medical aid in dying”. She writes that “this woman was clearly not depressed. She was just ‘finished with life’”. Campaigners for assisted dying in Britain would probably distance themselves from this notion: their ambitions are limited, for the moment at least, to licensing doctors to supply lethal drugs only to terminally-ill people thought to have six months or less to live. But, if the motivation of such legislation is, as Mr Fletcher put it, “empathy, compassion, choice”, on what grounds can assisted dying be offered to people who are expecting to die of natural causes in the near future, but denied to others who may have years ahead of them with distressing or otherwise uncongenial conditions?

Lord Falconer writes that there has been no migration “to a wider approach” in Oregon’s assisted-suicide law, currently the model for British campaigners. But he must surely be aware of the ongoing attempts to widen Oregon’s law beyond its present boundaries, attempts which are being resisted for the moment as an extension of Oregon’s law might frighten legislators in other states and make them think twice about legalisation.

One witness to a group chaired by Lord Falconer in 2011 was quite open about this unpacking of “assisted dying” in an effort to get it through the doors of parliament. What is needed, she suggested, is “something that will get through”. “Let’s get it through first,” she told the group, “and then maybe we could tinker with it a bit, and you water the safeguards down a bit because I do think they are a bit tough at the moment.”

Lord Falconer tells us that the existing law “cannot properly protect vulnerable individuals because investigation of the circumstances and consideration of vulnerability only happen (if at all) after the assisted death has occurred”. He ignores the law’s deterrent role. Under the existing law, anyone minded to assist a suicide has to reckon with a spotlight being shone on his or her actions and on any malicious acts or motivation coming to light as a result. Under Lord Falconer’s proposals, on the other hand, the only risk a malicious assister would run is that the request would be rejected.

An investigation after the event is not infallible, but it does focus on facts: on what has actually happened. The pre-event assessments that Lord Falconer proposes are little more than subjective opinions, in some cases best guesses. Moreover, with many doctors in Britain opposed to legislation (with only 21% prepared to prescribe life-ending medication in a medeConnect poll of 1,000 British GPs in 2015), they would be opinions offered in most cases by practitioners who had never met the applicants before and had no first-hand knowledge of them as people.

We should, perhaps, recall Aesop’s fable of the sick lion and the fox. Invited to enter the lion’s den, the fox demurred, remarking that he had noticed all the footprints pointed one way: into the den.

Ilora Finlay is a crossbench peer in the House of Lords and co-chair of Living and Dying Well

This article is part of a series of viewpoints on assisted dying.

Read more here: The case for and against assisted dying

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