Guest editorial by Paul Badham
from Modern Believing Vol 56:2 - April 2015
In recent years there has been a significant shift in public attitudes towards those who assist a terminally ill person to commit suicide. Theoretically it remains a criminal offence punishable by fourteen years’ imprisonment.
However in February 2010 the Director of Public Prosecutions published guidelines that made it clear that no prosecution would follow if the dying person had reached ‘a voluntary, clear, settled and informed decision to commit suicide’ and if the person’s helper was ‘wholly motivated by compassion’.1 On 27 March 2012 the House of Commons unanimously endorsed these guidelines.2
However, while the law itself remains unchanged, doctors in England and Wales cannot help their patients commit suicide. To get medical help to commit suicide, the patients must still travel to Switzerland.
Lord Falconer believes this situation to be ‘incoherent’.3 He therefore proposes that if a terminally ill person of sound mind is within six months of death and repeatedly asks to be given the means to end their own life, doctors should be allowed to provide the help asked for.
There is clear public support for new legislation and in view of the uncertainties in the present law the Supreme Court has also asked parliament to address these issues. In light of this, the House of Lords agreed on 18 July 2014 to allow Falconer’s Bill a Second Reading unopposed, so that it could go on to the Committee stage.4 In Committee on 7 November 2014 the Lords unanimously accepted an amendment to the Assisted Dying bill proposed by Lord Pannick and supported by Lord Falconer.5 This agreed that all applications for an assisted death should receive judicial oversight from the Family Division of the High Court. This was welcomed by campaigners as a major step towards changing the law.
In the Observer the following Sunday Dr Kailish Chand, the Deputy Chair of the British Medical Association, declared his belief that in the light of these developments a change in the law is now inevitable, and will happen within as little as two to three years.6 He urges doctors to end their opposition to such a change.
These developments pose a considerable challenge to the Christian and Jewish communities whose leadership has in the past opposed proposals for changing the law. However, as the debate progresses some are changing their minds. The first two articles in this special issue come from religious leaders who were formerly strongly opposed to assisted dying, but now support it on religious grounds. Rabbi Jonathan Romain, editor of Assisted Dying: Rabbinic Responses, presents a ‘Jewish view on Assisted Dying’. Lord Carey gives ‘A personal testimony’ setting out why he has changed his mind. Lord Carey’s intervention played a key role in the passage of the Second Reading, particularly as he was supported by Archbishop Desmond Tutu who has has for years voiced the conscience of the Anglican Communion.
The importance of the interventions by Archbishops Carey and Tutu may be gauged by the fact that when General Synod debated the issue in February 2012 Canon Rosie Harper was the sole voice defending assisted dying. She did this on the basis of her family’s experience of the Swiss situation. In her present article she gives a thoughtful analysis and commentary on Hans Küng’s ‘Theses on Assisted Dying’. These update and summarise the position Küng argued for more fully in his book A Dignified Dying: A Plea for Personal Responsibility.7 Canon Harper’s article is a helpful reminder that one of the most widely read theologians of today is a staunch advocate of assisted dying.
Yet this is a complex subject in which many factors have to be considered. Some of these are spelled out in Jonathan Clatworthy’s discussion, ‘The Dilemmas We Face Today’. These include puzzles about the sanctity of life, the medicalisation of death and the power of modern technology to extend life.
The medical issues are discussed further in an article by two consultants in pain medicine: Dr. Rajesh Munglani and Dr. Arun Bhaskar. Their article ‘Pain and Suffering in Cancer Patients’ is longer and more technical than most articles in Modern Believing, but what they document so fully is crucial to the public debate. Palliative care is of great importance in terminal illness, but it is not the universal panacea that it is sometimes claimed to be. Most people who join societies like Dignity in Dying do so because they have witnessed at first hand the suffering of a parent or spouse. Dr Munglani and Dr Bhaskar demonstrate that such experiences are sometimes an inescapable concomitant of terminal illness and significantly contribute to some people’s desire for a change in the law.
However, although sympathetic to suffering, many moralists and theologians believe that to change the law would give rise to other difficulties. After Lord Falconer’s note was published Professor Michael Marsh convened a symposium of theologians and other ethicists to discuss a response to Falconer. The remaining six articles began life as a response to that initiative.
Nigel Biggar, Regius Professor of Moral and Pastoral Theology at Oxford and author of Aiming to Kill: The Ethics of Suicide and Euthanasia, has long been one of the foremost opponents of legalising assisted dying.8 His article on ‘Falconer’s Revolutionary Imprudence’ highlights the problems he believes would follow such a change.
A similar critique from a non-theological perspective is made by Robert Preston, Director of Living and Dying Well. He defends the current compromise where the law is clear in forbidding assistance in suicide. He believes this remains necessary to prevent malicious or self-interested assistance. At the same time it is good that those whose motivation is wholly compassionate should escape prosecution after rigorous examination of their motivation.
Professor Michael Marsh is concerned with the parallelism between the safeguards in the Abortion Act of 1967 and in Lord Falconer’s proposed Bill. In both cases the key safeguard is the need for two doctors to approve the proposed action. In the case of abortion this safeguard has proved wholly ineffectual. A reform intended only to apply in a small number of ‘hard cases’ has been extended so far that today we virtually have abortion on demand. Professor Marsh believes that something comparable would happen if assisted dying were legalised.
A common factor in such opposition to changing the law is fear of what might happen to public health and to attitudes towards sick and vulnerable people if such legislation were passed. My own article responds to such concerns by providing ‘An International Overview’.
Assisted dying or voluntary euthanasia is currently permitted in ten European and North American jurisdictions. In every case legalisation has been followed by improvements in medical services, particularly in the provision of palliative care and in financial support for long term geriatric patients. The Euro Health Consumer Index provides invaluable information for this in European countries.9 For Oregon we have the testimony of their Hospice Association that ‘absolutely none’ of their ‘dire predictions’ had been realised. In the US State of Oregon where Assisted Dying was first legalised, their Hospice Association had initially been strongly opposed to the new Act but after eight years’ experience of how it was working they acknowledged that ‘absolutely none’ of their‘dire predictions’ had been realised. Instead they had experienced a massive expansion of palliative care.10
Our final two papers go beyond the assisted dying debate to two closely related topics. Kathryn Paul’s article is on ‘The Ars Moriendi: A Practical Approach to Dying Well’. This highlights the fact that in former ages the Church felt a responsibility to help people prepare for their inevitable death. Now death is often a taboo subject even in contexts of terminal illness. Much of the suffering in terminal illness is the product of seeking to fight death by all technological means rather than accepting its inevitability. Where there is open and honest discussion of our mortality people are better prepared to face the reality of their impending demise.
In the final article, Professor Paul Fiddes writes about ‘Acceptance and Resistance in a Theology of Death’. He discusses the continuity between this life and the eternal life in God for which Christians hope. He argues that this does not depend on belief in an immortal soul. We die completely. But God remembers us and it is through him and in him that we rise to new life.
I hope that the breadth and variety of these perspectives may help readers as they grapple with these challenging issues.
Director of Public Prosecutions (2010) Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide. Available at http://www.cps.gov.uk/publications/prosecution/assisted_suicide_policy.html (accessed 16 February 2015).
Assisted Suicide, House of Commons Hansard debate (2010-12), 27 March 2012, vol. 542, cols 1363–97. Available at http://www.publications.parliament.uk/pa/cm201212/cmhansrd/cm120327/debtext/120327-0002.htm (accessed 16 February 2015).
Lord Falconer (2011) Report of the Commission on Assisted Dying Demos front cover and as further developed in his proposed bill.
Assisted Dying Bill Second Reading, House of Lords Hansard debate (2014-15), 18 July 2014, vol. 755, cols 775–822. Available at http://www.publications.parliament.uk/pa/ld201415/ldhansrd/text/140718-0001.htm (accessed 16 February 2015).
Assisted Dying Bill, House of Lords Hansard debate (2014-15), 7 November 2014, vol. 756, cols 1851–98. Available at http://www.publications.parliament.uk/pa/ld201415/ldhansrd/text/141107-0001.htm (accessed 16 February 2015).
Doward, J. 2014, ‘Assisted dying will be made legal in UK “within two years”’, Observer 9 November 2014. Available at http://www.theguardian.com/society/2014/nov/08/assisted-dying-will-be-legal-within-two-years-bma-deputy (accessed 16 February 2015).
Küng, H. and Jens, W. (1995) A Dignified Dying: A Plea for Personal Responsibility. London: SCM Press.
Biggar, N. (2004) Aiming to Kill. London: DLT.
Health Consumer Powerhouse (2014) Euro Health Consumer Index 2014. Available at http://www.healthpowerhouse.com/index.php?Itemid=55 (accessed 16 February 2015).
For fuller details see pp. 197–201 of my chapter in this journal and see also discussion of Oregon in the articles by Jonathan Romain and Robert Preston. The quotation comes from a talk on ‘The reality of assisted dying in Oregon’ by Ann Jackson, Chief Executive of the Oregon Hospice Association speaking to the All Party Parliamentary Group on Compassion in Dying on 19th April 2006 in the House of Lords, Committee Room 4b.