JUST as the season of weddings yields to the season of divorces, so we move from ushering our children into the world to supporting older relatives as they depart it.
I’m at an age now where very few of my friends haven’t sat at a bedside watching a life ebb away, and the consensus is that, once your loved one enters that last terrible phase, the best you can hope - for them and for you - is that it happens quickly, peacefully, and with as much dignity as possible.
For many, that will be the case. Even in our hard-pressed NHS, medical staff do their best to keep their patients comfortable and their pain at bay. But for others, particularly those suffering from certain types of cancer and heart disease, the experience will be traumatising for all involved.
I will never forget interviewing three sisters, Sarah Drummond, Zoe Black and Victoria Burns, whose mother Heather Black had suffered the worst of endings, dying in such agony she begged her daughters and nurses to put an end to it. The law prevented them from taking action, and Heather - who had worked with drug addicts and Aids patients in the 80s - spent her last four days crying and vomiting brown foam.
The sisters were talking to me in 2020 in support of Dignity in Dying’s campaign on assisted dying. The organisation was pushing for a new bill which would address some of the reservations that had scuppered earlier ones. For example, where co-leader of the Scottish Greens Patrick Harvie’s 2013 bill would have embraced all those “with terminal or life-shortening illnesses or progressive conditions which are terminal or life-shortening”, the new bill would apply only to terminally-ill patients with a prognosis of less than six months, and would have safeguards built in. Scottish Liberal Democrat MSP Liam McArthur is expected to introduce this member’s bill later in the year after winning the support of 36 MSPs.
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The general public has supported assisted dying for a long time now. A Dignity in Dying poll has put the figure at almost 90%, up from 82% in 2015. Within the medical profession, too, opinion has shifted. A survey of the Royal College of GPs suggested that in the space of six years, support for the College’s policy of opposition had dropped from 77% to 48%, although the figure amongst palliative care doctors was closer to 80%. A public consultation on assisted dying received more than 14,000 responses, with around three-quarters of respondents supportive.
Last week, however - surprise, surprise! - three faith groups: the Catholic Church, the Church of Scotland and the Scottish Association of Mosques expressed their “deep concern” about the proposed legislation and called on MSPs to vote against it. “Society is called on to care for those who are suffering, not end their lives,” Kirk moderator, the Rt Rev Iain Greenshields, Bishop of Paisley John Keenan, and Imam Sheykh Hamza Khandwalla of Dundee Central Mosque, wrote in a joint statement.
The faith leaders chose the phrases “end their lives” and - elsewhere in the statement - “help [them] to commit suicide” for maximum emotive power, but their use was disingenuous. The new law will only apply to those who are already close to life’s finishing line, and only if they have capacity to consent and are able to administer and ingest the medication themselves.
It is true that society has a duty to care for those who are suffering, and that palliative care, like so much else, is under-resourced. But another way to care is to hand a degree of control back to individuals whose existences have been stripped of it; to give them the chance to manage their ending, once that ending is both inevitable and imminent.
These approaches are not mutually exclusive, and faith groups shouldn’t pretend they are. Nor should the failure to fully fund the first be used as an excuse to block legislation for the second. For some people, the alternative to assisted dying will be a lonely suicide attempt, or a mercy killing, which may culminate in a murder charge.
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Others may opt for an expensive and logistically-tricky trip to the Dignitas clinic in Switzerland. Such a trip requires the patient to be well enough to travel, a factor which may push them to go sooner than they would have wanted to avoid getting to a stage where it would be too late.
The faith leaders’ statement goes on to say McArthur’s Bill would mean “our society as a whole loses its common humanity”. But it is difficult to see what’s so humane about the status quo.
Another, perhaps stronger, argument against assisted dying is that the UK is currently a dystopia, where a former politician like Ann Widdecomb can utter the words “If you can’t afford cheese, don’t make a cheese sandwich” without shame, and the poorest are made to feel their lives are expendable.
When writing a recent piece on health inequalities, I spoke to a GP who told me about a cancer patient with so little income, sandwiches were all she ate. Her GP was distraught at the conditions in which she was forced to spend her final months.
If the lives of the poor are deemed worthless, what’s to stop pressure being brought to bear to make them end more quickly? There is already a degree of controversy over the alleged abuse of Do Not Resuscitate orders. DNRs can be a force for good. There are circumstances in which CPR would be barbaric and ineffective. But since Covid there have been suggestions they are being imposed without proper consultation with patients or their relatives and adhered to in inappropriate circumstances. For example, one woman claimed a DNR order meant her father was left to die after choking on food when it had been intended only if he suffered a cardiac arrest.
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But - with growing concerns that medically-assisted dying is already happening under the radar in Scotland - legislation would bring regulation or transparency. As an open letter from the Philosophers' Consortium on Assisted Dying in Scotland put it: “[It would be] far better for medically-assisted dying to be legally available to a small segment of qualified patients and carried out conscientiously and in the open by trained professionals.”
Religious faiths are always trying to impose their ideologies and social conservatism on our increasingly secular world. That is their prerogative, but they should not be allowed to dictate how others choose to live; or choose to die.
What they want, I suppose, is the same as most of us: for a greater value to be placed on human existence. But the value of a life is not always measured by its longevity. And valuing people means having faith in their judgement, too; trusting them to be able to make the best decisions for themselves and their families.
McArthur’s bill recognises the need for safeguards. It contains no reference or risk to those with chronic conditions, disabilities or mental health problems and requires an assessment by two independent doctors.
What it comes down to, for me, in the end, is that a good death is an extension of a good life, and that both are best achieved through choice and empowerment. Not everyone who is in the last six months of a terminal illness will want a medically-assisted death. Some who thought they would, may find they don’t. But, for some newly-diagnosed patients, the mere knowledge that the option exists for them if and when they need it will offset their anxiety about the future, and allow them to better enjoy the time they have left.
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