Select Committee on Assisted Dying for the Terminally Ill Bill Minutes of Evidence


Memorandum by the Centre of Medical Law and Ethics, King's College London

  The issues raised by the Bill divide into those concerning fundamental moral principles and those about possible risks and dangers if the Bill is passed and how they compare to the possible risks and dangers of the status quo.

1.  FUNDAMENTAL MORAL PRINCIPLES

Supporters and opponents of the Bill tend to appeal to different basic moral principles. Those who support the Bill usually give great emphasis to Autonomy and to Preventing Avoidable Suffering. Those who oppose the Bill usually give great emphasis to the Sanctity of Life. People on both sides appeal to Respect for Dignity. There are questions to ask about the principles invoked.

(a)  Autonomy

  This part of the case for the Bill is that it respects the autonomy of the terminally ill person. (This line of thought was encapsulated in the title of the play and film Whose Life is it Anyway?) This was part of the case for removing the legal prohibition against suicide, and the present Bill can be seen as an extension of this. People able to commit suicide are legally allowed to do so, and the Bill would extend the same control over their life and death to those not able to commit suicide without assistance.

  Critics of the appeal to autonomy make the point that respecting someone's autonomy is most often a matter of not preventing them from doing something. For society to respect autonomy in matters of religion is to allow people to build churches, synagogues and mosques as they please and to allow them to practice their religion unimpeded. It does not require society or anyone else to assist them in worship or to provide them with facilities. On the other hand, providing facilities such as wheelchair access is often seen as required by respect for the autonomy of people with disabilities. There is controversy over the line to be drawn between what kinds of positive assistance are or are not required if someone's autonomy is to be respected.

(b)  Preventing Avoidable Suffering

  This part of the case for the Bill appeals to the humanitarian thought that, if someone is suffering, it is desirable to stop their suffering if it is possible to do so. Here "suffering" can mean physical pain or other, psychological, distress. Few would dissent from the principle as stated, but critics say that sometimes there are other, less drastic, ways of avoiding suffering. (How often this is so is a disputed issue of fact.) Critics also point out that the humanitarian thought has a suppressed "other things equal" clause. A lot depends on what means are needed to eliminate suffering, and what are the costs (not in any limited financial sense) of those means. The central disagreement is whether it is acceptable to end someone's suffering by ending their life. The humanitarian principle may come into direct conflict with the principle of the sanctity of life.

(c)  The Sanctity of Life

  The sanctity of life is not normally interpreted to mean that any life ought to be preserved at all costs. It is normally restricted to human life (though supporters of animal rights query this). And it is normally interpreted to prohibit absolutely the intentional killing of innocent human beings. ("Innocent" allows the possibility of killing, for instance, in a just war. Someone who is part of an army committing an unjustified act of aggression is not in this sense "innocent".) The phrase "intentional killing" allows for two other possibilities. Allowing someone to die is distinguished from killing. And some doses of pain relieving drugs have the foreseen consequence of accelerating death, but if the intention is only to relieve pain, this is not intentional killing.

  Critics of the sanctity of life say that "sanctity" suggests a religious prohibition and that in a society with a plurality of religious and non-religious views, particular religious prohibitions have no place in the law.

Others question whether the distinction between killing and letting die is a clear one and whether it is a distinction that really has moral importance. Critics also claim that the contrast between consequences that are intended and those that are foreseen but unintended is a distinction without a difference.

(d)  Respect for Dignity

  Some of those who request assisted suicide do so less because they wish to avoid suffering than because they wish to avoid the indignities of incontinence and of other forms of loss of control.

  Opponents of assisted suicide sometimes say that respect for human dignity requires absolute respect for innocent human life.

  It is clear that different conceptions of what human dignity is are in play in the debate.

2.  RISKS AND DANGERS

  Supporters and opponents of assisted suicide also disagree about the relative risks and dangers of enacting the Bill as against the status quo.

  Supporters cite the danger of the law being made to look an ass, or at least out of touch, when there is a wave of public sympathy for someone in a distressing state and yet the law does not allow their request to be helped to die. This may lead to doctors furtively doing things to get round the law, which may not enhance the standing either of the law or of the medical profession. It may lead people to go to other countries to obtain the assistance that is illegal here.

  Opponents cite the danger of a slippery slope. Will legalizing assisted suicide or voluntary euthanasia lead on to legalizing euthanasia without the request of the person whose life it is? There is the memory that the Nazis murdered 70,000 psychiatric patients in the name of "euthanasia". On the other hand, there is a question of how we tell which slopes really are slippery. (There are factual disputes about whether the experience of the Netherlands tells for or against the slippery slope argument.)

  Opponents also cite the danger of medical professionals feeling obliged to act against their own religious and/or moral convictions. And they cite the dangers of people being pressured by family members to request assisted suicide. It is clear that family members could have motives for this: either financial motives or the desire to be rid of a burdensome relation. We will make some brief comments on whether the Bill contains adequate safeguards to meet these concerns and make some comments on the experience in other jurisdictions.



 
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