Death doesn't become us - revisiting the case against 'assisted dying'

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My Mum has just gone into a nursing home. It hasn't been an easy time for my Dad and I feel slightly guilty that, for reasons of distance and business, I haven't been there as much as perhaps I should. But this isn't about me visiting my angst on you, dear reader, but rather about what it costs. Not because I think that johnny taxpayer should pick up the tab willy-nilly but rather to demonstrate the financial advantages - for families and the government - of people dying more quickly.

The fees at Mum's home run to about £1000 per week, which my maths tells me is £52,000 per year. And this is a hell of a lot of money. More, I suspect, than my dad ever earned in a year and comfortably more than the average earnings of people today (my Dad retired in 1997). Again, let's be clear that I do think our savings and assets are best directed to our own interests and this includes providing care - I really do not feel that I have any right to demand that young people with big mortgages and families to raise pay more tax so I can inherit Mum and Dad's house.

But this cost - £26,000 in a six month period - is one very good reason to question the seemingly inexorable move to what is called 'assisted dying'. Now when I read the advertisements placed by Dignity in Dying I am, like you will be, touched by the stories there of people's last days and how a quick exit would have saved them suffering. I don't doubt the sincerity of the people involved - knowing their beloved brother, wife or mother was dying they sought only to make what was left of their life less painful. And they think that helping these people to die would have been a release from that pain.

It's hard not to find the case compelling. So to help you understand my doubts, let me tell you something else about my Mum. Something I wrote some while ago in a little article called, "Death doesn't become us":

My Mum spent 25 years and more working with old people in and around Penge – delivering meals-on-wheels, driving the mini-buses and running Penge & Anerley Age Concern’s lunch club and day centre on Melvin Road. In this time she saw every sort of folk – from Mr Squirrel who worried that he couldn’t (at 96) dig the garden as in times past to Dr Arnott, communist party member, academic historian and employer of a maid.

Every day, my Mum would tell us, one or more of the people she saw would proclaim – in that depression of loneliness so common among the old and infirm – “I’m just a burden, I’d be better off dead”, or some similar formula of despair. Mum’s response would be to tell them not to be so silly, have a cup of tea and a chat.

But Mum’s view – informed by bitter experience – was that not all the relatives and carers took the same view as she did.

And this last sentence captures my concerns. You and I may be good, honest folk who wouldn't dream of having granny bumped off so we could inherit earlier. But can you be certain that others have our scruples? That there is no circumstance where 'six months to live' is liberally interpreted:

...where a depressed, slightly confused, sad old person signs to say they want to die, where the bureaucracy takes this as consent and Auntie Sissie or Grandpa Geoff is shipped safely across the Styx leaving his worldly goods behind for the inheritors to enjoy.

I know there will be safeguards. I'm sure people have considered how they would mitigate the possibility of the six months rule being abused. But I am less sure. My Mum told too many stories of rapacious and uncaring relatives, of useless solicitors and deadening, rule-bound social workers or doctors for me to be so sure that, despite the agony of those stories in Dignity in Dying's advertisement, we can go to a place where we deem it acceptable to kill another human being.

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Life, death and why 'assisted dying' shouldn't be legalised

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This afternoon we watched 'In Time', a dystopic science fiction movie based on the idea of immortality:

It is the year 2169 and humanity had been genetically engineered to be born with a digital clock, bearing a year's worth of time, on their forearm. At the age of 25 a person stops aging, but their clock begins counting down; when it reaches zero, that person "times out" and dies.

Without dwelling too much on the plot (or indeed on the rather predictable rich/poor dichotomy) there are some moments in the film when characters discuss the idea of immortality. And the idea that we really don't want to be immortal regardless of whether that immortality comes at the cost of others' lives. Implicit in the story is the idea that a short time of interest, excitement and fun is better than a drawn out life spent avoiding 'doing anything stupid'. The core principle of public health as lifestyle control is rudely countered - why shouldn't we eat, drink and be merry just because some doctor says it will shorten our life?

The idea of immortality is important to us. It lies behind the continued popularity of major religions - follow this life and you will life forever in paradise - and in our attitude to modern medicine. Anything that might shorten our lives - drinking, smoking, bacon sandwiches, cave diving and, of course, driving fast on drugs while getting your wing-wang squeezed - is to be frowned upon, discouraged and even completely banned. Especially where such activity grants us pleasure.

Our doctors, the media and the government is entirely wedded to the idea that life must be prolonged and that adding a few extra months through medical intervention after medical intervention is the right thing to do, is the embodiment of Hippocrates principle. In the Spectator's Coffee House, David Blackburn questions this view:

...Hunt says nothing about the elephant on the operating table: what is the purpose of modern medicine, on which ever greater sums of public and private money is spent? The grandfather mentioned above died after a short illness in January 1991 aged 78; nowadays, he would have been kept alive in some discomfort and for little purpose for many more months. Men like him lived for golf and conviviality, not morphine and daytime TV. I can’t say whether I or anyone else would chose death over life in such circumstances; but how dispiriting to think that the last thing over which you imagine to have control – one’s will, one’s iron in the soul – is actually tethered by a public servant, empowered (perhaps against his will) by the choices of others.

We all have some sympathy with this point of view - it seems intolerable for a once active and engaged person to slip into dementia, to end trapped in a wheelchair or lying prone in a hospital bed surrounded by bleeping monitors and plugged with drips and wires. And the logic of such a concern, of the pain of watching someone die slowly, is to adopt the position of A N Wilson (cited in Blackburn's article):

‘I believe it is not those who support assisted dying but those who oppose it who have a moral case to answer.’ He quotes, at length, the daughter of Dr Ann McPherson, whose protracted death from cancer — despite palliative care — makes painful reading.

It seems to me that there is a moral case against this argument, one that isn't trapped in the religiosity of much right to life campaigning. In explaining this position I will draw on my mum's experience - more poignant because mum has spent much of the last year tiptoeing closer to death.

A while ago I wrote this about assisted dying:

 Every day, my Mum would tell us, one or more of the people she saw would proclaim – in that depression of loneliness so common among the old and infirm – “I’m just a burden, I’d be better off dead”, or some similar formula of despair. Mum’s response would be to tell them not to be so silly, have a cup of tea and a chat.

It is only a short step from the pain of Dr McPherson's daughter to a different sort of relative. The relative who sees the chance presented by a old person, perhaps housebound, who worn down by pains and aches declares a desire to die. How easy will it be to - if we allowed it - take that next step to getting a form signed and proceeding to that gentle injection and death?

And how much closer are we - for this is implied in David Blackburn suggesting we can't afford 'modern medicine' on the universal basis we afford it now - to a different science fiction dystopia?

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