Let's Talk About Dying With Honesty

Let's talk about dying with honesty: UK Dignity in Dying, Aug. 2, 2009.

Debbie Purdy's remarkable victory in the House of Lords will have far-reaching consequences. The judgment itself simply requires the Director of Public Prosecutions (DPP) to clarify the precise grounds on which he chooses to exercise his discretion in applying the Suicide Act. The Act itself has not been changed and its provisions remain intact. But the implication in their judgment is that the law has failed to keep pace with changes in society.

When the DPP publishes his policy, we are likely to discover that there is only a minimal test to ensure there has been no coercion. We may also discover that there is no discrimination between the categories of people seeking assisted deaths – whether disabled, non-disabled or terminally ill. What will be revealed is that we have simply outsourced a politically sensitive moral issue to a country with very few of the safeguards we would want to see in a UK law.

So far public debate has focused only on safeguards. Despite evidence from other countries that safeguards do work, some tenacious opponents persist in claiming that vulnerable groups will be at risk and that relatives will be coerced into accepting an assisted death for the good of others. From my own experience of my mother's assisted death at the Dignitas clinic in 2006, I find this unlikely.

If we are to build on Debbie Purdy's victory, we need to move the debate on to the morality of assisted dying. Is this an issue such as homosexuality, where the state has concluded that it has no interest in restricting people's freedom to form the personal relationships which suit them? Or is it an issue such as the taking of recreational drugs, where the state has concluded that individuals themselves, as well as wider society, need protection?

We need to acknowledge that it is perfectly reasonable to set the bounds of individual behaviour for the good of society as a whole. Along with most of the population, I believe that it is moral to allow people who have started the natural process of dying to choose to accelerate their own deaths in order to avoid suffering. And, like most of the population, I believe that it is moral for people in other categories, such as the disabled, to be helped to live, rather than given state help to die.

As humans, we must recognise our innate desire for life and self-preservation; we must also recognise the value of our lives to other human beings. Society should never value life with indifference; but sometimes it is rational to value death more highly than life.

Extremist religious opponents, who are by far the most vociferous, hide behind and amplify the objections of other opponents, such as some doctors, who are concerned at how a future law will be implemented. We have to challenge this notion that more life is invariably a good thing. Presumably those people whose life was extended to witness the birth of their first grandchild went on to die before witnessing the birth of their second? How much life is enough?

My own father died from a degenerative neurological illness which gradually robbed him of the ability to control his body. He was a GP, and knew what was coming. Two years before he eventually died, he was admitted to hospital with peritonitis. Without treatment, he would have expected death within days. He declined treatment, as was his right, and we all patiently and tearfully waited for him to die, while he was dosed up on morphine to control the pain. Contrary to expectations, he survived. He had always been very fit and, said his own doctor, had "interest in the bank" which allowed his body to fight his infection and repair his ulcer.

The following two years were wonderful for me. I spent time with him, went on holiday with him, cared for him, found out about his early life and we crossed a major hurdle for Englishmen: we were able to say that we loved each other. Two months before he died, and with difficulty, he attended my sister's wedding reception.

As his death approached, he knew that the only way he could control it was to starve and dehydrate himself. In his final days, he was no more than a stinking, breathing corpse. Sadly, the manner of his death was not unusual.

Who did those two extra years of life benefit? Me, undoubtedly. And, for the first year, my father. But the final months were a cruel torture for him. Was it really better that he died two years later than he might have done? He saw his daughter's wedding, but missed my civil partnership and the birth of his grandchildren.

Would it have been better if he were to have died at the age of 73, rather than 72? Quality of life is at least as important as quantity of life. And yet I hear palliative care doctors recounting tales of lives extended and deaths averted. In many cases, this may be a good thing. But not always.

It is an anomaly that my father was able to decline life-saving treatment. Yet there were no safeguards to ensure that he wasn't being coerced by his family into declining treatment. No second medical opinion was required, no cooling-off period, no sworn solicitor's declaration, no requirement that he be within the last six months of a terminal illness. If the opponents of assisted dying are genuinely concerned about the risk of coercing vulnerable patients into an assisted death, shouldn't they be equally concerned about the thousands of patients who each year decline life-extending treatment? Or are their concerns a cover for another objection?

We need a moral debate about the extent to which society should restrict people's free choices at the end of life. We need all participants to come clean about their own personal beliefs and to consider carefully whether they are right to seek to impose their morality on others. I quote the Rev John Cartwright: "Those who do prevent moral choice are actually making moral choices for which they themselves will have to account."

By the way, I'm a humanist.

By Edward Turner, in The Independent