An acceptable way to arrange our death

Last Friday the House of Lords voted, to my great disappointment, to wreck Lord Joffe’s private member’s bill on assisted dying for the terminally ill. The peers who oppose it, many of them for religious reasons, managed to kill the bill by 148 to 100 votes, and prevent any further parliamentary debate.

This was predicted. The Christian churches and others financed an enormous, very expensive campaign against it, organised by a group with the tendentious name of Care Not Killing — the Joffe bill has nothing to do with killing, only with the choice to commit suicide in extremis. All that Lord Joffe can now do is introduce another bill another time, and he has promised he will.

Remember Diane Pretty. She campaigned ceaselessly, despite the ravages of motor neurone disease, for the right to be helped to die, before her terrible disease reduced her to helpless misery, but she failed and she died exactly the terrifying death she most feared. This seems to me unspeakably inhumane.

There are conditions which palliative care cannot reach. Between 3% and 10% of the population cannot be helped by painkillers, for instance; besides, pain is not the only terror in the process of dying. In any case, why should a responsible adult be denied the freedom to die, with carefully supervised help, if she is one of the tiny minority of people who would wish to do so?

Whenever there are public discussions of matters of life and death, people never fail to talk ominously of slippery slopes. Last week’s impassioned debates, both inside and outside the Lords, were full of slippery slopes. Allow this one freedom, the argument goes — to choose to die, to select a healthy embryo or to do a few days’ stem cell research — and we will slide quickly into a hellish abyss of legalised mass murder or Nazi eugenics, or whatever.

The truth is that the slippery slope is the human condition. We are already on it, and we cannot escape it. It’s our destiny to struggle along in life, upwards or downwards, with very uncertain footing. There is no safe plateau of moral security; we are constantly faced with painful dilemmas. The threat of a slippery slope is no argument against something that’s acceptable in itself, even though if pushed to a logical conclusion it might lead to something unacceptable. That’s the nature of moral decision-making: human moral effort is to keep seeing and drawing the line, and struggling to stay above it.

Those who don’t believe in God are obliged to play God. Playing God on the slippery slope is not very comfortable, but unless you are religious, there is no alternative. Even religious people are not always agreed on what God has ordained. Christians disagree passionately on some matters of life and death, as was clear in the House of Lords, when some Christian peers spoke as eloquently in favour of doctor-assisted suicide as others spoke against it.

Friday’s debate strengthened my feeling that religion ought to be kept out of political decisions. You cannot argue with religious belief, or with holy writ; scriptures and edicts and personal convictions are knockdown arguments. You can, however, argue on secular questions. Secular thinking is open to change and compromise.

There has been a rather cunning rearguard action on the part of some religious people to suggest that the scientific-materialist world view is merely a chosen belief system like any other, in effect, another religion. It follows that that secular arguments are of no more value than religious. The Archbishop of Canterbury made this point in passing. But it isn’t true. The point about the scientific, empirical worldview is that it is open to evidence, it can be publicly tested and it can be shown to be wrong. It is corrigible. Scientific theories can be changed. Laws can be repealed. Facts help.

I’d like to suggest a few corrections that can be made to some current fears about the bill. In a letter to The Times on Friday, the Archbishop of Canterbury, the Archbishop of Westminster and the Chief Rabbi said that “such a bill cannot guarantee that a right to die would not, for society’s most vulnerable, become a duty to die”. There’s a widespread fear, we’re told, that insensitive, overmighty doctors might bully confused little old ladies into signing their lives away, perhaps because they were a burden, or under pressure from greedy relations, or because NHS funds were low.

But these fears can be allayed by strict, legally binding safeguards. There were more than enough in the Joffe bill. (Furthermore, had the bill been allowed to go on to a standing committee of both houses, this question could have been re-examined).

Under the Joffe proposals, nobody — no patient, no doctor — could be required to have any part in doctor-assisted suicide; nor could any hospital or other establishment. No doctor could be required to raise the question with a patient, or to refer the patient to another doctor who would. The little old lady herself must make the request herself, in writing, she must be examined by two doctors, one of them a consultant independent of the other, and they must be satisfied that she is indeed terminally ill, with six months or less to live and that she has the capacity to make such a decision.

If in any doubt, she must be referred to a psychiatrist or psychologist to assess her capacity. It’s my understanding that if she lacks capacity she will be protected by the Mental Capacity Act, like anyone else. She must also be told about and offered palliative care. If she still persists in wanting to die, she must sign a form, witnessed by two people, one of them a solicitor, and neither with any remote interest in her affairs (no greedy relations). Then after a period of two weeks, her doctor may give her a prescription, which she may never in fact choose to take, and she can revoke her decision to die at any time.

On my count that makes at the very least five independent professionals, not to mention the nurses and other care professionals surrounding her, who would all have to be complicit in pushing her into suicide, against her will and against her right to life. It assumes that her family members and friends would be either complicit or uninvolved. These sound to me like adequate safeguards; this is hardly a Shipman’s charter. It is indeed a slippery slope, but that’s inevitable in life, and how far we choose to slip lies in our own earthly power.