Rebecca Coulson is a freelance classical musician and writer, and was Parliamentary Candidate for the City of Durham at the 2015 General Election.
I. To stand to or by; to be present.
II. To aid, help.
(Oxford English Dictionary)
In the twenty-four-and-a-half hours following sundown on a Friday night, many Jews respect Shabbat. For the most observant, this includes the avoidance of creating anything new. A famous example is light: switches go untouched. World leaders in the hi-tech race, Israeli companies have invented various imaginative devices to help those who feel that circumventions of this rule do not detract from their faithfulness. These devices usually work on the basis of passivity; they allow their user to gain a desired result without directly causing it.
In 2005, a bill was passed by the Knesset (the Israeli parliament) including proposals regarding a similar device. A delayed-response timer would permit a ventilator to qualify as a temporary form of medical treatment, which a patient could choose whether to continue. As continuous life-prolonging treatment cannot legally be withdrawn, this new provision has been popularly described as facilitating passive euthanasia*. This development – in the land of a religion that strongly opposes suicide, and where the word ‘euthanasia’ has monstrous historic connotations – epitomises the force of the global campaign to reconsider end-of-life care.
The issue is mired in easily confusable terminology. It is essential to note the differences between passive euthanasia (the intentional avoidance of the possible prolongation of life), assisted dying (someone being enabled to take their own life), and active euthanasia (another person doing this for them). It is further complicated, as it is grounded in the consideration of moral values: those that are concerned with the distinction between good and bad.
We can’t prove moral values to be objective absolutes in the same way that we can other truths. Yet, in order to fight against corruptive relativism, we need to believe that there are such things to be searched out. British law has progressed to the point at which it treats everyone equally, regardless of differentiations like gender, sexuality, and race. Most of our citizens firmly believe this to be good and right. Gradually, laws have also developed regarding other moral issues, including abortion, suicide, and genetic engineering. To many, some/all of these laws are evidence of our society’s admirable progression. But, for many others, some/all of them are controversial, or wrong. Regardless of disagreement, we should accept that these issues raise questions with true answers.
Assisted suicide is increasingly seen from the former perspective: a missing component of humanity’s compassionate liberalisation. Rob Marris, Lord Falconer’s successor in proposing the Assisted Dying Bill – which will have its second reading debate in the Commons this Friday – is convinced that the ‘current law does not accord with social attitudes.’
This view is concentrated upon the individual who wishes to die. And, of course, it is right to want to help people who suffer. In the preface to death, life can become so unbearable that some sufferers come to consider suicide (which has been legal in Britain since 1961) their preferred option. This is understandable, and – without contradiction – also extremely sad. Sometimes, however, sufferers require assistance to commit suicide. This, as I understand it, is at the heart of the Assisted Dying Bill.
It is a common concern that a bystander (see definition I of ‘assist’, as above) could incriminate themself by being present at the time of a terminally ill person’s suicide. This hinges upon the fear that they – the bystander – might be unable to prove that they did not help (see definition II, the standard explication) to bring about the death. Watching a responsible person commit suicide is not a crime.
This Bill, therefore, is not simply about someone who has chosen to die. Suicide is already legal; rather, the Bill aims to enable a legal death, by allowing another person to assist in it – specifically, a health professional. The wording of the Bill’s title (‘to enable competent adults who are terminally ill to choose to be provided with medically supervised assistance to end their own life’) focuses on the sufferer’s ‘choice’. However, the wishes of this choice can only be enacted with the legalisation of another’s action.
But what is this action? There are various ways in which someone might require help to commit suicide. In the cases that would be made legal with the passing of this Bill, these would involve the procurement (indeed, prescription) of life-ending drugs, and, more significantly, assistance (where necessary) in the taking of these drugs.
Whilst the Bill continually emphasises ‘self-administration’, it clearly states that someone assisting may: ‘prepare the medicine for self-administration by that person; prepare a medical device which will enable that person to self-administer the medicine; and assist that person to ingest or otherwise self-administer the medicine.’
It is hard to square this final clause with the following subsection, which claims that it ‘does not authorise an assisting health professional to administer a medicine to another person with the intention of causing that person’s death.’ The Bill attempts to address this contradiction by insisting that ‘the decision to self-administer the medicine and the final act of doing so must be undertaken by the person for whom the medicine has been prescribed.’ But what if, for instance, the assistant’s involvement included a point at which the sufferer might have changed their mind about dying, but was, by then, unable to inform anyone? Then, we would risk countenancing not just assisted suicide, but active euthanasia.
If someone needs assistance to self-administer a medicine, they cannot be taking that medicine entirely by self-administration. And death is certainly the intention of all involved in the act.**
Marris claims that his Bill focuses on ‘the choice of a well-informed terminally-ill mentally-competent adult to decide to control the manner and timing and location of their own death by their own hand’. Can this be true? Can a person in need of assistance die entirely ‘by their own hand’?
One of the few objective moral absolutes on which most of us agree is that (outside of war-time) the taking of another’s life is wrong. Yes, the current framework surrounding end-of-life decisions might seem confusing, uncertain, or even negligent. But does this necessitate its replacement with a potential refutation of that moral absolute?
It is tempting to try to ease disturbing dilemmas with quick panaceas – particularly if these dilemmas cause preventable suffering. But we mustn’t depend upon superficial solutions that circumvent – or even exacerbate – the problems at hand. Distressingly, compassion is not always simple.
* If the intent here is to allow a patient to refuse treatment, rather than to hasten their death (a resulting effect), this is not euthanasia as understood in British law.
** Indeed, if the sufferer decides not to commit suicide when the life-ending drugs are brought to them by the assisting health professional (within the specified time period after the sufferer’s official declaration that they wish to die), the drugs must be ‘immediately removed’ from them.