[...] religion was on my mind last week as I joined the discussion on euthanasia at Cranmer and OurKingdom - and thanks to everybody who contributed to those discussions, particularly David at Britology [...]

David, first: thank you for continuing this discussion, despite my occasionally snark. Your clarifications are helpful, but unfortunately I still don't think that you are putting forward a coherent position.

"My point is that it is arguably immoral for them to do so. That’s what I meant by putting people in a situation where they feel or in fact are legally obliged to carry out that wish."

It is arguably immoral, but that's their choice to make. I realise that I bring a whole host of assumptions about privileging individual choice over communal interests, thus fitting nicely into the Moral Foundations model proposed by Haidt and others. However unless you can convince me that not only is it my role to decide for the suffering individual, but also for their family and friends, then I am unlikely to find this line of reasoning persuasive.

"‘Obliged’ relates more to the emotional pressure this imposes on relatives; but medical professionals could also feel ‘morally obliged’ to carry out their patient’s declared wishes; and if the law also permitted this, it could be very hard to resist in some cases."

I agree that there will be all sorts of complications at play in any given case, and that we need to be very careful about the social impact of loosening the restrictions on assisted suicide, yet I don't find this a compelling argument for extending the unnecessary suffering of others. Once again, we are not talking about compelling family, friends or medical practitioners to do anything at all; we are talking about making it legal for individuals to seek the assistance of people and organisations that are prepared to provide that assistance.

"You say that safeguards should be put in place to protect patients who are no longer able to communicate their wishes. But it is naive to think such safeguards would work in every case, leading to inevitable and tragic mistakes."

I didn't say that they would work in every case. However as I have pointed out already, this issue is not what this blog post is about. To take the example of the recently-deceased Chantal Sebire, this is a woman who had clearly decided that she wanted to die, who did not have the possibility of reprieve and who faced brain damage that would have progressively undermined her capacity to make a rational choice. I cannot see any reason why this case would not meet the most stringent possible criteria for permitting an assisted suicide under carefully managed conditions.

"If someone wishes to take their own life but is unable to communicate this to others, this must indeed be enormously distressing to the person concerned. But it is irrelevant to a discussion of the ethical issues around euthanasia or assisted suicide because there is by definition no way we can know whether that person wants to die or not."

If it's irrelevant to the issue of euthanasia, why did you raise it in the case of somebody who previously wanted to die but has now changed their mind? You can't have it both ways - either it's a factor or it isn't, so please make clear which you believe.

"they should really take steps to ensure they can do so themselves rather than make others feel emotionally or morally obliged to do it on their behalf, which is making them complicit in a morally questionable act."

I am afraid that I cannot reconcile the idea of dying with dignity with not being able to talk to your loved ones about the most important decision of your life and then killing yourself in private so that they can find the body (or never find the body at all). Forcing people to die alone and ashamed simply to satisfy the moral compunctions of other people is abhorrent to me.

I should add that, contrary to those who are worried about the slippery slope, I believe that loosening these restrictions would put us on a firmer footing. It would make it possible for people to openly discuss their suicidal thoughts with their loved ones, enabling both sides to understand each other better and making it possible to discuss their death rationally, rather than being forced to avoid the taboo.

"This is an issue, but it is not a fatal flaw. One of the requirements should be that a living will has been made while they were in sound mind, in anticipation of just such a situation. No document, no euthanasia."

The problem is the same as with capital punishment - once the person has been killed, there is no comeback. No mistake of that order can be rectified. This is partly why I am against both.

"I wouldn’t feel that I was being rejected by a relative who wanted to end their life"

You might not, but numerous other people would. It's also a hell of a burden to put on anyone's shoulders, as it often delegates the responsibility to someone else, who has to get the drugs etc, or even administer them. In addition, the relatives may be split over any such decision and it may precipitate a major rift in the family.

There's also an issue about violation of the Hippocratic Oath too.

Unlike Japan, we don't have a society which accepts certain forms of suicide, or so called mercy killing. This coupled with abuse of the system (which will happen), makes it a pretty bad scenario.

“Of course, people are allowed to make decisions about their death.”

What I meant is that people are allowed to commit suicide. Currently, of course, they're not allowed to engage others in assisting their suicide. My point is that it is arguably immoral for them to do so. That's what I meant by putting people in a situation where they feel or in fact are legally obliged to carry out that wish. 'Obliged' relates more to the emotional pressure this imposes on relatives; but medical professionals could also feel 'morally obliged' to carry out their patient's declared wishes; and if the law also permitted this, it could be very hard to resist in some cases. Your analogy with the death penalty is quite illustrative of the moral issue: of course, no one individual was actually obliged to exercise the profession of hangman; but someone had to do it while the law permitted executions.

The problem is the legal permission to kill in certain circumstances, which could appear to exonerate the person who does kill; but that person may feel it is not right to do so and still feel pressured to go ahead, because of that social licence. This also provides scope for abuses, including from psychologically deranged medical practitioners who could take pleasure in this sort of killing (there've been many examples of this sort of thing). You say that safeguards should be put in place to protect patients who are no longer able to communicate their wishes. But it is naive to think such safeguards would work in every case, leading to inevitable and tragic mistakes. These would indeed be analogous to the errors of legal justice that resulted in innocent people being hanged while capital punishment still applied.

If someone wishes to take their own life but is unable to communicate this to others, this must indeed be enormously distressing to the person concerned. But it is irrelevant to a discussion of the ethical issues around euthanasia or assisted suicide because there is by definition no way we can know whether that person wants to die or not. Even if someone is able to communicate their wish to die, this is not conclusive in determining that it is morally legitimate to assist them in doing so. Someone in profound despair owing to clinical depression might plead to be allowed to die; but does that authorise us to accede to their request? Clearly not, because there is always a chance they will recover their mental balance and gain renewed hope. Similarly, someone in despair because of their physical pain and deterioration could also change their mind, and discover hope and meaning in their situation, even in death itself. What right do we have to preclude that possibility on the basis of our fallible judgement that the dying person's situation can have no psychological or spiritual meaning, for them or for us who love them? And equally, what certainty do we have that the death a person 'chooses' - through (assisted) suicide - will be any less painful, psychologically, physically or spiritually, than if death is allowed to take a more natural course, with time for emotional and spiritual catharsis and reconciliation?

My last comment that you pick up on (people should "carry out the act while they still can - not expect someone else to do it for them when they can’t") means that, if someone knows they have a terminal condition, and if they are resolved not to endure a lingering physical or mental decay and death by taking their own lives, then they should really take steps to ensure they can do so themselves rather than make others feel emotionally or morally obliged to do it on their behalf, which is making them complicit in a morally questionable act.

David, aka Britology Watch

"Paul C, I don’t know where you got the ‘killing off people’ quote; but it wasn’t from my comment."

It wasn't a quote, but a paraphrase: specifically, of your comment "Who are we to decree that people whose lives appear no longer to have any kind of quality or value... do in fact not have any quality of life and can be terminated?"

"Of course, people are allowed to make decisions about their death."

The entire point of the blog post is that people aren't allowed to make decisions about their own death; for you to propose the opposite seems slightly odd. Could you explain to me in what way people are allowed to make decisions about their own death?

"the dying person may have doubts about their original decision when it comes to the moment, and they’re not able to communicate that change of mind or put a halt to the process"

So we must put in safeguards that take into account a deterioration in capacity for communication. How would you deal with the reverse situation - somebody who decides that they do wish to end their life but is unable to communicate it?

"if it is wrong to take a human life - including the life of someone who despairs of finding any further meaning in their existence, either before or after death - then it is wrong to make someone else feel, or in fact be, (legally) obliged to take their life."

It's lucky, then, that nobody is proposing this. Nor are they likely to, any more than the legality of the death penalty previously made everybody in the UK legally obliged to personally execute criminals.

"If someone wishes to take their own life, which actually is a pretty selfish thing to do from the point of view of those who love them who have to go along with it"

But you don't think it's selfish for their loved ones to prevent that person from taking their own life? I'm interested to know why you think the selfishness of the loved ones outweighs the selfishness of the suffering individual.

"then they themselves should carry out the act while they still can - not expect someone else to do it for them when they can’t."

What a very strange proposal. You appear to be arguing that people should kill themselves now on the strength of the possibility that later they may have a terminal condition and be unable to manage it.

Paul,

Quoting myself and then you in response: '"My point is that it is arguably immoral for them to do so. That’s what I meant by putting people in a situation where they feel or in fact are legally obliged to carry out that wish.”

'It is arguably immoral, but that’s their choice to make.'

Well, I guess the point is that I do think it is immoral a) to take one's own life and b) perhaps even more so, to ask someone to help you to do so. But yes, the law does allow many things that are immoral, according to many different sets of ethics. But if you don't agree that it's wrong for a dying person to ask family members, or charitable or professional organisations, to assist them in taking their own life, it is still possible to see it as very unfair - and also, it would feel wrong to most people that organisations should receive money for terminating lives in these circumstances.

It is unfair to ask relatives to accept their loved-one's chosen course of action, and even to assist in it, as those relatives may be profoundly upset or in disagreement with it - emotionally or morally. Even if they are not, I am unconvinced that this is the best way to help all affected by the death - those who die and those who remain - to cope with it and be reconciled with it, and with each other. At a visceral, emotional level, if someone decides they do not want to be cared for by their loved ones when they are no longer capable of looking after themselves or taking their own decisions, this must often be experienced as a profound rejection; the loved-one is turning away emotionally from their relatives and hastening an end that those who survive dread. There may not be enough time to finish all the unfinished business, to say all that needs to be said; indeed, if the dying person is saying 'only this much and no more', this could foreclose any further discussions and reconciliations that are needed. Similarly, how much extra guilt - conscious and unconscious - will those relatives have to carry if they've participated in accelerating their loved-one's death. Is this really the best way to begin the grieving process? There are alternatives to this desperate and negative course of action, including some truly wonderful hospices and also much improved palliative care. It's hard for me to see anything much positive in someone shortening the dying process that can be a very meaningful experience for all involved, albeit a painful one - irrespective of the spiritual dimension that for me and many is absolutely key.

And the example of someone wanting to die but not being able to communicate it or kill themselves is not at all the same as that of someone who doesn't want to die but knows their life is going to be taken because they'd previously said that's what they wanted. The former is a situation of deep distress; the latter is an absolutely terrifying situation where you know you've signed your own death warrant and there's no escape; and your consenting relatives are unwittingly acquiescing in your murder - the taking of your life without your consent.

David, aka Britology Watch

Ray: the comparison with capital punishment doesn't work at all, as far as I can see. There's a difference between somebody's choice and a punishment imposed upon them. Of course, that's why I said that anybody found abusing this should be charged with murder, since that would be what it is.

In your second point, you seem to be arguing that an individual should suffer for an undefined period because, if they chose to die, their relatives might feel rejected or it might split the family. I'm afraid that I can't see this argument as being anything other than ridiculous. Why don't you let people decide for themselves, rather than presuming to know what's best for them?

The Hippocratic Oath is not set in stone; the interests of the patient may be best served by giving them a peaceful end (rather than two years of having their face and brain eaten by cancer, for example). This doesn't preclude advising them against such a course of action, or providing treatment for as long as they wish it.

I have been following the exchanges between David and Paul with great interest; and I must admit that David’s shifting position makes me feel pretty narked. His position seems to be that if someone can commit suicide unaided, that’s fine; but if for any reason they cannot, then tough shit and don’t you dare ask someone to assist you to die because that will be selfish in a variety of ways. In other words, leave things as they are.

Well I was driven to write my post because I don’t think we can or should leave things as they are. The classic religious objections are outmoded and should no longer determine the law. David assumes that it is equally easy for everyone to commit suicide. But the case of Diana Pretty, who was suffering from motor neurone disease, shows how facile and indeed discriminatory his position is. Mrs Pretty was paralysed from the neck down and had to have assistance both to continue her life and to spare herself a degrading and lingering death. The British courts and European Court of Hunan Rights were ‘sympathetic’ but refused to acknowledge a right to die at the hands of a third person or with the assistance of a public authority.

I am not sure whether or not David was asserting that I simply want to get rid of old people. To be clear, I was not. I respect the right to live just as I demand the right to die. My point is that we as human beings have the right to choose to die when our lives become unbearable. It is an individual right made more urgent by society’s refusal to devote the huge resources necessary to give care and comfort to the huge and growing population of elderly people in this country. And I certainly am being selfish, as it is a right that I want for myself.

"So at this stage, doesn’t ‘assisted suicide’ and ‘euthanasia’ merge ambiguously into ‘mercy killing’ and ‘murder’?"

No.

Clearly we need to put in place the necessary legal, medical and social framework to ensure that any termination procedure is carried out with the full knowledge and consent of the individual concerned, even if that consent is given in advance.

"Killing off people that you don't want hanging around" is not what this post is about, and it's not what this debate is about. It's about whether people are allowed to make their own decisions about their lives - including their deaths.

What you are arguing - essentially - is that religious communities have more rights over the individual than the individual does themself. If you are happy with that, please feel free to live accordingly; but don't expect others to do the same.

"Don’t eat pork. Very sensible in hot countries without fridges and modern hygiene; superstition now. Don’t worship graven images; superfluous now."

Try telling orthodox Jews or Muslims that the prohibition against eating pork is 'superstition' - especially as many of them continue to live in hot countries with inadequate refrigeration! And 'don't worship graven images; superfluous now'? Really? Depends what you mean by a graven image, I suppose; but there are lots of false gods people worship nowadays, including those reliant on 'image': celebrities, power, money, etc.

Similarly, you seem to think that religious beliefs about suicide are no longer 'necessary to protect societies'. Why? Because societies no longer need to mobilise all their moral and legal resources to ensure they perpetuate themselves, because population continues to rise? So is suicide a convenient means of population control, relieving society of the expensive burden of maintaining lives that have become no longer economically productive?

It's nothing to do with society; it's about the individual and his or her conscience and relationship - or apparent absence of relationship - with God. Who are we to decree that people whose lives appear no longer to have any kind of quality or value (such as those in an advanced state of Alzheimers) do in fact not have any quality of life and can be terminated? The patients themselves in that condition can't communicate this to us. So at this stage, doesn't 'assisted suicide' and 'euthanasia' merge ambiguously into 'mercy killing' and 'murder'?

People have a legal right to take their own lives - we can debate about the ethics till the cows come home. But is it reasonable to expect others to participate in this process after a point at which the dying person is no longer responsible for their actions or for the actions that are done to them? Then, from a religious perspective, the dying person is not only putting their own salvation in peril, but also that of others they love.

Of course, you can always take a massive gamble and dismiss such scruples as superstition.

David, aka Britology Watch

"I must admit that David’s shifting position makes me feel pretty narked. His position seems to be that if someone can commit suicide unaided, that’s fine; but if for any reason they cannot, then tough shit and don’t you dare ask someone to assist you to die because that will be selfish in a variety of ways. In other words, leave things as they are".

Stuart, on the contrary, I feel I've been pretty consistent and moderate in the expression of my views throughout this exchange, in contrast the occasionally disrespectful tone and misrepresentation in some of your and Paul's comments (which he sort of admits to in his last contribution). I neither think it's 'fine' to commit suicide unaided nor to ask someone to help you; and I regard both acts as selfish: the suicidal person putting their feelings and wishes above those of the people who love them.

And I don't think it's sufficient to 'leave things as they are', at least in the sense that I agree with you that much better care and more resources should be devoted to looking after the elderly and the dying. But your statement that I quote below seems to confirm the link I made in my first comment between society's sanctioning of assisted suicide and its not being willing to spend money on looking after the long-term elderly and sick: "we as human beings have the right to choose to die when our lives become unbearable. It is an individual right made more urgent by society’s refusal to devote the huge resources necessary to give care and comfort to the huge and growing population of elderly people in this country". Is there a suggestion in this statement that you also regard the cost of looking after so many long-term elderly as too huge?

I can confirm, however, that I do not think you 'simply want to get rid of old people', Stuart. But it's a well-known argument that many old people might feel they had to accept offers of 'assistance' in dying if they were made to feel they had become too much of a burden on those around them and on 'society', and that their lives no longer had any value. You yourself do seem to concur with the view that if a terminally sick person thinks their life no longer has any value, it does no longer have any value. For instance, you refer to Mrs Pretty's courageous stand in the courts as an attempt to spare herself "a degrading and lingering death". Lingering, perhaps - although that suggests that someone is hanging around for a bit longer than one would wish - but degrading? Does such a fate truly degrade a person's humanity? I don't think so; and I think it's the job of society and all who care for chronically sick people such as Mrs Pretty to let her know that her life and her person continue to be infinitely precious even in the midst of decay and suffering. Surely that is the way to minimise the pain of death, not to encourage people to seek a way out that is effectively a denial of meaning and of love still to be given and received.

So my position is built on a belief in the infinite value - in both senses of the word 'infinite' - of life, even in the midst of death. If this an outmoded religious position, then I'd rather have that than a life-denying, modern-day consumerist culture of death.

David, aka Britology Watch

"But all too often it can condemn them to a fate where, like Alzheimer’s disease which as Terry Pratchett has movingly described it, “strips away your living self a bit at a time”, it promises a living death for huge numbers of people."

Sure, but bringing up Alzheimer's brings up one of two (literally) fatal flaws* in the so called "right to die". Is said person of sound mind, when they make that decision?

Of course, it's not just the old and ill, that want to die, as we can see in parts of South Wales just now. Do we condone the actions of the teenagers in Maesteg and Bridgend, as somehow making a valid choice?

* The other one is if the person really wanted to die, or was coerced. Or even had their wishes falsified.

"It is unfair to ask relatives to accept their loved-one’s chosen course of action, and even to assist in it, as those relatives may be profoundly upset or in disagreement with it - emotionally or morally. Even if they are not, I am unconvinced that this is the best way to help all affected by the death"

That's my point in a nutshell. If the individual concerned and their relatives accept this course of action, and are not profoundly upset by it, then it is a matter of supreme unimportance whether or not you are convinced by it.

Your attempt to articulate the various ways in which this might not be healthy was insightful and helpful for me. I can only speak for myself, however. I wouldn't feel that I was being rejected by a relative who wanted to end their life, I don't dread anybody's death, I believe the knowledge of exactly when somebody is going to die would help me to resolve unfinished business, I wouldn't feel any guilt in assisting their death, and being part of their decision-making would help me with the grieving process through understanding them better.

In short, I don't believe the things you believe, I don't think about these things in the same way as you, and I certainly don't want you legislating how I live my life - or die my death. The difference between us is that my view of how we should treat death will accomodate your wishes, but your view specifically excludes my wishes; and this I can never accept.

'“Killing off people that you don’t want hanging around” is not what this post is about, and it’s not what this debate is about. It’s about whether people are allowed to make their own decisions about their lives - including their deaths.'

Paul C, I don't know where you got the 'killing off people' quote; but it wasn't from my comment. Of course, people are allowed to make decisions about their death. However, whether they have a right to impose an obligation on others (carers, doctors or relatives) to terminate their lives (or, as Stuart Weir might euphemistically put it, 'accelerate the ending') when they themselves have reached a point where they are no longer capable of taking and carrying out that decision is ethically disputable. This is firstly because the dying person may have doubts about their original decision when it comes to the moment, and they're not able to communicate that change of mind or put a halt to the process; and b) if it is wrong to take a human life - including the life of someone who despairs of finding any further meaning in their existence, either before or after death - then it is wrong to make someone else feel, or in fact be, (legally) obliged to take their life.

If someone wishes to take their own life, which actually is a pretty selfish thing to do from the point of view of those who love them who have to go along with it, then they themselves should carry out the act while they still can - not expect someone else to do it for them when they can't. This at least is having the courage of one's convictions.

David, aka Britology Watch

"Sure, but bringing up Alzheimer’s brings up one of two (literally) fatal flaws* in the so called “right to die”. Is said person of sound mind, when they make that decision?"

This is an issue, but it is not a fatal flaw. One of the requirements should be that a living will has been made while they were in sound mind, in anticipation of just such a situation. No document, no euthanasia.

The other issue you raise - whether the person really wanted to die, or was coerced - is more problematic, but equally non-fatal. The relevant legislative and medical framework should have as many safeguards as possible to prevent this from happening, and where such situations are discovered, they should be treated as murder and prosecuted to the full extent of the law.

'“It is unfair to ask relatives to accept their loved-one’s chosen course of action, and even to assist in it, as those relatives may be profoundly upset or in disagreement with it - emotionally or morally. Even if they are not, I am unconvinced that this is the best way to help all affected by the death”

'That’s my point in a nutshell. If the individual concerned and their relatives accept this course of action, and are not profoundly upset by it, then it is a matter of supreme unimportance whether or not you are convinced by it.'

The point I was making was that I don't think this is the best way for an individual to face up to death emotionally (let alone spiritually) or to ensure they are truly accompanied and supported in their dying by all their closest friends and relatives. You say it's possible for the relatives (all of them?) to not be profoundly upset (just a little upset?) by their loved-one's decision to accelerate their passing. Well, of course if they truly love that person, they will do their utmost to rally round and show them support; but whether this equates to all of them being fully behind the process and therefore really being with the dying person (emotionally, in spirit) as they pass away is another matter. Similarly, on the part of the dying person, this does represent a turning away from love and support that might have been with them till the end if the end had been allowed to arrive at a more natural pace.

Clearly, however, you do think and feel about these matters quite differently from myself, and I can't presume to judge the merit or the genuineness of what you say about how you would react to someone you love opting for assisted suicide. My moral and legal objection to this concept, as opposed to how you feel about it (which I can sympathise with), is twofold: 1) an absolute conviction that it is egregiously morally wrong - an immoral form of legalised killing along the lines of capital punishment or abortion (but let's not open up that Pandora's Box); 2) a view that legalising it, even under the kinds of safeguards you refer to, would result in more abuses, accidents and coercive euthanasias than it would enable properly consensual assisted suicides. In fact, the mere possibility of any non-consensual euthanasia happening under the auspices of the law is sufficient justification not to create the legal circumstances that could result in such things happening.

In one of his contributions above, Paul C dismissed the importance of the possibility of tragic mistakes in the following terms: "I didn’t say that they would work in every case. However as I have pointed out already, this issue is not what this blog post is about". Well, precisely; you are putting what you perceive as the / your right to die ahead of other people's right to live. That's the reason why I oppose a change to the law.

David, aka Britology Watch