Dying With Dignity

The death of Brittany Maynard, a 29 year old Californian, has reopened dialogue on the seemingly controversial issue of assisted suicide. Having been diagnosed with stage 4 glioblastoma (a devastating form of brain cancer), she made the decision to move to Oregon in order to make use of the state’s Death with Dignity Act and passed away peacefully on October 1st surrounded by her husband, friends, and family. Her decision has since made headlines globally and served as a reminder that this is an issue which will rear its head again and again until significant changes are made.

Meanwhile, Friday 7th November saw the unanimous acceptance by the House of Lords of an amendment to the current assisted dying bill, signifying a substantial move towards changes in the existing law. The Scottish Green Party co-convener, Patrick Harvie, has also recently spoken of his taking on of responsibility for the Assisted Suicide Bill in Holyrood, following the death of Independent MSP Margo MacDonald.

MacDonald, who died earlier this year, had introduced several bills into the Scottish parliament which would legalise and regulate assisted dying. However the progress of these bills has been rocky.

qmunicate spoke to Professor Sheila McLean, University of Glasgow Emeritus Professor of Law and Ethics in Medicine and a frequently cited authority on assisted dying and legal reform, who suggested that despite broad public support for allowing assisted dying she “did not believe that the political will exists to support law reform in this area” at the present time.

Despite the mood among lawmakers remaining mixed, Britain has seen a growing number of academics and public figures arguing in support of such measures. Dr Kailash Chand, the deputy chair of the British Medical Association, said: “The present law definitely needs changing. It discriminates… We currently have a two-tier system – one for the people who have the resources and money to go to the Dignitas clinic in Switzerland and another for the majority of people who don’t have the resources or money.”

It is difficult to approach this from a non-emotional standpoint; for a situation that is literally life or death, it can seem trivialised by being reduced to debate etiquette and practicality. Those who oppose the passing of laws permitting assisted dying could argue their case using this very reason – surely a government should not condone acts of such significance if they could be based on anything other than cold, hard fact? Such a thought process may hold some merit, but not enough to surpass the importance of what the conversation should come down to: autonomy.

Legislation is put in place to protect and assist citizens, but it should not be implemented to infantilise them. Personal autonomy should be maximised as far as possible without infringing on the rights of others, and this should include an individual’s power to end their painful suffering with grace. To deny someone this is to tell them that they can’t be trusted with a decision of such gravity, and that their right to die with dignity is outweighed by the challenges involved in the creation of such delicate legislation. Instead, we hear of people diagnosed with terminal illnesses who felt forced to take their lives earlier than they would have, had they been comfortable in the knowledge that they could receive assistance and not leave their loved ones to potential prosecution, never mind societal persecution.

That’s not to say that said challenges don’t hold any weight. The question of contradiction in medical professionals’ duty is a relevant one, at least in terms of public perception. But is that really a strong enough argument to deny all patients the right to control? As receivers of care – and it is worth noting that we have access to first-rate palliative care in this country, though it’s not enough – we must ask ourselves if a doctor who is obliged to treat patients with compassion and understanding is genuinely of less integrity than one whose main responsibility includes keeping people alive at all costs despite their wishes, showing a rather simplistic approach to medical ethics.

There must, of course, be tight regulation to ensure absolutely no coercion in each case and strict assessment to determine mental competence. This almost seems a given – you’d be hard-pressed to find an advocate for assisted dying who wants the process to be an unregulated free-for-all. Yes, the cold and sterile language surrounding the issue which can seem off-putting is certainly necessary, but it shouldn’t stifle the humanitarian needs of the terminally ill.

There is disparity in our allowance of terminally ill patients to refuse care and our drawing a line at giving them the freedom to decide how far their suffering goes. In 2014, nearly 70% of the UK public polled in support of reforms to allow assisted dying – change which is beginning to appear inevitable.  Brittany Maynard asked people to do three things: “Number one: love life; number two: love each other; and number three: make end of life choice available.” This is an issue caught between kindness and governmental legislation – we must find the correct balance to benefit our terminally ill patients.

[Hannah Westwater – @hannahpavlove]

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