Euthanasia

The Reality of Assisted Dying: understanding the issues

Edited by Julian C. Hughes & Ilora G. Finlay (Open University Press/McGraw Hill: 2024 - £25.99)

This is a timely book. On 16 October this year, Labour MP Kim Leadbeater introduced a Private Member's Bill on Assisted Dying in the House of Commons. If passed, it would give terminally ill adults in England and Wales the right to end their life. At the time of writing, the 2nd reading of the bill was scheduled for 29 November. Earlier this year – 26 July – Lord Falconer introduced a similar Bill in the House of Lords. It too will be debated in November by peers. A week after Kim Leadbeater introduced her bill, the Welsh Senedd (Parliament) held its own debate, with members voting 26 to 19 against a cross-party motion in support of assisted dying in principle and the introduction of such a law in England and Wales. But the Senedd cannot change the law anyway – it does not have the power to do so – that is reserved to Westminster.

Meanwhile, the Scottish Parliament's Law Reform Committee is currently scrutinising its own bill on Assisted Dying for Terminally Ill Adults, prior to it being debated by MSPs. Introduced by Liberal Democrat MSP Liam McArthur on 27 March this year, this will be the third time such a proposal has come before the Scottish Parliament – two previous attempts having been defeated in 2010 and 2013. Interestingly, the question has been raised at Holyrood as to whether or not such a measure is "outside the legislative competence" of the devolved parliament. The SNP's Health minister, Neil Gray, has queried it on two points: first, that the supply of medicines, medical supplies and poisons is a reserved matter, and second, that the regulation of health professionals is also a reserved matter. It is possible that the Scottish government may need to have recourse to Westminster in order to bring such a Bill within its competence. That could take between 12 and 18 months.

Over in Ireland, the Dáil (lower house) recently voted 76 to 53 in favour of a joint committee report which called on the Irish government to legalise assisted dying "in certain restricted circumstances". However, the vote will not change the law in Ireland – assisting someone to die remains a criminal offence – so such a change would require the support of both the upper and lower houses of the Irish Parliament, as well as the approval of the President. By contrast, the Isle of Man – a crown dependency but with its own legislature – is close to introducing a law which would permit assisted dying for someone who has lived on the island for at least five years and who has less than twelve months to live. The proposed legislation, now in its final stages, can be amended or delayed, but not voted down. Having received the Royal Assent, it might come into effect by 2027.

Euthanasia and assisted dying have already been legalised in Belgium, the Netherlands, Canada and several states in the USA – it might happen here in Britain (there is no legislation planned for Northern Ireland). So, the subject is very real and vivid – it should concentrate our minds. The Reality of Assisted Dying is therefore a timely examination of the various aspects of assisted suicide and euthanasia. Comprising 34 short but deceptively comprehensive chapters, the 44 contributors – politicians, academics, lawyers, doctors, medical consultants, palliative care specialists and theologians – put the case against assisted dying over the course of its 210 pages. Little is left out. The first three chapters set the debate in context; these are followed by a section on the global perspective, which takes account of the current situation in the Netherlands, Canada, New Zealand and Australia; there is a section on the law and associated legal topics. After that, there are a dozen chapters devoted to medical and palliative care issues, and to safety and vulnerable groups. The final two sections deal with philosophical and ethical concepts, and to "faith or no faith"

Even humanists oppose assisted suicide. Each chapter is fully referenced; there is a short bibliography at the end of the book; and it concludes with a detailed index. Baroness Elizabeth Butler Sloss, former High Court Judge and Lord Justice of Appeal, provides an overview of the debate in her introduction. The Reality of Assisted Dying is long on fact and short on emotion. It provides a much-needed resource for those wishing to challenge the emotive appeals behind the hard-case scenarios. So what are some of the areas that the contributors address in this volume? John Keown looks at seven prominent but weak arguments in favour of the legalisation of euthanasia and assisted suicide, and explains why they fail. They are weak, he argues, and gain no force through repetition. "By contrast, both in principle, and because of the inevitable and dangerous consequences of legalisation, the case for maintaining the legal bright-line prohibition on intentional killing or assisted suicide remains strong." [p.26] "Read the question!" shouts Robert Preston, in the first of his two contributions, then follows it with: "Safeguards – what safeguards?" He acknowledges that we are living longer. "While for many people this can mean a new lease of life, for others it can mean a life of pain, discomfort or frustration as life-limiting illness and immobility overtake them. But reaching blindly for the Statute Book is not the answer." Assisted dying, he says, is "yesterday's answer to today's question." [p.76] In the section on global perspectives, Conall Preston provides some "real-world examples of unintended consequences from assisted dying legislation": a 38 year-old Belgian woman with autism, who successfully applied to be euthanised following a failed relationship; a 71 year-old Canadian man who was told that he was terminally ill with chronic obstructive pulmonary disease (COPD) and who was euthanised within 48 hours – an autopsy revealed that he did not have COPD; a 61 year-old Canadian woman who suffered severe concussion after a car accident, and who could not get suitable treatment over the course of several months – she received Medical Assistance in Dying (MAiD) within a few days; a 23 year-old Belgian woman who developed Post Traumatic Stress Disorder (PTSD) after surviving a terrorist bomb attack at Brussels airport – she successfully applied to be euthanised. These were real people, none of whom were terminally ill. [pp. 29-30] There are three excellent chapters – authored by Sheila Hollins, Alice Firth, John Wyatt and Julian Hughes – on people in vulnerable groups: those with mental disabilities and autism, newborn babies and handicapped infants, and older people and those with dementia. All of them can be coerced into dying; some don't even have a choice. Infanticide now sits alongside abortion as an option for getting rid of unwanted children – even though it was "the early Christian Church [which] adopted the prohibition of infanticide" and legal opposition to it has prevailed right up until the present day. Since 2005, however, the Groningen Protocol has permitted the intentional medical killing of infants in Belgium and the Netherlands. [pp. 156-157]

The case for better palliative and end-of-life care is persuasively made by Katherine Sleeman and Lesley Williamson: "Put simply, we now have strong evidence that palliative care works." [p. 114] They conclude: "Providing high-quality palliative and end-of-life care is a strategic, economic and moral imperative, as improving palliative and end-of-life care leads to more integrated care, lower costs and improved outcomes for people living with life limiting illnesses." [pp. 117] Who could argue with that? Perhaps the most effective argument against assisted suicide and euthanasia is the one put forward by Kevin Yuill in the book's final chapter. Yuill is a humanist – he doesn't believe in God – so he is like the majority of the British population, which also does not believe in God. (The British Social Attitudes Survey reported in 2020 that 53% of the population said they had no religion, while only 37% described themselves as Christian.) And yet, he is very clear-eyed about the dangers posed by assisted suicide and euthanasia if it becomes law: "Assisted suicide/euthanasia remains now as it was in the past – a method of ridding society of individuals whose continued existence is burdensome to themselves and burdensome to society. It has always been about compassion and utility. There is no doubt that compassion motivates some of those who wish to legalize assisted suicide/euthanasia. However, even that compassion is shaped by a perception that some lives are of less value than others. "There is no contradiction between religious and secular morality on the issue of killing human beings. In fact, secular morality – the religion of humanity, as [Emile] Durkheim puts it – must be even more respectful of human life as we have no faith in any afterlife. Human beings, whether infants with their promise and potential or the elderly with their wealth of experience and knowledge, must be accorded respect. "It is time to think again about assisted suicide and euthanasia" [pp.208-209].

DAMcC

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