“The risk of older people being nudged to die by health and social care,” writes leading dementia expert Professor June Andrews, “or even by a family with ‘inheritance impatience’ is more than I can bear without a broken heart.”
I am concerned about the rather dodgy assisted dying legislation currently being debated.
I’m neutral on whether people should be allowed to kill themselves, but I think we are opening an unnecessary Pandora’s box.
I don’t want older people to end up being afraid of their doctor. What if people who are depressed and stuck at home, and who might have difficulty persuading the council to give them a wheelchair ramp for outside their house… but find it easy to persuade the doctor to let them die?
With the current crisis of funding of palliative care, the whole thing is a terrible mess. The idea of a law to make it feasible for people to kill themselves with help from a doctor is worrying. It’s the “help from a doctor” bit that worries me. Why would you want or need help from a doctor? It’s not just about people who are physically unable to find or to give themselves a fatal potion. They want it as part of the health service.
Two sorts of people demand this change. On the one hand are those who don’t trust doctors to keep them pain free and comfortable to the end of life… and they’d rather check out quickly with the doctor’s help. On the other, there are those who believe that they have a right to choose the time of their death and that the health system must provide the means for that.
I’d argue that they already have the freedom to choose that time, and their freedom doesn’t create a responsibility for society to provide a doctor to make it happen.
Loopholes in the law
Let’s break it up a bit. I’m a professor specialising in the care of older frail people and those who care for them. I’m neutral about whether there should be laws about people killing themselves.
But I’m not alone in being worried about the proposed law as drafted. Palliative care doctors don’t like it. The Law Society doesn’t like it. Ordinary people who find out more about what’s involved start not to like it. The detail of what is done to the person is chilling. The loopholes through which bad things might start to happen “within the law” are huge. We know this from other countries where laws that allow doctors in some circumstances to help patients to kill themselves have silently started to mutate.
People who have been refused assisted suicide successfully challenge it in court on the grounds that the state has discriminated against them, opening a door for others to follow through. A small number of doctors end up doing most of the “treatment”, and if you seek out the right doctor you never get “no” for an answer. And people start to successfully request help to die who you thought the legislation would exclude. This includes very young people with mental health problems, or anorexia, or people in the extremely early stages of a disease that might kill them but where there is a lot of living to do – like dementia.
Suicide used to be illegal, but it is no longer a crime to try. Statistically, the people who kill themselves are mainly lonely and mentally unwell. Probably also poor. I would support anything like Samaritans that tries to stop a person who is mentally unwell from killing themselves because they can get better and in the end are often glad that they didn’t die.
Currently anyone who helps a suicide could be charged under section 2 of the Suicide Act 1961. The Crown Prosecution Service (CPS) clearly describes these cases as “by their very nature complex and sensitive” and sometimes “wholly motivated by compassion.” It’s fair. Cases are passed to Specialist Prosecutors within the CPS. The Director of Public Prosecutions must consent before prosecution can start. Hardly anyone ever gets “done” for this.
To get the numbers into proportion, it is worth considering the suicide rates each year in England. In 2023 that was 5,579 in one year, set against the statistic that only 187 cases were brought over the last fifteen years by the police to the CPS. The police themselves then withdrew 36 of those cases. The CPS rejected another 127. Of the 24 left, eight were referred onwards for prosecution for homicide or other serious crime because of questions of the motivation. Only four so far in fifteen years have been found guilty of assisting suicide.
People say this new law is to prevent well meaning people from being branded criminals. Because hardly any got to court and even less got convicted, you have to ask if it is worth a whole new set of legislation and the cost of setting up a new NHS service for what amounts to about 0.215% of suicides.
Every death is a tragedy, but not every tragedy can be helped or prevented by a change on the law.
Who protects those who are persuaded to die?
Can you hold on, for a moment, to the fact that no one has ever been punished for this unless there was good evidence that they had a motive for murdering the person who “wanted to die”? Do we really need a law to protect those few innocent friends from the inconvenience of being reported and getting off after being checked over?
Given that there are websites that actively try to get strangers to kill themselves or enter suicide pacts out of macabre control pathology, you’d want assisted suicide to continue to be a crime in order to pick up these evil people. Helping a friend or family member to die is a dangerous business, so we need those checks and balances.
Those people who want the law to change to stop daughters being arrested for taking their mum to Switzerland are missing the point. We need vulnerable people to be protected, and the law as it stands currently doesn’t particularly punish anyone with a half decent story. The last thing we need is for the risks that will arise if the door is pushed open wider. Because it is already an open door.
If someone kills themselves without my involvement it’s none of my business. I hesitate to call it their right, but it’s definitely their own business. Except of course, if I love them and depend on them in which case it is cruel and unfair of them to hurt me like that, but it’s a personal injury, not a crime. Questioning this legislation does not mean I’m denying anyone their right to kill themselves or trying to interfere in their private business.
How can doctors decide?
So, what’s my concern? Well, the doctor only must check that the patient is “competent” to make the decision. There’s no requirement, for example, for the doctor to check with loved ones who might rally round, or any charity or even social services. No need even for a mental health assessment or treatment for depression that might reverse the suicidal urge.
I know that there are people who have a painful death. But not all death is bad. Many people have a peaceful, well medicated, end of life. If I ask for my life to be shortened by a doctor, I am suggesting to him or her that they don’t have the knowledge or experience or resources to look after me and that I think I’d better kill myself now rather than get their services. They are claiming that they don’t have that knowledge or experience or resource they need to treat me, which might be true. They are, in addition, giving their view I’d be better off dead.
We ask doctors for clinical opinions for which they are trained and educated. Those opinions are called diagnoses. They are not trained and educated for an opinion about whether someone’s life is worth living. That’s just an opinion, not a diagnosis. It’s none of their business. They are trained and educated to look after me and follow my wishes in respect of improvements in symptoms.
Giving them the power to suggested they stop my symptoms by switching me off is too much power. I’d be afraid to have my beloved older family member and friends to see a doctor alone (which I normally support with all my heart) if that was on the table.
Choosing to live with dementia
In my life supporting people with dementia, I often meet people who think a person with dementia would be better off dead. My friends with dementia do not agree. Many of them have lives that are fulfilling and exciting, maybe more so now that they know time is running out and precious moments with family and friends must be seized.
I, of all people, know dementia can be horrid, but often what makes it horrid can be remediated with good care and support. Yet people are more afraid of dementia than they are of cancer. With the cost of care including care homes being so great, I can imagine the conversation with a cash strapped system going along the lines of the wheelchair ramp dilemma. We’ve not got money for the bit of infrastructure that would help make what’s left of your life worth living, so frankly you’d be better off meeting Dr Z who deals with assisted suicide and allows you to leave your money to your children.
It’s legal and less expensive than the alternative. For everyone, especially the State.
So, although someone else’s decision to die isn’t in general my business, I think this change in the law as drafted is dreadful. It tries to medicalise later life even more than we’ve already accepted… and the risk of older people being nudged to die by health and social care, or even family with “inheritance impatience” rather than being “a burden” is more than I can bear without a broken heart.
Your views? Write to the editor at info@theageactionalliance.org
Photo by Marcelo Leal on Unsplash
