We need to deconstruct in these circumstances what might be meant by freedom, and what might be meant by choice, and above all to consider not intentions, but as Karl Popper always reminds us, of unintended consequences of changes to the law.
Overview
Freedom of choice implies freedom without coercion, and I am very concerned about the admittedly largely anecdotal evidence – but true accounts none the less – of where arguments are made either by medical professionals (themelves under pressure to triage against elderly people with rising costs of medical care) or relatives and friends to “choose” assisted suicide. A picture is certainly emerging where psychological pressure can be brought to bear against weak and vulnerable people in which case “freedom” becomes a much more ambigious and contested action.
I would therefore take very seriously the questions raised by Justin Welby:
“How do we know that someone has come to a settled and informed decision? Psychiatrists tell us that it can take the full six months proposed in the Bill to rule out an individual suffering from clinical depression; a condition that would surely preclude them from accessing prescribed lethal drugs. “
“How can we be absolutely certain that individuals will not be put under considerable pressure to end their lives? Of course, no one is going to march their elderly relative to the GP’s surgery. Pressure can be subtle and might begin years before a terminal illness is diagnosed. “
"How can we be sure that proposed protocols will be properly followed? Sadly, we know that there have been terrible lapses of care in some parts of the NHS and in some care homes over the past few years. Can we be completely certain that this could not happen if assisted suicide became legal?"
Medical Cost Cutting
In 2017, Canada legalised physician assisted suicide and euthanasia (PAS-E). Following this, a recent report noted: "Medical assistance in dying could reduce annual health care spending across Canada by between $34.7 million and $138.8 million." Given the pressures on health budgets, how long before the Liverpool Care Pathway (LCP) becomes the norm?
Many witnesses have testified that elderly patients were admitted to hospital for emergency treatment and put on the LCP without documented proof that the patient consented to it, or could not recover from their health problem; 48-year-old Norfolk man Andrew Flanagan was revived by his family and went home for a further five weeks after doctors put him on the LCP. The Royal College of Physicians found that up to half of families were not informed of clinicians’ decision to put a relative on the pathway.
As Justin Welby asked:
"How can we be absolutely sure that a “right to die” will not eventually become a “duty to die”? If assisted suicide was legally available in the UK can we be assured that an economic evaluation of costly palliative care over inexpensive “assisted dying” would have absolutely no impact on any subsequent treatment?"
Having seen how much cost cutting there is already in the heath service, I am not optimistic about this. A law introduced for one purpose can easily be subverted in this way.
The Effect on the Disabled
I would note that the position of the disabled in the Netherlands, where assisted suicide is permitted, seems to have led to a marked lack of tolerance for disabled children and the parents who raise them. In fact, Professor J. Stolk, a specialist in mental retardation at the Free University in Amsterdam, has documented cases where parents of disabled children are rebuked.
For example, parents have heard statements such as: "What? Is that child still alive?"; "How can one love such a child?"; "Nowadays such a being need not be born at all"; "Such a thing should have been given an injection.". It is demoralizing and frightening for parents to hear such things about the children for which they care.
The Slippery Slope
Justin Welby mentions “slippery slopes”, and that is happening in the Netherlands.
As the report “Physician-Assisted Suicide and Euthanasia in the Netherlands: A Report to the House Judiciary Subcommittee on the Constitution” notes:
“The Dutch experience vividly shows how judicial sanctioning of physician-assisted suicide for terminally-ill patients motivated by supposedly high ideals such as the right to individual self-determination and the "compassionate" alleviation of physical suffering can easily lead to the unchecked nightmare of non-consensual termination of human life. Simply put, an individual's so-called "right to die," over time, can be transformed into a demand by society that certain individual's have a "duty to die." This is the slope down which the Netherlands has slid. The tragedy of the situation in the Netherlands should serve as a graphic reminder to courts and legislatures in this nation that there is no way to regulate euthanasia. There is no way to stop the slide once a society steps onto the slippery slope by legalizing physician-assisted suicide.”
The problem with “autonomy”
Jason Micheli highlights, I think, some of the problems of human beings as autonomous individuals,and thereby “freedom of choice” as not something which is without consequences for others.
“The language of individual autonomy, though common, is deceptive. It may sound true that my life is my life, yet a family’s experience of suicide proves just how false a claim that really is. The language of individual autonomy is limiting because the fact is our lives are bound together with family and friends in a number of ways.”
“My life is not just my own because it’s a life that exists in relationship with scores of others: many who love me, many who depend upon me, many who understand their life in relationship to my own.”
And Karl Barth puts this well in his Church Dogmatics:
“When one person is ill, the whole of society is really ill in all its members. In the battle against sickness the final human word cannot be isolation but only fellowship.”
“The Dutch experience vividly shows how judicial sanctioning of physician-assisted suicide for terminally-ill patients motivated by supposedly high ideals such as the right to individual self-determination and the "compassionate" alleviation of physical suffering can easily lead to the unchecked nightmare of non-consensual termination of human life. Simply put, an individual's so-called "right to die," over time, can be transformed into a demand by society that certain individual's have a "duty to die." This is the slope down which the Netherlands has slid. The tragedy of the situation in the Netherlands should serve as a graphic reminder to courts and legislatures in this nation that there is no way to regulate euthanasia. There is no way to stop the slide once a society steps onto the slippery slope by legalizing physician-assisted suicide.”
The problem with “autonomy”
Jason Micheli highlights, I think, some of the problems of human beings as autonomous individuals,and thereby “freedom of choice” as not something which is without consequences for others.
“The language of individual autonomy, though common, is deceptive. It may sound true that my life is my life, yet a family’s experience of suicide proves just how false a claim that really is. The language of individual autonomy is limiting because the fact is our lives are bound together with family and friends in a number of ways.”
“My life is not just my own because it’s a life that exists in relationship with scores of others: many who love me, many who depend upon me, many who understand their life in relationship to my own.”
And Karl Barth puts this well in his Church Dogmatics:
“When one person is ill, the whole of society is really ill in all its members. In the battle against sickness the final human word cannot be isolation but only fellowship.”
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