In defence of the final human right

A review of euthanasia and end-of-life issues may help to spur legislative change, says Julie Stone

April 17, 2008

This sensitive and succinct book explores the arguments for and against euthanasia and assisted suicide, and the polarised positions that have so far thwarted three attempts to change the law in the UK to allow legally assisted death for competent adult patients who request it. The authors consider the experiences of the Netherlands, Belgium and the US state of Oregon, where assisted dying is permitted, and they look at the impact this has had on patients, society and on healthcare professionals.

This book encourages us all to consider end-of-life issues, because this "is not a clinical question to be answered by the medical profession, but a social question for society at large". Even-handed in their analysis, Mary Warnock and Elisabeth Macdonald favour a change in the law to permit assisted suicide, arguing persuasively against blind reverence for the preservation of life at all costs.

In reaching this conclusion, they rehearse, and ruthlessly dispatch, many of the well-trodden ethical arguments surrounding euthanasia and assisted dying. They make short shrift of the justification of the doctrine of double effect (prescribing of sedatives and painkillers as good clinical practice), distinctions between killing and letting die (morally equivalent), and slippery slopes (which need not be slippery if appropriate safeguards are in place).

Because of the disproportionate weight that religious views continue to exert in the UK's supposedly secular democracy, they analyse in detail the flaws inherent in the sanctity of life argument, which posits that all life is sacred apart from when it isn't, as in cases of self-defence, "just" war and, presumably, collateral casualties.

Notably, even those who rely principally on the sanctity of life argument invariably feel the need to back this up with consequential doom-mongering. The authors counter this with empirical evidence, citing research from other jurisdictions that shows that assisting patients' death has, if anything, deepened doctors' sensibilities, and has not created a generation of Shipmans.

Neither has the introduction of physician-assisted dying witnessed a sinister slippage from "voluntary" euthanasia to "non-voluntary" euthanasia. This should not surprise us given that doctors are already adept at making value judgments about whether or not to prolong life-sustaining treatment and withholding treatment that is deemed futile.

This book not only has the power to stimulate informed discussion, but also to shape social policy and inform good professional practice. The authors distinguish the case of neonates, where expert guidelines in the UK provide an appropriate framework for making hard choices. But for competent adults seeking an easeful death, a legislative approach is deemed not only achievable, but increasingly desirable, with evidence from a 2007 survey suggesting that 80 per cent of the British public is ready to embrace such a change. The challenge is how to devise a law that allows us to relieve the suffering of those who want to die without endangering others who do not want to.

Moral choices must, increasingly, be informed by social reality. Better objects of moral outrage should include the growing numbers of elderly patients and those with dementia dying in care homes from neglect and malnourishment, the under-prescribing and withholding of necessary sedation and painkilling medication by those scared of being accused of helping patients to die, the lamentable provision of care in the community and support for carers, and the lack of state-funded hospice provision.

Our ageing demographic will exacerbate these problems. Keeping people alive longer, but miserably, on the say-so of a religious minority, is not the hallmark of a humane society. Easeful Death deserves a wide readership and it should be compulsory reading for politicians and policymakers.

Easeful Death: Is There a Case for Assisted Dying?

By Mary Warnock and Elisabeth Macdonald
Oxford University Press
172pp
£12.99
ISBN 9780199539901
Published 6 March 2008

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