I’ve made up my mind on complex moral issue of medical suicide

THE introduction in the Scottish Parliament of a bill to authorise medically assisted suicide has turbocharged a centuries-old debate. Nearly 2,000 years ago the Roman philosopher Seneca called suicide the last defence of the free man against intolerable end-of life-suffering. “It makes a great deal of difference,” he wrote, “whether a man is lengthening his life or only his death…”

The problem is more acute now than in Seneca’s day. Advances in medical science have made it possible to extend human life beyond the point where it is worth living. It is often extended beyond the point where a person can put an end to their life without help.

In our highly regulated world, help is usually not available. It is a criminal offence to help someone to kill themselves. Evasion of the law is difficult. We can no longer make these choices informally, with the support of family and a GP, as people have done, without officious strangers looking on.

To campaigners, the question seems easy and the answer obvious. Change the law. Yet they oversimplify a complex moral dilemma. It involves a clash between two of the most fundamental values of humanity.

The first is our reverence for human life. We instinctively feel life has an intrinsic value, whether or not it is valuable to the person concerned or to any one else. This is why the law has never recognised the consent of the victim as a defence to murder.

The second is our respect for autonomy. People are masters of their own fate. Compassion for suffering and a basic respect for dignity require us to let them make their own decisions about the timing and manner of their death when they are terminally ill.

Since there is no way in which these contradictory instincts can be reconciled, both sides of the debate tend to resort to more utilitarian arguments. They argue about the effectiveness of palliative care, about how oppressive the current law really is, and about the “slippery slope” that might lead to a general licence for euthanasia. A lot of this debate is unedifying. Those who want change exaggerate the problems of the current law; opponents make light of them.

There is only one utilitarian argument that really counts, but it is a formidable one. It is the pressure that may push the old and terminally ill to do away with themselves too readily, even if they are competent mentally.

The problem is not that they may be manipulated into giving their consent by unscrupulous heirs. It is what is sometimes called “indirect social pressure”. This arises from the low selfesteem of many old and sick people who find themselves dependent on other people. It is aggravated by negative public attitudes to old age.

Many old people assume their lives have become a burden to those around them. It can lead them to place a low value on their own lives, and to assume that others do so, too. These feelings of uselessness are likely to be particularly acute in those who were once highly active, for whom the contrast between now and then can be painful.

The pressures will inevitably become more powerful in a world where medically assisted dying is normalised, and has become just another end-of-life choice. It is hard to distinguish between those who have voluntarily decided to kill themselves and those who have decided in response to real or imagined pressures arising from the impact of their disabilities on other people.

The Bill, if enacted, would need the patient’s prognosis and voluntary nature of their decision independently assessed by competent medical practitioners. Procedural safeguards such as these will not eliminate the problem of indirect social pressure. But it will limit it. There are no risk-free options in this area. The real question is how much risk to vulnerable people are we prepared to accept to facilitate suicide by those fully informed, mentally competent and determined to end their lives.

After much hesitation, I have come to the conclusion a law change is morally justified for terminally ill patients. I do not want to see it more widely extended. I have had personal experience involving two people close to me. This is not a straightforward issue or a clear moral choice.

‘I have had personal experience involving two people close to me. This is not a straightforward issue’