Lord Sumption: How we value life teaches us how to value death
End-of-life care should not include assisted suicide, writes George Pitcher. But we should be asking the right kind of utilitarian questions.
Former Supreme Court judge and Reith lecturer Lord Sumption was very nearly euthanised for suggesting on the BBC the other day - and later retracting - the view that not “all lives are of equal value” and that it follows that some lives are worth saving while others are not.
If there’s one thing to make anyone agree that their life is not worth living, it’s a mauling by the media. Lord Sumption needs to be put out of his misery. We wouldn’t treat a dog like that.
Among other rows, the episode resurrected from the dead the campaign for a change to the law to allow assisted dying, or assisted suicide or voluntary euthanasia as it used to be called, in the UK, which was last lost in a parliamentary debate by a majority of 330 to 118 in 2015.
Those who oppose a change in the law and who also happen to be vicars (like me, on both counts) are accustomed to having our opposition greeted with some social-media-troll version of “Religious people like you shouldn’t be allowed to inflict your views about the sanctity of life on the rest of us.”
What does sanctity of life actually mean? And, whatever they think it means, do they suppose it’s dictated to me by what they’re pleased to call my “sky fairy”? Really?
Two-tier system for human life
In truth, my reasons for opposing assisted suicide are profoundly secular. Among them is that it is a danger to liberal democracy for the state to endorse a two-tier system for human life, in which some lives are calculated to be worth living more than others. Another reason is that it introduces an extreme moral hazard into the medical profession that doesn’t currently exist.
But most arguments over assisted suicide are now reduced, like Sumption’s, to the utilitarianism of Enlightenment philosopher Jeremy Bentham, who argued that a course of action should be judged as to whether it benefits the person affected by it (positive utilitarianism) or avoids doing them harm (negative utilitarianism). This developed into the utilitarian argument that actions are justified that benefit most people, or that protect most people. It’s a form of consequentialist ethics really.
For me, most people are protected by the current law, which makes it a criminal offence to assist someone with their suicide, with cases arising being scrutinised and judged on their merits and with compassion and imagination. For assisted-suicide campaigners, such as former Labour Lord Chancellor Charlie Falconer, most people support it, most people could be protected in law from unscrupulous relatives or from taking their own lives while depressed and most people wouldn’t use it anyway. Classic utilitarianism.
But what does it for me with that argument is this: Not Falconer nor anyone else in any consultative paper or bill put before parliament has claimed that no one would die unnecessarily (or who didn’t want to) as a consequence of a change in the law to allow assisted suicide. So my question has to be: How many lives lost or wasted by wrongly applied assisted suicides are deemed worth it by Falconer and his euthanasia lobby for them to have what they want? One such life? 10? 100?
Because that’s deeply utilitarian too - thousands may be granted their wish to die, while a number that shouldn’t have died are the price accepted for such indulgence.
Toss a coin
This week, a letter in The Times made the point that it was to be hoped that, if admitted to hospital during the pandemic and there being insufficient oxygen, a doctor wouldn’t have to toss a coin to decide between the elderly correspondent and a young parent with dependent children.
That nods to a utilitarian argument too. And it’s quite neat. I’m grateful to the medical ethicist Alexis Paton, writing in the Independent, for making the point that it is imperative that doctors speak to their patients so that every case is treated uniquely on its merits and that “Quality-Adjusted Life Years” (QALYs), deployed by Sumption to calculate that his life was worth less than his grandchildrens’, are a calculation “not used to assess the value of a life – they are used to assess the value of a medical intervention.”
That shifts the focus, rightly, from assisted suicide to the quality of end-of-life care that we want. Which brings me to Rachel Clarke’s excellent and deeply moving book of last year, Dear Life, about her work as a palliative-care doctor in a hospice.
Clarke is a self-declared atheist - so no sky-fairies, please - and declines to say where she stands on the issue of assisted dying. She writes:
For me, the relationship of trust between myself, my patients and their families is paramount, and I worry that expressing my views publicly might jeopardise that bond… At work I occasionally encounter patients who are furious with us for not helping them end their lives - yet others are terrified we may secretly use drugs in a syringe driver precisely in order to finish them off. I meet families who argue we would not allow a dog to suffer as their loved one is doing - while the patient, in private, tells us they still want to live… I believe that voicing my personal opinions is at best unhelpful, at worst potentially harmful.
Make of that what you will. But her book is full of stories of the joy and value of lives lived to the very end, with care and love. The book is like an unintentional manifesto for pouring all our effort, resources and money into first-class palliative care, so that most people live the most fulfilled lives until the moment they die.
And, yes, that has to be a utilitarian answer too.
George Pitcher is a visiting fellow at the London School of Economics and an Anglican priest.
Conveniently avoiding the fact that by not allowing that CHOICE, protected by a structure of strong safeguards, to those who face a truly ghastly end .. such as my grandfather, grandmother, mother, and 2 old friends, for all of whom the best available palliative care simply wasn't adequate .. he is actively consigning considerable numbers of his fellow humans to a very unpleasant inhumane end-of-life experience. Greater numbers for certain than would be at risk of any sort of abuse of a stringent assisted dying system. We have the wonderful tools these days to enable a peaceful end for those who are dying anyway. We use them for our beloved pets. We don't even know if our pets would want it but we decide for them out of compassion. With humans it is a different issue. We would NOT decide for them. It would be only for those who - in advance - have expressed the wish to be allowed that peaceful end should they find themselves in unbearable pain and/or mental suffering when terminally ill, and who wish to avoid the long-drawn out awfulness that through their condition (be it a cancer or auti-immune condition etc) some will inevitably face.(because palliative care sadly still has its considerable limitations) and who can still express that wish when the time comes. No one is going to make that decision about or for them. It is very dishonest to use emotive language to suggest it is something that would be done TO them by, and on the decision of, others. It is entirely about ones right over ones own life and death.
There really is something so bloody corrupt about society......The STATE allows wars to rage, supply weapons to despots, have a totally divided society that sends the poor to food banks. Societies that treat groups of people as 'less' - Travellers, Homeless, Roma, Blacks, Indigenous people and the poor generally.
We can kill so many in our horrible disgusting wars but to die peacefully after suffering a protracted painful disease oh no! That, at least in most of the World, is seen as wrong.......we really are a f***ed up species.
And yet and yet……..Life at ANY price seems to be the name of the game when you are ACTUALLY dying. The medical establishment MUST STOP seeing death as a failure.
Nurses tell how it is......Most Drs keep shtum. I am fed up to the back teeth with people defending Drs saying ‘well, assisted dying is against the law’.. YES it is against the law BECAUSE the medical profession REFUSE to vote in favour of it….then MPs go along with the medical stance. It really is all a closed circle.
We have to somehow break it. I see Drs as Drs, NOT moral philosophers. Do the mending of us of course, when we need it, that is their job. But stop meddling in the dying of us.
That is all we are asking......suicide is not the answer as it can go horribly wrong and most of us have no access to the right drugs.
Personally I DON'T want Drs there BUT the law stipulates they are the ones who can write prescriptions so we need them for that purpose alone.
Dignitas
In my husband Andrew’s case the Dr saw Andrew twice over two days. Then wrote out the barbiturate prescription, which was then given to Dignitas.
When my husband died at Dignitas NO DR was present.....just the WONDERFUL nurse and her colleague assistant.
My husband had the civilised death he chose rather than the living hell the UK would have chosen for him.