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Tallis in Wonderland

A Small Explosion From A (Relatively) Quiet Atheist

Raymond Tallis considers democracy and assisted dying.

The other week, at the Hay Festival in Wales, Leslie Close and I debated the pros and cons of Lord Falconer’s ‘Assisted Dying Bill’ with Richard Harries, ex-Bishop of Oxford. Leslie recently co-edited Assisted Dying – Who Makes the Final Decision? The Case for Greater Choice at the End of Life (2014) as part of her decade-long campaign to change British law, in fulfilment of a promise she made to her brother John, whom she accompanied on his final journey to the Dignitas Clinic in Switzerland.

John was suffering from motor neurone disease. Paralysed, speechless, and unable to swallow, he had had enough. The fact that he, a mentally competent adult, in the end-stages of an illness whose symptoms were beyond the reach of palliative care, could not be assisted to die in his own home, despite his clear and settled wish, may seem extraordinary, even barbaric. But had Leslie helped him to die in the UK, she would have faced a possible fourteen year jail sentence.

In the years since John Close’s death, there have been two attempts to introduce a Bill to legalise assisted dying in the UK. They were led by Lord Joffe, a barrister who, among his many distinctions, was Nelson Mandela’s defence lawyer in the 1960s. Both of the Joffe Bills were defeated, the most recent in 2006. Crucial to this second defeat were the votes of the unanimously opposed bishops.

Which brings me back to the Hay Festival. After the debate, there was an audience vote. Lesley and I won by the hardly slender margin of 250 to 4 (this is not a misprint) in favour of Lord Falconer’s Bill. This is even more impressive than the nearly 80% of the general UK population, 79% of disabled people, and 62% of people belonging to religious groups, who support assisted dying.

It was, however, a hollow victory. The power exercised by Lesley, myself, and the members of the audience, was as nothing compared with that of the personally very nice but unelected Life Peer on the panel. When it comes to the Falconer Bill, Lord Harries, unlike anyone else in the room, will have a vote where it matters, in the House of Lords: as I write this, the Bill is due to receive its crucial Second Reading in that House on July 18th, which will determine whether it’s made into UK law. This spectacular example of a democratic deficit prompted me to consider whether I was, after all, too moderate. Assisted dying, after all, is an issue that potentially touches all of us.

Assisted Arguments

I don’t have enough space to rehearse all the arguments supporting a law to permit assisted dying, especially one with all the safeguards built into the Falconer Bill. But I cannot resist the opportunity to mention some of them, if only because the cruelty and danger of the present situation is outrageous, and the opposition of most religious leaders (such as the ex-Bishop) is illustrative of the potentially malign influence of religions, even a religion as moderate as Anglicanism.

The essence of the positive case for assisted dying can be summarised in three words: compassion, choice, safety. UK law at present lacks compassion for dying people who have intolerable suffering which cannot be relieved by palliative care. It tramples over the choice made by some dying patients. And the law, at the moment, given that it turns a blind eye to all sorts of fudges to hasten patients’ deaths, is unsafe. This is not only ethically unacceptable, it is also at odds with the deepest values of the profession of medicine, which I practised for nearly forty years.

Unfortunately, the well-organised opposition of a vocal minority of individuals who believe that their religious faith requires them to block liberalisation of the law – if necessary by misrepresenting its consequences – has so far prevailed. The most powerful organisation, ‘Care Not Killing’ (CNK), headed by Peter Saunders, is particularly active. However, knowing that in a largely secular society, theological arguments will cut little ice, organisations like CNK specialise in scaremongering – asserting, in the face of contrary evidence from other jurisdictions, that the Bill would have serious adverse effects on society at large, and on patients in particular. They make extensive use of the ‘slippery slope’ argument, according to which a law allowing assisted dying would inevitably pave the way to legalising assisted suicide more generally, including for people who are chronically disabled but not terminally ill, or for depressed teenagers. Sooner or later, they argue, euthanasia will be available on request for all and everyone who wants it. Finally, vulnerable people will be ‘put down’ without their say-so because they are a burden.

These dubious claims have been discredited by the experience in Oregon, where for the seventeen years over which a law similar to Lord Falconer’s Bill has been in place (though the latter has more safeguards), the slope has stubbornly refused to be slippery. The proportion of deaths that are assisted has levelled out at about 0.2%, with a slight recent dip (although ten times as many discuss the possibility with their physicians, and gain great comfort from this), and there is no public appetite for extending the law beyond assisted dying. These reassuring findings have prompted the passage of similar laws in Washington and Vermont. Most tellingly, the Oregon Hospice Association, who initially opposed assisted dying, found that “There is no evidence that assisted dying has undermined Oregon’s end of life care or harmed the interests of vulnerable people” and has moved to a position of support.

The ingenuity of opponents to assisted dying in manufacturing red herrings is exceeded only by their willingness to bend the truth. Here are some examples (the relevant evidence against the claims is set out in Lesley’s book):

• That assisting a patient to die breaks with medical ethics and the professional code (it doesn’t);

• That the need to determine the prognosis of patients, who have to have 6 months or less life expectancy to qualify as being terminally ill, presents insuperable problems (not true);

• That terrible irreversible mistakes will be made (the chances of mistakes in end-of-life care are actually reduced);

• That the availability of assisted dying would block much needed improvements in palliative care (the reverse is true);

• That it will be impossible to establish mental competence in patients who seek assistance to die (we accept that it is possible establish competence elsewhere in medicine, and there is no special difficulty in the case of a dying patient);

• That there is no way of safeguarding patients who ask to die because they have a treatable depression (not true);

• That liberalisation of the law will break down trust between doctors and patients and the medical profession and society (not true);

• And that Lord Falconer’s compassionate Bill implies a devaluation of human life (the reverse is true).

Some particularly desperate opponents have claimed that there is no need for assisted dying because good palliative care can deal with all symptoms. Against this, recent research has confirmed what all honest doctors admit. According to the Economist Intelligence Unit, the UK leads the world in the quality of death. Even so, a Department of Health survey found that one in fifty of patients in hospices (where they can receive the best possible care) had unrelieved suffering in the last three months of their life. My predecessor as Chair of Healthcare Professionals for Assisted Dying, Ann McPherson, coped with pancreatic cancer with courage and dignity for three years, and then she had had enough. Despite receiving optimal palliative care, she endured unmitigated hell, begging to die for the last three weeks of her life.

Those of us who support assisted dying have covered this territory endlessly, but the same factoids and false arguments come back again and again because empirical data and rational discourse are powerless to change the mind of some of those who believe their opinions come from a Higher Authority – God. As a last resort, some have even argued that pain is good for us – even that this is the message of Christ’s suffering on the cross – although it is likely that they will bear the suffering of others more heroically than they might bear their own.

Worldly Powers

In an earlier piece (‘Why I Am an Atheist’, Issue 73) I set aside the track record of religion – the behaviour of religious people and of religious institutions – as a valid argument against the essentially metaphysical doctrine that the world was created by God. And I also pointed out that we can’t run history twice – with and without religion – to see whether its net effect on human history has been good or evil. But in contemporary life some aspects of its influence are surely to be deplored. In order to be disabused of the idea that religion is harmless, we do not have to look to distant theocratic societies where bearded patriarchs of different persuasions condone the ghastly oppression of women, denying them rights, freedoms, life chances, reproductive health, and sexual pleasure, and apostates, gays, and those accused of adultery face execution.

Recently, David Cameron, in a bid to appeal to an electorate that he imagined could not spot that he was on his knees praying for votes, claimed that Britain was a Christian country, and that the values that drove his policies were Christian values. Those of us who do not admire his vindictive attitude to the poor and his sucking up to the rich are proud not to share his values. Many of us also wish that what ex-Archbishop of Canterbury Rowan Williams said in response to the hoo-ha that followed Cameron’s self-serving profession of Christianity were true: that Britain was a post-Christian country. Even more, we wish it were true that this was a post-religious country.

Unfortunately it is not: there is an established church, with the Queen at its head, and the church’s tentacles touch on many aspects of national life. The ranks of unelected prelates taking their seats in one of the legislative bodies of the United Kingdom, the House of Lords, is a particularly distressing manifestation of this. The ubiquitous, but often discrete, influence of the clerics, acting as the curators of ideas and attitudes that should have been consigned to history, is, to say the least, irritating. Having said this, I have been privileged to share platforms with enlightened figures in the church, such as Canon Rosie Harper, who is an eloquent and passionate supporter of assisted dying.

If bishops toeing the party line help to sink Lord Falconer’s much-needed Bill, this will be more than just irritating. Being obliged to walk away from the suffering of dying people for the sake of a dogma that is itself on its last legs, is a particularly bitter irony. This is a scandal that should prompt constitutional experts and political philosophers to subject the present arrangements to rigorous examination.

Raymond Tallis’s new book Epimethean Imaginings, is out now from Acumen.