With this in mind, it is myopic to think that a law legalising euthanasia won’t itself eventually have a narrowing effect on what kinds of distress are considered tolerable. Indeed, a quick look at current internet trends contains useful intelligence for writers of dystopian fictions set in the near future.
People who treat chronic illness as an identity of sorts are a huge social media ecosystem: finding each other with hashtags such as #spoonie, #fibromyalgia, #chronicillness and #PoTS, documenting their daily symptoms, and offering each other public support. Most of them are women, and many feel the medical profession offers them nothing but scepticism and contempt. Whether or not these people are indeed incurably ill, the more important point for current purposes is that a lot of them clearly believe they are, and find their own suffering unbearable. Locked in apparently interminable physical dysfunction and with no agreed cure in sight, one doesn’t have to work too hard to imagine a world where assisted dying seems to them the only exit available, with added opportunities to record the whole thing on TikTok channels.
Do we really know for sure that relevant institutions, weak as they have already been shown to be, would be able to see off impassioned appeals from such a cohort for kindness in helping to relieve them from the burden of living? If we Brits look with horror on Dutch doctors legally euthanising a 29-year-old woman on grounds of “chronic depression, anxiety, trauma and unspecified personality disorder”, it is perhaps only because our own old-fashioned ethical standards have yet to catch up.
Grasping for certainty, we might assume that what counts as a disease or an illness, at least, is purely physically determined — but here, too, things are not so clear-cut. The late philosopher Ian Hacking wrote perspicuously about the way that some illnesses are “interactive kinds” showing “looping effects” — meaning that the public’s grasp on the existence of a particular illness, and what count as medically accepted conditions for its diagnosis, can influence the acknowledged prevalence of the illness in question. This in turn imperceptibly shifts the diagnostic criteria over time. For both reasons, the pool of patients can suddenly markedly expand, and especially where there is no easily ascertained underlying physical cause.
As people begin to apply a set of diagnostic criteria to their own lives, and interpret their physical experiences within that frame, hundreds of thousands of people can come to count as patients of a given syndrome, whereas at one point only a few did. Hacking’s prescient examples included multiple personality disorder (now known as dissociative identity disorder) and autism. There’s every sign that chronic disorders such as fibromyalgia and postural tachycardia syndrome (PoTS) are going the same way, with added internet rocket fuel.
There is a way of reading this argument that implies many or even most such self-diagnoses are bogus. Once again, though, this is too simple-minded an approach. Clichéd as it has become to say it, the mind and the body are connected. The habitual framing of a particular bodily sensation as having pathological origins can have knock-on physical effects, building up a prison of real and distressing symptoms over time. Only hubristic doctors feel able these days to pronounce with certainty about whether a given symptom is “purely psychological” or not. From a distance, most of us can see the shape of the problem at scale — the strong effect of transitory cultural influences upon bodily and mental resilience across a population — but at the micro level, treating individual patients, it is usually therapeutically irrelevant information.
Given these treacherously shifting sands, might we at least collectively fight off the idea that a diseased or suffering life has only whatever subjective worth the individual patient places upon it — and that if the answer is “none”, it is time to put an end to things? It seems we have a big job on our hands. One problem is that, perhaps subconsciously craving some kind of hero’s journey in a boringly meaningless world, many of us have turned the quest for physical optimisation into a public identity, with an accompanying sense of failure once inevitable decrepitude sets in.
Broadsheets now tell you how to reduce your “metabolic age” through exercise and changes to diet; dedicated watches track every vital function, spawning thousands of everyday acts of neurotic checking for signs of imminently waning powers; ageing actresses’ faces are cut up and remoulded to hide signs of cellular decay. There is even a “Don’t Die” movement, whose exponents actually hope to achieve immortality through things such as fasting and temperature-controlled mattresses. Though nobody ever explains what all this frenetic body-hacking is for, exactly, Gen Z have obviously received the memo, drinking less and exercising more than previous generations but without much added happiness to show for it. When they too eventually arrive at old age and disease, it will be hard to convince them that the failure of their bodies is not a personal disaster after a lifetime spent hearing the opposite.
In effect, this is the bastardised version of “dignity” we seem to have inherited: one where you only count as having it if all your bodily functions are currently under control. Dignity in dying is a concept we hear a lot about — indeed it’s the name of one of the most prominent organisations campaigning for a change in legislation — and yet dignity is also a culturally porous entity, changing its shape according to prevailing norms and ideals. The Enlightenment philosopher most famous for representing dignity as a universal human value was Immanuel Kant, but he would be horrified at the idea that its possession — or not — somehow depended on your contingent physical state. Yet when a cross-party group of MPs dramatically complains that, under present legal conditions, “so many are forced to die without dignity”, it seems likely this is exactly what they mean.
Nobody relishes the prospect of the opposite. I once worked in a nursing home and a lot of my time there was spent dealing with incontinence: not much fun, either for the resident or the carer. Still, in the right sort of setting, both become accustomed and can look past it to more important things. The venerable Kantian-inspired ideal is that in periods of frailty, you can retain dignity in spite of what is happening to you physically; and this is recognised when carers look after you in non-instrumental, respectful ways that acknowledge your intrinsic human worth.
From this angle, the legalisation of euthanasia does nothing to increase dignity but provides new ways to undermine it, and especially in the present non-ideal context where social care is already underfunded and overstretched. If by “people should be allowed to die with dignity” politicians really mean “people should be put out of their misery” — and where that misery is a direct function of inadequate and demeaning care standards — they should say as much, explicitly, and not hide behind sentimental language designed to make them sound like moral heroes.
“The legalisation of euthanasia does nothing to increase dignity but provides new ways to undermine it.”
This week it was reported that 38 Labour MPs, including 13 in government roles, are already backing demands for the scope of the forthcoming bill to be extended; to cover not just the terminally ill, but the more vaguely construed “incurably suffering” as well. It seems that despite all the denials, a slope beckons after all; though those concerned still seem to think they are in control of the descent. It is ironic that, for a set of people so apparently keen on the value of personal autonomy, politicians defending the legalisation of euthanasia display a naïve trust that the world will always collude with them to maintain sufficient defences against unethical slippage or abuses of power.
They talk as if medics will always make consistent decisions about whether stated legal conditions have been met, and patient pressure groups or ideological movements will never form to distort their judgements; as if subsequent language users are bound to understand vague concepts like “unbearable” or “incurable” in just the same way as we do now; as if distressing illnesses presently affecting a relative few can’t metastasise in future. They are happy to talk simplistically of kindness and cruelty as if they are in primary school, while outsourcing responsibility for maintaining adequate guardrails to more grown-up sounding people and things: doctors, bioethicists, legal definitions, forms signed in triplicate.
In short, although with their babyish words politicians imply that a personal choice about whether and when to die is disconnected from the decisions and actions of other people, it is not, and it never will be. A big clue is in the term “assisted”. If we had any sense as a society, we would decline the invitation to set foot on their big shiny playground slide, but I won’t be holding my breath.
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SubscribeWhilst I do agree with Kathleen Stock that the idea of suffering can vary from age to age, society to society and even individual to individual and what others class as being unbearable I’d probably disagree with vehemently, at the end of the day why is my opinion any more valid than theirs? Who am I to force people to carry on existing if they genuinely don’t want to?
As long as there’s safeguards to ensure they aren’t being pressured into it, and no doctor is forced to perform it if they don’t wish to them I say let people choose to end their life if they wish
Agree. Ms stock cited the case of a Dutch woman who was ‘euthanised’ at age 29, so I Googled and the first result, a Guardian article, quotes the woman:
““I was on a waiting list for assessment for a long time, because there are so few doctors willing to be involved in assisted dying for people with mental suffering. Then you have to be assessed by a team, have a second opinion about your eligibility, and their decision has to be reviewed by another independent doctor.”
It sounded like a long and thorough process. I’m glad that, if I got a diagnosis of something like motor neurone disease, I live in a place that does have voluntary assisted dying, because I know I would want that option there.
Did you read the article in full? There are no assured ‘safeguards’, as these qualifications are always subject to being degraded. Your argument for ‘choice’ is also criticised rightly as being based on immature reasoning, or hastily made feeling-based assumptions. The author laments that this is so, as it will lead to legally recognised killing that will be impossible to halt once it has been established.
Would you respect a persons choice if they have a Do Not Resuscitate notice on them in hospital? Or if a Jehovahs Witness chooses death instead of a blood transfusion?
In both instances we’re letting people choose death when they could have otherwise by saved, so why is assisted suicide any different in that regard?
Allowing yourself to die naturally is one thing; asking someone else to take, or facilitate the taking of your life is another. You seem to be hung up on the idea that personal choice is the pre-eminent factor. Your ‘choice’ can affect others, both directly and indirectly by influencing attitudes, so it’s not simply ‘yours’, in isolation. Take abortion as an example. Not so many years ago (I’m old enough to remember) abortion was considered unthinkable by most women, who saw it as horrible and immoral. Now, since it has been eroded into a ‘right’, sensitivity towards it has diminished and ‘pro-choicers’ are screaming for it, and outraged that it might be curtailed. Assisted suicide could, and probably will, go the same way, as Kathleen Stock fears.
Rubbish! “Not so many years ago abortion was considered unthinkable by most women”. Absolutely not true.
Exactly.
A superb piece.
James Mumford’s book, ‘Vexed: Ethics Beyond Political Tribes‘ changed my mind on this issue a few years ago, focusing IIRC on the direct/indirect pressure and distress this may place on the elderly to end their lives. It was only after this that the unfolding horror of the Canadian MAID program emerged.
Your comparison to gender medicine is apposite. There will always be doctors prepared to sign off on this. They will become well-known and set up private practices to profit from it.
If ever there was a legal change with ‘unintended consequences’ written all over, it is this one. The darker side of my mind ponders whether, for some, the inevitable outcomes are, in fact, not unintended at all.
There are indeed already private Euthanasia Clinics in British Columbia.
Are they as demanding as Dignitas? A friend of mine was suffering greatly, but was refused because he wasn’t terminal. Thankfully (?) he was diagnosed with stage 4 pancreatic cancer shortly afterwards, and was gone in little over a week.
In no time young people hoping to be able to put a deposit on a home will be shiny eyed when a dear older member of the tribe yields to pressure and makes the best of all gifts. Beware.
If, in a few situations, callous, greedy people want old relatives to die faster they’re probably killing them off anyway.
A few. Most people are like that. The sanitised world we have all lived in,that was deliberately constructed post WW2 is being deconstructed and older realities are resurrecting.
The least of our worries. Far worse is: you want to die, but due to disabilities, you are unable to end your life and are forced to live.
Doctors willing to sign off on killing people for the greater good? We just call them mengalistas.
Because most real good doctors don’t want to do it because of the implications they are going to allow private companies to do it. So good luck to anyone who voluntarily puts themselves into the power of and the hands of sadistic vampire executioners.
I understand Poilievre has said he won’t extend MAID to include mental illness, but hasn’t said he’ll dismantle MAID completely.
He will need to dismantle the Supreme Court first.
That’s a cynical response. One assumes you’re not in a position of terrible suffering.
No. I’m not.
That doesn’t mean I have no voice here.
I think of spies in the war, captured by the Nazis, taking a cyanide capsule to avoid brutal interrogation. I think of those poor souls with no hope of relief suffering terrible pain. I understand the impulse. I understand the desire to be free of the suffering.
Nike response is far from cynical; it is not unreasonable to worry that this might be abused.
I think of abortion. Shouldn’t it be safe, legal and rare? It is not; 200,000 abortions in the UK each year. Such things can grow beyond what the original legislators wanted to achieve.
Virtue signaller.
I have read that the plan is to outsource to private companies. The act of murder won’t be carried out in NHS hospitals. I’m guessing that you will go to your GP who will have a duty to refer you on. I know a lot of GPs are repelled by this and the implications for them. So once they’ve done the referral you’ll be in the hands,or the premises of a private business. Now that premise of this bill is that the state pays the bill,that’s what we are being encouraged to assume. So even poor people like us can go in Dignitas style.
I hope Dame Death is going to publicly and flamboyantly sign up to be first in.the queue. She must be looking forward to a good old chat with her old mate Jimmy. However The State is never that generous with paying out as we know so maybe that last meal wont be oysters and champagne. More like a Greggs bake and cola. And those necessary chemical are expensive,they come from a factory in Germany. They developed quite an expertise in this sort of thing. So as it costs £400 to have your old dog put down,how much will the State be paying a private business to put you down. Only it might not be as painless and dignified as you think.
The old medical adage has, “Thou shalt not kill, but needst not strive officiously to keep alive.” It seems that somehow, despite the arguments above, the doctor has some power of decision over the end of life. And it has been so for years. But assisted dying need not rely on the decision of the doctor. There is the Living Will, by which the conscious and capable person describes the future condition in which he or she wishes their life to end. It is an instruction, with the force of law, just like a will concerning property. The pressure for assisted dying should incorporate this mechanism for the exercising of personal choice; the choice that no-one in Britain enjoys today.
Living wills can definitely help PL and seen this in action. Most of course don’t have one. But regardless they are not quite the same as giving the individual the right to ask for assistance to bring their own life to a close in a more proactive manner. They tend to be more about what treatments should not be continued. That can help, but it’s not quite the same and therein lies the dilemma.
It is a good idea for everyone to have a living will. Where I live there have been public campaigns to encourage this.
Agree. I saw much more of this in N America.
Kathleen Stock gives full rein to her considerable philosophical powers in this essay. Do i detect, however, an issue about which she’s being less than objective about when she argues that the concept of the ‘gendered soul’ has been utilised by transactivists to shift the Overton window on physical intervention, especially for a group that might be regarded as being at the opposite end of life to those the essay is concerned with in terms of vulnerability: the young? I would agree with her.
Her academic career has been hugely disrupted by being labelled a terf, so it’d be almost inhumanly objective of her not to be influenced in any way during exposition of her arguments. After all, is a professional.philosopher any less human than any of us?
In citing the ‘gendered soul’ issue in support of her case against assisted dying, there could be a parallel drawn with the concept of ‘the soul’ itself. What do we mean by that, and is it what distinguishes us from the rest of the animal kingdom? I pose the question but, i hasten to add, without positing an answer. However, if it were to be our distinguishing feature as humans, invoking therein such concepts as ‘dignity’ which seems central to the whole argument around assisted dying, we should remember that we have no qualms in relieving the suffering of animals, especially beloved pets, by intervening in their deaths. Might i also suggest that she clouds her argument, in this respect, by using the term “euthanising”.
But humans have a soul, and agency, we might insist. Again, i’m not suggesting that isn’t the case; what i’d ask the author to consider however, is whether invoking the ‘gendered soul’ argument (as an example where society shifts the dial) is any different in kind than considering humans as opposed to other animals based on a concept of soul; and if this isn’t the basis for her case against assisted dying – what is?
What might be the most obscene aspect of this issue is MPs making the decision about whether the legislation passes or not, in any country. I feel pretty confident in saying that they have very little individual input in the content of the legislation. These are the very last people who should be included in the debate. But our laws pass through parliament, that’s the way the system works, or not.
The fear of having to live in pain is great. I haven’t been around anyone who has had to endure it, so I have no first hand experience. As legislation it may be something we’re incapable of dealing with. Words like dignity, quality of life, autonomy, the soul, they bring me no closer to a personal resolution. What I can deal with are ideas like quality care, pain management and dignity under circumstances, What that means is financial investment in care: pharmaceutical, carers, accomodation, family, management and everything else that may be necessary. These are not “syrup-laden” platitudes but material solutions that can be easily put in place. There are people out there (not in parliament) who can make this work. The way we end our lives affects everyone, all generations. It’s not like the boomers chewing up the budget at the expense of coming generations. Everyone has an investment in making it work.
I think your use of the phrase ‘obscene’ part of the problem BH when we have to debate, as a Country, judgments like this.
We elect MPs because grappling with complex legislation is not something we can all do in some form of direct democracy. Jeez haven’t we learnt that from things like Brexit where something actually complex was overly simplified and then politicians had to work out what the hell it meant. And arguably something like Brexit much less important than an issue like this.
There will be some MPs not giving this sufficient thought, but most will agonise about it and take soundings from multiple quarters.
Destroying and undermining our institutions with hyperbolic criticism not the Burkean way.
Despite what you say I don’t think this should be determined by these people. Therefore it cannot be approved in parliament. It doesn’t matter how agonising their decision is, they are not good enough to do it. In fact I don’t think it’s their right to make such a decision,
Destroying and undermining our institutions with hyperbolic criticism not the Burkean way.
If this is directed at my criticism of MPs then criticism is hardly destroying and undermining institutions, but declaring that they are not up to it. It may not be the Burkean way, but why should that be the only way?
Is there another BH? The revolutionary thinks they can refashion a society quickly. History teaches they can’t and you destroy current institutions at your peril. Challenging them, changing them, allowing evolution – but ripping the roots out when those roots have taken far longer than you have to evolve history shows leads to some v bad endings.
Back to the Article – who would you have decide the law on assisting dying?
Back to the Article – who would you have decide the law on assisting dying?
Maybe just read my comments, there’s no point in me repeating my thoughts.
You refer to needing individual input. There are 68million of us. How you managing this?
I’m not getting a sense you’ve really given it much thought beyond a dig at MPs, many of who work exceptionally hard.
Maybe subs here only read replies to their own comments, otherwise you wouldn’t be asking me that. My position is that I’m not sure we’re capable of making decisions like AD that are sound and contain real safeguards to future-proof things that so often go off the rails. Things get very messy, ie. abortion and trans rights. Nor am I saying we need individual input. Where did you get that from?
I don’t believe that many politicians are any smarter than you or me. There are some, but not many. I don’t believe they’re any better at addressing these issues than I am. Presumably they receive and have access to many different views: medical, philosophical, sociological, etc. Well, give me access to the same then have a referendum.
I don’t understand what you mean in your first paragraph. Are you saying that there should be a referendum on the legislation? If so, all indications are that it would pass, as a majority of Britons are (as I understand it) in favour of VAD.
No. I’m saying MPs aren’t good enough for this decision. Nor can you know how many of the people are for it. Anymore than you can say that about Australia.
But surely in a parliamentary democracy, it is MPs who (collectively) make decisions like this? The only other way to do it is to have a referendum.
Yes, you’re right. So I guess i’m saying that without MPs making the decision, who I don’t believe are capable (they can’t even deal with the simple thing), and without a referendum (always subject to political and socially entrenched pressures), without any alternative, this is a decision beyond our capabilities.
In Australia VAD was done state by state over time, so there were many, many polls and they all showed string support for VAD, so I think we did know that it had majority support.
You don’t know anything of the sort. Polls are not reliable evidence of anything.
You might doubt one or two polls, but when you have many, over time, I think you should accept that their predictive power is more accurate.
To me polls are suggestive of something but not necessarily a measure of something, And we know that polls are consistently used by those they benefit. A referendum is the only way for a closer feel, but that to is subject to campaigns by different interests.
I do note that New Zealand had a referendum before introducing their legislation. It got up with a 65% Yes vote.
I can’t hear anyone complaining about it having been legalised, and it seems to be working well.
And anyone who disagreed was ridiculed into silence.
Simply not true if you look at the news coverage. Are you seriously suggesting that the Catholic Church, for example, was ridiculed into silence?
I watched an episode of Q&A in which the Catholic ethicist Margaret Sommerville, who has researched the whole issue in depth and who has accurately predicted slippery slope consequences, was definitely ridiculed and dismissed as lacking any compassion. An older woman said something along the lines of, “Don’t you tell me what to do. My husband and I will choose to die when we want to” and the audience showed wholehearted approval.
That is just one example. I think Kathleen Stock is correct when she says the “Be kind” message is a powerful persuader. It is an effective way of making objectors appear heartless.
I didn’t see that episode, but I think the comment you referred to was a fair one. The Catholic Church might feel it can “make the rules” for Catholics, but why would non-Catholics care what they think about anything?
Brilliantly argued by Dr Stock, as always. One micro-quibble: the article over-optimistically states that “carers look after you in non-instrumental, respectful ways that acknowledge your intrinsic human worth”. Apart from ignoring care-home scandals, this assertion skates over the fact that in 2023 alone, the UK brought in 89,236 carer visa immigrants. What proportion is really looking forward to wiping bottoms in “respectful ways” that “acknowledge your intrinsic human worth”?
Totally agree. This is not just the Uk. Quality care means professional, empathic carers, jobs that are valued and paid accordingly. Not filled by anyone who is only after an income with little long term commitment. This means they are professional appointments and appropriately paid.
Agree BH, which means a fundamental change on how we fund Social care so we can better value those working in it. But even then our demographics mean reliance on some significant immigration is not going away.
Instead the Right has ducked that and instead heaps prejudice on much of the workforce propping it up.
The answer means we all have to pay more for it. Watch for where you see the new Tory leader, or likes of Farage, ever admit this.
I just realised, though, that I had conflated aged care with palliative care. Obviously two separate things. I’m not sure just who the staff are in palliative care and what conditions are like.
There will be specialist palliative care practitioners – doctors and nurses. The basic care though will be delivered by staff much the same as in a Nursing Care Home. The specialist staff better paid, the more junior health care assistants much less. In a Hospice the person helping you with the basics will more often be the latter.
In my experience (Australia) nursing home care is more rudimentary than hospice care, although there are staff in both that really do ‘care’. It is only recently that the government has ruled that every nursing home must have a registered nurse on duty at all time.
The staff try very hard to treat people with dignity but when someone is on the maximum pain relief allowed and still screams in pain every time someone touches them and begs for it to stop, it is time to give them more even if it kills them. I know. I was there recently.
j watson In my opinion Reform UK has a very good position on the matter of improving services and social care. By getting millions more native British people back to work via a tax friendly system that encourages working over benefits. Further, relying on low skill immigration doesn’t solve the care problem because those very immigrants will need immigrants to care for them given non replacement birth rates. This is to say nothing of the fact that we now know that unskilled immigration is not an economic gain for us but an overall loss.
Nice theory. Collapses moment come into contact with reality. Corralling people into social care employment not going to raise standards and safety, and you assume they’d then have the qualifications, training and physicality (these are physical jobs) to function. You also assume that the need correlates with where greater economically inactive live. But if we paid more and trained better we could recruit more locally. You do imply you don’t really want to pay for that though. Cakeism I’m afraid.
As regards does the point ‘immigration just creates the same problem in due course’, it doesn’t hold. Our demographics mean we need more young, and not just to staff the care sector. (In fact leaving the EU reduced the incidence of migrants coming here to work and then returning home later in life because it was close and fairly similar – which of course in many ways was v optimal. We also hadn’t paid to educate and train them. Now we recruit from further afield and they do not return later. Great bit of Brexit thinking wasn’t it).
Unfortunately you are a bit like King Canute and the sea on this one. It can be better managed and better explained but get your head round it – it’s not stopping in your lifetime and v good chance you’ll end by being grateful in your dotage for a kind immigrant bringing you a cup of tea and helping you wash and dress.
I suspect the number of people who lack compassion and empathy outnumber those who possess it. Just because someone becomes a professional carer, nurse or doctor doesn’t mean they actually care.
That is true and I know because I am one. A person lacking in compassion and empathy. Up to now we have lived in a society where it was important to at least fake those qualities or make a token show,not that I bothered much but my experience of life has shown me that MOST PEOPLE are actually the same as me to a greater or lesser degree and it’s actually stupid and self defeating to have a ‘Saviour’ complex ( knew someone with this) and think that by taking on poverty and finding some suffering to embrace you are identifying with the POOR who are actually right ungrateful bastards. No it wasn’t me ,I’ve seen this and it’s stupid as is this death idea . I wonder how much they are paying the old girl to.front the scheme
And can’t be afforded. Where is the money better spent? Keeping alive someone who may only live another few miserable months or youth who have decades more to live. Some life prolonging treatments should be outlawed.
It doesn’t take much for someone in these comments to have a dig about immigrants. Now perhaps if you majored on what it would take to reduce reliance on carer recruitment abroad? But alas nothing. Too complicated. Instead let’s have a dig at the people holding the thing up.
It is true that in many Care settings there is considerable reliance on overseas workforce. One intriguing thing is that workforce, in general, tends more towards a ‘faith’ still being more important to them than the norm nowadays in the indigenous population, and that ‘faith’ often aiding and underpinning that caring vocation. These are generalisations of course, but something in it and you’d need to spend much more time in such settings to grasp that. That linkage probably something we should be grateful for.
No carer, and I’d class myself as one both in my current employment and with elderly relatives, welcome the distress you see when someone knows they need help with their most basic functions. And yet once well trained you realise quickly it is in these moments we most show our humanity and that is a blessing.
It doesn’t take much for someone in these comments to have a dig about immigrants. Now perhaps if you majored on what it would take to reduce reliance on carer recruitment abroad?
Its my experience that too many immigrant carers in institution are not really up to the job, they simply don’t care enough or respect the workplace they’re in. Just because AR doesn’t have a solution doesn’t invalidate his point of view. In fact you’re playing the race card by suggesting that criticism of current services is based on race, when it’s on the lack of care, commitment and empathy by those employed.
The daughter of a good friend of ours is an intensive care nurse/practitioner (she can prescribe drugs) in a large English NHS hospital. She will shortly leave for a job in the private sector. One of her main reasons for leaving is the large increase in immigrant staff in the intensive care unit. She says that the first question most of them (all females) ask is how soon would they qualify for maternity leave. She says they have low standards, show little respect for their patients and play the race card at the slightest opportunity. We are losing a highly skilled, qualified, experienced professional because of the appalling situation in the NHS. Both our children (doctor and dentist) moved to Australia because they became so sick of the poor conditions and grinding managerialism in their respective NHS jobs.
Exactly the experience I was referring to.
Actually that’s what I do now too. And by sounds of it we’ll be better off without the daughter of your friend. She will be a significant outlier with an attitude like that and I’ve worked in many ITUs now around the country. NHS has relied on immigrant workforce for decades. Your friend’s daughter probably in the wrong profession if she judges people in such a sweeping way. We all get taught to see people as individuals.
Wow! You are unpleasantly judgemental. I suspect it is people like you who are motivating her to leave the NHS. Contributing unpleasant observations adds zero to a discussion. Better not to say anything rather than commenting and revealing how unpleasant you are.
I should add to my earlier point – there are v few private sector ITUs. The private sector doesn’t generally want to do the most complex, risky surgery and the staffing and cost can be a significant overhead. More often patients needing this back-up are done in the NHS or transferred back to the NHS. There are some but they tend to be in the internationally well known private hospitals – the Humana, the Wellington, Cleveland etc. And guess where most of their work comes from? – yep overseas folks flying in for treatment, alot from the middle east. So the daughter in this anecdote likely gone to work for only those who can pay with big chance they are also overseas visitors, because she doesn’t like working with immigrants! The irony. But then again there are some all about themselves who welcome a cover story.
Could these thoughts of yours be due to conscious and unconscious bias, or is it just others who suffer from that?
Just look up how many Private Hospitals have full Level 3 ITUs. You can check it as a fact.
They send the patients to the big NHS hospitals for scans etc that need the big expensive treatment.. Private hospitals are glorified hotels. It works like this ( got several instances among relatives and friends). Your GP refers you to a consultant. He,usually he,says you need XY procedure. I’ll put you on the list. How long is the wait you ask. On average it’s 3 years he says. How much does it cost if I pay and how soon can it be done,where and who by,you ask. The consultant replies £5K,by me,in that private hospital across the road on Friday afternoon.
It’s a no-brainer.
Unpleasant speculation. The ‘daughter’ has moved to a hospice run by a charity, and is taking a lower salary. She is a dedicated professional.
And how much experience is that really BH? Are you sure your prejudice not out ahead of your true degree of experience, and even if you’ve some anecdotes that sufficient for such a sweeping reflex?
And yes – I am calling out a racial reflex when it’s there.
What can I say? That’s been my experience. How do you assess the world around you?
You recognise your experience may be v skewed and greatly influenced by your own conscious and subconscious bias. Then you can share an anecdote.
Right, and you think i’m a victim of that, incapable if assessing anything realistically, that everything I think is therefore wrong.
Thank you Watson.
A Robot, most immigrants decline assisted dying in polls. Most polls are crap anyway so the figure is probably lower than what is even recorded. Most immigrants are more religious than westerners and most of the carers are women. All in all, with this knowledge and my experience, I find most Asian and other immigrants who are long term carers in the UK do excellent work and culturally they care for the old more than our insipid culture. So I think it’s unfair to state that immigrants are short termist when I’ve witnessed the opposite in various different experiences with my family and friends in their old age.
Wow. That’s the first time I’ve agreed with J. Watson about anything.
My 94 year old completely dependent bedridden father died in a care home last year. Every single one of the ‘carer immigrants’ on whom you shamefully cast aspersions looked after him with kindness and humanity. Thank God they were there.
A Robot, it’s important to understand her point in making that quoted statement. She says (my bold) “this is recognised when carers look after you in non-instrumental, respectful ways that acknowledge your intrinsic human worth.”
“When” implies that she isn’t claiming that this condition is actually prevalent, only that it exists and could therefore be expanded, which in turn means that it is also possible to “retain dignity in spite of what is happening to you physically.”
It is her way of countering the assumption that dignity is dependent on a narrow set of conditions, for example those directly related to “inadequate and demeaning care standards” that may or may not continue to exist in the future. As she notes, “dignity is also a culturally porous entity, changing its shape according to prevailing norms and ideals.” Agitations for improved care, whether in a nursing home or palliative setting, can change the shape of what is considered dignified.
My thought exactly!!
The “slippery slope” argument also applies to abortion – and we allow abortion based on a set of rules. Whatever happened to the endlessly repeated principle of “My body – My choice” ?
The “slippery slope” slopes in both directions(!). Yes there is a risk that people will be stampeded into assisted dying for reasons other than their own. But there is also a risk, currently ascendant, that people will be compelled to live in pain or indignity for reasons other than their own.
As with abortion and capital punishment the attitudes usually settle onto one end of the slippery slope and ignore the the reverse slippery slope. Hence we get motivated reasoning from one camp or the other with little chance of resolution.
I am not sure the argument does work in both directions. It is currently illegal to help a person to commit suicide. Where does the slippery slope lead from there? We know what will happen if we continue with the present law – we can see it all around us. The slippery slope argument applies to potential future legal changes, where we don’t know what the unintended consequences will be.
An example of a current slippery slope is a practioner limiting pain relief to avoid claims they assisted a suicide. An excellent article highlighting unintended consequences. Particularly the power of the imagination. It will happen, so maybe we should argue for an irrevocable opt out to ensure that it can never be applied to oneself by other “well meaning” people.
Another example is elderly people saving and hiding their medication so they can make an exit at some point of their choice, often without the best drugs and often alone.
Exactly. My mother was old and had enough of living. She was determined to kill herself so to make sure she had a peaceful exit I sent her enough of the right kind of sleeping pills (available then not now) that she took with alcohol after stopping all her meds. She was in Australia and I couldn’t get there but my sister was with her and she just went to sleep and died. Isn’t that what we all want?
Good luck trying to get some effective pain medication in the US after the opioid crisis. The DEA has instigated knee-jerk rules that have doctors living in fear of losing their licenses if they give any dose that might work. Talk about living in pain and suffering! It’s a situation that is making more people not want to live.
Who is compelling anyone to live in pain or indignity?
My wife is dying. She’s had two stays in a hospice. She has certainly known terrible pain. It was very distressing to watch. With patient thoroughness, the doctors and pharmacist found a balance of drugs to control it. I can’t praise enough both them and nurses and cleaners for their honesty, kindness and respect for both her and me.
Equally I praise the hospice community nurse and the district nursing team. Plus our two GPs who are quickly responsive and knowledgeable.
My wife has the the option of dying at home or in the hospice. Esther Rantzen – whose New Forest home is not far from mine in the next county – should campaign for more hospices and better hospice care.
I was referring to the slippery slope(s) – the argued endpoint being compulsion to die when not wanted by the individual or the compulsion to live on when not wanted by the individual.
I am in favour (generally) of personal autonomy and do not want (possibly) well meaning interference by others. But sometimes the individual is no longer capable of giving consent – either way.
After seeing a relative receive good hospice care I do support their use. But you have to wonder why comparable NHS hospital care falls short.
Both options are not mutually exclusive. More excellent hospices, like our local one- but also, the choice to shorten a lingering, painful death.
Hospice care only works to a point. My partner died in a hospice in great pain screaming in agony every time anyone touched him. He had cancer which had spread everywhere from his bladder. He was considered “too old and disabled” for treatment. But he wasnt allowed to die even though he begged for it over and over. There was little dignity at the end. I hope your wife and yourself have a better outcome.
That your partner was “not allowed to die” is poor medicine.
“Thou shalt not kill. But thou shall not officiously strive to keep alive” is a reasonable ethical position. It is not the same as enabling a death. Rather it is accepting the inevitable that comes to us all in as gentle way as possible.
All doctors involved have made very clear to both of us that my wife will die of an extremely aggressive cancer. That attempted treatment to prolong her life would achieve little. The emphasis now is on the quality of life that she has left.
I am sincerely sorry that your partner – and you – did not have better care. I am also sorry for your loss.
Your post doesn’t say anything about what your wife thinks about the manner and mode of her passing. I take it that she is happy with how things are going, and would have no wish to be assisted to pass, but it’s something I would be keen to hear from her.
In the state of New South Wales, Australia, the government recently reduced the funds going to hospice care. This coincided with the introduction of legal medically assisted dying. A cynical move it seems to many of us.
Maybe the take up of VAD has reduced the need for hospice care.
As with many others who write on the topic, they refer to “assisted suicide” as though it were the same as “euthanasia”. This author should know better.
Surely the term “euthanasia” conveys the impression of a decision taken by someone other than the soon-to-be-deceased?
And who’s to say that it won’t slide inexorably into just that?
Presumably the legislation would provide that it wouldn’t.
So why the problems in Canada?
I have heard a number of Canadians (including on on this thread) say there are no problems in Canada.
There doesn’t seem to be much objective detailed case data from Canada – just received opinion.
The author’s point clearly being that there is a wide slippery slide from one to the other. Starting with the internalised pressure to conform to others so in the end the difference slips away. And to not give permission to have their life ended is felt as selfish absolving all of the burden on increased expensive palliative care.
This is an exceptional argument covering virtually every point there is against state-sponsored killing (I refuse to call it by its euphemistic name) but I do think there is one more element to this weird new campaign: the romanticisation of death. Despite everyone declaring themselves atheist these days there is an odd excitement about suicide in all its forms. It is the go-to threat of teens and spurned lovers, easier to make now that the Peter Pan idea of an “awfully big adventure” seems to have replaced the more prosaic image of “wormfood”. We seem to be avoiding actually trying to live life well, ignoring the necessity of struggle to give our existence meaning. There is a big philosophical reckoning coming and I suspect that those who have maintained religious outlooks will be tempted to say “I told you so”.
‘I suspect that those who have maintained religious outlooks will be tempted to say “I told you so”’. I imagine they will seek to do just that. It would be in keeping with the smug and holier-than-though way many of them live their lives.
Sounds very smug and holier than “them”?
One main difference: I would not presume to intrude on their choice, but they presume to intrude on mine.
Romanticising death, yes – I also see this in Esther Rantzen’s wish to die in her New Forest Cottage. Having a “good death” is increasingly meaning a beautiful location as well as an easy slipping away. To m, it paradoxically implies a clinging to the best the material world has to offer for as long as possible.
I think if ‘having a good death’ actually meant being able to die peacefully with well funded palliative care, either at home or at a hospice, the call for assisted suicide would have less of a hold on the imagination. It’s hard to not cynically view this approach as a way of reducing NHS costs for end of life care….
I’ve been atheist since I was eight years old, but rarely felt the need to ‘declare’ myself. And it is irritating that people of a religious nature like to portray anyone atheist as living a life bereft of meaning. We don’t all belong in labelled boxes in which everyone has the same views. We are a world of Venn diagrams.
So I hereby declare myself as atheist – and extremely worried about the current trend towards helping people to kill themselves.
What a burden to put on someone – who do you select for the privilege of administering the fatal blow?
If ever I felt that that was the only way out of an unbearable situation I’d do it myself, not ‘ask a friend’.
I agree with you on the “atheism” bit, and also the “do it myself” bit. The only problem is when you no longer have the capacity to “do it yourself”.
Is it a very difficult issue and v much welcome Articles like this.
Author is correct the hyperbolic language so often used in political discourse does not aid calm, rationale thinking that needs to strike the right balance on a v complex issue. She is also so right that we need to be v mindful of where a benign intent can lead. She linked this to Gender Recognition Act. One could add perhaps a similar trend followed the Abortion Act of 67. It’s advocates then never intended it to facilitate quite where we’ve ended up and a close reading of the legislation makes that clear. Perhaps though not the equivalence the Author prefers.
Back to the issue – and yet to see someone in pain and distress wanting help to maintain their own autonomy but not be allowed by law is also incredibly difficult.
But death IS a loss of autonomy; the ultimate such loss. We used to understand this, and see a spiritual benefit in graceful acceptance – many cultures and religions teach this the world over. We are corrupted by the delusion of autonomy that wealth offers.
Yes – many cultures embrace this graceful acceptance of when the appropriate end has arrived, and celebrate when a person is able to make the decision for themselves, on their own terms. We seem fixated on keeping a human body technically alive for as long as possible, even when the person themselves has long since departed, for fear of being accused of not doing everything possible.
Voluntary Assisted Dying is coming to Britain, as it has come to many other countries, including Australia (where I live). The reason is that the people in those countries are in favour of it. Those who oppose it are just going to have to come to terms with that fact.
Those who oppose it are just going to have to come to terms with that fact.
I’m not going to make any criticism of those who support assisted dying, but there will be a time when things go a bit sideways. It seems inevitable to me and it doesn’t have to happen. But the fear of living in pain is great, as is no longer being an autonomous being, and most support in the country will probably come from people who’ve had no experience of the end of life and what palliative care is. It’s possible, being legal, that I might choose it myself. I would not want to judge others who have faced it. But at least we could make sure that palliative care is the best we could have and a real alternative. And I do wonder how assisted dying might affect the quality of palliative care. But we have no idea on how many people want it. A referendum has never been carried out.
I am not anti-palliative care, but when I reach the point where I can’t perform ablutions without assistance, I’m checking out (whether by means of VAD, or with the assistance of things that reside in my gun cabinet). That is an entirely personal view, and I have no issue with others taking a different path.
I understand. However I don’t know how i’ll respond at the time. It’s all theoretical at this stage, and maybe all based on fear.
Do you support patients being allowed to give Do Not Resuscitate notices in hospital? Surely that’s not too different to assisted suicide, as doctors are letting a person die who they could otherwise have saved? Likewise with Jehovahs Witnesses refusing blood, should they be forced to accept treatment they don’t want in order to carrying on living?
I think I agree with everything you say.
I can’t remember the statistics, but a significant number of people who are accepted for Voluntary Assisted Dying, and have access to the drug, don’t take it, they find the pallative care is sufficient. They just wanted the reassurance that if things became unbearable they had an exit. So, offering good pallative care, as well as VAD, seems a reasonable way to go.
Yes, i’ve seen interviews with people who were accepted for AD but didn’t do it. Though I don’t know of the final outcome. I really don’t think many of us have enough information on this state of end-of-life to make decisions about what the answer is. But I do think high quality palliative care is something that can be easily addressed without the ethical bind we face with AD.
I actually don’t have a problem with the two being combined. Something like “You are on a morphine drip. Don’t push the button more that six times in a day. If you push it ten times, you will die”.
Letting a person die (in accordance with their wishes) is not the same at assisting them to die.
Why not? If you have the ability to save them and prolong their life but instead choose to let them die (if that is the patients wish) why is that so different to assisting them to do so, especially if they’re terminally ill and will likely go in the next few months anyway?
Why do you respect one persons wishes to die (such as in the examples I mentioned) but not those who request assisted suicide?
I can only speak of my own experience of those close to me dying, but my answer is that dying is a process. Some choose to live through that process until they take their last breath, without interruption. I have seen three close loved ones choose such an ending, one in a hospice (heavily medicated for pain), one in a hospital (with minimal intervention) and one at home (with just one pain tablet). In all three cases the dying was gentle.
And I’ve seen a family member whittle down to nothing, barely able to eat and just wishing it was all over. She told me if the option was there she’d have taken it. By the end she was so pumped full of drugs she didn’t know where she was by the time she shuffled off.
Her being alive for that last few months was absolutely pointless, as harsh as that sounds. She didn’t want to be here, couldn’t do anything and the rest of us were simply counting down the days and visiting out of a sense of duty.
Give me deadly cocktail over that any day
Fear of what? Certainly not fear of dying!
Fear of chronic, debilitating, endless pain.
In my own case, and debilitating pain I suffer at end of life isn’t going to last long.
“Those who oppose it are just going to have to come to terms with that fact.”
As long as “those who oppose it” don’t end up also comprising the subset of people expected to undergo the treatment, I’m guessing?
If it does, even partly so, I think we might have missed a few crucial considerations here.
Another article starting from an obviously false generalisation:
“Deep down, everybody knows that the introduction of assisted dying legislation will create a new tier of vulnerable people who decide to jump before nature pushes them, and who would not have done so otherwise.”
No. That’s not true. I certainly do not believe this. What right has Dr. Stock to claim to speak for all of us ?
The article is ridden with such subtle manipulations and emotional arguments – the same faults the author claims to find in her opponents.
As usual, the hidden undertone is of a minority group of people wishing to assert their religious and/or cultural beliefs over a majority. The tyranny of a minority and the very same thing so many of us object to when it’s called DEI or positive discrimination.
And as others have noted, we’re already on the “playground slide” with abortion.
Deep down, everybody knows that the introduction of assisted dying legislation will create a new tier of vulnerable people who decide to jump before nature pushes them, and who would not have done so otherwise.”
No. That’s not true. I certainly do not believe this.
“Everybody knows” is a big statement. Of course you don’t know if it’s actually wrong. But like Kathleen you’re allowed to believe what you like. Nor do you know it’s a minority against it, unless there was a referendum.
Plus, just because one do not happen to believe something does not automatically make it untrue.
Kathleen Stock is an atheist.
And I never said she wasn’t (“religious and/or cultural beliefs”). And even if she is, she still has personal beliefs and prejudices just like the rest of us. Which I have no problem with. As long as she’s not trying to force them on the rest of us. However politely and covertly she might be doing it. And as long as she’s being intellectually honest about what she’s doing.
Kathleen Stock is an atheist.
Presumably you are not. Which means you prefer to look at the world through your intellect and address issues logically. But your comment doesn’t seem to suggest that.
Oops, that came out wrong.
You are presumably religious. How does your position make Stock wrong? How does using her god-given ability to think and comprehend the world mean her opinion can be dismissed by calling her an atheist?
Excellent piece, thank you. I think there is a dangerous, political dimension to ‘assisted dying’, implied perhaps, but has been left out, which is how convenient officially sanctioned assisted dying would be in our current neo-liberal/socially communist democracy. To be able to ease the exit of people who do not ‘contribute’ to society as such would be cheaper for the government and ease the burden on the NHS.
Trans is a similar issue from this point of view, though from a different angle, there is a lot of money to be made with trans (instead of money saved) by making ‘gender’ something you can acquire; drugs, wardrobes, accessories, plastic surgery etc, plenty of profit to be made in the market.
It seems to be these new liberal directions, like trans already, and assisted dying potentially, in our society, when they can be combined with either huge profits or savings, are particularly dangerous and damaging to us as human beings. The market, capital, is leading the way and the market has no morals.
Well said Claire. The whole ‘trans’ debacle has shown how easily we can be sucked down a rabbit hole of unintended consequences. The GRA (a nonsense bit of legislation that conflates sex & gender) has led to actual ‘self id’ in which men may now legitimately pretend to be women to the extent that some men’s sex fetishes must now be accepted in every public sphere as a showpiece of some wonderful aspect of ‘diversity’. How long before ‘assisted dying’ becomes ‘mercy killing’ becomes just… killing.
And thence to actual murder becoming just another ‘diverse’ aspect of our social contract.
Very unlikely.
Again, shock horror at where the thin end of the wedge leads. A society that allows a mother to kill a baby and call it termination will naturally kill anyone that’s inconvenient, more predictable angst and faux moral panic.
Not “baby”. “Fetus”. One is not allowed to kill babies in Britain.
Wrong, more than 4m human lives killed for convenience since 1967. Only women can kill legally, sorrowfully tragic
My point is that they were “fetuses” not “babies”. Completely different.
It’s a foetus until delivery. But delivery times vary. So definition is pretty vague. A premature baby, born much earlier than is considered the average term, is suddenly a baby, even though the others still in the womb but older are considered as a foetus
Both are human beings and both are killed : the unborn and the born. No legal technicalities can validate difference. Everyone knows this is true.
I would absolutely dispute that is true, and so would many others commenting on this thread. My view is that something that is not viable outside the womb can be aborted (and it would seem the law agrees).
Sure, but just admit it’s murder.
Nope. No more so than removing an appendix is “murder”.
That’s the real problem with so much of today : people believe they have their very own truth. Facts are negotiable depending on the weather. Nope, life, the universe and everything does work that way. There is only one truth, no personal truth, truth is non negotiable. That’s why there’s phrases such as neo con, post this or post that. All of them follow the idea of relativism to dent truth to serve the self. Even scientific fact is negotiable depending on politics or race or sex : garbage, all of it . Trouble today is that after decades of coddling, truth and fact disturb and trigger so many. But in this one, the truth is their in front of even the eyes of those in denial. An unborn baby is a human being. No amount of legal text or false viability utility can change the fact.
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Foetus is an unborn baby and a human being – abortion is legalised killing identical to legalised killing of the old and infirm.
We will have to agree to disagree.
This is a false equivalence. One can be pro-choice for women when it comes to abortion, but very dubious about ‘assisted dying’.
This is far too complex a topic about which to make sweeping generalisations.
Wrong. How is it false? Women kill their unborn child. Some very subnormal minds consider the unborn child as a mass of unfeeling cells, as commented elsewhere. All you need to see is a 12 week aborted baby (foetus if it helps) to know this is a human being- facts are very inconvenient for some.
And another thing: who owns my body? My estate is responsible for its disposal. Who owns my life? We often hear of a life being taken, but from whom? My body, my life, my choice.
We do not allow animals to suffer (it means physical pain in this context) and are happy or encouraging for them to be euthanised. Are we so very different?
The difference with animals is 1) there is no palliative care for animals and 2) they’re owned by someone.
Surely we “own” ourselves, and are accordingly qualified to make this decision on our own behalf?
That’s true. What I mean is that the power to euthanise an animal by the owner is never questioned, which makes it so easy.
And the monetary cost of palliative care for an animal is very high.