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I’ve seen too many bad deaths Doctors already make end-of-life decisions

Medics don't want to play God. Christopher Furlong/Getty Images

Medics don't want to play God. Christopher Furlong/Getty Images


November 28, 2024   4 mins

As an emergency physician, I make agonising life or death decisions every day. When caring for a terminally-ill patient whose organs are failing, and who can’t recognise her own children, I work with colleagues and family members to decide whether to withdraw treatment. We do this when both evidence and experience suggest there is no hope left.

These decisions are incredibly sensitive. Yet compared to the intense controversy over Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill, which Parliament will vote on tomorrow, the public doesn’t seem that concerned by end-of-life medical care. Critics of the Bill worry about doctors will be “playing God” by interfering in the workings of death. But trying to ensure our dying patients a dignified death is already part of the job. Not only do physicians determine the limits of care: we also choose when and whether to withdraw treatment. The question isn’t whether these decisions about death will be made, but how best to make them with dignity.

The Assisted Dying Bill would in fact reduce the role of doctors in the process of death. Currently, every significant end-of-life decision I make involves consultations with other physicians; discussions with family members; and respect for the patient’s wishes via an advance directive or “living will” that states a desire to refuse treatment — should he or she be unable to communicate. If it becomes law, the Bill would bolster these existing safeguards with additional layers of protection. And it would take decision-making out of the hands of medical professionals. Doctors would simply execute legally-sound protocols, as we currently do with Do Not Resuscitate (DNR) orders.

Let’s imagine how this would play out in practice. An adult patient with full mental capacity, who faces a terminal diagnosis or severe deterioration, and is in their final six months of life, could request an advance directive for assisted dying with the help of a doctor, who would ensure that the patient meets the eligibility criteria. This means, according to the Bill, that the person has a “clear, settled and informed wish to end their own life” and that they have come to the decision “voluntarily, without coercion or pressure”. If two doctors independently state that the eligibility criteria have been met, the patient may apply to the High Court for approval.

If the High Court approves the request, there would then be a 14-day reflection period (if the death is imminent, this would fall to 48 hours). After that, the applicant may make a second request for assistance to end their life. If their doctor still deems the patient eligible, a life-ending “approved substance” could be prescribed for self-administration. This is hardly a snap decision made in a moment of distress. At any point along the line, clinicians could decide that the criteria haven’t yet been met and defer action for review in three to six months’ time.

This multi-layered approach provides significantly more checks and balances than are in place for many current end-of-life decisions. When, for instance, I come across a terminally-ill patient with a perforated bowel at 3am in the emergency department, I am forced to make an immediate decision about the appropriate care limitations. While I always seek advice from my colleagues in such cases, I do not have much time. Every emergency physician can recall cases where treatment choices didn’t achieve the intended outcome — not due to negligence, or poor judgment, but simply because doctors are making complex decisions about the most intricate machine on Earth: the human body.

The proposed assisted dying framework would remove the element of time pressure, and take the decision-making burden away from doctors. I would focus instead, quite rightly, on patient autonomy and dignity. I cannot help but recall the tragic case of the judge, Sir Nicholas Wall, who at the age of 71, having been diagnosed with a rare case of fronto-temporal lobe dementia, “lost the will to live” and hanged himself in his care home in 2017. While I have no personal stake in the assisted dying bill, I do believe that those in positions like Sir Nicholas — who, in his own words, could find within himself “no hope for the future” — deserve the right to choose a dignified death.

Why would anyone be opposed to this? Part of the reason is that the debate over assisted dying has been cast as an existential battle between good and evil; between those who value the sanctity of life, and those who are willing to trample over it. And yet this Manichean way of thinking entirely misinterprets the reality of current medical practice. In his passionate critique of assisted dying legislation in UnHerd earlier this week, Giles Fraser argued that “fundamentally, the state should not be in the death business”. But the state, via the NHS, is already deeply involved in end-of-life decisions. The question isn’t whether these decisions will be made but how best to make them with humanity, clarity, and the appropriate safeguards.

“The question isn’t whether these decisions will be made but how best to make them with humanity, clarity, and the appropriate safeguards.”

There are many who argue that any system of assisted dying would be open to abuse by unscrupulous characters looking to exploit a patient’s lack of mental capacity. And yet our legal system is well versed in spotting subtle forms of coercion in many contexts — from contract law to criminal justice. It would be difficult for anyone to get around the proposed system, which promises an unprecedented level of scrutiny. I expect that any questionable death will be referred to the Coroner’s Court, the oldest in the land, for a thorough review, and, if necessary, criminal sanction. This level of oversight would be unimaginable in current end-of-life decisions.

Another factor to bear in mind is that the quality of an emergency department isn’t measured solely by how many lives we save. An equally important metric is how we care for the dying. Currently, I spend too much time with elderly patients who are shadows of their former selves — many are incontinent, confused, combative, and can no longer recognise their loved ones. Surely, people deserve a choice about their future suffering?

I’ve seen far too many bad deaths in my time — often in cases where doctors preserved biological function long past the point of meaningful life. The assisted dying bill offers a better way forward: not by empowering doctors to play God, but by enabling individuals to make informed choices about their own end-of-life care, supported by appropriate medical and legal safeguards. While death is an inevitable part of life, an undignified one need not be.


Dr Emma Jones is an A&E consultant based in the Midlands.


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Lancashire Lad
Lancashire Lad
28 days ago

I’ve been highly critical of Dr Emma Jones in the past, mainly on the grounds of her ability to describe events in her neck of the NHS woods in a way which is both too personal (i.e. “my patient”) and without any attempt to prescribe a cure for what she sees at NHS ills other than throwing more money at problems which require a far more nuanced approach.
In this article, however, she’s on much firmer ground. In my opinion, it’s a very well elucidated riposte to the article she refers to by Giles Fraser a few days ago, which was full of the usual handwringing around assisted dying. Dr Jones brings her direct experience to bear on the matter, and as she sees it, the parliamentary bill not only has more than sufficient safeguards but would simply make explicit what doctors do in an implicit way throughout their careers – but in this case, by allowing patients able to make a decision (or having previously has their wishes recorded) to take the burden away from the medical professional and into their own hands.
In other words, it’s entirely possible to counter the “slippery slope” argument, and provide greater agency for individuals rather than have them take their chances with the vagaries of the NHS. This dose of realism is to be welcomed, and i really hope the bill passes into law.

Citizen Diversity
Citizen Diversity
28 days ago
Reply to  Lancashire Lad

Would Sir Nicholas Wall, whom Doctor Jones refers to, have qualified under the terms of the proposed Bill? If he deserved a dignified death for ‘having lost hope’, this provides an argument – a cogent one – for extending the provisions and eligibility for assisted dying accordingly.
A doctor who is not involved in the assessment of a person for assisted dying would ‘simply execute legally-sound protocols’. They would lose agency at the point they see the patient, perhaps as Dr Jones does, in A&E.
Which body will approve the ‘approved substance’ to be used? Introducing a ‘substance’ in lethal doses into the heath care system is somewhat different from withdrawing medical treatment at the limits of the capabilities of such.
A country that can accept with equanimity a quarter of a million abortions a year cannot really have much ground for refusing several dozen people the ability to end their own life legally.
Despite all this, all praise to Dr Jones and her colleagues everywhere. I have seen first hand how they treated a patient, a close relative, as she describes.

UnHerd Reader
UnHerd Reader
28 days ago
Reply to  Lancashire Lad

Wow! For a Lancashire Lad you sure use a lot of big words, a lot of unnecessary words, a lot of words – noticeably more, l think, when you’re suddenly agreeable, then sound like you’re from sycophantishire?

Andrew Roman
Andrew Roman
28 days ago

An application to a judge seems unnecessary as the judge is less knowledgeable about the patient’s health than the physician and the patient. It may also cause delay and needless expense.

Mary Belgrave
Mary Belgrave
28 days ago
Reply to  Andrew Roman

Also no one has explained how the evidence would be gathered to assist the judge to make a decision.

Lewis Lorton
Lewis Lorton
28 days ago

I have a close up view of this problem. My wife died in 2018 years after diagnosis with a variant of the same disease as Judge, Sir Nicholas Wall.
The first years of her illness were just very upsetting as she lost many functions but the last year was intensely traumatic to the family and her self.
She could no longer sit, stand, walk speak, understand or manage any of her needs. I couldn’t bear the idea of her being in any kind of care home where she was alone, being cared for only by strangers, so I kept her home and brought in care givers when I was not able to actually be there with her.
The last 2 days were agonizing for all. She was deep into Cheyne Stokes breathing and I sat there by the side of her bed, holding the morphine solution left by the hospice organization, knowing that she was gone but her body was suffering and I didn’t have the will, alone, to give her enough morphine to end it.
Luckily she, at last, expired and I am left with the thought that I could have spared her body some agony but didn’t.
A mechanism to help in that circumstance would spare survivors’ memories.

Bret Larson
Bret Larson
22 days ago
Reply to  Lewis Lorton

It’s a powerful memory with a tinge of hope.

Thank you for sharing.

David Lindsay
David Lindsay
28 days ago

David Cameron has come out in favour of assisted suicide because Boris Johnson, and The Spectator under Michael Gove, have both come out against it. Whose view on anything could possibly be swayed either by Cameron or by Johnson, or indeed by Liz Truss? What matters in today’s Times is the leading article, which correctly contends that, “Such flippant and ad hoc reasoning behind this most important of bills condemns it.”

Hugo Rifkind’s column is also moving and significant, concluding, “So no, I’m far from certain. But damn it, if MPs have to decide, then a columnist should be brave enough to do so too or forever hold his peace. With trepidation then, and with conflict, and with no small amount of guilt toward the people who yearn for this law and have every reason to, I would vote against.”

We can win this one.

UnHerd Reader
UnHerd Reader
28 days ago
Reply to  David Lindsay

You mean conscience, rather than Party or constituents, may yet prevail?

Evan Heneghan
Evan Heneghan
28 days ago

Despite the performance of the entire medical industrial complex during Covid, most people still trust their doctor in face to face real life situations. We implicitly trust doctors to try and treat people in end of life scenarios with as much respect and dignity as is possible. We know sometimes doctors end up dosing terminally ill patients who are suffering in the final hours with lethal doses of morphine after consulting with their loved ones and are comfortable with the non statutory, informal nature of the arrangement.

My fear, and I imagine the fear of others who do not support this bill, is that placing this option in front of patients DOES add additional pressure on them to ‘do the right thing’ and ‘not be a burden’. It’s more open to abuse than the system that currently exists. It’s disingenuous to claim the safeguards that are in place will prevent this. For one thing, people can still feel those pressures and commit to killing themselves as a result, but most importantly, we all know these safeguards will be relaxed as they are in every country that allows this. The qualifying criteria will be expanded, and the possibility of abuse will be ever increased. This legislation is the thin edge of the wedge and I for one hope it does not pass.

Mary Belgrave
Mary Belgrave
28 days ago
Reply to  Evan Heneghan

Families are often estranged and adult children who live miles away and have not had much contact with their elderly parent or relatives often tend to rush to the bedside at the late stages. I saw this often when I worked in A/E.( as a social worker). It’s easy to see how in such a situation the elderly ill patient feels they are a burden and therefore chooses Assisted Dying. Time and time again older people in hospital told me “ I don’t want to be a nuisance” and they felt their needs were secondary to that of the hospital system.

UnHerd Reader
UnHerd Reader
28 days ago

Excellently article!

Catherine Farrar
Catherine Farrar
28 days ago

To be accurate, treatment decisions involve whether it is in the patient’s interests to give the intervention, not whether to withdraw it. That may sound pedantic but it’s important. Unfortunately in practice we act as though the intervention is the default. Also, Emma, it’s DNAR not DNR – Do Not ATTEMPT Resuscitation. Not wanting to be petty but that distinction is important as there is so much public misunderstanding and as a health professional you should know. It’s also misleading to describe it as like a legal protocol because there is discussion and clinical judgement involved in the process. You also talk as if there is no distinction between actively ending someone’s life and allowing a natural death which happens when you stop prolonging it through intervention.

Andrew Horsman
Andrew Horsman
28 days ago

The human body is not a machine.

Ben Scott
Ben Scott
28 days ago

Safeguards. The argument that all will be well because of robust safeguards is, I find, difficult to buy. There is currently a line in the sand – we do not actively end a persons life. Once that line is crossed it is up to legal people and politicians to redraw the line. And it will be redrawn and redrawn: 6 months to live, 12 months to live, living with intolerable this, that or the other. And we all know that the redrawing of this line will be like anything progressive: unidirectional.
Ah, but the safeguards will stop the line being moved. The fact is that the reason for this bill being put forward, is the very reason the safeguards will ultimately fail. It is my choice to end my life. If the freedom of the individual to choose is elevated above the current laws, the freedom to choose becomes sacred, and someone with 9 months to live will argue (in the courts, I’m sure) that their freedom to choose trumps any 6 months to live limitation. And so on and so on until the safeguards are nigh on worthless.

Martin Smith
Martin Smith
28 days ago
Reply to  Ben Scott

As night follows day, as water flows downhill, as Spurs fail to deliver on a promising start, so shall it be.

Peter B
Peter B
28 days ago

A compelling and consistently and objectively argued article which makes some critical points. Notably that all the dilemmas and decisions here are known problems that already have to be dealt with in modern health systems and that we are not really crossing some new moral threshold here.
It’s interesting to hear from a frontline doctor that no lawyers or judges are currently involved in these decisions. I’m still not totally persuaded that dragging them into the process will improve it.
For many of us, any objections here are essentially practical and not principle ones. That said, assisted dying should be seen as an exception rather than a right – a sort of rarely necessary evil. If there is a danger here, it’s that we start to think of it as a normal right.
Emma Jones has avoided her usual tendency to making bold emotional claims here and the result is so much better. There are times when I hope she doesn’t read some of my comments on her work here. Not today.

Archibald Tennyson
Archibald Tennyson
28 days ago

If you can’t tell the difference between withdrawing care and giving your patient a deadly poison (ghoulishly described here as an “approved substance”), I don’t think you should be practicing medicine.
To say nothing of your inability to see assisted dying beyond the confines of clinical standards. This issue exists within a much broader philosophical and religious context: one that sees our culture engaged in abortion, anti-natalism, nihilism, and strangled by other tentacles of the Octopus of Death.
I wonder who would hate humanity enough to try deceiving us into believing there’s compassion in killing? None but the Father of Lies.

Naomi Franz
Naomi Franz
28 days ago

“Currently, I spend too much time with elderly patients who are shadows of their former selves — many are incontinent, confused, combative, and can no longer recognise their loved ones. Surely, people deserve a choice about their future suffering?”

As it stands, the proposed Assisted dying bill would not cover such people unless they happen to also have a prognosis of fewer than 6 months to live, most of whom will not. They can make an advanced directive to refuse treatment whenever they like, before they lose the mental capacity to make decisions – that’s nothing new. They already have ‘a choice about their future suffering’ which is entirely separate from the assisted dying proposals.

Such an unhelpful argument and irrelevant to the vote tomorrow. If it passes, by all means make the argument that it should be expanded to include everyone with dementia who is ‘incontinent, confused, combative, and can no longer recognise their loved ones’ but that is a very different discussion and it would not be the patient making the choice unless they had an advance decision anyway.

Bret Larson
Bret Larson
28 days ago
Reply to  Naomi Franz

Well the downhill direction is evident from her argument.
(how firm might the footing be at the place they decide to legislate to?)

George K
George K
28 days ago
Reply to  Naomi Franz

This part also caught my attention as it seems to suggest someone else would be evaluating the quality of their lives and making decisions for those people

Naomi Franz
Naomi Franz
27 days ago
Reply to  George K

Precisely. It is of profound concern – which man has the right to choose whose life is worthy?

Nick Wade
Nick Wade
27 days ago
Reply to  Naomi Franz

Exactly this. This and other specious arguments, such as “I wouldn’t want to be a burden to my loved ones” are frequently trotted out, even in advertising. Is six months that much of a burden?

They are not pertinent to the bill being debated, but appeal to everyone’s fear of wandering around a dementia ward themselves and other scenarios. There are valid arguments for assisted dying, but the ones being used are emotive, disingenuous, and speak to our times. “Me, me me!”

Peter O
Peter O
28 days ago

A good article. I would quite like the option of a painless death while still in possession of most of my faculties, when the time comes. But as frail care is very expensive, I do also worry about “the right to die” morphing into “the duty to die”. Some of the stories coming from Canada aren’t precisely comforting on that score. It’s crucial to get the safeguards right, and Dr Jones thinks that the proposed legislation will improve the ones now in place. I can only hope that she’s right.

James Lennox
James Lennox
28 days ago

The state should not be deciding who is worthy of life

Peter B
Peter B
28 days ago
Reply to  James Lennox

How is the state deciding under these proposals ? These are about increasing individual choice – i.e. less state interference and control than there is at present.

Bret Larson
Bret Larson
28 days ago
Reply to  Peter B

Sometimes less choice by society is more choice for individuals.

As in, it’s ok for me to want to continue living.

And it’s ok for me to not burden somebody with killing me.

Kevin L
Kevin L
28 days ago

I have been shocked at the many misleading criticisms of the bill from prominent politicians:
“It it should not be easier to get assistance to die, than to live”, MSP Duncan-Glancy. The patients are already dying. Helping to live is not an option. She also fears that the bill gives the government the right to kill handicapped people. But handicapped people are excluded from the bill unless they have less than six months to live — and the bill does not give the government the right to kill anyone. It gives dying people a choice to die without pain.

Peter B
Peter B
28 days ago
Reply to  Kevin L

Yes, there’s an amazing amount of chaff being thrown up to try and muddy the arguments. But we should not be surprised.
Wasn’t aware that an MSP is a “prominent politician” in this context. This is also a Westminster matter for Scottish MPs (they are still over-represented here) and not MSPs (sort your ferries and all your other problems out first before straying outside your remit).

Bret Larson
Bret Larson
28 days ago
Reply to  Kevin L

They are excluded for now.

Hannah 11
Hannah 11
28 days ago

“But the state, via the NHS, is already deeply involved in end of life decisions. The question isn’t whether the decisions will be made but how best to make them with humanity, clarity and the appropriate safeguards.”
Doctors make decisions every day on when to withdraw life-prolonging medical treatment, yes. This is not the same thing as taking deliberate measures to end a life. There is a world of difference.

Philip Gerrans
Philip Gerrans
28 days ago
Reply to  Hannah 11

it is the same thing. The act-omission distinction doesn’t stand up as a general principle. There is no difference between failing to give someone naloxone and giving them an overdose of nitazine.

Brett H
Brett H
27 days ago
Reply to  Philip Gerrans

It is not the same thing. There’s a difference between allowing someone to die in a natural process and putting your hands around their throat.

Catherine Farrar
Catherine Farrar
28 days ago

I also take issue with the assertion that the courts are well-placed to identify coercion – not the case. We see already in so-called “Mercy” killings a leniency regarding the motives of relatives who kill. Fundamentally, once you establish the principle that it is reasonable for a person to kill themselves if they feel their life is unendurable and that medical professionals can support this, where do you draw the line? If someone can have medically assisted suicide to avoid weeks or short months of suffering, why not those who face long years? The situation faced by Nicholas Wall is not covered by the proposed legislation – a diagnosis of dementia does not infer imminent death, but clearly this is the direction of travel (which Emma appears to support). And how do you define unbearable suffering?
Finally, Emma references bad death “often in cases where doctors preserved biological function long past the point of meaningful life” – such an important point. No-one is addressing the pervasive practice of inappropriately and harmfully prolonging life beyond the point of natural death. Palliative care professionals agree that there is too much intervention and this often leads to a a worse death. Why do we not want to talk about this?

Ethniciodo Rodenydo
Ethniciodo Rodenydo
28 days ago

A thoughtful essay, but the author is wrong when she says ” our legal system is well versed in spotting subtle forms of coercion in many contexts — from contract law to criminal justice.”
This is simply not true. Our legal system is sometime capable of sitting up and taking notice if a highly motivated person kicks up a fuss, but absent such person the legal system is not very effective at all.
Also, over and above the speed of light, there is one immutable law of physics, the thin end of the wedge.
What the advocates say they what to achieve is not where we will end up. We have seen this happen time and again and we can reference the Canadian experience with assisted dying.
Maybe don’t ask don’t tell is the best approach

Brett H
Brett H
28 days ago

our legal system is well versed in spotting subtle forms of coercion in many contexts 
More often after the event.

William Amos
William Amos
27 days ago

I too found that senence landed like a bad joke.
Try telling the girls and young women of Rochdale that ”our legal system is well versed in spotting subtle forms of coercion in many contexts — from contract law to criminal justice.
Coercion and control were overlooked, as a matter of policy, when it served the ‘higher purposes’ of the state.
If the last two decades have meant one thing for those outside the professional classes in this land, it has been a total collapse in faith in the rigour and competency of our administrative systems and managerial caste.
And now we are being asked to trust those same systems and that same caste with the power to end life?
What could possibly go wrong?

Ann Thomas
Ann Thomas
28 days ago

It sounds all very civilised but we do now have many precedents of what can happen when important decision-making is passed through ideologically warped and adversely rewarding systems of the state. The use and ‘advice’ for Midazolam, the Covid era in general, Canada’s ever expanding definitions of ‘terminally ill’, Liverpool pathway. What use are checks and balances run through an inadequate process?

William Amos
William Amos
28 days ago

“Every emergency physician can recall cases where treatment choices didn’t achieve the intended outcome — not due to negligence, or poor judgment, but simply because doctors are making complex decisions about the most intricate machine on Earth: the human body..”

Unintentionally revealing.
Hubris and horror stalk the Benthamite view of the human organism. The “human body” is not a machine to be switched on or switched off. Life and death are not discrete ‘outcomes’.
The physical conception of human life, mind and body, is revealed in all its poverty. The Benthamite summum bonum is pre-agreed as ‘happiness and pleasure’. This radically reductionist, materialist, utilitarian ethic then tries to calculate the exact ratio of human ‘happiness’ measured against ‘suffering’ – neither of which terms are material or quantifiable in that way. And the ‘correct’ outcome is found. Death to the physician becomes merely another ‘outcome’ to be managed.
It is precisely the same ethical model as Eugenics.
What could such a world view possibly know about ‘dignity’? The very use of the term suggests that the dying have been viewed, externally, as undignified, This is the confession of a guilty mind. And shows the beginning of the slippery slope. The fear of an ‘undignified’ death will loom ever larger for ‘patients’.
Shakespeare and Donne knew far more about death – and death in the open street, not the operating theatre – than any physician and they both struggled existentially with self slaughter.
It is to these that a thoughtful nation could turn to guidance for the ethics of the question.
The medical profession may speak of drugs and physic but why would they be in any postion to pass comment on happiness, justice, dignity, hope or quality-of-life? These are not medical questions.
Ne sutor ultra crepidam.

Brett H
Brett H
28 days ago
Reply to  William Amos

The very use of the term suggests that the dying have been viewed, externally, as undignified
Very good point. What exactly is this idea of undignified? Is it the manner of dying, the physical collapse, the helplessness, the pain, the loss of autonomy? Does that also mean the whole of a life, in its messiness, it’s ailments and depredations of daily living, both physical and mental, is undignified? That the imperfection of life is undignified? What is it that makes a death dignified?

AJ Mac
AJ Mac
28 days ago
Reply to  William Amos

Well framed. But no one has verifiable expertise on another’s happiness, justice, dignity, hope, or quality-of-life. So it might better to allow even the cobbler or baker to have more say about his or her own final moments of life, or state, of mind, body, and soul.

As a Canadian citizen and fellow human, I’m worried about the slippery slope too. I just don’t think we’re still at a point when total prohibition can hold for much longer. We should try to chase the devil away from the details, to the extent we can. One’s life is not entirely one’s own; even less does it properly belong to a materialist physician or the Department of Medical Efficiency, consulting their DOMEsday Book.

William Amos
William Amos
27 days ago
Reply to  AJ Mac

“And yet I know not how conceit may rob/ The treasury of life”
I fear that we have about as much ‘say’ in our final moments as we do in our birth.
‘Choice’ it seems is the last red letter rubric in our aged, confused and distressed era. But is has shown itself to be a broken reed time and time again.
As with IVF, so with Assisted Death, neither we nor the physician can give or take life. We can only help foster the conditions and assist in the processes which permit for those strange, poorly understood miracles of nature to occur.
In the first instance by care and comfort, in the second by chemically attacking, battering and debilitating an already declining organism.
I do wonder, on a deeper level, though, whether the “poor, infirm, weak, and despis’d old man” which this article and writer posits for their ‘patient A’ is not equally a walking shadow for our culture and civilisation as it has manifested itself this last half century.
The Irony here is that there is a new generation coming through who, it seems, would rather play the Edgar to the elder, despairing Gloucester of their parents
The coming generation is hungry for hope and meaning and instinctively sympathetic to the immaterial and immanent nature of reality and being, and has turned its countenance away from Dover Cliffs and Dover Beach.
All six cabinet ministers who have publicly opposed the bill—and none of the seven who support it—are under the age of forty-five. 

AJ Mac
AJ Mac
27 days ago
Reply to  William Amos

Potent Reply. Arnold’s lasting poem (objectively: still read and discussed a century and a half later) still makes me a bit angry, but also saddens me. He blames his own loss of hope and faith too much on the 1867 zeitgeist as he perceives it. EVERY generation needs figurative and real bluebirds over the white cliffs of Dover.

I will say that I find some resonance in the Eastern idea that we DO at least in part choose the circumstances of our birth in some way that is inscrutable to us. Speculating: While most would quite predictably and naturally prefer to return to their own times: I wonder how many among those who’ve lived before us would pity us today, or share the same type of nostalgia that old book lovers like us are wont to indulge in.

“ The Golden Age is never the present age” -Franklin

*I see the votes have been cast. I hope that the devil is removed from most of the details.

Tyler Durden
Tyler Durden
28 days ago
Reply to  William Amos

Freedom and pleasure: a world view seeking only the maximisation of these sub-concepts to achieve individual affect places this assisted dying complex within the same civilisational lineage as the Pill and abortion on demand. They may also explain why an entire culture can support medical interventions to change the gender of young people if not children – being North American culture.

Janet Baker
Janet Baker
28 days ago

I haven’t read the comments yet, and perhaps one or more address my question here. Why cannot the existing framework allow the Catholic take on dying, which allows our choice on *ending treatment,* but does not permit that ‘substance’ that kills us. The Church says we may reject treatment for a number of reasons–that it won’t substantially change the outcome of the illness, that it is too painful, or even that it costs too much. At that point, why cannot treatment be ceased, but care be maintained (food, water, warmth, cleanliness), including perfectly adequate pain control, until natural death occurs? That way the ‘pulling the plug’ scenario of actively killing the patient does not raise its horrible head. Because what will happen then, which I may be wrong, I may have missed it in the article, is that that practice will become standard, overriding the patient’s choice to ‘die with dignity’ on God’s own time. My pastor, who also attends many deaths, says hospitals don’t even read end of life directives, they assume it means pull that plug, end all treatment and administer the ‘substance.’

Michael James
Michael James
28 days ago

As the welfare state sinks into bankruptcy, if parliament legislates for assisted dying then old people will increasingly be expected to see themselves off. People need to save in personal welfare funds as soon as they start earning so that they can afford their own age care.

James Davis
James Davis
28 days ago

As defined by the World Health Organization, “Suicide is the act of deliberately killing oneself.” Anything else, whether described as “assisted” suicide or euthanasia is a homicide of some degree.

Martin M
Martin M
27 days ago
Reply to  James Davis

Ok, so maybe some definitions need to be changed. What of it?

Lesley van Reenen
Lesley van Reenen
28 days ago

Informed and sensible article.

Anna Bramwell
Anna Bramwell
28 days ago

The dementia patients are suffering? Or is it the family who js suffering? We have no way of knowing how dementia patients feel or whatvthey want.

Martin M
Martin M
27 days ago
Reply to  Anna Bramwell

Seriously? Look at their faces during their interactions with others. They know “things are not right” with them.

Bret Larson
Bret Larson
28 days ago

Pretty much managerialism at its worst. Yes people are ok with frontline staff helping with decisions concerning death. No they don’t want to hear from the politicians and judges. Once you let the genie out of the bottle the discussions goes from these are your choices on treatment and the prognosis, to is your life really worth living.

While some manager is looking at their budget.

Is that where she wants to work.

As to undignified death.

Healthcare staff need to stop believing they are trained as priests.

Martin M
Martin M
27 days ago
Reply to  Bret Larson

Thankfully Healthcare staff aren’t trained as priests. If they were, they’d spend all their time in the Children’s Ward “ministering to” the little kiddies.

Bret Larson
Bret Larson
26 days ago
Reply to  Martin M

You hang around daycares do you?

Bret Larson
Bret Larson
26 days ago
Reply to  Martin M

Got something against priests? Her type of dignity is an abomination.

John Galt
John Galt
28 days ago

“Hmmm we could spend £50 million more pounds on pallative care to help those in their last stages of life but those people are never going to make the money back. On the other hand we could spend 10 million on increasing ‘awareness’ of assisted dying and have 40 million to spend on ‘green initiatives’ (that I just so happen to own some positions in.) that will save more people in the future.” – MPs in the UK within six months of the bills passage.

John Tyler
John Tyler
28 days ago

With breathtaking ease the writer dismisses the completely valid criticisms of the extremely weak safeguards included in the bill. Safeguards should be unambiguous, which certainly cannot be said of most in the bill.

Okay, so you’ve “seen too many bad deaths”, but that is not and cannot be a justification. I’ve seen too many attempted suicides, so help them finish the job? It’s a poor argument.

Benedict Waterson
Benedict Waterson
28 days ago

She spends ‘*too much time* with elderly patients who are shadows of their former selves’
Whom she judges to be ‘suffering’ and in need of the ‘choice’ to end it all..

Ah, I see.

Martin Smith
Martin Smith
28 days ago

I found this article informative and very interesting up to this point: “Part of the reason is that the debate over assisted dying has been cast as an existential battle between good and evil; between those who value the sanctity of life, and those who are willing to trample over it.”

That assertion is simply false.

Jonathan Andrews
Jonathan Andrews
28 days ago

This is genuine question. I wonder if when Shipman was murdering his first patients he considered them mercy killings? Perhaps, they truly were. Perhaps, he assisted the suicides of old, ill and suffering people.

I have little experience of ensuring pain and a bleak prognosis. I have been lucky and avoided the despair that makes people suicidal. Neither am I able to imagine the moral difficulty that doctors face when deciding whether or not to withhold treatment. They have my respect for their courage.

And yet, the slippery slope is real. We see it in Canade and the Netherlands. We saw it with abortion legislation. Acts that would be rare as an worthy attempt to help people becoming more common, more acceptable.

God help me, I’m asking those poor souls suffering to put up with it as best they can for as long as they can for other people’s sakes.

Alan Hughes
Alan Hughes
28 days ago

You note “Currently, I spend too much time with elderly patients who are shadows of their former selves — many are incontinent, confused, combative, and can no longer recognise their loved ones. Surely, people deserve a choice about their future suffering?” But who makes this choice as the people you are describing don’t seem able to make the decision themselves. Should the tired, exhausted and weary family member decide, or perhaps the doctor who can’t find a bed for them in an appropriate facility. The Act being discussed would not help in these circumstances at all.

Michael Walsh
Michael Walsh
28 days ago

Thank you

William Cameron
William Cameron
27 days ago

How does someone who is confused and cannot recognise their own family make an informed decision ?

Brett H
Brett H
27 days ago

I’m very wary of MPs making the right decisions about this and their reasons for choosing. So far in Australia I have not heard of any problems regarding assisted dying. It’s interesting how I’m never sure what to call it, there are so many names for it. I myself would not vote against others wanting it. I would not want to endure unbearable pain, even though I have no idea what that is. My support has nothing to do with a dignified death (of which there is no such thing, only dignified dying) but only the pain. I’d be interested to read a survey of people actually in this situation, not friends and family, but the actual person living with this situation, whether there’s a difference being cared for at home or by staff in palliative care, for instance. It seems to be a little obscene of us to debate this issue with very little input from those actually caught up in their last, fading months right now. In some ways this is the business of the law, those who can efficiently write the conditions and safeguards for legislation. As much as I might argue things from a philosophical point of view we are changing what we are. We’re going to be different in the future. That’s how it is, that’s the way we’re evolving. There will be problems and abuse, there always is. We’re a long way from being perfect, but let’s imagine the good still outweighs the bad.

mike flynn
mike flynn
27 days ago

Stopped reading in first paragraph. How is a self identified emergency physician an expert in palliative care/ terminally ill treatment decisions?

mike flynn
mike flynn
27 days ago

As if legal assisted suicide will save NHS from its financial woes.

Peter Mott
Peter Mott
26 days ago

Well, I would stay well clear of Dr Emma.
“14-day reflection period (if the death is imminent, this would fall to 48 hours)” Why if death is imminent is there any need to hasten it? Especially as the process of securing the required permission carries a financial cost.
“Surely, people deserve a choice about their future suffering?” A fraught ambiguity. It can be read “Surely doctors (people) deserve a choice about patients (their) future suffering” then they will no longer “spend too much time with elderly patients”.