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The Position to which We’re Sticking


Posted by Dr No on 14 July 2014

styx_2.jpgDeferring to the General Synod, which has decided that the Assisted Dying Bill is a Bill up with which it will not put, a bishop declared, ‘that’s the position to which we’re sticking’ (there have since been calls for a Royal Commission, presumably with the long grass in mind). The clarification was needed after an ex-archbish put the cat among the clerics by coming seriously unstuck. Writing in the Daily Mail – hullo? – Lord Carey has come out very publicly in support of assisted suicide, just before the Bill is to be debated in the Lords. Words like shocking rattled round the media faster than balls rattle at Wimbledon. Spigott, the BBC’s God correspondent, had to pinch and remind himself that Carey really was once Chief Pongo of the CoE. This wasn’t the moon faced oval headed conservative Carey bowling from the pavilion end, it was far more striking, as if he had blown his moral brains out. In the event, it turns out he may have shot himself not in the head but foot. Carey’s outing of his change of heart has electrified the established Church into a frenzy of opposition to assisted suicide.

Carey’s ‘I nail my heart to a box of barbiturates’ article is here. There is, as is to be expected, much soul-searching about souls, not to mention anguish about anguish and painful reflections on pain. Apparently the eclipse on the road to Damascus happened after Carey had contemplated the Nicklinson case. The sky went dark with suffering, Carey’s moral compass did a Bermuda Triangle number, and he came out pointing the other way. Instead of the hope of mercy, Carey now wants to provide the certainty of death. Somewhere in the Triangle, one of the Ten Commandments got if not redacted then seriously caveated: Thou Shall Not Kill (unless we say you can). Those who counter that assisting a suicide isn’t killing might do worse than reflect on whether handing a loaded revolver to a person hell-bent on killing themselves isn’t killing. Like hand grenades and horseshoes, it’s near enough.

Dr No is not a Christian (or a follower of any of the revealed Abrahamic religions) but as an outsider he gets the distinct impression that the one thing that isn’t up for debate in these religions is the authority of God. This authority is absolute, infinite and wise, in fact it is so absolute infinite and wise that is surpasses all human understanding. In the beginning was the Word, and the Word was with God, and the Word was God… And the Word was Thou Shall Not Kill. It’s one of the Ten Commandments, for Heaven’s sake, not Item 4.2.7 subsection (d) in a modern committee written guideline.

Be that as it may, and Dr No is aware there are times when killing is sanctioned by the Church, legitimate war being one, Carey’s foray into the valley of the shadow of death has pushed assisted suicide back into the spotlight. Online news articles and blog posts are gathering three and four figure numbers of comments. In places the comments generate more heat that a nuclear power station approaching meltdown. Of the lights to be seen glowing in the heat, the three familiar ones are present: autonomy (for: how dare you tell me not to kill myself, with assistance if necessary), sanctity (against: God’s Word, as above) and skids (against: the slippery slope, and it’s darker side, coercion). It is to the last Dr No turns today, to consider not the counter, but counters to the counter argument, if that makes sense.

The are two standard counters to the slippery slope argument. The first is the bad real world example of states that have in some shape or form legalised mercy killing, that is killing to end suffering, whether the act be done by the one not long for this world or another. The suggestion is that these states have not seen a run on killing, when in fact some have, significantly so. The Dutch, for example, have seen year on year numbers rise, from 4188 notified cases in 2012 from 2331 in 2008, the authorities are concerned that killing is now so commonplace that they can longer keep up with reviews to exclude foul play, and yet there are calls to extend the law to include those who are over 70 who are merely tired of life. If this isn’t killing with skids on, then Dr No doesn’t know what is.

The second standard counter argument is rather more obtuse, and relies on the observation that most people don’t kill themselves nowadays, so why should a change in the law to allow assisted suicide change the numbers substantially? The premise is that since most people don’t commit suicide, few will choose assisted suicide. This argument is fallacious, relying as it does on the idea that the addition of one word – assisted – makes no real difference. In fact it makes a huge difference. It changes, as Peter Cook might have said, the whole moral tone of the enterprise.

Solo suicide (which is legal, though almost always regrettable) is by its nature a solitary act. The moment we introduce assistance we fundamentally alter the dynamics: what was once solitary has now become a joint endeavour. Not one solitary will but two, indeed, under the Bill more than two, minds are at work, and therein lies the dark grease that eases the slide down the slope. Consider the old, the frail and the vulnerable, and those concerned lest they be a burden to their family. Today, by and large – of course there are exceptions - these folk must cross rivers of Stygian depths to kill themselves. The moral climate and illegal nature of assistance both stand as barriers. Now imagine instead the Bill enacted, the moral climate changed and assistance made legal. Willing helpers now line the banks of the Styx. Some of these willing helpers may be saints, perhaps even some with God in their heart, but the banks of the Styx are a place open to all. The legacy hungry, the care weary, and even the down-right nasty all have open access. What could be simpler than to pop Billie in a boat and suggest a little journey? Don’t for a moment think it won’t happen. Murdering for money may be hard to do, but a gentle shove from the banks of the Styx? Easy as falling off a log…

8 comments:

A very tricky subject as you said. Having had cancer, if it comes back and is terminal I would prefer to end my life on my own terms when I feel it is necessary. Only thing is it means I cannot have my family around to make sure they are not implicated in any way which would be sad. I have seen two horrific deaths from cancer despite all the best efforts of palliative care. I would be glad to know help was available if required. The Bill as it stands would not help those unable to carry out the act by themselves and my biggest fear is not cancer or dying but developing dementia, then I really would want someone to put an end to it whatever their motivations.

Murdering for money may be hard to do, but a gentle shove from the banks of the Styx? Easy as falling off a log…But 1.2 Million and being struck off>
Well murder that paid well!!!

http://www.standard.co.uk/news/psychiatrist-struck-off-over-1m-gift-afte...

It has taken a horrific crash to knock Falconer's Assisted Dying Bill, due to get its second reading in the Lords today, off the top of the news pile. Meanwhile, DiDLP (Dignity in Drinking Lethal Potions) continues its social media campaign. Two oddities strike Dr No.

Firstly, DiDLP have been plugging a bizarre tweet which claims 'An assisted dying law would not result in more people dying, but in fewer people suffering'. Last time Dr No checked up on the matter, he found the only determinant of the number of deaths is the number of births. What Falkie's bill will do if enacted is increase the number of premature deaths, but the overall total number will stay the same.

Secondly, DiDLP make a big play on '80% want the law of assisted dying changed', with a sub-text that our leaders are out-of-step, and should man-up and enact the Bill. Well, thousands of Americans think they have been abducted by aliens (you can even get alien abduction insurance (with or without impregnation cover for both sexes) cover if you are really that worried), but that doesn't mean they have. Less frivolously, more than half of Britons are said to be in favour of capital punishment (another variant of assisted dying, one supposes) but parliament remains, correctly, firmly opposed. A key reason for opposing capital punishment is the reality of miscarriages of justice. A key reason for concern about assisted suicide is risk of miscarriages of assessment (the doctors signing off the proposed suicide get it wrong - and that's without even contemplating developments like the Dutch 'mobile death squads' (DM headline) that provide the country's 'euthanasia on wheels' (BBC headline) service).

Meanwhile, Dr No is pleased to see the WD and her black cat have returned, pointing out another difficulty enshrined in Falconer's bill - knowing when a patient is going to die, which is necessary, if one of the safeguards (<6m to live) is to be met. As DN has been know to say, prognosis is the original bit of string whose length is not known until it is cut...

Anon - the problem of suffering is indeed a thorny one, with the standard answer being we need more and better palliative care, which we do. Dr No has no problem at all with the doctrine of double effect: if the morphine given to relieve pain and distress also coincidentally hastens death, so be it. The doctor's duty is to cure sometimes, to relieve often, to comfort always.

Dementia is even thornier, because we don't have effective palliative care for dementia. In advanced dementia, patients almost certainly (we don't know, because we can't ask them) lose awareness of their condition, with the prognosis at that stage typically - but note the string remark above - being between six to eighteen months with a median survival of 1.3 years (so Falkie can perch like a goblin on the end of the bed but his Bill won't apply). In the earlier stages, patients do suffer, sometimes terribly, but although they have an often fatal condition, they are not, in the earlier stages of dementia, terminally ill, so again the Bill won't apply. In any event, at some point the patient is going to lose capacity, so - you guessed it - the Bill won't apply. Throughout, relatives and carers suffer as much if not more than the patient.

The bottom line is that the Bill for the Provision of Lethal Potions isn't here or there for dementia patients. When the patient has capacity, he/she isn't terminally ill, and when the patient is terminally ill, he/she won't have capacity... or for that matter the ability to self-administer the potion.

The position couldn't be starker. If we are going to end (by death) the suffering of dementia patients, we have but one solution: euthanasia (or, possibly, a radical extension to the assisted suicide Bill which would allow pre-emptive suicide - the Bill on skids again, it's safeguards blowing away like blossom on the breeze). Since euthanasia is another can of worms that is not the subject of this post, Dr No will leave the can opener on one side and do without worms for today.

The "safeguards" incorporated into this Bill as it stands would, if passed, render assisted suicide illegal in almost every circumstance. Are those who designed these "safeguards" as thick as mince? Hopefully they are because the alternative is more sinister...... They are assuming that the public masses who don't give the matter much thought are even thicker than mince as they manipulate them into agreeing to the principles of assisted suicide under the current terms of the Bill. Once significant support has been obtained in this way they will see to it that, by introducing "suitable" amendments, possibly un-noticed by most of the population, they will ensure The Bill creeps down the slippery slope - the same slippery slope that the supporters of assisted suicide / euthanasia are at pains to deride and deny.

This sounds like one of My Black Cat's conspiracy theories, and since she talks so much drivel at times it is probalby more likely that many of "our Lords" are indeed as thick as mince.

“Assisted Suicide: Don’t Go There”

Interesting and worrying article by Dutch Ethicist Professor Theo Boer here: http://alexschadenberg.blogspot.co.uk/2014/07/dutch-ethicist-assisted-su...

We all should take note...

The Bill as it currently stands, Dr No suspects, is something of a fart in a spacesuit, unpleasant while it lasts, but doomed to fade away. It is so loaded with safeguards, not to mention the how long is a piece of string riddle, that it difficult to imagine a patient who both wants die and meets all the criteria.

Instead, Dr No believes, the Bill's real purpose is grooming: grooming us towards the idea that state sanctioned killing is a Good Thing, because it embraces two Good Things: choice and dignity. True, the Bill is about suicide, but it is assisted suicide, which if a fundamental game changer. Instead of A killing A (ie suicide) we now have A killing A with B's help (assisted suicide). The once solitary act is now a team effort; and we all know how sacred 'teams' are. The peer who blew it over 'illegal' morphine doses alluded like Dr No to the proverbial loaded gun handed to the suicidal patient. The peer even said she would have been prepared to pull the trigger herself - B killing A (euthanasia).

This is none other than the slippery slope in action, proposed without missing a single beat by a peer in the Lords.

Yes, Dr No, The Witch Doctor also believes we are witnessing "grooming" of the public and that My Black Cat is also correct when she sniffs out that there is a conspiracy afoot.

However, they don't call it "grooming" or "a conspiracy" of course. They call it "Baby Steps." Same thing.

Here is what Joyce Robins, co-founder and co-director of "Patient Concern" has to say in her evidence to the Commission on Assisted Dying chaired by Lord Falconer.

"“JR: I would like to see that, yes. I mean as I say, I think we can only go for terminal illness at the moment, so this doesn’t actually apply to the people who are probably about to go into care homes. But, you know, baby steps, and we’ve changed our mind on so many things in my lifetime, homosexuality being one, and so on and so forth, and I think we will change towards that in due course. But at the moment we’ve got to fight this one through.”

http://www.commissiononassisteddying.co.uk/wp-content/uploads/2011/05/Jo...

The problem, or at least one of them is 6,000 agonising deaths. rather than the idea of grooming
http://www.bmj.com/content/349/bmj.g4285

No relief in the last 3 months of life even with the best palliative care - I dread to think what it must be like for those who can't access such services?

Of course there are no drugs to treat the mind if we accept the idea of agency rather than converting such sentiments (wanting to escape intractable suffering) into a pseudo form of mental illness.

I suppose we'll just have to soldier on with the Dignitas model for the time being.


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