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Michael Nazir-Ali: Let us care for the ill and vulnerable - not help them to die

Nazir-ali-web2Michael Nazir-Ali is Director of the Oxford Centre for Training, Research, Advocacy & Dialogue, and was formerly the Bishop of Rochester.

Time and again, Parliament has refused to relax the law on assisted suicide.  Having failed there, attempts were made to get around the law by persuading the Director of Public Prosecution to revise guidelines about who might be prosecuted for helping a relative or a friend to end their life.  A relentless campaign has been kept up in the media inspite of the thinness of the medical, legal and moral arguments which are regularly brought up in support of changing the law.  The refusal of professional bodies to endorse this agenda has also not deterred the enthusiasts for legalising assisted dying. Now we have an "independent" commission, reported to have been packed with supporters of euthanasia and funded by people like Terry Pratchett, known to be advocates of changing the law in this area.

To be fair, even such a biased commission has not been able to ignore the abuses which will take place if the law is changed. They did not like much of what they saw at the Dignitas clinic in Switzerland. It seems they were appalled by the width of the law in Holland, where even children are allowed to request an assisted death and where you could be helped to die if you are depressed. They were not very impressed with the situation in Oregon either.  Yet having seen the large problems in three of the leading providers of assisted suicide, they are still able to recommend it for terminally ill patients in the UK who have a year or less to live.  Whether the safeguards they prescribe are enough will be debated in the days to come.  But my question is whether legal provision for assisted dying is necessary at all.

As a bishop, I was often visiting hospices and care homes for those with terminal illnesses or with dementia, the two conditions most argued for as meriting legalised assisted suicide. What did I find in them? I found people at their most vulnerable, uncertain of what was to follow and many who were desperately eager not to be a burden on anyone. The pressures on them are enormous and come from many directions. They are certainly not those to whom assisted suicide ought to be suggested and I am so glad that the, by and large, wonderful staff in hospices and care homes are not allowed to do so. The commission is not recommending that dementia sufferers should be able to ask for help in ending their lives, but some of its supporters and funders are definitely in favour of such a move.
The hospice movement has Christian origins and I found staff committed to increasing the quality of life of residents. Pain can nowadays be managed and the emphasis in the hospices is to make sure that "the last days are not lost days".  Through care in the home, day clubs and inpatient nursing, patients are made as comfortable as possible and enabled to reflect on what has gone before and what is to come, to concentrate on their loved ones and (if they wish) to meditate and to pray. If people have less than a year to live, why not concentrate on caring for them relieving their pain and making them comfortable? By the way, how does anyone know that a person has less than a year to live? We have all come across people who were told long ago they had a year or two to live and who are still with us today.

Although those with dementia may not immediately be in the commission’s sights, we must look now at this issue as well - because they are in the sights of its funders and supporters. Where those with dementia are concerned, it is very important that we should not judge their quality of life in terms of how they relate to us. Again and again, I have met spouses, siblings or friends who are bereaved because their husband or wife, sister or brother or friend does not "know" them anymore. Such bereavement must, of course, be dealt with pastorally but it is emphatically not a reason for helping the ones with dementia to end their lives prematurely. With dementia sufferers, I have often felt the importance and sacredness of the present moment; what is of value to them at this time, without relying on memory. This may be a colour, a taste, a smell or a touch which they like. Having said that, it is amazing how many will be able to remember at least a little of a hymn or a prayer learnt at school or Sunday School. The sacraments of the church also often evoke a response and help people to orientate.
The Chair of the commission, Lord Falconer tells us that palliative care is "patchy".  I have not found it to be so. Many hospices and care homes are well integrated into the community and valued highly. Raising funds for them, volunteering and visiting all contribute to community cohesion in significant ways. If, however, we grant that palliative care in the community can be improved, my preference would be for scarce resources to be allocated to improving the quality of life for those whose illness may be terminal rather than in provision for assisted suicide at the hands of medical practitioners. There is a "thin end of the wedge" situation here.  If assisted suicide is legalised for limited categories of patients and in strictly controlled circumstances, as the commission is suggesting, there is no guarantee that the door, once been prised open, will not be made wider, as it has in countries like Holland.

In case, this is thought unnecessarily alarmist, we need look only at the workings of the Abortion Act. This was passed by Parliament to help a relatively small number of women whose own health, or that of the unborn child, was in danger and where there was a risk that illegal abortions would further endanger it. In fact, it has resulted in a situation of "abortion on demand" with perfectly healthy foetuses, and those with slight deformities or disabilities,( like a cleft palate or club-foot) being routinely aborted.  We do not want to be a generation which kills children and then finds that it is in danger of being killed by its children. There will, of course, be hard cases where it is right to exercise compassion and not to prosecute a relative or friend who has helped someone to take their life. Hard cases, however, make bad law and execptions should not be turned into principles. In particular, using the medical profession to take life rather than to protect it is crossing a moral boundary which should not be crossed.
Behind the arguments, there is a false view of autonomy. Individuals are regarded as isolated units who can do as they please with their own lives.  In fact, we are highly interdependent beings. We rely on our parents, friends, spouses and children, at different stages in our life, and they rely on us. This is also true of wider society. Throughout life our options are being reduced. Whether that is bearing children or having paid work or enjoying good health. Such a narrowing of options in life is natural and is by no means a sufficient reason to seek an end to the gift of life.  Professor Stephen Hawking, who would have been a prime candidate for assisted dying when he was diagnosed with motor neurone disease and given two years to live, has said on his 70th birthday that this is a 'glorious time to be alive'. Can we wish for anything less for others in similar situations?
I am so glad that David Cameron has made it clear that he will oppose any moves to change the law. The Care Not Killing coalition tells us that the commission's report has not added a single new argument or fact to the debate. I hope the government and the public will not be swayed by what Care Not Killing has called "a deeply worrying and flawed" report.


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