Boris Johnson "inclined" to back Assisted Dying Bill

Tory MP Boris Johnson has used his Telegraph column to discuss Lord Joffe's Assisted Dying for the Terminally Ill Bill.   Pro-life groups have produced excellent briefings against the Bill (see, for example, here) but Mr Johnson is minded to support the right-to-die at the heart of the legislation:

"The closer I study Lord Joffe's Bill, the more inclined I am to think it reasonable. It is full of restrictions - notably that death must be only a few months away at most; and all sorts of attestations are demanded from doctors and solicitors.  I can see all the disadvantages, and if the law were to be changed, then it would need careful review, to make sure that people were not coming under any pressure whatever to take their lives. But I think it might be better than seeing increasing numbers of British people forced to take their lives in a foreign country."

'WHERE THERE'S A WILL THERE'S A RELATIVE...'

Mr Johnson attempts to directly address the fear that a right-to-die might quickly become a duty-to-die:

"It is certainly possible to imagine that, if assisted suicide were legal in this country, then old, confused and pain-racked people could start protesting that they "didn't want to be a burden", and their exhausted and demoralised relatives could indeed begin to persuade themselves that this was the best solution.  That is the reason why many people will oppose the Joffe Bill on assisted suicide, currently in the Lords. I completely understand their reasons; and yet we should also be clear what we are saying to people such as Dr Turner, and the doctors who might be tempted to help them out of their misery.  Sorry, we say: you are physically incapable of taking your own life (an action decriminalised in this country in 1961), and therefore we must sentence you to whatever physical and mental tortures your mortal biology may send you, for the term of your natural life. If necessary, you must go on and on in unbearable pain, and any doctor who helps you to die will be liable to 14 years in prison."

The "unbearable pain" argument is hotly disputed by pro-lifers who point to significant advances in palliative medicine and Britain's globally-respected hospice movement.  Some of the best arguments against the Joffe Bill were put by Rowan Williams in a recent op-ed in the Mail on Sunday.  These were the Archbishop of Canterbury's main concerns:

• The end of the 'do no harm' principle: "If we say that people have a right to die in some circumstances, does this create a duty on the part of doctors and nurses to bring about death?"
• Conscientious objections: "What are the safeguards for the right of medical professionals to refuse [to end a patient's life] on conscientious grounds?"
• Patient-doctor trust: "What will be the effect of legislation be on trust in the medical profession?"
• A right-to-die becomes a duty-to-die: "Will there be a suspicion or fear that pressure will be brought to bear on those in terminal or extreme conditions to ask for 'assisted dying'?"
• Resource constraints lead to euthanasia: "Will individuals or their families - not to mention doctors and nurses - be able to cope with the feeling of unspoken pressure to save scarce resources?"  The Archbishop of Canterbury notes that elderly people are already moving away from Holland and Switzerland (where voluntary euthanasia is legal) because of fears of what might happen to them when they need medical care.
• Legal euthanasia reduces the incentive to invest in pain control and other medical research: "Can we be sure that high-quality research will continue into ageing, dementia and pain control, when there is a swifter and less costly option available in the form of 'assisted dying?'" and similarly, "Will this legislation undermine investment in palliative provision?"

During the run-off stage of the leadership election ConservativeHome asked the two candidates if they would support Joffe-type legislation.  David Cameron's answer was simple and direct.  He replied "no".

Comments

[Chad]

When I lived in the Netherlands, my next-door neighbour opted for an assisted death. He was in his late sixties, and had just been diagnosed with widespread cancer. It was a dignified ending for a dignified man.

As we have seen in the high-profile case of baby Charlotte, doctors do make choices not to prolong life, even against parents wishes. Should we not give an adult with a terminal illness the same right to choose?

[Julian Morrison]

I would say that torturing people to provide "incentive to invest in pain control" is hardly taking the moral high ground!

Besides, the A. of C. hasn't thought that through. Pain control at end-of-life is routinely used as a cosh for semi-passive euthanasia, as Boris describes, over-prescribing morphine, etc. Meaning, without euthansia the incentive is to use dangerous drugs, or at least not to care about the danger.

[Kenneth Irvine]

Lord Joffe's Bill, when I looked at it as a candidate, failed to deal with several serious issues, especially financial.

It did deal with conscentious objections, "duty to die" and the "do no harm principle". Resource constraints may not lead to euthanasia but they can cause death through failure to treat properly. Whether it dealt with them effectively is another issue. There will always be an incentive to invest in pain control. It is not just the dying who need it.

Euthanasia is always a difficult issue but a person owns his/her life and should be able to opt to end it in clearly defined circumstances. However, Lord Joffe's Bill may not deal with the above issues and it is the drafting of the Bill, as well as the principle, that counts.

[James Hellyer]

As we have seen in the high-profile case of baby Charlotte, doctors do make choices not to prolong life, even against parents wishes.

Not prolonging life by witholding treatments is not the same as using a treatment to end a life.

Pain control at end-of-life is routinely used as a cosh for semi-passive euthanasia, as Boris describes, over-prescribing morphine, etc.

More accurately drus are prescribed to control pain, which as a side effect shortens a life. They are not prescribed with the aim of shortening a life.

[Matthew Oxley]

I'm pleased Boris is giving this Bill careful hearing.
To lose somebody is bad enough , but to dreadful suffering is even worse.

I haven't had enough time to really study all the arguments/implications involved with this Bill yet, but I do believe there are arguments of merit on both sides.

[Chad]

"Not prolonging life by witholding treatments is not the same as using a treatment to end a life."

No it is not, I agree; One involves allowing a patient to die without family agreement and is perfectly legal, and the other is involves allowing a patient to die following their wishes.

imho, this is a glaring anomaly.

Death is death. Doctors are allowed to choose, so why should adult patients with terminal illness not be allowed the same right?

[Ed R]

Good article from Boris. I agree with him.

[James Hellyer]

One involves allowing a patient to die without family agreement and is perfectly legal, and the other is involves allowing a patient to die following their wishes.

No, one involves not offering treatment to keep someone alive who would otherwise die, while the other is a deliberate act designed to end a life. The comparison doesn't stack up.

[TC]

In Oregon, physician assisted suicide is legal. While working out in the States, I read an article by a relative who had been through this. The harrowing article described how in the end, it was the daughter and wife who prepared a pie which contained the prescribed poisin and gave it to him.

Since then, the author complained about the difficulty of coming to terms with the fact that they had killed somebody they were very close to. From her perspective, the trauma would have been avoided if palliative medicine had been used for the the final stages of this persons life.

[Mark Fulford]

"No, one involves not offering treatment to keep someone alive who would otherwise die, while the other is a deliberate act designed to end a life. The comparison doesn't stack up."

Yes it does. Deciding not to offer treatment (that exists) is a deliberate act, every bit as deliberate as providing treatment to end life.

"They are not prescribed with the aim of shortening a life. "

They are prescribed at higher levels than would be used if the patient was expected to survive - and in the full knowledge that the pain relief will cause death before the illness.

[True Blue]

The funny thing is that Boris appears to be in favour of the bill because of the horrors of "British people forced to take their lives in a foreign country." Imagine that - dying somewhere foreign. That would never do.

This must absolutely be a free-vote issue. Let's keep it out of party politics altogether.

My take is - if someone in full possession of their faculties who fufils the Joffe criterai wants to die and they have been through whatever counselling processes are required, then a specially qualified expert (not a normal doctor) should fulfil their wishes. No normal geriatric doctor should be forced to make that choice. If there is any doubt over the patients motivation, then they should be refused.

The "conscientious objections" argument is a red herring. No doctor is ever forced to carry out procedures against their will. Catholic doctors don't have to perform abortions and there is no specific legislation against that.

The number of people affected by such a bill will be very few, simply not enough to affect investment in pain relief or save money - not that I believe it would anyway.

[Chad]

"No, one involves not offering treatment to keep someone alive who would otherwise die, while the other is a deliberate act designed to end a life. The comparison doesn't stack up."

!!

I hope you are joking. How many people are in hospital who would die otherwise without treatment? I thought that was what doctors, do, try to save those who would die without intervention.

I am not sure how anyone could argue that leaving someone to die against their wishes is morally better than assisting someone to who wants to die and is terminally ill.

Where do you draw the line James? What about someone who is in a car crash and would die if they do not have a blood tranfusion? Leave them to die too as that is not assisting death but just not intervening in a case where the person would "otherwise die".

[James Hellyer]

Yes it does. Deciding not to offer treatment (that exists) is a deliberate act, every bit as deliberate as providing treatment to end life.

No it doesn't, Mark. Allowing nature to take its course is not the same as deliberately intervening to end someone's life. All you're saying is that both involve decisions, which entirely misses the point that the nature of the decisions is different and in the latter case goes against the Hippocratic oath.

They are prescribed at higher levels than would be used if the patient was expected to survive - and in the full knowledge that the pain relief will cause death before the illness.

But they are not prescribed with the aim of curtailing a life.

[James Hellyer]

I hope you are joking.

Not providing treatment to prolong the life of someone who will never recover, is not the same as failing to provide treatment under any other circumstances - it's a very different point to the bizarre straw man you came up with!

[Chad]

OK James, someone is diagnosed with inoperable cancer, they will not recover.

For clarity, you advocate leaving them to die without treatment, as they will not recover?

[James Hellyer]

For clarity, you advocate leaving them to die without treatment, as they will not recover?

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By withdrawing treatment, I mean things like removing feeding tubes and artificial respirators, without which the patient will not survive.

I am not talking about extreme bio-ethics!

[James Maskell]

Being "pro-death", I support the Bill. If the proper safeguards are there, why cant people be allowed help in kiling themselves?

[True Blue]

By withdrawing treatment, I mean things like removing feeding tubes and artificial respirators, without which the patient will not survive.

So starving people to death - denying them basic human necessities - is OK, but killing them painlessly isn't? Pretending that removing life support isn't killing someone is vacuous.

Put it this way, if someone snuck into a hospital and turned off someone's respirator and they died, you think it wouldn't be murder.

[William Norton]

At the moment we effectively have a sort-of "don't ask; don't tell" policy. You're not telling me that the odd doctor here and there doesn't use his discretion to bump up the morphine dose (or whatever) towards the end. Remember Dr Bodkin Adams? Perhaps, however, Dr Shipman has upset all that.

Aside from the usual unease about assisted suicide - doctors are supposed to keep people alive, greedy relatives wanting their hands on the inheritance etc , they were all in the Rowan Williams piece - there is a more practical fear.

Imagine what will happen if the people responsible for the National Curriculum, or tax credits, or for that matter NHS reform, get their hands on this procedure.

Have you filled in all three forms, provided your passport and a utility bill?

Your assisted suicide is in a queue and will be attended to shortly. Please be assured your call is important to us.

Your assisted suicide scheduled for the 17th has had to be cancelled due to staff shortages and a double-booking of the operating theatre. Please make a new appointment with the receptionist.

The local assisted-suicide committee has reviewed your mother's case and has decided that she isn't ill enough. You can make an appeal by filling in form YZX-38(b) and sending it to ....

etc.

I wonder just how dignified some of these dignified endings will be in practice.

The law at present is unsatisfactory. It's probably better left where it is. I don't like assisted suicide; I don't support assisted suicide; I'm not wholly convinced however that it's any of my business (or the law's).

[Mark Fulford]

"the nature of the decisions is different and in the latter case goes against the Hippocratic oath."

I disagree that sitting on your hands to let someone die is morally any different to assisted dying.

The Hippocratic oath isn't used any more. The actual oaths are the Declaration of Geneva, the Prayer of Maimonides, the Oath of Lasagna, and the Reinstatement of Hippocratic Oath. All four oaths require the doctor to treat patients to the best of their ability and not to cause intentional harm.

WRT the oaths, I'd argue that relieving suffering is not harm, prolonging suffering is harm, and not providing treatment is definitely not the best of a doctor's ability.

[Chad]

It is a very tricky area, I agree.

I am sure the pharmaceutical companies would much prefer keeping people alive in a zombie state for as long as possible to keep the revenue stream flowing from the taxpayers' coffers.

I just cannot see how keeping someone alive against their wishes just to fill the pockets of pharamceutical companies and their shareholders is morally better than enabling the person to die sooner rather than later.

[Richard Allen]

This is an extremely difficult subject and while I could never back such a bill I fully understand why many do. It is clearly an area for a free vote and party politics should stay well clear.

[Chad]

...also could there not be some inheritance clause that freezes a person's assets for 5 years (for example) after their assisted death to deter any "family pressure" to encourage the patient to take such action?

[Mark Fulford]

"...also could there not be some inheritance clause that freezes a person's assets for 5 years"

That someone will be pressured into dying for the value of their estate is a weak argument against assisted dying.

My family might be able to persuade me to sign-away my dough, but they'll never get me to sign-away my life unless I 100% agree. Death and dough don't have to come in that order.

[Chad]

Yes, you are right Mark.

I was just looking at ways to offset that particular "anti" argument. Obviously people will choose an assisted death for a mixture of reasons, and the important point for me is that they are given the right to do so.

[Sean Fear]

As a probate pracititioner, I have no doubt that there are plenty of people who would pressurise elderly relatives to "do the decent thing" in order to get their hands on their money, if assisted dying were to be legalised.

While this is a difficult subject, I'm concerned that breaking the taboo against euthanasia would bring about a situation where society expected elderly people to exercise that option, and placed moral pressure on them to do so.

[Esbonio]

Re Boris's article, I am inclined not to agree with him; but then I have found myself disagreeing with him quite a lot over the last few years which is why I did not remew my Speccie subscription.

As a society we appear to be constantly lowering the barrier for extinguishing life and I think there is a great danger that we have or are about to go too far.

Perhaps OT but William Norton asks if anyone remembers Dr Bodkin Adams. I don't but my father does as Dr Adams attended to my father many moons ago (i think it was a sprain or something).

[James Burdett]

The problem here is that 2 separate arguments are being conflated. There is the moral argument for Euthanasia for which unsurprisingly there is no right answer.

The second argument is political, is it politically acceptable to allow people to choose to die. On balance I think that it probably is politically acceptable, even though I have severe personal moral issues with it. The problem is in these political/moral issues that whenever you answer one question you open up myriad other questions. The debate is necessary but we need to come to a good answer not just a quick one!!

[Andrew]

There are some horribly difficult hurdles to overcome in such a law, but ultimately it boils down to one thing: does the government own your body? Horribly ill people who decide they have no wish to continue suffering should not be constrained by others' moral qualms, especially those based on irrelevant religious dogma.

In practical terms, the safeguards will have to be extremely extensive, and the whole process carefully designed. In particular I'd like to see a self-administering system, so doctors or relatives don't feel any semblance of moral equivalence with killing.

[Esbonio]

I entirely agree with Andrew's point as regards self-administration and wonder why this aspect appears to receive so little coverage.

[John Hustings]

"Being "pro-death", I support the Bill. If the proper safeguards are there, why cant people be allowed help in kiling themselves?"

Because it's a slippery slope. I don't want to live in a culture that has become inured to taking life and to suicide.

[Mark Fulford]

And I don't want to live in a culture where your prejudices affect my life.

[John Hustings]

"And I don't want to live in a culture where your prejudices affect my life."

Prejudices? Excuse me?

[Chris Palmer]

He probably meant morals, John. Why, because you are morally against something, should it be banned or outlawed?

[John Hustings]

"He probably meant morals, John. "

I think it sad that "morals" should be labelled nowadays as "prejudices" as if it were something offensive.

"Why, because you are morally against something, should it be banned or outlawed?"

You have it the wrong way round. We are not talking about banning a currently legal activity. We are talking about legalising a currently illegal activity. Whenever we do such a thing, we should be wary as to what the adverse consequences might be.

In my view -- and it is only my view, so I am not "imposing" my will on anybody -- to legalise assisted suicide would be the first step towards hardening us to the idea of death. I believe a healthy society regards life as sacred, but it is not necessarily so that we will *always* regard life in that way. When abortion was first legalised, it was done so with great reservation realising that it is a terrible thing, but wishing to do good in the interests of those women for whom pregnancy was not a choice. However, we have now reached the stage where 180,000 abortions happen every year and abortion is regarded as not a big deal -- a woman can do whatever she likes with her body.

We should *always* be wary -- in my view -- whenever we embark on "culture changing" measures.

In Japan, young people get together on the internet and commit suidide together. It is a shocking thing. But it demonstrates that the idea of the "sanctity of life" is not present in every culture. There is no reason why it should remain in ours. And so while we are currently fortunate that suicide and taking life are still currently taboos in our society, I feel we should endeavour to keep it so.

[a-tracy]

John Hustings 16:06 - an excellent post, we should be wary - in my view too.

[Simon C]

To respond to some of the points raised on this site & elsewhere.

1) Double-effect is hugely misunderstood, and, thanks to the advances in modern palliative medicine in Britain, should no longer be a feature of practice. Double-effect is the idea that doctors administer large doses of morphine to releive pain & if that hastens death, that's not what was intended. We now know much more about morphine that we used to, & doctors trained in palliative care can judge minutely the levels of morphine required to relieve pain. Research shows that morphine administered in the last week of life does not hasten death. Good palliative care means that double-effect is a red herring. BTW pain is no longer very often advanced as a reason for euthansia in Britain, because of palliative medicine. That's why the VES is focussing on dignity instead (more below).

2) There is a clear ethical difference between withdrawing or withholding treatment for a patient who is in the finals stages of a terminal disease - in effect dying - because that treatment is judged to be too burdensome to the patient, and on the other hand actively intervening to bring about the death of somebody who would otherwise have months to live. When people are dying, their bodies shut down. Continuing to pump nutrients into them can increase their discomfort. This is not a question of doctors killing people, as the Daily Mail ludiscrously asserted last week. It is instead to let a terminal disease take its natural course at the very end. The patient's death is caused by the disease, not by lethal medicine. To suggest that doctors making these sort of decisions are in effect killing their paiteints is ill-informed, offensive, and, worst of all, will alarm dying people and their families by leading them to believe that they are being killed by those supposed to be caring for them.

3) Contrary to their protestations, pro-euthanasia campaigners are seeking to impose their views on others: they are saying that in some cases an active intervention to bring a patient's life to an end months earlier than would otherwise have happened should be regarded as a positive & good outcome. They are saying that medicine is something that you can take to bring about the end of your life, not just to make you better. In short, they are imposing a view that would upturn the established principles on which our medical culture has been based for centuries. As a result people living with life-threatening conditions, who are fighting every step of the way, are having to read in the newspapers or see on television the view that it would be far more dignified of them to take the euthanasia route. There are other ways of dying in dignity. It is quite wrong for the Voluntary Euthansia Society to suggest that it has a monopoly on dignity by changing its name to "Dying in Dignity" and then applying for trademarks to claim exclusive ownership of that language.

4) The supposed safeguards in the Bill do not meet the unanimous recommendations contained in last year's House of Lords Select Committee that considered the Joffe Bill. Interestingly, Lord J was a member of that Select Committee. In some cases the safeguards have been loosened, not tightened. For example, it is no longer a requirement that the "unbearable suffering" (a phrase the Select Committee thought was too subjective to be enforceable) needs to be caused by the terminal illness.

[Julian Morrison]

"You have it the wrong way round. We are not talking about banning a currently legal activity. We are talking about legalising a currently illegal activity." - that makes no difference. A law is written in the past, but it's imposed in the present, and if the imposition is wrong then it should just stop.

[John Hustings]

"that makes no difference. A law is written in the past, but it's imposed in the present, and if the imposition is wrong then it should just stop."

Perhaps it's because I'm a conservative that I don't see things the same way.

The laws which were handed down to us -- I feel -- were quite often there for a reason. Many of our changes in the name of "progress" have had adverse consequences. (I was about to add "which nobody foresaw", but I daresay that this is not true, it is merely that the warnings of what might happen were not heeded.) Since this is the case, and since many of our changes are likely to be for the worse rather than the better, it behoves us to be extremely cautious when embarking upon "culture changing" measures, especially such fundamental ones as how we regard life.

I like to think that life has been regarded as sacred for centuries for a reason -- and *not* just "prejudice".

[Tom Ainsworth]

Might it not be that the relaxing in attitudes towards abortion, which John Hustings refers to, has as much to do with changes in the extent of religious beliefs? I don't know. Perhaps the decline in religion had already happened.

One should also be aware - not that I'm saying you're not - that abortion and euthanasia are two very different issues. One's position on the former is essentially determined by what one thinks about the foetus: since clearly it has no choice in the matter, the question is how valuable is it's life in comparison with that of an adult. Those who are pro-euthanasia can much more straightforwardly claim to be pro choice. It then comes down to weighing up whether practical considerations justify stopping very sick adults enlisting the help of others to end their lives. That's how I see it anyway.

[Burkean]

Hmmm. Seventy percent of Britons descibe themselves as Christians. I wonder what the percentage is of commenters here. It seems very small. Archbishop Taffy may not be every conservative's choice as Primate, but he's advanced sound Christian reasoning here. I'd rather take the advice of our Lords Spiritual on this one than leave it to a bunch of secular utilitarians.

[Julian Morrison]

I'd rather leave it to the individual. If they choose to consult their priest, up to them.

[Oberon Houston]

I'ts a tough one this, but state endorsement of -- assisted suicide -- is getting into some very precarious areas. I can understand that there may exist strong cases to demonstrate support of it, but, I can see the number of problems a relaxation of the law on this causing much more downside than any possible benefits and I therefore think leaving the law as it stands is the best course of action. Its the 'assisted' bit that will create real problems in law.
No, I don't like it.

[Mark Fulford]

John H, perhaps “prejudice” was an overly emotive word to use, so I apologise for that.

As a libertarian, I always challenge law that restricts personal choice without good reason. For me, the unsupported supposition that legalised euthanasia may cause indirect decay to our culture is not enough. If euthanasia were legalised, would you feel any more likely to use it? Who are the people that you’re worried about and why are they any less able to judge matters for themselves than you?

[John Hustings]

"As a libertarian, I always challenge law that restricts personal choice without good reason. For me, the unsupported supposition that legalised euthanasia may cause indirect decay to our culture is not enough."

As a libertarian you might take that position. I am not a libertarian.

" If euthanasia were legalised, would you feel any more likely to use it?"

No, but I do not believe that society is just a collection of individuals. It is about more than just "my" rights.

"Who are the people that you’re worried about and why are they any less able to judge matters for themselves than you?"

I am worried about the elderly and the vulnerable.

[Tom Ainsworth]

Burkean,
Yes but fewer than 15% are members of a church, never mind actually attending... In 1975 it was 18.5%. Admittedly, given the more rapid rise in numbers of abortions since 1967 it seems unlikely that declining religious belief is a decisive factor.

I doubt ConservativeHome contributors are as unrepresentative as you suggest. Even if we are, that's not much of an argument.

[AlexW]

I feel that the Joffe Bill could potentially be a big divide between the libertarian and traditional conservative wings of the party, so - much like IDS' ill-fated three-line whip on gay adoption - it should absolutely be subject to a free vote. A divide like this on a significant issue would be unnecessary and damaging.

John H: Surely the problem with the "slippery slope"/acceptability of death argument is that this isn't the first step by any means. The Suicide Act 1967, legalising suicide per se, was surely that first step. Clearly, the sanctity of life is no longer regarded as paramount, and the notion of individual autonomy has trumped it. What a person does with his own body is regarded as no business of the criminal law.

The manifest injustice is that whereas anyone can take their life personally, those who are physically incapable of doing so, and moreover those who have arguably the most cause to do so, are effectively prevented from having their wishes carried out. A person suffering from a degenerative terminal illness may kill himself in the early stages, when the pain is mild, but is precluded from doing so when the pain is excruciating and he is confined to his bed. Surely it makes no sense that say that at the point when the illness is most distressing and most painful, this is precisely the time when the patient's wishes are de facto revoked. The purely philosophical opposition to suicide per se is, perhaps, arguable, but to contend that people have a general autonomy over their bodies which is essentially forfeit upon their becoming incapable seems entirely unjust. So long as there are sufficient safeguards in place to ensure that the patient is making a definite and informed decision, why should his rights be quashed?

The safeguards in the Bill are such that the constraints are greater than in unassisted suicide: if I wish to take my life myself, there is no need for me to be in great physical pain, or to consider in depth the alternatives. The procedural intricacies mean that, unlike unassisted suicide, the family will almost invariably be involved in the discussion, the mental state of the patient has to be vouched for, and the patient can subsequently revoke his decision. The Bill itself is an extremely conservative piece of legislation, which simply remove a manifest unjustice.

I believe it should be supported accordingly.

[AlexW]

I feel that the Joffe Bill could potentially be a big divide between the libertarian and traditional conservative wings of the party, so - much like IDS' ill-fated three-line whip on gay adoption - it should absolutely be subject to a free vote. A divide like this on a significant issue would be unnecessary and damaging.

John H: Surely the problem with the "slippery slope"/acceptability of death argument is that this isn't the first step by any means. The Suicide Act 1967, legalising suicide per se, was surely that first step. Clearly, the sanctity of life is no longer regarded as paramount, and the notion of individual autonomy has trumped it. What a person does with his own body is regarded as no business of the criminal law.

The manifest injustice is that whereas anyone can take their life personally, those who are physically incapable of doing so, and moreover those who have arguably the most cause to do so, are effectively prevented from having their wishes carried out. A person suffering from a degenerative terminal illness may kill himself in the early stages, when the pain is mild, but is precluded from doing so when the pain is excruciating and he is confined to his bed. Surely it makes no sense that say that at the point when the illness is most distressing and most painful, this is precisely the time when the patient's wishes are de facto revoked. The purely philosophical opposition to suicide per se is, perhaps, arguable, but to contend that people have a general autonomy over their bodies which is essentially forfeit upon their becoming incapable seems entirely unjust. So long as there are sufficient safeguards in place to ensure that the patient is making a definite and informed decision, why should his rights be quashed?

The safeguards in the Bill are such that the constraints are greater than in unassisted suicide: if I wish to take my life myself, there is no need for me to be in great physical pain, or to consider in depth the alternatives. The procedural intricacies mean that, unlike unassisted suicide, the family will almost invariably be involved in the discussion, the mental state of the patient has to be vouched for, and the patient can subsequently revoke his decision. The Bill itself is an extremely conservative piece of legislation, which simply remove a manifest unjustice.

I believe it should be supported accordingly.

[James Maskell]

Yep, its got to be a free vote. This is a matter of conscience not party politics.

[John Hustings]

"Surely the problem with the "slippery slope"/acceptability of death argument is that this isn't the first step by any means. The Suicide Act 1967, legalising suicide per se, was surely that first step"

I find this a perverse argument. You are saying that because it is not the *first step* on the slippery slope that we shouldn't worry about sliding further down it.

You give a convincing reason for why we should resist slippery slopes at all: even if by the mania for social progress we were to reach the highest possible expression of human society, it would not last long; for the mania would demand that there was still further to go.

This also means that whatever "safeguards" you offer are not enough, because we know that this bill will not be the last say on the matter. We know that "progressives" in the future should like to take it further, and as you say, there will be nothing to stop them, because the road has already been embarked upon.

Where do you draw the line when it keeps getting moved?

We also know that it is extremely unlikely that the legalisation of euthanasia should ever be reversed. This suggests we should be doubly cautious about introducing it. This decision will stay with us forever.

[AlexW]

John H: I'd be very wary of teleological approaches to "progress". In the aftermath of the war, many non-socialists were convinced that the future was ever-increasing socialism which would eventually triumph (e.g. Schumpeter's "March into Socialism"). This was, of course, the mirror to standard Marxist historicism that the fundamental inconsistencies in capitalism would make the triumph of the proletariat inevitable. Hegel discussed at length the notions of "stages of history" with the future being essentially predictable. "Slippery slopes" are a weak argument precisely because they are not slippery. Societies change, attitudes reverse and decisions are altered. Mrs Thatcher's great triumph was to debunk the prevailing wisdom that "managed decline" was the outlook for Britain by boldly asserting that we didn't have to sit back and accept what was supposedly destined for us.

That aside, you haven't deal with my main objection: what do we allow able-bodied people to take their own lives, but deprive those who are terminally ill at exactly the time at which it is most understandable that they may wish to end theirs?

[Andrew]

Teleological justifications are always the most convincing - something in our psychology perhaps, where the future becomes less threatening if it can be seen as a straightforward (ideological) continuation of the past.

As for your point on methods: you merely need a setup where the person is able to move a finger, or even their tongue, to press a button. Or voice activation perhaps.

Yes, it's macabre to consider these details, but for many people the final triggering mechanism is of moral significance. As a society I don't think we should put such a burden on doctors' shoulders.

[John Hustings]

"That aside, you haven't deal with my main objection: what do we allow able-bodied people to take their own lives, but deprive those who are terminally ill at exactly the time at which it is most understandable that they may wish to end theirs?"

I don't find that dichotomy very persuasive. Simply put: we have to draw the line somewhere, if we don't draw it here, society will be much the worse.

[AlexW]

John H: I'd be very wary of teleological approaches to "progress". In the aftermath of the war, many non-socialists were convinced that the future was ever-increasing socialism which would eventually triumph (e.g. Schumpeter's "March into Socialism"). This was, of course, the mirror to standard Marxist historicism that the fundamental inconsistencies in capitalism would make the triumph of the proletariat inevitable. Hegel discussed at length the notions of "stages of history" with the future being essentially predictable. "Slippery slopes" are a weak argument precisely because they are not slippery. Societies change, attitudes reverse and decisions are altered. Mrs Thatcher's great triumph was to debunk the prevailing wisdom that "managed decline" was the outlook for Britain by boldly asserting that we didn't have to sit back and accept what was supposedly destined for us.

That aside, you haven't deal with my main objection: what do we allow able-bodied people to take their own lives, but deprive those who are terminally ill at exactly the time at which it is most understandable that they may wish to end theirs?

[AlexW]

Gah! Apologies for multiple posts - my browser is playing up.

[Simon C]

Alex - we may have de-criminalised suicide, but we don't encourage it as a society. In fact, in every other case, we actively discourage suicide, & do our best to revive would-be suicides. That's because we still place value on life.

This echoes the argument I unpicked in my first platform piece. People are free to commit suicide - but they don't have an enforceable right to do so. Nor should they.

Slippery slopes aren't that weak an argument. The House of Lords Select Committee that looked at the previous Joffe Bill identified 5 separate ways in which a slippery slope might manifest itself in the case of euthanasia. It didn't reach a conclusion on whether any of those actually existed - because the committee itself was split and unable to agree. There was however evidence before the select committee that supported slippery slope arguments. Not least Lord J's own evidence that he saw the Bill as a start & not the end to it.

[rick]

i will happily vote for the assisted dying bill if only boris johnstone would let us try it out on him first.