Colin Young, the ALLIANCE, considers proposed Assisted Suicide legislation from an ethical standpoint.
This week the Health and Sport Committee began its consideration of the controversial Assisted Suicide (Scotland) Bill. The Bill seeks to make provision for it to be lawful, in certain circumstances, to assist another to commit suicide.
Discussing death evokes emotion. It can be an uncomfortable conversation, for which the traditionally Scottish attitude of ‘keeping it aw’ in’ is often a cause of such discomfort, especially when it comes to debating such topics in the chamber of the Scottish Parliament. Yet the re-introduction of the Assisted Suicide Bill, originally brought forward by the late Margo McDonald MSP, causes us to reflect upon how we feel about dying, what we mean by suicide, and, crucially according to the Bill, if people who deem their life to be ‘intolerable’ should be allowed assistance to die without fear of the assistant being prosecuted. While not taking a position on the ethics of legislating for assisted suicide, this Viewpoint discusses its dilemmas.
Whether it is talking about the existential aspect of it with friends, debating its religious connotations with people of the same or different faiths, or planning for its arrival with loved ones, our reaction to death can be fundamentally different from one another. Yet we all agree that dying is an inevitability that is out of our hands. Perhaps more emotive then, suicide, with debate surrounding its legality, morality and the mere act of ‘committing’ it, provokes us to consider death as a rational, reasoned and calculated action for which the individual involved is responsible. Therefore it would seem that not being in control over one’s own death legitimises the case for assisted dying.
However, when discussing death in reference to disabled people and those with health conditions, this inevitability has at times been commandeered by those other than the individual themselves. Not always have people with impairments had their right to life within their own destiny – societies across the world have been known to cast disabled children aside, mothers have been advised to abort disabled foetuses, and calls have been made not to resuscitate disabled people when their quality of life has been questioned.
And yet, perhaps paradoxically, recent high profile cases have caught the nation’s passion for or against assisting disabled people to die when they have expressed a wish to do so. But while disabled activists have raised concerns about the message it sends to disabled people, that if they want to die because the nature of their impairment has made their life ‘unliveable’ they can be supported to end it, much of the debate has focussed on the outcome of the assistance. The individual concerned, the media, legislators, and the judiciary have centred their argument on whether the act of assisting should be considered as an illegal one – rather than on why opting for assisted suicide should be a right of disabled people. The power imbalance that disadvantages disabled people in their daily lives, through exclusion and discrimination, pertains also to their ultimate question. The issue of intolerability is thus being split between the individual and their assistant.
But now, with the Assisted Suicide bill proposing a strict process in the application to be eligible for support to end their life, the poignant question to be asked is whether disabled people should have control over their death. With the pendulum swaying in the direction of disabled people having choice and control over their lives, it is logical to suggest the same right and responsibility should be offering in dying. The difficulty with the name of the bill ‘Assisted Suicide’ is that it suggests simply an equalities solution – if a person can take their own life should they want, then shouldn’t a disabled person who can’t be enabled to do so? However it is not a fair comparison. Research points to the main cause of suicidal thoughts being due to deterioration in an individual’s mental health (1), the factors contributing to which are most often socially engineered – a traumatic event, substance misuse or loss of an important aspect of their lives. Whereas, the reason being advocated for requiring assistants to commit suicide is medical; the deterioration of one’s physiological condition. While for the former, mental health conditions (such as schizophrenic thoughts) are given as a reason for it being committed, the treatment suggested is not to support their doing so. On the contrary, individuals cannot be considered in the application for assisted suicide if they have a ‘Mental Health Disorder’. So in effect, choice and control to die with assistance is being equated to whether one’s impairment is making their life intolerable.
In the spirit of autonomy over one’s life, for which disabled people have long campaigned, it is equally arguable that the assessment of whether life is intolerable should be an independent choice. Everyone has a different bar and it is surely for them to decide when that bar is reached. Yet, choice suggests there is more than one option. Is death an option, and is choosing it an informed choice? Well, unless you subscribe a belief that there is an option beyond death, it is difficult to suggest that the choice is being made with all options available. The only assessment being made therefore is the intolerability of life. Exploring the other options to living is perhaps less deterministic and requires the support and funding to ensure better options are available, but at least it is a choice of equals. Choosing to die then, becomes not about the intolerability of living but the inevitability of death.
We are, again, all going to die. The choice that most people search for is where and how, hopefully why, but not when. Making sure that the choices are available to people for whom dying is an important aspect of their end of life – of being at home rather than in hospital, being in least amount of pain, supported to be comfortable in the space one wants to be at that point – should be paramount regardless of when the time comes to die
(1) NHS Choices, ‘Why people attempt suicide’, 2013; http://www.nhs.uk/Conditions/Suicide/Pages/Causes.aspx