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The suicide dilemma part 4

Sir Terry Pratchett, the enormously successful science-fiction author, has been diagnosed with Alzheimer's and has talked very publicly about the effect that has upon him and the dilemmas he will face. Alzheimer's is but one of a number of illnesses which effectively and ultimately strip human beings of both their dignity and their real personality. When something like that happens, it is not only deeply distressing for relatives and friends to see the contrast between the person that once existed and the shell that remains, knowing how appalled that person would be at their present state, but there is also ultimately a feeling when they eventually die that you really lost the person a long time ago. Many feel cheated of a moment at which to mourn, because by death they feel that the moment has long passed. It is perhaps therefore unsurprising that Sir Terry feels that he wishes to be in a position to pick the time to go.

One point that he has made is that it is really unsatisfactory that he should have to travel abroad to do this. He feels that it is wrong that he should be prevented from doing it in this country. (Of course he is not prevented from doing it in this country in the sense that he could commit suicide, but it would not be possible to obtain the medical assistance that is available abroad in places where different legal regimes operate).

We have seen before now in many different circumstances that hard cases make bad law. The desire of people to commit suicide rather than live in unbearable pain or in circumstances where they have lost all human dignity and their essential personality is entirely understandable. The need for assistance is likewise understandable. The desire of relatives or friends or loved ones who truly and disinterestedly want to assist is likewise understandable. The true question is exactly what should the law provide for, where should the line be drawn, and what would the consequences be.

It is also important to recall that decisions and views of individuals can change. The law recognises this in various contexts (such as consumer credit "cooling off" periods). It is also important to recognise how difficult it can be to resist the pressure of expectation. If the law provides that you can legitimately obtain medical assistance to terminate your life, many who feel themselves to be a burden may well feel an obligation to take advantage of such a procedure. They may be appalled at the prospect of medical bills and other care costs which will eat into any inheritance of their children or other beneficiaries on death. They may also feel that this makes them a handicap to the family for financial as well as other reasons.

Nor would this necessarily be restricted to a feeling of obligation as regards relatives. Old people who were dependent upon NHS or the public funding could likewise end up feeling themselves to be a burden. Whilst many would regard it is inconceivable that there could be any form of subtle pressure (whether deliberate or not) operating upon patients, the reality is that the cost of health care is spiralling and there are always hard choices which have to be made as regards the allocation of available resources. I do not regard it as inconceivable that if assisted suicide were lawful that the cost consequences of keeping elderly people alive would be brought home to them, at least in some instances. (Imagine getting the impression that if you went for the procedure this would free up extra resources to treat sick children etc).

It is also horrendously difficult to precisely identify or deal with those circumstances which amount to pressure from relatives and to distinguish them from those which do not. The torrent of ill drafted legislation which emanates from Parliament does not give one incredible confidence in the likelihood of any statute appropriately dealing with the problems, even before considering in any event the intractable difficulties of drafting effective legislation in such an area. One can assume that there will be few instances of that are so direct has someone effectively putting a gun to the proposed suicide's head. Pressure can be much more subtle than that. Dropping the occasional hints may well be enough.

In addition there is the difficulty of defining exactly what conditions ought to permit of assistance. Some of those who promote assisted suicide suggest that it should be available to all. There is also the difficulty of considering mental state of the proposed suicide, depression temporary or otherwise etc.

The idea of independent experts assisting gives me little confidence. People will tend to find those who are likely to say what they want to hear. Looking at it historically, solicitors knew which barristers were likely to recommend legal aid in virtually every case, and although experts have their duties to the court and take them seriously, for example in personal injury cases solicitors will know which experts are instinctively sympathetic to plaintiffs and which to defendants. Everyone has a point of view. One can anticipate that even if medical opinions were required, people would tend to go to those doctors who were instinctively likely to be inclined to support the proposal.

I do not believe that it is likely that a satisfactory law could be framed without either having undesirable consequences or turning out to be the thin end of a very considerable wedge. Whilst having every sympathy for people in the position of Sir Terry Pratchett or Debbie Purdy, and their relatives, my view is that the law should remain as it is, but with the DPP setting out the prosecution guidelines and approaching such cases on a sympathetic basis.

Michael J. Booth QC