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Back to Stephen Brookes Column Index



To be, or not to be…..

By: Stephen Brookes MBE

Whilst seeing that there are dangers of legalising assisted euthanasia, as a disabled person, who has been deeply involved in looking at the status of disabled people in everyday life, I pose the question at what point is it better to have any form of life than no life at all.

Naturally, like myself, most disabled people have non life threatening disabilities, albeit that their lives are restricted. But the recent assisted suicide of Ronald Crew in Switzerland, and the failed attempt to seek a death with dignity by Diane Petty has brought the issue of the more serious problems faced by people with disabilities or illnesses which have closed off any quality of life into relief.

In such circumstances is the doctor giving diamorphine to relieve pain? Or to shorten life? And can you meaningfully separate the two, as Euthanasia is one of those subjects in which confusion is endemic, as we discovered again last week with the case of Mr Crew. There are few issues in which those on both sides of the argument so routinely dissolve into rhetoric and prejudice.

In theory the case for euthanasia is straightforward. Some people suffering from painful, incurable or humiliating illness would prefer to die swiftly and without pain. If their doctors are happy to assist them to suicide, the state should not interfere with the free, informed choices of its citizens in matters that do not cause others harm.

The case against is equally plain. Every life has intrinsic value, irrespective of the individual's mental state or physical condition. Agreeing to clinical homicide in the heart-rending cases would be the start of a "slippery slope" in which today's right to die would become tomorrow's duty to do so. And certainly both pro and anti media would play every emotional card in trying to justify its stance.

The trouble is that there is little clarity of thinking in the debate. Advocates of "mercy killing”, insist that many doctors practise euthanasia without declaring it. Yet the same distinction is used effectively in courts to distinguish between murder and manslaughter. On the other side, those opposed to euthanasia talk about the "sanctity of life" as though it were an absolute which, were it so, would rule out the notion of self-defence and force us all into pacifism.

There is a similar wilfulness when it comes to facing facts. The hospice movement generally insists that 96 per cent of cases of pain can be relieved. But, what about the remaining 4 per cent? The pro euthanasia groups suggest that if somebody who is terminally ill is prepared to accept sedation, nobody need die in pain.

Yet medical advances have also brought new considerations on the other side of the argument. It is now understood that the brain (which controls the heart and breathing) and the cortex (which thinks, feels and remembers) can die separately. If the brain alone perishes, the person is "locked in" to a paralysed body but can survive on a life-support system, and can communicate by blinking. If the stem survives, but the cortex withers, then consciousness disappears but the body maintains a cycle of waking and sleeping, heart and lung rhythms and reflex responses to certain stimuli; and according to records this permanent vegetative state has been known to last 36 years.

Inevitably advocates of euthanasia, press for the extension of the practice to such as Mr Crew, those with motor neurone disease, who are not in pain, not suffering, who have not got the ravages of vomiting or whatever from cancer, but who have decided they don't want the indignity of total helplessness. Advocates of Euthanasia suggest that if such a patient wanted to die next week rather than next year when he's completely helpless, then "killing that person would be a caring thing to do".

It is small wonder, in the face of this ruthless logic, that opponents of euthanasia talk about slippery slopes and thin ends of wedges. Such metaphors are usually dismissed, yet philosophers distinguish between two kinds of "wedge" arguments: those rooted on moral logic and those based on an analysis of how society actually works.

Moral imperatives are not the only arguments at work today. There is a growing demand for organs for transplant. There are ever- increasing pressures on budgets in the NHS - in which, advocates of euthanasia point out, half of all healthcare spending goes on people in the last six months of their lives. Legalisation of euthanasia must risk abuse and misuse, strains on the relationship of trust between doctor and patient, and self- generated pressure on the elderly "not to be a burden". And certainly families will be in dispute about the rights and wrongs relating to their relative.

In the end logic is not enough. For it plays into other cultural values - about who is valued in our society, about our tendency to place worth on what people have, produce or do - rather than on who and what they are. But in fact, whilst our leaders spend days looking at fox hunting, or Middle East wars, thousands of disabled or seriously ill people live in their homes or rooms waiting for overworked care staff to arrive, and clean their soaked beds, and feed them, and whilst waiting they increasingly despair over their pain and their lack of dignity.

I am resilient and active, but I’m not so naïve to think that everyone has my quality of life. The argument goes on, but sadly so does the mental suffering.

© Steve Brookes MBE
Copyright © - Stephen Brookes MBE 2003 - All rights reserved


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