As a young schoolboy, many years ago, I began, perhaps not always very thoroughly, to read the Scottish broadsheet newspapers. Over time, I became aware of court proceedings as they were being reported, with special reference to big crime, sawn-off bank robberies, vicious gangsterism, serial killings – all the things so appreciated by young boys in the epoch. In that setting, I have a memory still of court cases involving the deaths of elderly and sick people, deaths accelerated by the intervention of family members – those who delivered overdoses or willfully withheld the medicine critical to the prolongation of the life concerned. Yes, we talk of what is now called Assisted Dying.
In my recollection, the perps fully cooperated with the police and made no attempt to disguise their involvement. They were promptly arrested and charged with – this was often deemed totally appropriate – murder. Thus the matter was investigated and prosecution was, well and truly, prosecuted. Guilty pleas were the norm with the final disposal by the Court hinging on motive and mitigation. In other words, the defendant could argue – and his/her advocate could summon witnesses accordingly – that the motive was nothing less than the release from inexpressible suffering on the part of, say, a much loved but terminally ill grandparent.
In open court, this mitigation would be duly pummeled by police, prosecutors, doctors, judges… to see how upright it could stay standing; perhaps the evidence would suggest that the defendant had simply grown bored with having to supply care and wanted to bring the duty to a close. Wills were, in addition, produced and any beneficiaries of the deceased – quite possibly including the defendant – were openly named. Now, with guilty pleas in place, the judge obviously had to pronounce sentence. But – and this was the thing – he (invariably male back in that day) had wide discretionary sentencing powers. Life imprisonment lay at one end of the scale. However, if he were ultimately convinced that the mens rea, while still criminal, had been humane he was free to impose a suspended sentence (perhaps hanging-over for years ahead). So, what was imposed was still a conviction, still a criminal record plus a very explicit warning that the crime could be revisited and the person in the dock re-sentenced for it should there be any future criminal activity of any kind.
The question here is whether this world – this memory, possibly this phantasm – is really any worse than what we have now. The culture of Assisted Dying lies in shambles across much of the Western world. So what is to be done?
First of all, something of the approach outlined in the childhood story above, is still alive, in England at least. The CPS, once made aware that an assisted suicide has taken place / once the details have been scrutinised, tends not to prosecute at all – although since 2009 (statistics are available up to 2021) relatively few cases have been so referred (some 167 in total). Moreover, CPS guidelines allow for an active presumption against prosecution if “the suspect was wholly motivated by compassion”.
It may not, meanwhile, be a popular thing to say but little decisive progress can be expected from the medical community or the pharmacological or the judicial or the parliamentary. So many professional bodies seek to protect their members from legal exposure while so many insist that conscience-clauses – ie permission for, say, a chemist to opt-out of any discussion/action relating to an assisted suicide – must always pertain. Like Governments, judges tend to look to Parliament to clarify the law – while it is a feature of modern Parliaments that they entrench constituency-based faith communities in which formal resistance to the entire business can run deep. The search for “an appropriate forum” wherein precise rules of engagement for doctors/nurses/family members/police officers in any assisted-dying process remains elusive. Some may put faith in the slow creep of case law and perhaps small but telling decisions from the courts. But it has to be considered that progress here is likely indeed to be both ultra-slow and not necessarily, in the sense we use the word here, progressive. The value of one’s investments can go up as well as down.
Down on it, this is a subject which needs its Big Bang, its Apollo Mission, a jackhammer to its Berlin Wall. Maybe the campaign in favour of PAD should lose all timidity and etiquette in the face of objection, conscientious and otherwise. Maybe it should stop trying to persuade opponents that the first national legislative step will be so short it will hardly be a step at all. Maybe it should tell all professional bodies that to hold to a position of neutrality in this matter – given all the evidence of colossal stress and suffering – is just plain nauseating. Now, of course, to die peacefully and painlessly when in the vicious corrosion of a terminal illness requires advanced medical and chemical knowledge to be on hand. Far too many desperate people still try to hang themselves or worse, the most ghastly form of DIY on earth. The most recent scholarship – from Hitchens to Wootton to Engelhart to Yalom – has painted crumpled death scenes in colours that even Munch could not match.
While we are here, let’s share a word about suicide. Any scan of nationally gathered incidence-data from, say, Europe or North America will reveal the obscenity : the numbers of all ages who dispose of their own lives is very high (around 6,000 souls pa in England/Wales, over 40,000 in the USA). But at least it is here recognised that the phenomenon exists and has to be properly accounted. Globally speaking, this is not always the case. In too many regions, suicide is both spiritually deprecated and, putting it softly, under-acknowledged as a social reality. Such an attitude can well harden entire communities against any form of PAD. But nobody has the right to tell another human being that they, in turn, do not have the right to close their existence. And they are entitled to seek professional assistance in so doing.
The age lobby groups have a tendency to bypass this entire subject, moved as they perhaps understandably are to celebrate and exalt the Third Age. But we speak here of maybe, as it were, a Fifth Age, the space where a certain octo-nonagenarian can progressively find neither sleep nor relief from pain. This will not be everyone’s lot but one life, so poisoned, is a life too many. Such suffering has no meaning, no purpose, no glory. This whole story has to be brought into the internet age, a future where symptoms and experiences can be apped and shared and viewed, where law-makers and law-keepers can be engaged in the decision to pass right from the first expression, where one’s personal wealth does not help and one’s poverty does not inhibit. And where the law falls like an anvil on the selfish and the impure.