Assisted Dying: 19 February

An Open Letter to Terry Pratchett who broadcast the BBC Dimbleby lecture recently arguing in favour of Assisted Dying

Dear Terry,

Thank you for your compassionate and forthright explanation of why you think the law should be changed to allow assisted dying. I trust it is OK to respond, explaining why I consider the law should not be changed.

Thank you for your tremendous writing. You have made me laugh more than any other writer. The affection which people have for you is well placed.

I am an Anglican Minister who has worked for 20 years in parish ministry and for just over 2 years, a while ago, in a Hospice.

I entirely support your call to question the ‘life at all costs’ attitude. One woman in our hospice, complained determinedly to me that God had not taken her on her 90th birthday. She was in sound mind and more than ready to die. She contracted a chest infection, was unable to communicate, and was given antibiotics. At the multi-discipline staff meeting I questioned how appropriate it was to give antibiotics to a woman with a settled and reasonable wish to die sooner rather than later. The doctors found my question unacceptable. They looked scared, scared probably of someone suing them for negligence. I was surprised to find this ‘life at all costs’ approach within a hospice.

The hospice movement generally does not adhere to ‘life at all costs.’  Palliative Consultants Robert Twycross in Oxford and Mary Baines in Syndenham have both said clearly that sometimes it is appropriate to treat an infection with painkillers and not antibiotics. Pneumonia should sometimes be seen again as ‘the old man’s friend’ giving a helping hand towards death. Outside hospices this attitude is rare.

Legally, there are ways that people can ensure that they are not given unwanted life-prolonging treatment. A Lasting Power of Attorney and a Living Will should secure this protection. It is good also for people like you to keep putting the case. Much unnecessary suffering will be avoided if, after a certain point, ‘nature’ is formally allowed to take its course.

What you are asking for goes further than not being given life-prolonging treatment after a certain point. You want to choose when you die, in the way you want, with the help you want. This is a very specific choice. You already have the choice to end your life. As you know from your journalist days, many people successfully end their own lives and you could do the same. It requires considerable determination to carry through on your own, but the matter seems to be important enough for you to carry through.

You, however, want an easier option than choosing to fall on your sword while you are able. You want to choose to end your life when you are no longer able, with the assistance of other people. This is taking matters considerably further, crossing an important line.

Most people are happier not having to choose when we die. Most of us have a desire not to be a burden to others. Not having the choice of an early exit, having to wait for factors outside our control, stops that desire from becoming intolerable. At what point would I say ‘send me off’? When would the concern for the burden on my relatives outweigh my desire to live a little longer? When would I begin to think it was my duty just to go, no matter what others thought? How could I decide? How would I live with this choice every day? It is too hard a choice to bear.

Tony Benn first alerted me to the burden of the choice to die at a Seminar at St Christopher’s Hospice in Sydenham. We had heard Anthony Grayling speak eloquently about the nobility of humans taking on themselves this ultimate choice. Tony Benn then spoke about the experience of his wife’s death. He was asked if they would have benefited from a change in the law allowing assisted death. He said that he was glad that they didn’t have that choice. The more I have considered what he said, the more I think he is not alone. It a choice which comes with too much anguish.

It is not possible to give the choice of assisted death to some people, such as yourself, and not to others. The Law has to apply to everyone. You may be strong enough to bear the choice of whether to make every day your last. Most people are happier not to be in that position. Securing your choice would burden many others.

Seeing more choice about death for terminal patients and their families as an intolerable burden, does not mean that they have no choice now. One of the clear lessons learnt by all who minister to the dying and the bereaved is that we already can exercise choice over exactly when and where we die.

The most common instance is the terminally ill person attended day and night by their family, who dies as soon as they are left on their own. I have taken several funerals of people who wanted to die at home, stayed alive until they could leave hospital, and then died within 24 hours of returning home. Other people have died shortly after seeing a significant relative, waiting until the time was right finally to let go.

A friend of mine’s terminally ill father was very keen to see his other, somewhat estranged son. The son, my friend Fred’s brother, visited. The father then lay back and said ‘Now, put me out.’ Fred was distraught that he could not grant his father’s wish, and wrote years later that this powerlessness still haunted him, although his father had actually died a couple of days later. I was able to point out to him that his father didn’t need anyone else to put him out; he put himself out when he was ready. Fred accepted this and was much relieved.

Some hospice patients died sooner than expected, having taken the attitude that sooner was better than later. One doctor called these people’s attitude ‘face to the wall.’ One woman was growing remarkably stronger; the nurses said that her skin tone had become much more healthy. But she too made the decision that continuing with life would be too much of a struggle, and ‘put herself out’ shortly afterwards.

The message that we already have some control over the timing and manner of our death is one of the ‘Final Gifts’ given to us by the dying, as recorded in the book of that name by Maggie Callanan & Patricia Kelley:  ‘Most people believe that we die when “our time is up,” or when an illness finally overcomes the body; they see death as passive and the dying person as powerless.  In fact, many people are able to exercise some control over their deaths; knowing about that control – of the time, of the circumstances, and the people present – makes dying seem less passive and helps show that dying people do have power.”[i]

Let us not pursue life at all costs. Let us encourage each other to make full use of the power, the choices, that we have already, and not to seek further powers, further choices which would end up burdening most of us.

 Roger Harper

[i] Final Gifts – Understanding the special awareness, needs and communications of the dying.’

Maggie Callanan & Patricia Kelley,  Bantam 1992  (p222)

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