ON DYING WITH DIGNITY
January 18th 2000
Unsympathetic people are likely to say hard cases make bad law. Sympathetic people would say that law that does not respond sympathetically to hard cases is bad law. Nowhere is this contrast of attitudes more evident than in cases of terminally hopeless distress.
This matter has come especially to my notice recently with regard to an eighty-year old lady of my acquaintance. I shall refer to her as W. I know W's family well and I have known many of its past members but I do not have any close rapport with W herself. For the last fifty years she has lived in Australia (while I have lived in the UK) and we have met only on the three or four occasions of her visiting the UK during that time. We have communicated annually by telephone and the occasional letter.
W is now almost helpless with advanced Parkinsonism; she cannot look after herself even to the extent of carrying a plate of food successfully; she has the help of kind neighbours and professionals of various sorts; she insists doggedly upon not being institutionalised. I have to ask myself the following question were I close to W, both personally and geographically, what is the best help I could offer her? - the operative word being "offer". Several possibilities occur to me:
1) I could make some attempt at palliative care - keeping a daily eye on her, helping others with the domestic tasks, keeping her doctor informed etc.
2) I could offer her assisted suicide but, in view of her disabilities (particularly in her hands) the word "assisted" is somewhat disingenuous; I would actually have to, say, put the plastic bag over her head and pull the drawstring tight, myself.
3) I could collude with her doctor, explicitly or by nod and wink, EITHER a) to withhold treatment in the event of her contracting, say, a respiratory infection (let her die by constructive neglect .... OR .... b) to give her, in the event perhaps of a fall causing painful injury, a huge dose of painkiller that would kill her as well as kill the pain (let her die by the double effect).
Option 1 would have to be the choice if, and only if, W were committed to the notion that to survive is, in itself, an absolute right/duty ..... irrespective of quality of life and informed hope. If W truly thinks this then palliative care is her due ...... unless she goes into the persistently vegetative state - when presumably the courts would have to decide, at some stage, upon the legality of switching off life-support.
Options 2 and 3 both involve people acting close to, or even beyond, the boundaries of legality. To act in disregard of the law is not, of itself, morally wrong; the law may itself be morally wrong. You do not have to be a religious sceptic to believe that there are wider considerations than mere legality; who was it who is reported as saying render unto Caesar etc etc? Where can we read that there is time to heal and a there is a time to kill?
These are all terrible questions and we should make every effort to bring the law into line with the common sense morality that most people see as properly applying to terminal distress.
I have no great personal stake in the affairs of W and, being on the other side of the world, I could do little in any case. But I know what is involved, emotionally, in these matters. Two deaths that I cared about, and still care about, were achieved with due dignity; one person was killed by constructive neglect ... the other by double effect.
I am glad that these two due deaths were procured by the means stated; I hope that W fares as well as these two people fared in their terrible circumstances, ; I have the means, and I hope the integrity, to kill myself should my quality of life, and its chance of improvement, both look like falling too far. We cannot expect to die at exactly the right time; my vote is for dying, with dignity, a little too soon rather than, without, it a little too late.
E.S.
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