Audio Blog on "Terry Pratchett: Choosing to Die"

cross-posted at Single Lens Reflections

Full Transcript:
Deborah: Hello there. Today we're going to talk about the BBC documentary, “Terry Pratchett: Choosing to Die” which was on on Monday night and is available to viewers in the UK on BBC iPlayer until next Monday night, that's the 20th June.

Stephen: The programme featured a number of different people suffering from different conditions, all of whom were either supporters of, or in the program to be helped to kill themselves. We are both somewhat ambiguous [sic.] when it comes to assisted suicide. That doesn't mean that we have any moral or ethical issues with suicide in general, certainly no religious problems with the idea. And we completely understand how severe illness can produce a situation in which you want to end your life as soon as possible rather than suffer any more than you possibly have to.

However, there were problems with the programme, which is difficult for me to say because I'm a huge fan of Terry Pratchett and his work. But there are many things to talk about and that's what we're here to do.

D: That having been said, I think we both have very serious concerns about assisted suicide and the way it is presented in the media, especially as far as the representation of disability is concerned. The idea that there are some lives which are less valuable than others, and that some lives are less liveable than others just because of a physical difference.

My problem with the assisted suicide debate is what appears to be an assumption that a physical disaster – a physical health disaster – has a special status, where if you become paralysed, if you have a degenerative condition, that's different from experiencing a major depression, becoming bankrupt, getting divorced, having some of your dreams destroyed in some way other than a physical illness. Physical illness and injury have a special status that means that people aren't expected to get over it, people aren't expected to find new ways of living within those limitations and it seems that our culture thinks that's a legiti...

S: That's not a degenerative condition, that's just how she is and I do not wish her to kill herself just because she can't say legitimate.

D: Legitimate. The problem is there does seem to be a special status of having a physical illness or a physical injury which is seen as a legitimate reason to kill yourself whereas all manner of personal disasters which lead people to suicidal ideation are not.

S: Well said. I think perhaps we should go through the characters we meet. Characters is perhaps the easiest way to see them because, over the course of the programme, we do see one of them die and hear from one person who also dies although we do not see their death. So it is not easy watching. It is not light-hearted evening viewing, so be warned if you're going to watch it.

First of all we saw Peter Smegly?

D: Smeadley.

S: Smeadley. Sorry, that's Red Dwarf for you. Peter Smeadley, whose family had got money through canning goods, who had Motor Neurone. He was not apparently hugely disabled by the Motor Neurone already. I think that's fair to say?

D: Um, not by our standards.

S: Not by our standards at least. He would struggle to get up but his struggling was on a level with our own at times and he was not obviously using many mobility aids, despite his family money which would have paid for a great deal of help which isn't necessarily available to everyone, although it should be. He is the man who we see die and we'll talk about him more in in a minute.

We also meet a chap called Andrew, who had MS. He was not a member of a canning empire and he seemed, at least, to live quite a quiet and lonely existence.

D: I think the worrying point about Andrew was he was crawling about the house, he said he got out of bed by falling out of bed and crawling from room to room.

S: On a bad day.

D: On a bad day. But even so. His accommodation wasn't really suitable for him, he really should have been using a powerchair, I would say. But whether that was simply unavailable to him, or not, I mean the fact is he didn't have the adaptions which would have made his life a lot more liveable – or at least one would presume it would do. That's perhaps not a fair thing to say but

S: I think it's fair to say because we all need the correct environment in which to live our lives properly.

D: Yeah, but he might have still been completely and utterly miserable

S: Yes indeed.

D: But you'd think that would, that should have been tried first. And it should be the case that he'd have the support to try that first but not knowing his personal circumstances I don't know whether that stuff had been

S: It's difficult to say, as is much as what we'll say during this podcast. We must say this is our own opinion of seeing what must have been quite a heavily edited collection of interviews.

D: Yes and it was – the programme was certainly edited for pathos. Lots of soaring music. We saw a lot of Peter, the chap we saw dying eventually, struggling to get up and struggling to sit down again and a lot of camera time on the point that he had a physical impairment.

S: I must say it reminded me a lot of the Disability Living Allowance forms that we've just got to, which are, if anything, a good starter in your quest towards suicide. Where they ask you do you have problems getting into and out of chairs, or they used to, I dont think they have that question now, but it was a bit like watching our answer in the form, and the answer to the form was that rather than being given benefit or using money to enable to live your life with joy and accomplishment and so on, you can just kill yourself.

D: I think it's a subjective matter. I think that there are real differences, things that aren't spoken about in the public domain because of the negative representation of disability, because of the idea that if you've got physical limitations your life must be pretty rubbish. I think there are real differences with conditions, with the things that can be utterly demoralising and soul destroying and the things that aren't. And of course that varies a great deal from person to person. But in many ways I had far more sympathy for, no sympathy is the wrong...I had sympathy for everyone, but I had far more sympathy with the desire on the part of Terry Pratchett not to go on throughout the entirety of Altziemers, because having experienced cognitive dysfunction and confusion and disorientation and memory problems too, that stuff is far worse than most physical pain, obviously physical pain after a while, but fact is I dont think I've ever had physical pain where there wasn't a drug that couldn't touch it even if I didn't have access to it at the time. But that stuff is far worse than physical pain and far worse than physical limitation. And of course with a condition like Motor Neurone Disease which Peter had, there is that possibility that he would lose some of his cognitive faculties. And I think that's much more distressing for the individual and his family and I can understand, in fact I think that is the one thing where if my illness became much worse again, that would be the one thing that I would have a lot of trouble adapting to.

S: I think at this point, rather than talking about Alzheimers, which we'll leave for a minute, because there was another person as well as Terry Pratchett who was – or who had killed himself, having suffered from Alzheimers. There was another man who had Motor Neurone, who I think was the most interesting point of view on the entire programme. He was called Mick, he was an ex-London cabbie.

D: Who demonstrated the fact.

S: Who demonstrated the fact and did this properly by asking for payment at the end. He was a really charming chap. And he had a good sense of humour and despite being much more disabled than the Motor Neurone than Peter, he was, I would guess, pretty much confined to his electric wheelchair.

D: He was in a hospice.

S: Yeah. He had moved to a hospice and Terry Pratchett said that, you know, there are other ways of dealing with things and some people move to hospices to die. I think he was wrong. I think that Mick had moved there so that he could enable his living and his enjoyment of life for longer. And he really showed this off. He was bubbly and expressive. And yet he was pro-assisted suicide. Which I almost wasn't expected. But his was a very rounded opinion. He wanted to live his life as long as he possibly could and as well as he possibly could. And he was using every resource he possibly could in order to achieve this. And I found that admirable, in a programme like that.

D: Yeah, it's quite funny because – well, not funny, funny peculiar. It wasn't funny.

S: Ho ho!

D: There really wasn't very much funny about this programme at all. What was funny peculiar was that after Peter has taken his life, Terry Pratchett says that he's the bravest man he's ever met. And in many ways I think Mick may have been the bravest man he'd ever met. And bravery is a very difficult issue.

S: Especially with disability. Especially in the current political climate.

D: And I certainly wouldn't say that Peter had taken a cowardly path. I don't think that is an useful concept either. But I think Mick had chosen to live and I think choosing to live can take an awful lot of courage. And considering that he was in favour of assisted suicide and it was something he had thought about himself and he had been in touch with Dignitas himself, but then he chose the other way, I think that was a brave thing to do.

S: Another incorrect statement, I felt, given by Terry Pratchett was that Peter's death was a happy thing because he got to decide when he died, etc. But I disagree and I think that Deborah disagrees as well.

D: Yes, I do.

S: That the death were not happy. There was a death described that we'll get to eventually which was certainly beautiful but it wasn't happy. None of the deaths were happy. Happy would have been achieving joy and all manner of other things. These were releases from fear, sometimes a release from pain, certainly a relief, but they weren't unhappy. They were just an end.

D: Two of the things I find disturbing about the assisted suicide debate in general is firstly the idea that there's nothing like that going on, that it's a common experience to suffer in agony unnecessary until you naturally die, when in fact I think probably most cancer patients in the UK die of diamorphine overdoses – I think that's a very common thing, that pain relief kills people, because we do prioritise people's comfort over people's lives at the end. But also the idea that “the happy death”, the death that people “choose to have” - that anybody can really choose a particular kind of death. I don't think that a millionaire would have chosen to die on an industrial estate on the outskirts of Zurich. I don't think that was the death they would have truly chosen. Both the idea that suffering is commonplace and we do keep lots of people – I mean, there are people who are alive after they want to be, but there are very few. And also, the idea that any death can be what someone has chosen and everything is exactly how they would like. I think there are better deaths and there are worse deaths, but none of them are happy and none of them, we have an awful lot of control over. Even when people take there own lives, I think, you've still got a very limited amount of control and if we did have assisted suicide in this country, it would still have to be terribly controlled. Terry Pratchett said he'd like to die in the sunshine, which is a lovely romantic idea, but if we had assisted suicide in this country

S: It would be in the hospital.

D: It would presumably be in a hospital – you couldn't just do it on a hillside. Although if we had -

S: Unless he slipped.

D: Slipped? I'm not

S: He's getting a bit frail, top of a hillside, slips.

D: But that's not

S: Assisted suicide because someone gave him a nudge.

D: This a very dark and sober subject.

S: Indeed. I think perhaps it's time to finally mention Hugo Klaus, who was the other man with Alzheimers. We never got to meet him, sadly. He was a Belgian author and we only got to meet his widow. He had died at – I think it was at the Dignitas Clinic?

D: No, because

S: Was it not? No because it was legal

D: It was in hospital in Belgium.

S: Yeah, because it's legal in Belgium for people to be helped to die but not for foreigners to be killed, to – sorry, for them to be assisted in their suicide. This is a problem I have because I don't see a great difference between the two. I know that many people would see a difference between the two and I fully accept that. Anyway, he had Alzheimers and his death was the rather beautiful one where he sang a song, having drunk a glass of rather good champagne and smoked a cigarette. He sang a song with his wife while he slowly died, and died singing. Which, you know, as authorial deaths go, is quite an impressive one. And this, I feel, is where the big problem comes in. That Alzheimers and other forms of dementia are really difficult. They are the things that scare us, the idea of cognitive loss, or losing oneself, of being lost in a nightmare. I certainly saw my grandmother destroyed by dementia and there wasn't anything happy about her death but it certainly was a relief. I was somewhat horrified to realise that Terry Pratchett would have to arrange his death with Dignitas, prior to becoming completely destroyed by the Alzheimer's, because he has to have enough cognitive function to say, “I want to die, I want to die, I want to die” - because they keep on asking you. I find it hard to imagine, having this option available to – even to people, what was the term that they were - ?

D: About twenty, I think they said 21% of the people who die at Dignitas don't have a serious physical disease, or perhaps not a disease at all, but they have become “weary of life”

S: “Weary of life”. Isn't that beautiful and happy? So I don't see how people who are “weary of life” can go to a place and be helped tyo kill themselves and somebody who has previously said, when I get to a certain point in my life, I want to die, that they cannot be helped. And I suppose this then becomes an act of killing as opposed to an act of suicide because someone has to actually inject them with a drug, rather than handing them a drink, if they can't then swallow it.

I find this really difficult and I think it's a big flaw in the process. And actually it makes me quite upset because I don't think people should be in that situation. As much as I find the idea of a legalised assisted suicide in the UK quite troubling, in many ways, and I would rather see greater care, it's Alzheimer's and Dementia where I see a real need for assisted suicide and yet it's there where there isn't, apparently, the option.

D: I can understand that because it's all about consent. If somebody's gone beyond the point where they're able to give informed consent, then they shouldn't be harmed. That makes utter sense to me because you've still got a person there even if they're not able to communicate. But the issue of consent brings us round to mental capacity and mental illness. Because assisted suicide in the UK is such a huge leap from where we are now. It's only decades since attempting suicide was a criminal offence and currently assisting suicide is a criminal offence, and if you see someone who is trying to kill themselves, you're allowed to assault them, you're allowed to break all manner of rules, just as if they were committing violence against another person, in order to stop them and prevent harm to them.

Meanwhile, if you repeatedly attempt to commit suicide, you're likely to get sectioned and have all your freedoms taken away from you. We take this very seriously. We assume that people who harm themselves are not in their right mind when they do so, and we tend to see this as a massively negative thing.

I think that it's extremely difficult to define when somebody could be in their right mind, when facing death. There might be people who have chronic mental ill health who are not able to manage in the way that all the people I know with chronic mental health – chronic mental ill health even, chronic mental health? There are people who may have been unhappy all their lives and may have made several conscientious attempts to kill themselves, who, on their final success, everyone who knows them may feel that they have got what they wanted, and nothing could have been done for them, and life could not have been improved for them. But for the vast majority of people with depression – whether they've got a chronic depression or whether they've got a reactive depression because life has gone wrong for them in some way – we have a cultural assumption that there is help and there is hope and it's about changing their life and changing their mind as opposed to simply opting out.

One of the most disturbing, well actually in my opinion, the most disturbing case of assisted suicide by a British person was a few years ago, a 23 year old lad, who was quadraplegic, took his own life at Dignitas in Switzerland, with the help of his parents, only 18 months after he had the initial accident that left him paralysed. And that's really scary for me. Lots of things go wrong for 23 year olds, and when you're that age, you do tend to take things in the worst possible way and you can feel like your life is over, because of the end of a relationship, because you started on one course of a career that suddenly you realise it's not going to work out the way you thought it would, because of financial problems – all kinds of things can go wrong for you. But given enough time, you sort of work it out. And certainly with illness and injury, 18 months is no time at all. The sort of peak of my feeling that my illness couldn't be lived with was about three years in, before the point where I thought, well it's not actually going to get any better and it could get a lot worse than this, then I really wanted out for a while. 18 months is no time at all.

And I think that's the scary thing, that whatever else might have gone wrong for that young man, any of those other things, people would have said, “Well, something will come up.” or “You will find another way of doing things.” But because it was something physical

S: And it sounds like it was a sporting family.

D: Yeah, I think so. I mean, this is one of the difficult things about the way that different impairments effect people. There's perhaps something especially tragic about Alzheimer's effecting a writer.

S: Hmm.

D: And when paralysis effects a sporty person, somebody who lives in their body a lot, that's perhaps worse than when paralysis effect someone whose intellectual. But even so, I struggle to see, but I feel that if we ever did put this in place, we would have to have some sort of system of defining how long and what options had been explored before people make that ultimate choice.

S: And who makes that decision? And who makes up the board that oversees who gets the chance to kill themselves? And who doesn't?

D: Yeah, I've always thought that perhaps some sort of tribunal that included a sort of pro-life disability activist, to sort of offer all the alternatives. Or an occupational therapist to sort of say “Well, you know, you feel you can't...”

S: I don't see how anyone with Motor Neurone who is in a better state than Mick, from the programme, could possibly kill themselves having seen what he achieves in his capacity in the hospice.

D: I mean, in fairness, I think one of the problems with assisted suicide and Switzerland being the only option for people in the UK, is that there's this issue of travelling and this issue of how far it gets along. Cause I mean, Motor Neurone Disease can go downhill quite quickly and people can reach the point where travelling becomes extremely difficult to do. And I think

S: And also the issue of cost.

D: Yeah. Well, yeah I know but that doesn't change when people do it.

S: Well, it changes whether they have the option to do it, which doesn't seem fair to me.

D: So you think it should be legal in the UK?

S: On the NHS. I don't know if it should be available on the NHS but I do have a problem with any service that is only available to someone who has the capacity to pay £10K for it.

D: Anyway, my point was before, about travelling, was that when people are forced to travel, they are forced to make a decision in advance of falling severely ill. And I do think that fear is such a big part of terminal illness. The fear that it's going to move beyond point. Last year I lived with friends, one of whom had emphysema and was heading – he died at Christmas in the end. But he was very frightened about what the end could be and in the end he had a very gently passing. But he could have effectively drowned to death and that could have happened quite slowly. So he longed to have some means of getting out if he could. Some days he wanted to just die because he was unhappy, because to be honest he was quite depressed. But I think, if he had had some means of getting out, it would have made him feel safer and more comfortable in facing his natural death.

I think it's Oregon in the US where you can effectively get a prescription for deadly drugs, and many of these prescriptions are filed but very few of them are actually taken, because once people have the means to get out, if they want to, they generally end up facing natural death. Because I think, as I said, with palliative care as it is, there are very few natural deaths which are these nightmare scenario of being locked in a body in agony for days or weeks or months, without being able to communicate with others, etc.

S: And I can't help but think, and it might just be the Yorkshireman in me thinking this, that if you've travelled all the way to Switzerland and have paid £10K, that when you're sat there, being offered a pair of drinks that are going to end you, you're not going to say, “Oh, on second thoughts, perhaps not today.”

D: Well yeah, this is a bit like the argument against prostitution, the idea that if you involve money, then consent isn't 100% pure any more. And the poorer you are, if you're spending £10K, you're going to go through with it. And of course, there's also the problem, one of the big arguments against assisted suicide is the fact that disabled people can become very costly, to the state and to their families, and in the case of elderly disabled people, they may feel like they're using up the inheritance they meant to pass on. And that becomes a big problem when you give people an out, because people in our culture are made to feel like burdens. I mean, especially in the political culture at the moment, we're really made to feel like Ballastexistenz.

S: And with that, I think we should leave it. I hope that wherever you are, and whatever you're doing and whatever you're feeling, that you're not wanting to die. And that listening to this has not made you any more eager to pop your clogs. So listen to us next time, we'll try to be a bit more cheery.

D: We should write, we should do some sort of podcast about the Joys of Life

S: Choose Life! Next time.

On Voluntary Euthanasia #2

That's enough frivolity for now, let's get back to matters of life and death!

The Right To Choose and The Obligation to Interfere

It never made sense for suicide to be a crime (although it was before the 1960s); a person's body does not belong to anyone other than its inhabitant so ultimately, one is free to do whatever one likes with it.Meanwhile, a person who is dead cannot answer for their actions, and the main concern with someone who has survived an attempt on their life is to keep them safe and help them feel better – an objective somewhat undermined by criminal prosecution.

But suicide is the only non-criminal activity I know of which we are allowed to use physical force to prevent. If you see someone about to jump off a bridge, you're allowed to tackle them, drag them away, knock them unconscious if necessary without being charged with assault. It's reasonable force, you understand; deadly force would be to defeat the point.

If you fail to prevent a suicide when it would be reasonable for you to do so, e.g. if you fail to phone an ambulance following an overdose or potentially fatal injury, then you risk being charged with manslaughter. Assisting suicide carries up to fourteen years in prison and even verbally encouraging suicide is a serious criminal offense. Meanwhile, if healthcare professionals believe you to be a serious risk to yourself, then they are allowed to detain and forcibly medicate you.

This does kind of make sense. What it means is that ultimately, you do have the freedom to die if you want to, but the rest of us are going to try and stop you. And the potential benefits of our interference greatly outweigh any harm we can do to you. If you are still alive, you still have the opportunity to choose. If you survive and go on to have a wonderful life, then what a glorious gift that is! If you still choose to die and go on to try again, then you haven't lost anything. But if we butt out, all will be lost in any case.

So it could be said that you have a right to die by your own hand and you certainly have a right to refuse medical treatment (or food, hydration etc.). But if you are not in need of life-sustaining treatment and you don't have the physical capacity to kill yourself, you're kind of stuck.

In most countries which have legalised euthanasia, it is exclusively about hastening an inevitable death. The Swiss example is pretty deplorable; assisted suicide is not a crime at all, so long as it is not done out of self-interest (e.g. you can't be paid). So for example, if your friend is unhappily gay, becomes suicidal about their sexuality and you happen to agree that it is better to be dead than gay, well you can help your friend shuffle off their deviant mortal coil. I think that lfe is worth a whole lot more than that.

And yet, I can't quite believe that a person must be condemned to be alive because an impairment stops them opting out. It's not a right, exactly - since we're talking about another person's (remarkable) participation, assisted suicide could never be guaranteed. Hmm, I don't think I'm going to get any further with that one.

But I completely reject the idea that we shouldn't comment on other people's decisions on this matter. I don't believe in harassing people or threatening them with the seventh circle of hell, but I do believe in trying to make the most fundamental decisions a person can make as informed as they possibly can be. We all have a responsibility to give one another the best shot possible.


The Last Resort

Most people who commit suicide have depression, which is a treatable (if not universally curable) condition. Meanwhile, very many people, including myself, have contemplated and/ or attempted suicide, failed and feel that the whole thing was a ridiculous mistake. Most people know someone who has succeeded and rarely it is anything but an unequivocal tragedy, a terrible waste and one of the most devastating kinds of bereavements for those left behind to come to terms with.

I don't believe that many people want death; what people want is change and it can seem that death is the only way to bring about that change. This is not an easil- corrected mistake; I spent about a year of my life thinking in this way, and it wasn't particularly irrational given my circumstances and my understanding of the world then. Because of illness, I could not have the sort of life that I had always wanted and expected, and while I had imagined myself to be quite open minded and flexible, it seemed that the doors had slammed shut on every other option. I had lost my future.

Meanwhile, I couldn't do any of the things I wanted to do. All the things I liked to do with my time had either been taken away from me or were massively disrupted by illness. All my friendships had been changed by my illness and at this point, I didn't really trust anyone any more – since I was so boring and inarticulate, I imagined the friends who stayed did so out of a sense of duty. I was living in a place I didn't want to live with people I didn't want to live with – which in turn I felt very guilty about.

I've often said that [...] saved my life, because if he hadn't come along, well I had a date and it was coming up very fast. Even so, it took much longer to learn that my life didn't need to have been like that - it wasn't just a question of “snapping out” of it or even a gradual recovery from depression – whilst I did get very depressed, none of the above was fantasy.

If I had died, it would have died because of an inflexible and unimaginative attitude towards education, work and the value of my existence, the stigma of chronic physical illness, the stigma of mental illness, my own disablist prejudice, self-disgust, inadequate pain management, unintentional familial pressure, careless drug prescription, inadequate options for housing, homophobia and living in Ipswich (it is a terribly depressing place). Not because of my physical and cognitive limitations.

It wasn't purely a change in my feelings which changed my mind, but different information. Feelings cannot be either legitimate or illegitimate, but you can have the wrong data. If every other option for improving a person's life and happiness has been totally and utterly exhausted before they decided to die, then it would be difficult to argue with that decision. But there is rarely any clue to that in the way these stories are reported.


Unintended Consequences.

Any change in the law is likely to effect only a small number of people directly, but disabled people are affected by the mere discussion. As it is, the lives of disabled people are not seen as on a par with those of non-disabled people. We are both pitied and regarded as a burden by very many people very much of the time. If society is able to forgive some disabled people for wishing to end their lives, will it be able to forgive the rest of us for wishing to live?

Almost all media stories about euthanasia ramp up the tragedy in ways that they could never get away with talking about disability in another other context. Generally it is pain which makes a condition unbearable, but instead these stories tend to focus on things like the level of personal care people need. Yesterday the BBC news website published an open letter from Lizz Carr to a chap called Noel Martin who wants out (and wrote back), concluding it with a video of the man getting his hair washed. As if this offers the other point of view; Carr says that life is worth living, but look, he needs someone to wash his hair for him!

However, I don't think a change in law could make society value us less. I certainly don't believe in any slippery slope where we begin find ourselves under social pressure to die - or that when disabled people are in despair, that those around us will agree that death is the answer. (Tayi points out in the comments to my first post on this subject that things might be different where there isn't socialised medicine, and illness is far more of an individual economic burden.)

I reckon that debates on euthanasia merely bring to the surface the stereotypes that people have always held - and then allow them to be contradicted. We're getting louder and more visible all the time; a fact demonstrated by the BBC publishing a bit of a debate between two disabled people as opposed to two non-disabled 'experts'. Meanwhile, people sneaking off to abroad to die and recently bereaved people risking criminal status is not doing anything for us at all, let alone what it is doing for the individuals who find themselves compromised in this way.

A small but significant proportion of disabled people will ultimately face a very slow and painful death. Some of us would be able to face that with less fear if we knew that we'd continue to have control of our lives, whatever happened to our bodies. I think the time has come for a change.

But I'm still not terribly happy about the subject!

On Voluntary Euthanasia #1

There are two things on my mind at the moment; euthanasia and party dresses. I got to writing about euthanasia and it got so long it will become two posts, but I'll do the one about party dress in between. If only I could post a cake recipe and some advice on dieting, this could be the blog equivalent of daytime TV!

Truth is that I long ago established that suicide might be one way to go. Much later on, if things get really grim. It is a rather morbid thought for someone who is neither depressed nor in any imminent physical danger, but it means I don't worry too much about future some worst-case scenario in which everything is suffering and pain. Might never happen, but if it does, I shan't be stuck here.

Meanwhile, I believe people should be allowed to do whatever they like with their bodies as long as they don't harm other people. However, the debate on voluntary euthanasia has always troubled me. It is one of those debates where I find myself disagreeing with everyone, so I am going to try and unpick this for myself.

We'll start with something relatively straightforward.


The Sanctity of Life

Human life is very precious, but I have no God to make it sacred. Death may be final, but it is not the worst thing that can happen to a person – which is a relief, since it's going to happen to everyone of us. Yes, maybe even you, should you accidentally eat some garlic or if someone set your alarm clock to go off before dusk. Meanwhile, the value of a life is all about quality, not the number of years, months, weeks or days that it can be sustained. Life-sustaining treatment is not always in an individual's best interests. Nor is it always reasonable; in the UK it is too high to effect many of us, but there is a limit on the resources that can be dedicated to maintaining any given pulse. I don't believe in life at any cost.

What's more, we bring life to a premature close all the time when the dose for effective pain-relief during the end stages of terminal illness becomes deadly. We don't take years away, but maybe a few days of agony here and there. An American friend told me of her childhood preacher who objected to diamorphine on the grounds that dying people could no longer feel the flames of hell licking at their feet and might miss their final opportunity to repent. But that's the only objection I've ever heard of.

If we are happy with this, it seems that there seems no fundamental problem with ending life. There is some argument about a big difference when killing is not the primary intention, but clearly it is regarded as an acceptable side-effect in these very extreme circumstances. It seems to me that in the case of someone who is dying and in great physical suffering but wants to shorten their suffering (and thereby, their life) by months or years, the only difference is one of timescale.

However, not everyone who seeks euthanasia is on their way out.


Manner of death vs. quality of life

There have been two news stories about voluntary euthanasia in the last month. I don't wish to write about individual cases, since these are ordinary people's lives and deaths, but the contrast between them is very important.

One story is about a lady with the sort of MS that can kill you, who says she would like to go on forever but she was seeking reassurances that, should the situation arise, her husband could travel to an euthanasia clinic abroad and not face prosecution on his return. Her case has failed. The other story is about a young man whose parents took him to Switzerland to undergo assisted suicide. This chap was in his early twenties and had been tetraplegic (quadraplegic) for just eighteen months. His parents supported and facilitated his choice in order to relieve their son of what they considered a second class existence. It is unclear as to whether they will be prosecuted.

These two stories demonstrate a big problem for me because one case seems totally reasonable - I instinctively wish that the lady didn't have to travel abroad to do what she wants to do - and the other makes me feel very uncomfortable indeed. One is about the kind of death a person hopes to have, the other is a rejection of a certain sort of life.

The life of someone in the latter stages of a terminal condition is as precious as anyone else's, but having decided that they want to die, it is extremely unlikely that they would change their mind should they survive. There is unlikely to be the time to develop a completely new perspective. The things which might make life pleasurable are only likely to decrease as the things which make life seem intolerable increase.

Someone whose life is not in any danger – especially someone whose condition is stable and might even improve – has a lot more to lose. I don't think there are any statistics on this, but I wouldn't be at all surprised if most people with any kind of acquired impairment, an injury or chronic illness, experience a period of despair. Similarly, people experiencing a nasty divorce, sudden bereavement, a terrible assault, financial ruin, some great personal humiliation or other, are likely to have a spell when they can't see how they could ever be happy again.

But they will be. When people say, “If I went through what you've been through, I would have killed myself,” the chances are that they wouldn't. Most disabled people were once non-disabled and almost all of us survived the change. So why should we condone someone's pessimism just because they have a physical impairment? How is a spinal cord injury different from a broken heart or bankruptcy?

I suppose there are three differences. The first is that we kind of think of non-medical disasters as recoverable from. One's heart is broken, it will heal with time, whereas physical symptoms won't go away. I'm not entirely happy with this. Physical symptoms can often be improved, and most certainly the impact of those symptoms on one's quality of life can be changed completely. Not always, not necessarily, but very very often.

The second difference is that one acquires impairment in a culture which completely accepts the idea that we live a second-class existence. If the whole world believes your life must be rubbish, then your own suicidal feelings on the matter are likely to seem completely reasonable.

But perhaps the most pertinent difference is that something like tetraplegia and certain other conditions, a person who is desperately unhappy about there situation can't escape it without help - or without a terribly painful and degrading death like starvation. We encourage one another to stick it out through the bad times, but there is no law against suicide. Which brings us onto the matter of Human Rights.

Which I shall write about after I've written about party-dresses. I bet you can't wait!