Guernsey Press

‘We owe it to islanders to debate assisted dying’

Whether or not to legalise assisted dying for the terminally ill is a thorny and emotive subject, but that should not deter the Assembly from talking about it, says Deputy Peter Roffey

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ASSISTED dying, assisted suicide, voluntary euthanasia or death with dignity. It doesn’t matter what you call it, or which variation on a theme you choose to consider, it is an area of policy which is completely toxic to any politician worried about alienating swathes of voters.

Why? Because feelings on the issue are so strong and so polarised that whether you come down on one side or the other you are bound to upset many. If you prevaricate you risk upsetting even more. That is why defensive, career politicians tend to just stay silent on the issue.

In doing so they do the public a disservice. It is a matter of genuine and growing public debate. It is an ethical issue of considerable significance and the job of governments is to turn a community’s ethics into a body of practice and law.

Sometimes it is also to take a lead in the inevitable evolution of ethical thinking. So deputies owe it to islanders to at least ventilate and debate such a thorny subject.

So here goes.

In favour of allowing people to choose when and how to end their own lives, whether by their own hand or with outside intervention, is the very simple concept of autonomy. To me this concept is a real policy compass. These lives belong to individuals, not the wider community and certainly not the government. So shouldn’t those individuals be able to decide for themselves if they think their lives are worth living?

When someone genuinely wants to end their life who are we to compel them to continue? Whether that is because of insufferable pain or a feeling of complete indignity and hopelessness due to a creeping loss of bodily function, is it really fair to say they must keep going? That they must live out the final few weeks of a terminal condition even if they really, really want to die and are finding existence extremely distressing? I don’t think so.

Of course, any of us can just commit suicide, but so long as voluntary euthanasia remains illegal and taboo then finding a good and dignified way of doing so will be very difficult. Even worse, if no one can assist you without risking prosecution then that suicide may need to be premature, particularly in the case of degenerative conditions when you know you are going to lose the physical capacity to take your own life.

So much for the arguments in favour based on autonomy, but that concept also brings difficulties. Clearly those who don’t have mental capacity can’t exercise that autonomy so where does that leave those suffering from dementia? Do we allow others to make the decision for them? That would surely be far more dangerous. What about those suffering from other forms of mental illness or depression?

Then there is the flip side of autonomy. It means that everybody must respect the decision of individuals to request to be kept alive by whatever means possible even if those close to them crave an end to their loved one’s suffering. Nor should there be the whiff of a suggestion from the wider community that the lives of the very sick or profoundly disabled are valued less. Respect for autonomy cuts both ways.

Talking of loved ones – one of the biggest arguments against allowing voluntary euthanasia is that vulnerable people will be encouraged to end it all by avaricious relatives. That is a danger, but I suspect instances will be rare. Most people love their family and are genuinely grieved by their deaths. Anyway I think such deplorable situations would be relatively easy to legislate against.

What I think would be harder to overcome in law is preventing people from choosing euthanasia not because their lives had genuinely become unbearable to them but rather out of a misguided view that they ‘shouldn’t be a burden’.

Then there is the issue of doctors and whether it would change their role and their relationship with their patients. Of course it probably would but that is not necessarily a bad thing. I regard my doctor’s job as caring for me and this would simply be an extension of that concept. Clearly though there would need to be an opt-out clause for those for whom assisted dying was against their conscience. There already is in relation to abortion.

In some ways I think it might be good for both doctor and patient to codify which medical interventions are allowed and in what circumstances in end of life situations. There is a very muddy situation now around the use of ‘double effect medication’ where the aim is to relieve pain but the side-effect might be an earlier death. I worry this places too much of the judgement with the physician rather than the patient. Perhaps that was seen as appropriate once but that relationship has changed a lot over recent years.

Then again as a potential patient I would far prefer my life to end cleanly through a positive intervention than simply through the withdrawal of treatment. Wilfully causing patient dehydration doesn’t strike me as a particularly moral pathway.

Then, of course, there are the religious arguments against any form of euthanasia. I confess to not really understanding them because I have never really understood religion. But I do know this. People of faith must be completely free to be guided by their religious convictions but they should not be free to impose them on the rest of an increasingly secular society.

In this article I have only scratched the surface of some huge and complex issues and yet I notice I have still used far more question marks than normal. This is a devilishly difficult subject but it is not one which should therefore be put in the too difficult tray.

I am pleased that Deputy St Pier is bringing it to the States 14 years on from the last time this matter was debated. Politically it is quite a brave thing to do and in response we owe it to him and the public to be candid about our own views.

I suspect it will surprise no one that I come down in favour of allowing individuals the autonomy to choose when to end their own lives. That moral choice is the relatively easy bit. The devil will be in drafting the required legislative safeguards.