Back in my early reporting days I was told something that surprised me at the time: nobody has to do what the doctor tells them. I learned this when the chief reporter, George Topley, slung my copy back at me and said, “Never say that a patient has been released from hospital unless you are talking about someone who is being detained on mental grounds. The proper word is ‘discharged,’ and even though the staff would like you to believe that you just can’t walk out until they say so, you damn well can. Although, generally speaking, it’s best not to be dragging a portable life support system down the steps with you.” George was a remarkable journalist who as a fiery young man would have fought fascism in the Spanish Civil War were it not for the fact that he stowed away on the wrong boat and ended up in Hull.
And I remembered what George said and vowed that rather than let Alzheimer’s take me, I would take it. I would live my life as ever to the full and die, before the disease mounted its last attack, in my own home, in a chair on the lawn, with a brandy in my hand to wash down whatever modern version of the “Brompton cocktail” (a potent mixture of painkillers and brandy) some helpful medic could supply. And with Thomas Tallis on my iPod, I would shake hands with Death.
I have made my position publicly clear; it seems to me quite a reasonable and sensible decision, for someone with a serious, incurable, and debilitating disease to elect for a medically assisted death by appointment.
These days nontraumatic deaths—not the best word, but you will know what I mean—which is to say, deaths that don’t, for example, involve several cars, a tanker, and a patch of ice on the M4—largely take place in hospitals and hospices. Not so long ago death took place in your own bed. The Victorians knew how to die. They saw a lot of death. And Victorian and Edwardian London was awash with what we would call recreational drugs, which were seen as a boon and a blessing to all. Departing on schedule with the help of a friendly doctor was quite usual and there is every reason to believe that the medical profession considered that part of its duty was to help the stricken patient on their way.
Does that still apply? It would seem so. Did the Victorians fear death? As Death says in one of my own books, most men don’t fear death, they fear those things—the knife, the shipwreck, the illness, the bomb—which precede, by microseconds if you’re lucky, and many years if you’re not, the moment of death.
And this brings us into the whole care or killing argument.
The Care Not Killing Alliance, as they phrase themselves, assure us that no one need consider a voluntary death of any sort since care is always available. This is questionable. Medicine is keeping more and more people alive, all requiring more and more care. Alzheimer’s and other dementias place a huge care burden on the country, a burden which falls initially on the next of kin who may even be elderly and, indeed, be in need of some sort of care themselves. The number is climbing as the baby boomers get older, but in addition the percentage of cases of dementia among the population is also growing. We then have to consider the quality of whatever care there may be, not just for dementia but for all long-term conditions. I will not go into the horror stories, this is not the place and maybe I should leave the field open to Sir Michael Parkinson, who as the government’s dignity ambassador, describes incidents that are, and I quote, “absolutely barmy and cruel beyond belief” and care homes as little more than “waiting rooms for death.”
It appears that care is a lottery and there are those of us who don’t wish to be cared for and who do not want to spend their time in anyone’s waiting room, who want to have the right not to do what you are told by a nurse, not to obey the doctor. A right, in my case, to demand here and now the power of attorney over the fate of the Terry Pratchett that, at some future date, I will become. People exercise themselves in wondering what their nearest and dearest would really want. Well, my nearest and dearest know. So do you.
A major objection frequently flourished by opponents of “assisted dying” is that elderly people might be illegally persuaded into “asking” for assisted death. Could be, but the Journal of Medical Ethics reported in 2007 that there was no evidence of abuse of vulnerable patients in Oregon where assisted dying is currently legal. I don’t see why things should be any different here. I’m sure nobody considers death flippantly; the idea that people would persuade themselves to die just because some hypothetical Acme One-Stop Death shop has opened down the road is fantastical. But I can easily envisage that a person, elderly or otherwise, weighed down with medical problems and understandably fearful of the future, and dreading what is hopefully called care, might consider the “Victorian-style” death, gently assisted by a medical professional, at home, a more dignified way to go.
Last year, the government finally published guidelines on dealing with assisted death. They did not appear to satisfy anybody. It seems that those wishing to assist a friend or relative to die would have to meet quite a large number of criteria in order to escape the chance of prosecution for murder. We should be thankful that some possibility that they might not be prosecuted is in theory possible, but as laid out, the best anyone can do is keep within the rules and hope for the best.
That’s why I and others have suggested some kind of strictly nonaggressive tribunal that would establish the facts of the case well before the assisted death takes place. This might make some people, including me, a little uneasy as it suggests the government has the power to tell you whether you can live or die. But that said, the government cannot sidestep the responsibility to ensure the protection of the vulnerable and we must respect that. It grieves me that those against assisted death seem to assume, as a matter of course, that those of us who support it have not thought long and hard about this very issue and know that it is of fundamental importance. It is, in fact, at the soul and centre of my argument.
The members of the tribunal would be acting for the good of society as well as that of the applicant, horrible word, and ensure they are of sound and informed mind, firm in their purpose, suffering from a life-threatening and incurable disease, and not under the influence of a third party. It would need wiser heads than mine, though heaven knows they should be easy enough to find, to determine how such tribunals are constituted. But I would suggest there should be a lawyer, one with expertise in dynastic family affairs who has become good at recognizing what somebody really means and, indeed, whether there is outside pressure. And a medical practitioner experienced in dealing with the complexities of serious long-term illnesses.