BBC's Pro-Death Propaganda

A BBC special by the renowned British author Terry Pratchett has caused a stir in the UK. Shown Monday night, "Terry Pratchett: Choosing to Die," included footage of a patient ingesting lethal medication and dying in a Dignitas clinic in Switzerland, where aid in dying is legal. Nearly 900 viewers contacted BBC to complain. The show caused a furor that reached the state level; several peers are accusing the station of taking a side in the aid in dying debate, one of the more contentious issues in Britain at the moment. Aid in dying is not legal in the UK. Terry Pratchett, diagnosed with Alzheimer's, is a vocal advocate for the right to die.

Last year Kier Starmer, the Director of Public Prosecutions, ruled that it was legal to assist a patient in their death, a decision that was the result of a court case brought by multiple sclerosis sufferer, Debbie Purdy, in 2009. Purdy asked the courts to allow her partner Omar Puente to assist her travel to Switzerland when she decided to end her life -- without risking court action when he returned.

(h/t Mrak)

Aiding Assisted Suicide in Britain, Reviewing the Laws

Meanwhile (see prior post), Britain has created a committee that will review their laws regarding family members and friends who help loved ones travel outside the country for assisted suicide.

The move follows a number of cases in which British people have travelled with friends or family to the Dignitas clinic in Switzerland, where terminally ill people are able to end their lives. Although police investigated the cases, none were taken to court. Last year, Debbie Purdy, who suffers from multiple sclerosis, won an historic judgment in the House of Lords that said she had a human right to know if her husband would face prosecution in such circumstances.

Falconer told the Observer: "It is probably a criminal offence to travel with someone to Switzerland to help them to die and yet it is so obvious that nobody on any side of the argument has the stomach to prosecute people like, for example, Dan James's parents." He was referring to the case of the 23-year-old whose parents helped him commit suicide after he was paralysed in a rugby accident.

Christian groups have already accused the commission of being biased.

Dying at Home in the UK

Britain's Health Secretary, Andrew Lansley, has announced that more people should be allowed to die at home, a phrasing that gets at the challenges of end of life care, from The Telegraph:

Speaking at the International Carers Conference in Leeds, he said: “Having a terminal illness is a very distressing time for individuals and their families. People should be able to choose where they are cared for – most would choose to be cared for at home, surrounded by their friends and family – and be certain that the care they receive will be of the highest quality.

“This review will look at how we better deploy the money we spend on palliative care – so those in need are better supported. We intend that whatever care patients choose will meet their needs and wishes.”

In the U.S., as I've written before, about 80% wish to die at home but only about 20% do. I've been interested to see how attention to end of life care changes when the issue of assisted suicide (in all it's nomenclature) is discussed. Britain has been in the midst of a public discussion of end of life care, assisted suicide and the legal challenges of such laws thanks to the Purdy case last summer. I wonder if this elevated level of awareness there has had any effect on Lansley and the proposed study?

British Doctor First to be Charged Under New Assisted Suicide Guidelines

An excerpt from the article in the Telegraph:

Dr Irwin has written a letter to Keir Starmer QC, the Director of Public Prosecutions (DPP), effectively inviting criminal charges within weeks, for which the former GP could be jailed for up to 14 years.

Dr Irwin, who admits he had accompanied two other previous strangers to the Dignitas clinic to help them take their own lives, wants to make a test case out of his assistance in helping Raymond Cutkelvin to commit suicide three years ago.

Mr Cutkelvin, 58, a post office clerk from north London who was suffering from advanced pancreatic cancer, chose to die in the "suicide clinic" in February 2007.

Mr Cutkelvin is one of some 140 terminally-ill Britons who have died with the help of Dignitas, which was founded in 1998. In Switzerland, "suicide clinics" are legal despite widespread criticism internationally and internally.

Just two months ago, Mr Starmer clarified the Suicide Act of 1961 which makes it an offence to assist a suicide. He published six "public interest factors against prosecution" and 16 "public interest factors in favour of prosecution".

Interview with Debbie Purdy.

Scotland on Sunday has a lengthy profile/interview with Debbie Purdy, the British MS sufferer who won a case last summer that allows her husband Omar to travel to Switzerland with her - and not face prosecution - should she choose to end her life. Here's a clip from the article:

It's the irony of Purdy. The multiple sclerosis sufferer is associated with the right to die campaign but displays a vitality that epitomises the best of living. Last year, she successfully challenged the 1961 law on assisted suicide in the House of Lords. The Scottish Parliament is currently considering a bill to legalise assisted suicide but such moves have been resisted in England. Attempting suicide is not illegal, but helping someone to take their own life is. A blind eye has often been turned to those assisting the terminally ill, but Purdy wanted concrete clarification. Her victory resulted in the director of public prosecutions in England and Wales laying out the conditions under which prosecution would and would not be likely to happen. In Scotland the Lord Advocate has declined to do the same.

The new guidelines make Purdy confident that her husband, musician Omar Puente, would not be prosecuted if he helped her travel to the Dignitas clinic in Switzerland, where patients are helped to die. MS is not terminal, but it is progressively debilitating. Purdy had argued that, without legal clarification, she would have to terminate her life prematurely when she could still travel unaided.

More than 100 people have travelled to Dignitas from Britain without any prosecutions. So was this part of the intellectual argument – and a bit of emotional blackmail – rather than the reality of Purdy's situation? Absolutely not, she insists. There is no guarantee about prosecution. The only person ever charged, though the case was dropped, had a Polish surname. "That was a worry." Puente is not white and middle-class. He's black and Cuban. "In 2008 I joined Dignitas because I was losing the ability to travel by myself, and that was terrifying. If we hadn't won in the House of Lords, I'm not sure I would have got to the European Court, which would have been the next stage, because I probably would have gone to Dignitas. I thought I was losing physical ability more quickly than has actually been the case. And that would have been a terrible mistake."

Purdy has become synonymous with an issue. We know what she stands for but not who she is. Now, she has written a book, It's Not Because I Want to Die. The title sums her up. "I don't think anyone should be in favour of assisted dying. But neither should they be against it. It's not the right choice for everybody, but it should be a choice to explore." It's an important distinction. To understand Purdy's attitude to dying, you first have to grasp her attitude to living.

Crazy Starmer Keeps Confusing State Law and Church Law.

The Pilot, a Boston newspaper of the Anglican Church, reports on British bishops' opposition to Kier Starmer's attempts at revising the assisted suicide law since the summer's successful case by Debbie Purdy. They just keep confusing church law and British law:

The bishops said Keir Starmer, director of public prosecutions, was creating categories of people whose lives would be legally considered less worthy of protection than other members of society.

They said his "interim policy for prosecutors" in cases of assisted suicide stigmatized the disabled, the terminally ill, the depressed and the aged and "could encourage criminal behavior" by sending the message that it was acceptable to help such people to kill themselves. They made their remarks in a submission to a public consultation on a clarification of Britain's assisted suicide law.

They criticized Starmer, head of the Crown Prosecution Service -- the organization that decides if criminal charges are to proceed to trial -- for exceeding his powers by ignoring the will of Parliament, which has twice in 18 months rejected attempts to change the law on assisted suicide and euthanasia.

Britain and Assisted Suicide.

This summer Debbie Purdy won her case in the British courts to ensure that her husband would not be prosecuted if he helped her to leave the country to end her life. Purdy is a multiple sclerosis patient; her case has caused the Director of Public Prosecutions, Keir Starmer, to draft revisions to the laws regarding assisted suicide. But the revision is meeting with strong opposition from lawyers, former lords and parliament. A group of like-minded players has come together to write a lengthy brief to the DPP strongly opposing the DPPS revisions. From the Telegraph:

In September, he published a list of factors to help lawyers to decide whether to prosecute people for assisting suicide. The rules have been interpreted by some campaigners as a way of “legalising” assisted suicide.

The DPP has now launched a consultion on the guidance which says that families who help terminally ill loved ones to end their lives are unlikely to face prosecution as long as they do not encourage them and assist only a clear and settled intention to die.

But the group - which also includes Lord Walton of Detchant, Professor Sheila Hollins, a former President of the Royal College of Psychiatrists and Baroness Campbell of Surbiton - says the new guidance is “not fit for purpose”.

The group has signed up to a hard-hitting response to the proposals from campaign group Care Not Killing, in which it warns that changes to the law could mean that the lives of stroke-sufferers, disabled people and those with arthritis, could be at risk.

It says: “Among the factors proposed as tending against prosecution are that the deceased was seriously ill or incurably disabled or had a history of suicide attempts. In Care Not Killing’s view these proposals are discriminatory as well as dangerous.”

*

In all, 11 of the 29 specific criteria proposed for deciding whether to prosecute or not to prosecute were judged to be “unacceptable in any circumstances”.

Dr Saunders added: “We recognise the attempt that the DPP has made to carry out a very difficult remit given to him by the Law Lords, and there are several aspects of the guidelines that we can support.

“But current guidelines adopt, however unwittingly, the political assumptions of the pro-euthanasia lobby, that assisted suicide will not be prosecuted if the right boxes are ticked.”

The group suggested that the guidance “should start with a clear statement that assisting a suicide is a criminal offence and that, in the absence of a decision by Parliament to change the law, it will remain so”.

British Doctor Explains Change of Position on PAS.

A British doctor, Raymond Tallis, writes for The Times today that he has changed his mind about assisted suicide and cites the example of Oregon, where Death with Dignity has been legal since 1994, for his conversion.

Tallis will join Debbie Purdy, the multiple sclerosis patient who recently won a court case in Britain to allow her husband, Omar, to assist her travels to Switzerland for assisted suicide, before a panel at the Battle of Ideas in London to argue for physician-assisted suicide (PAS).

Once a staunch opponent to assisted suicide, while serving as chairman of the Committee on Ethical Issue in Medicine at the Royal College of Physicians, Tallis explains why he has since changed his mind.

The case for such a Bill to me now seems clear. Unbearable suffering, prolonged by medical care, and inflicted on a dying patient who wishes to die, is unequivocally a bad thing. And respect for individual autonomy — the right to have one’s choices supported by others, to determine one’s own best interest, when one is of sound mind — is a sovereign principle. Nobody else’s personal views should override this.

So where did my initial opposition come from? I was in thrall to numerous incorrect assumptions. But the evidence changed my mind.

Culled from Tallis' article, here are his reasons to support assisted suicide:

1. Palliate care does not eliminate need for PAS because it cannot eliminate suffering among all patients and because PAS has shown to actually improve palliative practices

2. Availability of PAS has not inhibited advancements in palliative care, in fact, Oregon has the best palliative care in the US

3. Writes Tallis:

I also shared the worry that legalising assisted suicide would break down trust between doctor and patient. This is not borne out by the evidence. A survey of nine European countries put levels of trust in the Netherlands at the top. And this is not surprising: in countries with assisted dying, discussion of end-of-life care is open, transparent, honest and mature, not concealed beneath a cloud of ambiguity, as it is in the UK. And the knowledge that your doctor will not abandon the therapeutic alliance with you at your hour of greatest need will foster, not undermine, trust.

4. Legalizing PAS doesn't lead us down a slippery slope to involuntary euthanasia because legislation prevents it from doing so.

5. The legalization of PAS in Oregon and elsewhere didn't create a mad rush to die. Few elect the hastening of death.

6. Lastly, Tallis notes:

As a geriatrician, I was also worried that assisted dying would be offered to, or imposed upon, those who are most disempowered. A very detailed analysis of the data in Oregon has shown that there is an under-representation of those groups and an over-representation of comparatively well-off, middle-class white people — feisty characters who are used to getting their own way.

He continues:

Well, I happen to believe that even small numbers of people going through unbearable hell are important. The availability of assisted dying would bring much comfort to many more sufferers than actually use it because it brings a sense of having some control.

Death from dehydration and starvation in patients who have no means of securing an end to their suffering other than by refusing food and fluids, or botched suicides, reflect the unspeakable cruelty of the present law. To accede to someone’s request for assisted dying under the circumstances envisaged in the Joffe Bill is not to devalue human life, or devalue the life of a particular human being, or to collude in their devaluing their own life. It is to accept their valuation of a few remaining days or weeks of life that they do not wish to endure.

The British Debate Over Assisted Suicide.

Currently, assisted suicide is illegal in Britain. The recent case of Debbie Purdy, a multiple sclerosis patient who petitioned the courts to allow her husband, Omar, to help her leave the country for assisted suicide and be exempt from prosecution when he returned, has caused the Director of Public Prosecutions, Keir Starmer, to revise prosecutorial laws for those who assist suicide.

CommunityCare offers an informative outline and civil discussion on the recent revision of British assisted suicide laws. It gives Care Not Killing Alliance, an anti-assisted suicide group, and Dignity in Dying, an end of life patient rights group, equal space to make their cases.

The new prosecution guidelines require that:

1 The victim is under 18.

2 The victim's mental capacity was adversely affected.

3 The victim did not have a clear, settled or informed wish to commit suicide.

4 The victim did not indicate unequivocally to the suspect that she wanted to commit suicide.

5 The victim did not ask personally on their own initiative for the suspect's assistance.

6 The victim did not have a terminal illness, a severe and incurable physical disability, or a severe degenerative physical condition.

7 The suspect was not wholly motivated by compassion.

The converse of 3-7 are among the most important factors against prosecution.

Peter Saunders of Care Not Killing Alliance writes:

Three of the individual criteria listed are particularly open to objection - that a more lenient view of assistance with suicide might be taken if it is given to people with terminal or degenerative illnesses or with incurable disabilities; or to people with a history of suicide attempts; or if it is provided by spouses or close family members. These criteria which are said not to favour prosecution single out groups of people for special category status. In a civilised society, people who are seriously ill or suicidal should be protected by the law, not fast-tracked for suicide. Parliament has twice declined to change the law to allow assisted suicide for terminally ill people, yet here we have a criterion from the DPP that would facilitate it for them and for a range of other unwell people.

The suggestion that spouses and family members might receive more lenient consideration as assisters is based on the facile notion propagated by euthanasia campaigners that such people are invariably "loved ones". The reality is different: most violence and abuse takes place within families. These guidelines need further work before they can be considered fit for purpose.

Jo Cartwright of Dignity in Dying writes:

Although these guidelines are helpful, they only partly resolve the problem.

The guidelines clarify the law for the loved ones of those asking for assistance, but they cannot and do not provide a safeguarded means of assisted dying in the UK. Therefore, we continue to export our terminally ill abroad to die or condone suicides behind closed doors. This status quo is unacceptable and, fundamentally, the law needs to change.

Smith Uses Personal Narrative to Criticize Use of Personal Narrative.

"Abandoning the Most Vulnerable" is the title of a new article by Wesley J. Smith in The Weekly Standard, published on the 12th. In it Smith does more of what he does best: extrapolate an extreme example as fully representative of what is to come. But in this article, he also gets stuck inside his own logic.

He takes the case of Myrna Lebov, apparently killed by her husband, George Delury, in New York in 1995 and throws it up as an example of what will happen in Britain now that prosecutorial laws for those who assist suicide have been revised in the wake of the Debbie Purdy case. (Purdy, a multiple sclerosis patient, wanted to ensure that her husband, Omar, would not be prosecuted for helping her to travel to Switzerland for aid in dying once he returned to Britain, where aid in dying is illegal. She won her court case.)

But Smith trips himself up in the argument. Using the Lebov/Delury story - Delury was found to now have assisted his wife according to her will but in exasperation at the grueling work as caregiver - as an example of what will happen now that British laws have been adjusted - a bitter husband killing a suffering patient because of the trauma of care taking (the traumatization of Delury is something Smith chooses to brush over). Smith writes:

What do these guidelines teach us about assisted suicide? First, "death with dignity" is not just about terminal illness: It is about fear of disability and debilitation. A husband assisting the suicide of his wife, who wanted to die because their son became a quadriplegic, would be prosecuted under the guidelines, but he wouldn't face charges for assisting the suicide of the son.

Second, the guidelines prove that assisted suicide is not a medical act. Nothing in them requires a physician's review or participation.

Third, the court ruling and guidelines illustrate how the rule of law is crumbling. What matters most today is not principle, but emotion-driven personal narrative.

But arguing against use of personal narrative, and using a personal narrative to do so, is a little unconvincing. In the bait and switch, Smith fails to account for the failure of medical or social services to address the trauma of care taking Delury suffered. And he fails to note that Delury was indeed prosecuted for his role in his wife's death.

By legalizing Death with Dignity in the US, oversight and regulation will be brought to end of life care. By making Death with Dignity a "medical act," doctors and other staff members will be able to intercept and treat suffering patients and counsel burdened and traumatized caretakers. It is more regulation, discussion, and transparency that is needed in end of life care, not more opacity. By reforming health care to cover even the neediest of patients and by practically and maturely addressing end of life situations, greater regulation will prevent situations like that of Lebov and Delury.

In Britain, revising the laws on assisted suicide - though the revisions are imperfect - applies stricter oversight and prosecutorial reach on those who assist their loved ones in ending their lives. Malicious actions are not common. Preventing them is, however, important. So is respecting the wishes of suffering patients at the end of life and honoring the role that care takers play in ushering their loved ones to a humane end. I regret that Smith is unable to see the necessity of personal narrative in this debate.

For an ethicist, Smith seems to have sadly lost sight of argument logic as well.

New Targets in the Culture Wars?: Have British Doctors No Moral Backbone?

The Right is aghast at the recent events regarding assisted suicide and end of life care in their country. Women and doctors became their targets in the abortion battle. Who will be their targets in the battle over assisted suicide?

This summer Debbie Purdy, a multiple sclerosis patient, won a court case that would permit her husband, Omar, to help her leave the country for assisted suicide - which is illegal in Britain. The case asked for clarification of the 1961 Suicide Act. The Director of Public Prosecutions (DPP), in response to the Purdy case, was last week forced to clarify their position on how and when those who assist loved ones to commit suicide may be prosecuted. They have suffered deep and angry criticism.

British columnist Gerald Warner takes to task the creep of a "death culture" in today's Telegraph regarding the recent case of Kerrie Wooltorton. A 26 year old who was depressed over her inability to have a child and had attempted to commit suicide 9 times this year, Woolorton successfully committed suicide this week.

Wooltorton consumed poisons in her home, called an ambulance, and showed all medical staff her living will. She wished to be kept comfortable but not to be saved. In the wake of the Purdy case and new DPP guidelines, Wooltorton was not flushed of poisons this time. Doctors, fearing litigation under the 2005 Mental Capacity Act which allows patients to determine which types of lifesaving treatments they may receive, abided her wishes. From the DailyBeast:

In addition to her letter to medical personnel, she made her wishes verbally clear—at the inquest a coroner found that she "had the capacity to consent to treatment" but "refused such treatment in full knowledge of the consequences.

Warner echos many of the same arguments that we hear from the Right in the US regarding what he calls a society "perverted beyond all coherence, morality or even sanity." To blame are: the creep of socialized medicine; doctors who have lost their moral way; unclear lines regarding sanctity of life; an overzealous court system; the assertion of personal rights over the good of a (Christian) society; a permissive and blind media. He even manages to knock science and it's "climate change nonsense."

Because the Right, not only in the US but in Britain, Canada and other countries struggling with end of life concerns, has drawn their own goal posts in the discussion, setting the beginning and end of life according to their beliefs, the culture wars that began with the legalization of abortion (in the US in '73 and in Britain in '67) are being renewed in new territory. The concept of "whole cloth" fostered concerns of a "slippery slope," meaning the "compromise" of one area of the sanctity of life, from "womb to tomb" as Warner says, would lead to a total moral collapse of society. In the abortion culture wars, women and doctors were the targets, the corruptors of society.

Compromise over abortion has never come, despite the recent talk in the US of a (non-existent) "middle ground." A renewed Right in both Britain and the US challenges not only abortion but contraception (forcing them to side with doctors in a fight for conscience clauses); the suffering of the dying is a new battle ground in issues of health care reform, medical technology, and individual rights. Rather than face the failings of the medical industry (corporate entities with vested interest in prolonging the lives of the dying), the Right has chosen to couple "euthanasia" with abortion as two absolute poles on an eroding societal compass. Blaming women and doctors for abortion was easy; now the odd job of assigning blame for assisted suicide comes. It is a convoluted task, complicated by the political positioning in the US on health care reform, and in Britain by the court and government's hesitancy.

Wooltorton's death is a grave tragedy, without doubt. A woman alone, depressed, suicidal. One must ask what kind of treatment for depression and fertility she received after each of her prior nine suicide attempts. But I liken her case in the recent assisted suicide landscape to perhaps the murder of Dr. George Tiller: an anomalous, horrible tragedy not claimed as just by the majority on either side but used - grievously, disgustingly - to perpetuate the rancor of the culture wars.

Tiller was brutally harassed and murdered by those who held to the greatest extreme on the Right. I wonder who Warner's blind lashings will help to focus zealots on: doctors? court justices? politicians? Assisted suicide forms a new front in the culture wars. How the Right chooses to work their machine, created to oppose abortion and now employed to enforce the way those in pain die, is yet to be seen. We know who Warner is stirring up with his over-the-top rhetoric but we don't know yet who their targets will be.

Warner closes:

But English law no longer defends the weak; it is the plaything of self-consciously “progressive” busybodies, pseudo-moralists, bluestocking baronesses and knee-jerk opponents of the vestigial remnants of the Judaeo-Christian ethic. Welcome to Brave New World.

UPDATE: John Smeaton, director of the British Society for the Protection of Unborn Children (SPUC) urges prosecution of doctors in the death of Kerrie Wooltorton.

Death with Dignity Clarity in Britain.

Debbie Purdy, a British patient with Multiple Sclerosis, won a case in June that allows her to seek assisted suicide without the threat that her partner, Omar, will be prosecuted for his assistance.

This week, the House of Lords hopes to clarify their policy:

The director of public prosecutions, Keir Starmer, has drawn up an interim policy aimed at clarifying the law for people who want to die and are assisted by a "compassionate partner".

"This policy will cover assisted suicide wherever it takes place, including in England and Wales," Starmer told the Guardian. "It's a question of steering the right line between protecting the vulnerable, and not prosecuting in those cases where most members of the public would think it really isn't appropriate to prosecute."

Starmer hopes the new guidelines will help to clarify the Purdy ruling and lay clear regulations for those who assist terminal loved ones to hasten their death.

More on Kier Starmer, Director of Public Prosecutions, here.

More from the "pro-life" side of things from Wesley J. Smith who loves democracy until the public oppose his views and from John Smeaton, director of the British Society for the Protection of Unborn Children and a party in the case against Debbie Purdy.