I’ve made up my mind on the acute issue of assisted dying

Advances in medical science have made it possible to extend human life well beyond the point where it is worth living

The introduction in the Scottish Parliament of a Bill to authorise medically assisted suicide has turbocharged a debate that has been going on for centuries. Nearly 2,000 years ago, the Roman philosopher Seneca described suicide as the last defence of the free man against intolerable suffering at the end of life. “It makes a great deal of difference,” he wrote, “whether a man is lengthening his life or only his death…”

In modern conditions, the problem is more acute than it was in Seneca’s day. Advances in medical science have made it possible to extend human life well beyond the point where it is worth living. It is often extended beyond the point where a person is capable of putting an end to his or her life without help.

In our highly regulated and institutionalised world, help is usually not available. It is a criminal offence to help someone to kill themself. Evasion of the law is difficult. We can no longer make these difficult end-of-life choices informally, with the support of family and a friendly GP, as people have done time out of mind, without officious strangers looking on.

To modern-day campaigners for a change in the law, the question seems easy and the answer obvious. Change the law. Yet these people oversimplify a complex moral dilemma. The issue involves a clash between two of the most fundamental values of humanity.

The first is our reverence for human life. We instinctively feel that life has an intrinsic value, whether or not it is valuable to the person concerned or to anyone else. This is why the law has never recognised the consent of the victim as a defence to murder. The second is our respect for the autonomy of our fellows. People are masters of their own fate. Compassion for their suffering and a basic respect for their dignity require us to let them make their own decisions about the timing and manner of their death when they are terminally ill.

Since there is no way in which these contradictory instincts can be reconciled, both sides of the debate tend to resort to more utilitarian arguments. They argue about the effectiveness of palliative care, about how oppressive the current law really is, and about the “slippery slope” that might lead to a general licence for euthanasia. A lot of this debate is unedifying. Those who want change tend to exaggerate the problems of the current law, while their opponents make light of them.

There is only one utilitarian argument that really counts, but it is a formidable one. It is the pressure which may push the old and terminally ill to do away with themselves too readily, even if they are fully competent mentally.

The problem is not that they may be manipulated into giving their consent by unscrupulous heirs. It is what is sometimes called “indirect social pressure”. This arises from the low self-esteem of many old and sick people who find themselves dependent on other people. It is aggravated by negative public attitudes to old age.

Many old people spontaneously assume that their lives have become a burden to those around them. It can lead them to place a low value on their own lives, and to assume that others do so too. These feelings of uselessness are likely to be particularly acute in those who were once highly active, for whom the contrast between now and then can be painful.

The pressures will inevitably become more powerful in a world where medically assisted dying is normalised, and has become just another optional end-of-life choice. It is hard to distinguish between those who have voluntarily decided to kill themselves and those who have decided in response to real or imagined pressures arising from the impact of their disabilities on other people.

The Scottish Bill, if it is enacted, would require the prognosis of the patient and the voluntary nature of his or her decision to be independently assessed by competent medical practitioners. Procedural safeguards like these will not eliminate the problem of indirect social pressure. But it will limit it. There are no risk-free options in this area. The real question is how much risk to vulnerable people are we prepared to accept in order to facilitate suicide by those who are fully informed, mentally competent and determined to end their lives.

After much hesitation, I have come to the conclusion that on balance a change in the law is morally justified in the case of terminally ill patients. I would not want to see it extended more widely. I have had personal experience of two cases involving people close to me. Let nobody tell me that this is a straightforward issue or a clear moral choice. It is not.

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