It's not easy to choose a time to die

Lady Warnock's implication is that a dependent life is indeed a life that is not worth living

What a terrifying woman Mary Warnock is, with her vivacious energy, her intellectual vigour and her forthright moral certainty. The 80-year-old philosopher has really frightened the horses this time though, with her outspoken comments over the weekend on "hanging on".

What a terrifying woman Mary Warnock is, with her vivacious energy, her intellectual vigour and her forthright moral certainty. The 80-year-old philosopher has really frightened the horses this time though, with her outspoken comments over the weekend on "hanging on".

Baroness Warnock, Britain's most high-profile medical ethicist, used to be opposed to euthanasia, and in 1993 sat on a Lords select committee that was highly influential in hardening the law - and general attitudes - against it. Now, apparently after seeing a doctor assist her pain-wracked husband as he died two years later, she has changed her mind.

The manner in which she expresses her conversion, though, is unhelpfully doughty. "I know I'm not really allowed to say it, but one of the things that would motivate me [to die] is I couldn't bear hanging on and being such a burden on people," she declared uncompromisingly to a journalist. "In other contexts, sacrificing oneself for one's family would be considered good. I don't see what is so horrible about the motive of not wanting to be an increasing nuisance."

For obvious reasons, pressure groups like Age Concern are horrified by Lady Warnock's comments. Frail and elderly people quite often express their horror of "being a burden", usually in the fervent hope of reassurance that they are no such thing. The last thing senior citizens need right now - or indeed at any time - is a hearty octogenarian striding around and telling them that their worst anxieties are true, their neediness is shameful, and their lack of independence is nothing short of selfish.

The immediate legislative context of Lady Warnock's remarks is particularly uncomfortable. This very day the Commons debates the Mental Incapacity Bill, which has created controversy in some quarters because of its aim of legitimising "living wills". Living wills specify circumstances under which doctors can stop treating those who make them if they were severely injured or too ill to communicate. Highly controversially, withdrawal of treatment can be interpreted as ceasing to offer food or water to an incapacitated person, while the person given power of attorney under a living will can override the wishes of doctors, even if they believe the patient should live.

Support for some such provision in the law is high among the general public. Most of us believe that in the event of some massively debilitating illness, we would prefer to die with dignity than to be kept alive against our will. But those opposing the Bill are by no means hardline pro-lifers, with an unwavering belief in the sanctity of human existence no matter how pitiful.

Among those who do not support the Bill are the British Medical Association, the Royal College of Nursing, Scope (the cerebral palsy charity) and the Government's own Disability Rights Commission. Various reasons are given for opposition, chief among them the threat to normal doctor/nurse- patient relationships that the legislation may pose, the normalisation of the idea that some lives are not worth living, and the possibility of intimidating or frightening vulnerable people.

It's pretty plain to see that Lady Warnock's comments would not soothe the breasts of any of those who harbour such concerns. The latter two are writ large in Lady Warnock's attitudes, because her implication is that a dependent life is indeed a life that is not worth living. Widespread dissemination of such a view could, in turn, be used by an unscrupulous relative to put pressure on a vulnerable person to make a living will.

This, though, is not in the least surprising. Lady Warnock spoke out at the weekend in support of euthanasia, particularly in support of the assisted-suicide Private Member's Bill tabled by Lord Joffe in the upper house. The Mental Incapacity Bill, on the other hand, which is the Commons Bill that places Lady Warnock's comments in such a gristly context, is quite another matter.

Reviled by its detractors, and admired by its supporters (some of them anyway) as "euthanasia through the back door", in fact it is nothing of the sort. The Mental Incapacity Bill makes no provision for assisted suicide at all - drugs could not, if the Bill were passed, be given to prompt a comfortable end, for example, even though drugs could be withheld to hasten a miserable one.

All it really does - at least in this particularly controversial detail - is allow treatment to be withdrawn from people who cannot communicate their wishes because a while back, hypothetically, they imagined that in such circumstances that would be either what they might want, or what the person brandishing the will-form before them might want. With the right safeguards, living wills might be useful.

But those who wish to advance the cause of euthanasia would do well to treat these measures cautiously. It would be much better to win the argument for euthanasia through the front door, where the light is brighter, stronger and more certain.

Lady Warnock's comments, for example, in that light, look very different. Assisted suicide, when chosen by a person in full command of their mental capacities, is usually chosen by people who would find Lady Warnock's attitudes chiming with their own. Research by the Oregon Health Sciences University (Oregon being the only state in the United States which has passed assisted-suicide legislation) describes those who opt for euthanasia as people with a history of independence and self-reliance, courage and a strong will.

Lord Joffe's Private Member's Bill reaches out to those who are determined and lucid, who understand the consequences of their choices, and who deserve to be helped and supported in their desire to end their own lives. (It also supports those disabled people who are unable to commit suicide on their own, and who correctly argue that the Suicide Bill discriminates against them).

But it does not extend as far as to encourage or legitimise the frightening experience described by Jane Campbell, who is a commissioner for the Disability Rights Commission and does not support the Bill. Mrs Campbell has spinal muscle atrophy, a muscle-wasting condition, and last January contracted severe pneumonia. During her emergency treatment in hospital the consultants treating her clearly assumed that, as a disabled person, she would not want to be put on to a ventilator if her respiratory system failed. Only an impassioned plea from her husband changed their attitudes.

The point to be made is that those who want to see euthanasia becoming legal in this country, and working as an option for those who want it, should be most wary of this "back-door" option. The very nature of euthanasia means that it is a choice made by the most pragmatically courageous among us. Its legalisation should start by catering to those whose own cause is entirely unequivocal.

The Mental Incapacity Act, by its very nature, assumes instead that a person in one set of circumstances can always predict exactly how they might feel in another. This is a fraught and difficult area, far more difficult than that area inhabited by those in full command of their mental capabilities who wish to be helped to end their lives. Those who see the former as a lever in attaining the latter, are kidding themselves.

d.orr@independent.co.uk