It's a grim dinner party conversation that most of us have indulged in at one time or another. "If I were in that state," we say, "I wouldn't want to be kept artificially alive. I'm telling you now: if that happens, turn me off." For most of us it is, if not exactly a glib discussion, at best an intellectual conceit – a bit like the parlour game of deciding which historical figure to throw out of the hot air balloon.
It has not been a game for Dame Elizabeth Butler-Sloss, the judge who has spent the last weeks tussling with the question of whether the woman known as Miss B has the right to switch off the ventilator which is keeping her alive, paralysed from the neck down, with only a 1 per cent chance that her condition might ever improve. Nor was it an intellectual conceit for the woman herself who has been battling for "the right to die" for almost a year.
The judge's decision to "permit the woman to end her life peacefully and with dignity" involved cutting through a formidable tangle of legal rights, moral precepts and highly-charged emotional statements.
In one sense the legal considerations were the least problematic. The law is clear that any patient has the right to refuse medical treatment, unless they lack the mental capacity to make such a decision. Not that this was straightforward; two psychiatrists had pronounced her mentally competent, and then reversed their findings.
Yet what the court case made clear to anyone who followed it was the balance and lucidity of the woman's mind. She had surfed the internet and conversed with other ventilated quadraplegics about the difference that rehab schemes and high-tech aids had made to their life. She had heard warnings from those who said that they had nursed feelings of suicide, often for a decade, but had come to take pleasure once more in being alive. Yet her resolve was unchanged. Nor did she come across as a woman obsessed with the process of fighting the authorities. It did not seem the battle to die was what was keeping her alive.
Which brings us to morality. Interestingly, the woman revealed yesterday that she was a church-going Christian. "The dominant view in the church is that I should wait for God to heal me," she said in a statement. "Withdrawing ventilation would be seen as throwing in the towel. I have questioned myself about this and it has challenged my integrity. I have come to believe that people die and become disabled and God does not always intervene."
What she reveals here is an evangelical worldview focused on healing and divine intervention. There is another religious perspective. It suggests an individual does not have complete authority over their own life; that we also have obligations of solidarity to family, community, and wider society.
Miss B went some way to acknowledging this when she told the court that, though she has never married and has no children, she would not like to switch off the ventilator herself – if a device could be rigged up – because that would look like suicide. She did not want that burden to be placed upon her teenage god-daughter and her loved ones.
"It is also not necessary for my church to be worrying about whether it was suicide or not," she told the judge. "Of course, you do not care what people think when you are dead, but in a way you do because it goes towards your character and your integrity, and I think it does matter."
And the judge herself acknowledged a similar sense of the mutual bonds between the individual and society when, in her judgement, she added of Miss B: "I hope she will forgive me for saying, diffidently, that if she did reconsider her decision, she would have a lot to offer the community at large."
Yet this theological perspective admits that grave fear of suffering has a material effect on decision-making here. Discontinuing medical procedures that are burdensome, dangerous, extraordinary or disproportionate can be legitimate; as is the refusal of over-zealous treatment. Decisions on such matters should be made by the patient if they are mentally competent.
What the court has essentially decided – and which this view of morality would uneasily concur with – is that Miss B is sane enough to be accorded the right to refuse medical treatment. This is far from the same as granting that she has "the right to die", as it is interpreted by enthusiasts for euthanasia or the right of Diane Pretty's husband to assist her to commit suicide without fear of prosecution. This difference is not immediately obvious because Miss B is conscious and in a stable condition – with the potential to live for decades before dying.
But a more pernicious principle has already been set by the law when it sanctioned the killing of Hillsborough victim Tony Bland, whose life was ended by withdrawing food and water rather than medical treatment – even though, being in a "persistent vegetative state", he was in no position to protest about it.
So yesterday Dame Butler-Sloss made the correct decision. Legally Miss B has the right to have the ventilator turned off, when she can find someone who will do it. (Her existing doctors equally have the individual right to insist that they personally will not do it). Morally she has to be given the space in which to exercise her free will to make a right or wrong decision. But emotionally, those who have admired how she has conducted herself throughout the whole process will have to hope that, now the decision is hers alone, she will change her mind.Reuse content