“A question of when not if,” the British Medical Journal (BMJ) states, in a peer reviewed editorial on the subject of assisted dying. It calls upon doctors and their representatives to drop opposition to it in favour of a position of “engaged neutrality”, a concept that emerged from across the Atlantic. Accompanied by seven other essays, opinions and features, the clear intention is to show exactly this engagement ahead of the annual meeting of its publisher, the British Medical Association, from which it enjoys editorial independence.
But neutrality? What the BMJ has done doesn’t look much like that from where I’m sitting. You can start with the headline – “A question of when not if” – which implies that the debate is done. The editorial goes on to argue that “doctors should not obstruct a decision that is for society and parliament”, as if a policy of principled opposition to the idea is doing that.
As well as some broadly neutral pieces calling for research and summarising positions, there is an essay looking at support for the idea from within a religious community traditionally seen as being among its fiercer opponents, emotively entitled, “There is nothing holy about agony”, as if that’s the sole issue here.
There is also an opinion from “disability rights activist” Stephen Duckworth who says he wants “control over” his body while lambasting the objections from his community. Duckworth says that he is “deeply troubled by the persistent narrative that disabled people have something to fear from a change in the law on assisted dying.
“I also find it immoral that disabled people are exploited by those with principled opposition to law change. Disabled people have fought relentlessly to have their own voices heard in society; we should never be used to front somebody else’s cause.”
Huh? Take it from this disabled person, I’m not fronting for anyone on this subject. In fact, I find myself rather uncomfortable with some of those I’m theoretically aligned with, particularly the conservative religious groups who are arguing from a very different perspective.
It is also quite wrong of Mr Duckworth to say disabled people have nothing to fear. You only have to read the March report of the Care Quality Commission into the scandalous way do not resuscitate orders (DNOs) were applied to Covid patients without their knowledge or their carers’ knowledge to see that. The regulator found this to be “a particular concern in relation to people who are disabled”.
Those of us with disabilities were given still more reason to feel fear by the revelations that the government had been asking the question “who do we save” when its decisions had left hospitals at real risk of being overrun in the early days of the Covid crisis.
The truth is that the voices of disabled people aren’t being heard in society because we are viewed as second class citizens by large parts of it, up to and including the government and its ministers. That hard fact informs scandals like the one the CQC reported on. A mockery of a national disability strategy only adds to the weight of evidence. This is precisely why assisted death is widely feared by the community.
It is deeply regrettable that the BMJ failed to engage with this side of the debate, although it did offer an essay from a Danish doctor and ethicist putting a learned case against it.
However, it has in the past published the views of Baroness Jane Campbell, who noted in February 2019, prior to the Covid DNO scandal, that, “not a single organisation of, or for, disabled people, or one representing people with long term health conditions has campaigned for assisted dying to be legalised”.
I shall quote Campbell, a founder of the campaigning group “Not Dead Yet”, at length here in the hope that it will encourage some of those debating the subject at the BMA to bear her arguments in mind.
“It is hard to be positive as a disabled person, especially when the media is full of stories of abuse, neglect, cut-backs, and overstretched resources. Even when medical and social care are at their best, our fear of the future remains,” she stated. “Given this context, it is unsurprising that some patients develop suicidal thoughts, which perhaps will be endorsed by family, friends, and members of the medical team. A change in the law would thus permit the focus to switch from preserving life to ending life.”
I’ll wrap up with this: liberal opinion is opposed to the death penalty and with very good reason. The problem with it has been thrown into sharp relief by the work of the Innocence Project in the US, which notes that 18 people exonerated through post-conviction DNA testing had been sentenced to die. The innocent have no appeal against a death sentence after it has been carried out. There is no coming back from it. It cannot be changed, or reversed, in response to a change in circumstance.
The same is true of assisted dying. After the procedure has been carried out it is too late for a medical innovation, or a favourable benefits tribunal ruling, or for a family member to step up and say, “This is wrong, I’m going to care for my relative and improve their situation.” This explains why the procedure is so dangerous, regardless of any safeguards that may be proposed, which would inevitably be subject to change.
Opponents of capital punishment often question of the morality of the state killing people. Why is hastening along the death of those who may have been driven into the deepest of depression not so much by their conditions but by their situations and society’s unwillingness to address them, any more moral? Why do 70 per cent of palliative care doctors – those at the sharp end of this – oppose the procedure?
Before suggesting doctors to go down such a dangerous road, the BMJ should reflect upon that. This is a matter of right and wrong. Neutrality, engaged or otherwise, is simply impossible.
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