We have learned in recent days of the personal tragedy and courage of Mr Richard Selley, a former head teacher from Perthshire, as he confronts the late stages of motor neurone disease. He plans to die by means of assisted suicide in Switzerland but is campaigning for the law to change in Scotland to allow assisted suicide here.
I have tremendous respect and sympathy for Mr Selley and his family at this difficult time. The physical deterioration that motor neurone disease causes is deeply distressing.
However, when reading his blog, I have been struck by just how alive he is. The liveliness of his mind, the sharpness of his wit, his eloquence and grit. In the awfulness of perhaps the darkest time in his life, we are privileged to catch a glimpse of who he is.
Currently the law prohibits the intentional taking of life by an individual or by the state. Why is that? Because of the incredibly high value and worth that society places on all human life, without exception.
The primary danger of assisted suicide is that individual lives are devalued by society because they are ill, disabled, confused or that their contribution to society is perceived to be minimal.
The secondary danger is that terminally ill and disabled individuals may begin to devalue themselves because of the burden that they perceive they are to society. In a cruel twist, possible legislation on assisted suicide, that is designed to empower, may have the effect of eroding the autonomy of the most vulnerable.
I remember, in my previous role, as a junior doctor in Glasgow, l looked after a frail man in his 60s with advanced lung cancer. He had no family save an estranged daughter. We talked about his love for his motorbike and of a time when he was homeless. The nurses were kind and made him laugh.
On the second round of chemotherapy he developed a deadly infection. Had he been too frail for chemotherapy? Perhaps. There was no one to say, ‘Dad’s not right today’. He would never have complained or asked for anything extra. We were all he had. He did not respond to our antibiotic treatment and died peacefully a few days later.
I remember sitting with him at the end because there were no loved ones. The nurses had tears in their eyes. Was it a good death? I believe it was, because even though he had no one else, he had been valued and cared for with respect by the very fabric of society. Would he have accepted euthanasia had it been offered? Maybe! Would he have felt pressurised to opt for doctor-assisted suicide, because no one was affirming the worth and value of his life? Perhaps he would. Pressure is subtle and affected by all sorts of difficult family dynamics, full waiting rooms, tired doctors. Patients feel a burden in all sorts of unspoken ways.
I understand the right for Mr Selley to make his own decisions. Patient autonomy is rightly revered. Doctors should value and respect their patients. They should value their patients’ priorities and experience and expectations. They should remember that they may have lost a grandchild in an accident or cycled round Ireland in their prime. Patient autonomy should guard against the relentless medical agenda of ‘this is best for you because I know best.’
But the principle from which autonomy is derived– the respect for another human being– is that which underpins the prohibition of the taking of life. What do we do when taking life clashes with patient autonomy? Ethicists struggle over this in different ways. However, it seems to me, for a community to flourish we must, at times, choose to give up our individual autonomy for the sake of us all.
Some individual suffering is terrible as well as prolonged and we question if there is any other way. But the value and worth of all human life must restrain us, as a society, from taking life.
Responsibility to and for others is the very stuff of friendship and family, of the doctor-patient relationship, of society itself.
Dr Gillian Wright, senior researcher at the Scottish Council on Human Bioethics.