Andrew Grey responds to Polly Toynbee’s argument that a right–to–die law is the only way to prevent another Gosport.
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The appalling Gosport scandal, in which 650 people died from overdoses of pain–relieving drugs, should make professionals, policymakers and the public cautious about the end of life. People’s deaths are precious and professionals must have no more power over them than is necessary.
Yet Polly Toynbee has argued for the opposite – more power for professionals – by advocating the legalisation of assisted dying. Despite accusing people of being ‘quick to use the Gosport scandal’ to oppose assisted dying, Toynbee has leapt on the story to write another article campaigning for its legalisation.
Toynbee claims that legalising assisted dying would protect vulnerable people. But far from it, it would actually put them in more danger. The lesson of Gosport is not that people need to be able legally to choose an assisted death. It’s that professionals have no business intervening in people’s deaths beyond what is strictly necessary to give them comfort and support.
Good professionals who follow the rules know this. Every day thousands of people die in hospices, hospitals, care homes and at home, having what they and those close to them consider to be dignified deaths. To enable this, professionals have taken the time to build a relationship of trust with them, understand what they’re most worried about – pain, incontinence, unresolved conflicts with loved ones – and worked with the person and those close to them to alleviate these.
Crucially, they don’t intervene in people’s deaths by hastening them. They don’t give them overdoses, because their intention is not to kill them, it’s to make them comfortable. Toynbee is wrong to claim that making comfortable will become a euphemism for hastening death, and she risks misrepresenting the many honest medical professionals with integrity who don’t misuse drugs, but are instead fully committed to the comfort of those they care for.
If assisted dying were to be legalised, professionals would have powers far beyond these. How could we possibly ensure that these powers would never be abused? Of course, Toynbee (and other advocates of assisted dying) claim that these concerns are unfounded. This is because an assisted dying law (as proposed in the Houses of Lords in 2014 and Commons in 2015) would have all of the necessary safeguards: people would have to be terminally ill and mentally competent to make these choices. There’s no danger of this power being misused.
But this is at best naïve, and at worst deliberately misleading. Choice isn’t a panacea for negative influence; people can and do make choices with multiple influences. If assisted dying were legal, how could we safeguard against people feeling pressurised to make this choice? If those close to them send them the explicit or implicit message that they’re a burden, and overworked professionals happen to mention this easy way out, what’s to stop a person taking this option even when it’s not what they truly want?
More worryingly, Toynbee wants the law to go further and include people with dementia. They should, she argues, be able to consent to an assisted death ahead of time, while they still have the mental capacity to do so. But how can such a practice be implemented safely? Our decisions and choices change all the time – any palliative care professional will tell you that some patients ask for assisted dying when they’re feeling at their lowest, but change their minds when they’re feeling happier, more supported and valued. That’s what the professionals we interviewed for our Dignity at the End of Life report told us.[AS1]
Toynbee and other advocates of assisted dying caricature genuine fears and safeguarding concerns about people feeling pressurised to end their lives. They claim that people are just arguing ‘mainly for religious reasons’. But these concerns are real, and it’s dangerous to dismiss them in this way. Evidence from US states such as Washington and Oregon, which have very similar laws to the one proposed here by Dignity in Dying, shows that people fearing that they’re a burden is one of the biggest concerns of people who choose assisted dying. In the Netherlands one of the biggest motivations for people choosing this law is social isolation and loneliness. These are surely causes for alarm for anyone who cares about people who are dying.
If Toynbee and other advocates of assisted dying really care about vulnerable people, they shouldn’t use Gosport as a trigger for legalising assisted dying. Instead they should be advocating for palliative care to be properly funded, for transparency and accountability within organisations and in Care Quality Commission inspections, and for training to ensure that all staff are competent in palliative care. This, rather than an assisted dying law, is what will safeguard against abuse and premature termination of people’s lives.