Come on up to the House: The politics of dying


James Maxwell

Next year, Margo Macdonald MSP will attempt to legalize assisted suicide in Scotland. She has drafted a bill that, if turned into law, will for the first time allow a terminally-ill or severely disabled adult the opportunity to request that a medical professional prematurely induce his or her death. Only two other European nations — Switzerland and the Netherlands — carry similar statutes, and in both those countries debate remains pointed and polarized.
For Margo, who herself suffers from a degenerative disease, the issue is not one of endless moral complexity. Individuals should be free to choose the time and the place and the manner in which they die. Certainly the state has no place forcing people to exist in a condition they find unbearable, or below a set minimum standard of dignity, if it can be avoided. She summarizes her position succinctly: “I believe in the autonomy of the patient concerned.”

It is this idea of autonomy — of independent agents pursuing what they feel is best for them — that informs and directs Margo’s campaign to change current legal policy; policy she believes often serves to prolong and intensify suffering. If she successfully persuades a majority of Scotland’s 129 MSP’s to back her bill, it could signal a dramatic shift in the way we relate to and correspond with the state.

Margo, though, is keen to stress that her bill will not have as radical or disruptive an effect as one might assume. In fact, she says, very little will change for the vast majority of people currently receiving palliative care: “(Things would change) just for the people who find their life at the end to be intolerable, it would change for them. It would mean they would miss out on a bad death, just lets call it a bad death…but I don’t know that it would change for anyone else because even those people who want to end their lives would start out on a palliative care regime.”

The criticism most frequently leveled at the ‘right-to-die’ movement is that, were assisted suicide legal, unscrupulous family members would bully or coerce their frail relations into an undesired suicide for financial gain. Margo counters, “If you have the sort of the safeguards that [my bill has], the elderly or vulnerable person is better protected that they are present because they would have a doctor who would be duty bound to keep an eye on their circumstances. That is not the case with doctors just now. With elderly or vulnerable or progressively ill people, they [the doctors] are not obliged to keep an eye on their social well-being.”

Margo also dismisses the suggestion that legalizing assisted suicide will have serious disbenefits for the quality of palliative care in Scotland: “Rubbish. Rubbish. Only a very small percentage of people, whether they are on palliative care or not, only a very small percentage will want to end their lives That is what we find and it’s roughly the same percentage [across Europe]. There are not loads and loads of people in Holland say and practically none in Belgium [who choose to die]. It’s very, very similar.”

Seeking to nullify the hostility with which her proposals have been met, Margo adopts a uncharacteristically tentative and conciliatory approach: “All you have at the moment is a clash of faiths or ideologies or philosophies, but my bill is meant to be a practical measure. [Up until now all] we’ve had is ‘this is a decision for god and god alone’. For people who have that sort of faith, fine, I’m not trying to dissuade them…but for people who don’t share that kind of belief, they must be respected as having a value system that is worth, in terms of their rights before the law, as much as the traditional faiths.”

Margo is here referring to the elevated status the religious lobby has traditionally enjoyed (and continues to enjoy) in public discourse in Scotland. “The churches,” she says, “still have a respected and honored place; they still have a status, I think, in terms of their opinion and their power among the opinion makers.” Indeed, the Christian establishment has used its considerable, though now largely unwarranted, influence to campaign against any relaxation of the law governing medically assisted death in this country.

Margo suggests that there is a discrepancy between what many of her fellow parliamentarians believe is the appropriate legal course to take, and what they are willing to do and say publicly on the issue. She attributes this discrepancy to the distorting effect religious dogma has had on the debate. She says, “In the parliament there are complications because although a lot of MSP’s may not have a great faith themselves, a lot of their constituents have, so they do not want to be too out-of-step with their constituents.”

She continues, “There is no doubt about it… that faith — not just the Christian religion, it’s mirrored in Islam, it’s mirrored in the Jewish community as well — underlies much of, most, it underlies most, of the discussion… that there’s been up until now and I would prefer not to debate that because that’s not what the bill is about…it is to make sure that we are all given equality of respect.”

Putting the pious interjections of faith-based groups to one side, it is not hard to see why the idea of state sponsored suicide clinics — of NHS workers sanctioning and facilitating the deaths of those they claim to be caring for — discomforts so many people. Some fear that it might alter the nature the health service, others that it could place far too much power in the hands of an impersonal authority, and others still that it could endanger the lives of those patients incapable of clearly articulating what kind of treatment they want.

Gordon Macdonald (no relation) — Scottish policy officer and parliamentary lobbyist for the pressure group Care Not Killing — locates his opposition to the legalization of assisted suicide in the development of the human rights in tradition in the West: “Certainly, in human rights legislation up until now, in human rights doctrines…there has been no such right [to medically assisted suicide] recognized; the only right that has been recognized has been the right to life, and nobody has sought to extend that.”

He goes on, “The European Court of Human Rights has rejected the cases that have been brought to them in relation to assisted suicide and euthanasia. The whole framework of western society’s values over a number of centuries [has drawn] the line fairly clearly and said, ‘well we respect the right to life but we do not say that people have that right to determine the time and manner of their death.’”

Indeed, Mr. Macdonald goes to the extent of drawing a parallel between the fundamental moral underpinnings of the right-to-die movement with some of the worst excesses of Nazi sadism in the 1930s and ’40s: “I think what the Nazis did was a grotesque and extreme extension of the philosophy that started in the medical profession in Germany of essentially killing disabled children, and that doesn’t mean that if we legalize assisted suicide we’re going to end with concentration camps again, but it is the same root in terms of philosophical position, and that’s the problem.”

“The problem will be that if you legalize assisted suicide, there will be people who will not be asked [if they want to die]. Certainly, if you look at the Netherlands in terms of euthanasia, what we see is, you know, a thousand cases a year of people who have not given explicit consent and yet were euthanized.”

Here, however, Mr. Macdonald’s argument falters. What Margo has designed her bill to do is extend and enhance the control people have over the circumstances of their own demise; at base, to give individuals greater powers of self-determination. In this sense, the right-to-die movement stands in stark opposition to the authoritarianism of the National Socialist experiment. The legalization of assisted suicide could even come to be thought of as an important step forward in the progress of the human-rights tradition that Mr. Macdonald holds in such high regard.

But in fact for Mr. Macdonald it is a step too far. He views “the desire of some people to have absolute control and autonomy” as indicative of a rampant individualism that itself threatens to erode the legal safe-guards that support and protect people susceptible to the pressures of greedy or malevolent relatives.

He says,“[just] Because Margo Macdonald, say, is a strong person who is very forceful and who has a very clear view on this subject — she is pursuing this because she wants that option for herself, you know, she’s quite explicit about that, there’s certainly a vested interest here — because she is pursuing it for that reason, it will affect people who are not as strong as her, who are more vulnerable…who are being bullied, and that is a problem.”

Perhaps there is some weight to Mr. Macdonald’s objections. The scenario he presents is certainly credible. But if Margo’s bill contains, as she claims it does, effective regulatory mechanisms that would work to shield patients from predatory peers, there is nothing left of his opposition, principled as it is, that holds any real substance. It is not unfair, then, to suspect that Mr. Macdonald’s opposition is actually rooted in some deeper, undisclosed value-judgment.
For obvious reasons, death is a subject of extreme cultural sensitivity. When it becomes a political issue popular opinion tends to split into two irreconcilably opposed camps: those who assert the primacy of individual autonomy, and those who insist on the sanctity of established ethical standards. What results when these groups conflict is a tribal stalemate; a normative deadlock with no negotiable resolution.

The chances of assisted suicide being made legal in Scotland within the life-span of the current parliamentary session are slim. For Margo’s bill to successfully pass through all the necessary stages of legislative scrutiny, MSP’s will have to suspend their individual moral predispositions and judge it solely on its practical merits; on the tangible benefits it could have for ordinary people seeking to control the terms and conditions of their own deaths. Given what is at stake, such rigorous pragmatism is, unfortunately, highly unlikely.


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