New book examines divisive and controversial issue of assisted dying


BOOK OF THE WEEK 

The Inevitable: Dispatches On The Right To Die

By Katie Engelhart (Atlantic £15.99, 352 pp)

‘My body served me obediently for 80 years, but is now, quite suddenly, in every sense, unserviceable and well past its sell-by date.’

That was the judgment of Avril, a retired professor from Devon, one of Katie Engelhart’s interviewees in this compelling book about assisted dying.

The subject is coincidentally back in the news after the eminent neurosurgeon Henry Marsh, who has advanced cancer, said last week that he wanted the ability to ‘choose how, where, and when’ to die.

The current law ‘insists instead that I must suffer’. He has called for an inquiry into the issue, backed by more than 50 MPs and peers from all political parties.

Assisted dying is back in the news after the neurosurgeon Henry Marsh (pictured), who has advanced cancer, said that he wanted the ability to 'choose how, where, and when' to die

Assisted dying is back in the news after the neurosurgeon Henry Marsh (pictured), who has advanced cancer, said that he wanted the ability to ‘choose how, where, and when’ to die

Avril had no fatal illness, but she did have multiple problems.

One was incontinence. She had to wear nappies, and used a chamber pot so often during the night that by the morning it was too heavy for her to lift, meaning she had to drag it to the bathroom and ‘use a long-handled soup ladle to spoon the urine into the toilet’.

Avril — a lucid and eloquent woman — decided that her quality of life was now so low that she wanted to die. She asked several doctors for ‘a nice handful of barbiturates’. Assisting people to die is illegal in this country, so they refused.

One later visited her at home and explained, in tears, that he wanted to help, and had consulted a medical lawyer (at his own expense) to see if there was anything he could do. The lawyer said there wasn’t.

So, after careful research, Avril ordered a supply of lethal medication from a foreign company. Before she could take it, however, the police raided her home and refused to leave until she handed over the bottle. (They were acting on a tip-off — other customers of the company around the world were also raided.) Avril complied.

The police went on their way. What they didn’t know was that Avril’s bathroom cupboard still contained the second bottle she’d obtained in a separate order.

Opponents of assisted dying argue that while stories like Avril’s are undoubtedly powerful, enshrining a ‘right to die’ in legislation will soon make it a ‘duty to die’. 

Anyone who is seriously ill, perhaps even just frail, will feel pressured to choose death, rather than delay and deplete their loved ones’ inheritance.

But Henry said that the current law 'insists instead that I must suffer'. He called for an inquiry into the issue, backed by more than 50 MPs and peers from all political parties (stock image)

But Henry said that the current law ‘insists instead that I must suffer’. He called for an inquiry into the issue, backed by more than 50 MPs and peers from all political parties (stock image)

Not Dead Yet, a U.S. disability rights group, says that assisted dying laws ‘pose an implicit challenge to disabled people: ‘Why are you still here? Still burdening us by living?’

But you could say that it’s the other way round: modern medicine now keeps people alive for so long that the American constitution’s ‘right to life’ has become a ‘duty to live’. Doctors always cite their oath to ‘first do no harm’. This has traditionally included refusing to assist in death.

But couldn’t it also mean acting to reduce pain and suffering?

As one of Engelhart’s interviewees says of doctors: ‘Their whole education is ‘Save a life! Save a life! Save a life!’ Sometimes they forget what terrible shape people are in.’

Then there’s that word ‘dignity’. In 2019, Pope Francis and other religious leaders issued a joint declaration condemning euthanasia as ‘against the dignity of the dying patient’.

Archbishop Desmond Tutu would disagree: he has said he wants the option of an assisted death. And Maia, an American woman in her 30s suffering immense pain from multiple sclerosis, tells Engelhart that ‘as a person of faith . . . I believe the soul travels on and wants to be free from this prison that has become my body’.

Certainly those who talk about dignity cannot ignore cases like Avril’s. And that of Diane Pretty, the Luton woman paralysed from the neck down by motor neurone disease.

In a new book, Katie Engelhart interviewed Avril, from Devon, who decided her quality of life was so low that she wanted to die

In a new book, Katie Engelhart interviewed Avril, from Devon, who decided her quality of life was so low that she wanted to die

She wanted her husband to help end her life, but worried about him being charged with murder. So she took her case to court. It was finally rejected in April 2002, but by that time Diane was close to death anyway. She died a month later ‘after days in terrible pain’.

An alternative is offered by doctors like Lonny Shavelson in the U.S., who helps Californians take advantage of their state’s assisted dying laws.

Relatives sometimes tell him that the patient’s final moments are the first time they’ve seen them comfortable in years. (Shavelson’s nurse says of one mainstream doctor that ‘he will pry the lid off a coffin to try another treatment’.)

Natural deaths, argues Shavelson, often happen when a relative has left the hospital, or just popped out of the room. With a planned death everyone can say goodbye properly, even compose their final words.

And, of course, there are safeguards. In California you must be diagnosed as having only six months or less to live. In Oregon it’s the same, and the patient has to make two oral requests at least 15 days apart as well as a written one.

Canada has no six-month rule — the death need only be ‘reasonably foreseeable’. In Belgium, Luxembourg and the Netherlands, assisted dying is allowed if several non-fatal complaints combine to make life unbearable.

Without the option of help, some people try to kill themselves. A successful suicide usually means a traumatic death, while a failure can mean paralysis or a ruined liver. But having the opportunity to end your life more easily, we learn, can paradoxically keep people alive.

A Belgian doctor tells of a 40-year-old woman who requested euthanasia. The medic discovered that the patient was autistic, and asked her to undergo therapy. The woman agreed, and is still alive several years later. Without that first appointment, she thinks she would now be dead.

Assisted dying is always described as a ‘very difficult subject to talk about’, which in my view sums up the whole problem. Why the hell should it be?

Death is the only thing that’s certain in life (hence the book’s title) — and yet hardly anyone wants to discuss it. Engelhart is a wonderful exception, and her book is superb: well-reasoned arguments with absorbing personal stories.

And Avril? She did indeed take her own life in the end, after saying goodbye to all her friends.

She also left a note for whoever bought her house, urging them to carry on using her handyman Geoff because he’s very reliable.

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