Death as an option and an entitlement would fundamentally change the way we think about mortality, warns Gordon Brown.
Many times in the past 80 years, Parliament has considered – and rejected – the legalisation of assisted suicide. If, in the wake of revived debate on these matters, a new proposal were to come forward, I do not believe the outcome would be any different.Cases dominating the public arena make for harrowing reading and the first and most obvious response is to say that something must be done. But when these complex, individual and distressing cases are considered in detail, a solution that at first might seem sensible – the right to die in a manner and at a time of one's choosing – swiftly becomes less straightforward and more worrying.
I believe that people are drawn to support the right to assisted suicide because of fears about how they will be cared for when they are dying. They ask themselves: Will I be left alone? Will I suffer pain? Will I lose my dignity and my individuality? Will there be no one there to care for me? Will I be kept alive and subjected to tests and treatments that will do little good and serve only to extend the process of dying?
I believe that we should look more closely at such fears and what has been done to address them.
One of the greatest developments in medicine in recent times has been the rise of the speciality of palliative care – something I learnt a lot about when researching an essay on Dame Cicely Saunders, who pioneered hospice care in the last century.
Appalled by the fate of "incurables", and their abandonment by medicine, she showed through ground-breaking research and relentless campaigning how the last months of someone's life could be pain-free, dignified and worth living. Palliative care, in great part thanks to her efforts, has now become part of mainstream medicine.
I was fascinated to discover that Lord Raglan, who had tried in vain to promote a Euthanasia Bill via the House of Lords in 1969, later publicly debated the issue with Dame Cicely. After he had heard her talk, he graciously conceded that, if he could be sure he could be looked after by her and her team, he would cheerfully abandon all his efforts to legalise euthanasia.
We still have to do more to ensure that more people can have such care in their own homes, but I believe that a duty of government is to minimise the fear of dying badly.
Great progress has also been made to reduce the fear of over-treatment, when interventions might be uncomfortable and unhelpful, and only serve to prolong life without maintaining quality. People can now make advance directives that give them the control and the power to determine, when they are well and of sound mind, their treatment in changed circumstances.
Doctors are also more attuned to carrying out the wise advice of a senior medic to his junior:
"Heal the sick, comfort the dying – and don't get them mixed up."
But these are all difficult issues and we should remember that at the heart of each case is a family in tortured circumstances, which has to make the most agonising of choices.
This complexity has been recognised. Keir Starmer, the Director of Public Prosecutions, will tomorrow be publishing his final policy clarifying the factors to be considered in prosecution decisions on cases of encouraging or assisting suicide. It is for him to make clear his approach and the Government has not made any representation to him.
Following this clarification, and because of some important developments in care over recent decades, the case for a change in the law is now weaker.
The law – together with the values and standards of our caring professions – supports good care, including palliative care for the most difficult of conditions; and also protects the most vulnerable in our society. For let us be clear: death as an option and an entitlement, via whatever bureaucratic processes a change in the law might devise, would fundamentally change the way we think about mortality.
The risk of pressures – however subtle – on the frail and the vulnerable, who may feel their existences burdensome to others, cannot ever be entirely excluded. And the inevitable erosion of trust in the caring professions – if they were in a position to end life – would be to lose something very precious. For when I think of the kind of care Sarah and I saw in our local hospice, where we worked as volunteers, I know in my heart that there is such a thing as a good death.
And I believe it is our duty as a society to provide the skilled and loving care that makes it possible; and to use the laws we have well, rather than rush to change them.