A Point of View: The biggest decision

 
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A personal essay on a particularly controversial issue by the writer Will Self, arguing that we should accept the right of people nearing the end of their lives to take matters into their own hands if they wish.

This may seem rather shocking to you but I am expecting to kill myself.

Really I am, and if you'll hear me out I hope to at least nudge society in the direction of considering suicide acceptable when - and this is the important point - the alternative is a slow painful death from a terminal illness.

Why? Well, the facts are pretty persuasive when it comes to the business of British dying. We're living longer and longer, while our deaths are becoming commensurately more protracted.

Such is the brilliance of contemporary medical science, at least in our privileged realm, that we can be kept breathing long past the point where our existence is anything save miserable - miserable for us, miserable for our loved ones, and miserable for those who have been appointed by either by the state or a private health plan to minister unto us.

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Will Self
  • A Point of View is usually broadcast on Fridays on Radio 4 at 20:50 GMT and repeated Sundays, 08:50 GMT
  • Will Self is a novelist and journalist

Many, I'm sure, will disagree, having had positive experiences of care and kindness in hearth and home and hospice, but these experiences are far from universal.

There was a time, in the not so distant past, when either sepsis or infectious disease - or the very act of parturition itself - did for most of us considerably in advance of the biblically mandated "three score and ten". But nowadays the majority can reasonably expect to live long enough for senility to set in, and sclerosis or sarcoma to finish us off.

It's often said that there's an epidemic of cancer, or heart disease or Alzheimer's in our society. But what there really is an epidemic of old age itself, all these pathologies being merely its inevitable sequels.

What I am emphatically not proposing is that any given person of whatever age, or in any particular physical or psychic state, should kill themselves. I have friends in their 90s, who may be debilitated and depressed at times, but who nonetheless enjoy life intensely.

Often it seems to me that these aged ones have endured long enough that they are not so much hanging on to life as caressing it gently, in the awareness that this, like all bodily experiences, is, of necessity, transitory.

But what I do emphatically believe is that those who feel their suffering at the end of their days is intolerable should have the self-love needed to let go of their lives.

Some counter-arguments

  • Weakens society's respect for the sanctity of life
  • Implies that some lives (those of disabled or sick) are worth less than others
  • Start of a slippery slope, leading to involuntary euthanasia
  • Puts pressure on vulnerable people, and too much power in doctors' hands
  • Cheap substitute for proper palliative care of terminally ill
  • No way to regulate euthanasia properly
  • Religious argument that it is against God's will
  • If you have been affected by these issues, you could talk to your GP or someone at the Samaritans

Of course, for people of some religious persuasions, the notion that self-love entails suicide is anathema. For them all human life is inherently sacred, no matter that the body which lives this life is effectively mindless, or wracked by pains still transmitted by stubbornly vigorous nerves.

It's for this reason that in our society - one governed by Judaeo-Christian moral precepts - the suicidal individual was traditionally deemed felo de se (literally: "a felon of himself").

Nowadays, while we may take a rather more secular view of these matters - neither prosecuting those who, as it were, botch the job, nor quarantining for eternity the cadavers of ones who got away - nonetheless, the taboo against killing yourself remains so strong that few can dare to contemplate it, even in extremis.

And there are so many of us in extremis. As our population ages, our hospitals, care homes and hospices are full of people for whom the expression "quality of life" has purely an ironic application.

There is one thing and one thing alone, that gives the lives of many of the terminally ill what little quality they do have, and that's diacetylmorphine. At least, that's what the medical profession term the drug. To the general population it is better known as heroin, and it was called this because in trials conducted by the pharmaceutical company Bayer, those who took it said they felt "heroic".

That was almost a century ago, but the ascription remains apt, for now so many of us play out the final tragic act of our lives in this narcotised state.

Heroin Diacetylmorphine - heroin - is used to reduce pain for the terminally ill

Doctors and nurses will tell us that they can calibrate the dosage effectively enough for the moribund to experience no pain and yet remain lucid, but from what I've seen, palliative care at this late stage largely consists in rendering us oblivious of everything - and in particular our own imminent demise.

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I absolutely understand the desire to ward off death at any price”

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Both my mother and my father died of cancer while heavily sedated. In my mother's case, the nursing staff made no secret of the fact that they were upping her medication while withdrawing her nutrition, with a view to smoothing the path to her end.

My father died at his home, but was visited four or five times a day by medics bearing barbed gifts. On the morning after he died, the first task I had was to gather up all the pain-killing medication in the house - morphine in oral solution and pill form - and return it to the hospital.

I absolutely understand the desire to ward off death at any price. For those who are without any belief in transcendence, there is nothing beyond this life, and so they cleave to it for all they're worth. I tell myself that when things get bad enough, I'll make a dignified exit, but somehow I too worry that things won't ever get quite bad enough until they're excruciating and I'm incapable of acting.

That's why I believe a change in social attitudes would be a great boon. I've observed what might be termed a "creeping normalcy" in the existence of the terminally ill - with each successive stage of greater incapacity, indignity and discomfort somehow managing to be incorporated into the daily go-round.

Further reading

More debate about euthanasia - one of today's most controversial health issues

Besides, few of us really understand how to end our lives painlessly and effectively - this is just another crucial bodily matter that we want to leave, along with all the rest, to the professionals. And this is why the whole debate about assisted dying is really a shadow play, behind which lurks a still darker and more discomfiting dilemma.

Of course there are those with terrible conditions - locked-in syndrome, various forms of paralysis - who may wish to die, but be quite unable to do so without help, but for the vast majority of us suicide would be possible as a lone activity for some time after we knew that we were incontrovertibly dying.

But instead of stating this boldly and clearly, we collude with the medical profession who, at an unconscious level, are always only too pleased to increase the ambit of their own expertise, and ask of our legislators that suicide be rendered simply another medical procedure.

It's not, though. Rather, the decision to take one's own life could be, I would argue, part of affirming personal dignity, helping us to reach acceptance, and even gain some serenity - especially when the alternative is a long, painful decline through terminal illness.

Yet as things stand, our impotence in the face of our extinction means that a vast amount of medical resources are expended in the last few weeks of people's lives purely in order to render our deaths insensible and insensate.

When I see politicians campaigning relentlessly on their defence of the National Health Service, I often think that this is the unacknowledged subtext: vote for me, and I'll make sure you cease upon the midnight with no pain.

I don't say any of these things idly. Like many in middle age, my last few years have been heavily marked by an increasing awareness of both my own mortality and that of those who I love. Nor do I wish to offend religious sensibilities, or upset anyone who is either terminally ill themselves, or caring for someone who is.

While not a Christian myself, I still concur absolutely with the sonorous words of the committal service for the dead: "In the midst of life we are in death."

It's because of this that we should all keep constantly in mind that we cannot hope to understand how to have a good life, unless we also ready ourselves for a good death.

If you would like more information on this topic, the following websites may help: BBC Health: Support for terminal illness, National Council for Palliative Care and Dying Matters.

If you have been affected by these issues, you could talk to your GP or someone at the Samaritans.

 

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  • rate this
    +1

    Comment number 206.

    I think every doctor, as part of their training, should spend time in a hospice, so that they come to see death as a normal function of the life process; rather than how the majority seem to see death - as a personal failure in being unable to 'save' the patient.

  • rate this
    +1

    Comment number 205.

    Better people decide when to take their own lives rather than people decide for them.

  • rate this
    -5

    Comment number 204.

    Liverpool Care Pathway will kill you anyway.

    I believe in freedom to choose, but government find any way to save £££; euthanasia will be used for de-population.

    In the US there are sites with thousands of plastic caskets. They know what's coming, that is the sole aim of the UN, Agenda 21, CfR, Club of Rome, etc, etc.

    So no law changes thanks, people can't be prosecuted after they've died.

  • rate this
    +3

    Comment number 203.

    As i have said before, any one can do what ever the hell they like and if all parties involved are adults and fully consenting then they can do what ever the hell they like too. so long as it does not harm any other living thing. if and when i wish to kill myself i will, its nobody else's business.

  • rate this
    +2

    Comment number 202.

    The real problem is one of comparison. Once you permit suicide for reason a, then along will come reason b which isn't very different and then reason c ....

    Many people, tragically, commit suicide for reasons that are temporary and are, in fact, surmountable. Probably the most common being depression or other mental illness.

    There are no easy answers on this one.

  • rate this
    +1

    Comment number 201.

    We are slowly moving to a society in which discussing they way you wish to die is acceptable, but there's a long way to go. Not until you can post, on forums such as HYS, suggestions as to the best methods to end your life, will we truly have accepted suicide as a way out.

  • rate this
    -3

    Comment number 200.

    Today is a good day to fight-
    Today is a good day to die.
    - Crazy Horse, Oglala Sioux Chief, Battle of Little Big Horn

    From the Lakota language, " hóka-héy " - today is a good day to die.

    Mind you, you don't just mumble this; you belt it out like it's the last thing you will ever say on this earth, and you have already made your peace.

    This just kinda sums up my feelings on the subject ...

  • rate this
    +2

    Comment number 199.

    @jgm2

    You need to research the facts then obviously. He altered several of his victims wills not just one.

  • rate this
    +11

    Comment number 198.

    My mother died from Alzheimer's. she could no longer swallow and nurses had to use a tube to suck saliva etc from her throat, which was both distressing for her and the family & it took a number of days before she passed. This was not a dignified death. Her mother had died the same way & she had asked that we never let that happen to her, but what choice do we have? Please change the law.

  • rate this
    0

    Comment number 197.

    Of course they do.

    But ... if a lot of people choose suicide it just shows how terribly our society is being run. How crazy mankind has become ... and that is the reason people want to hide the problem. That is the reason why people want to stop suicide - because it makes the entire edifice of society look like an awful mistake.

    Nevertheless, people are free to do as they please.

  • rate this
    -10

    Comment number 196.

    See #142/159; Fear, either of the unknown or going against religious brainwashing can be an impediment to any state-operated scheme. I would propose state-sponsored brainwashing to help overcome such a fear; our soaps could usefully start the emollient process. We could even have a new series....the 'Ender Benders'!

  • rate this
    -2

    Comment number 195.

    YES

  • rate this
    0

    Comment number 194.

    Of course one can take one's own life if and when one wants. We're all able to do that. You don't need "permission" from the State to do that, you just can't involve anybody else in the process - as that would be illegal.

  • rate this
    -10

    Comment number 193.

    The question of life assurance payouts has been raised. The reality is this:

    The insurance world defines suicide as "...taking one's own life while the balance of one's mind is disturbed". They also assume that this level of mental instability cannot be maintained for any length of time.

    Normally, suicide after, say, 12 months becomes the result of a developed insanity & pays out.

  • rate this
    +4

    Comment number 192.

    The current law is based on religious morals from another centrury or two.

    Our understanding of science & debunking of lots of religious beliefs would suggest that we need to reappraise our laws & not be beholden to a small group who take their lead from ancient religious texts.

  • rate this
    +4

    Comment number 191.

    Funny how you'd be prosecuted (quite rightly) for allowing your pet dog to die in agony, but the law says you MUST allow yourself or your loved ones to die in agony, and in fact we will go all out to draw it out for as long as we can. Thank goodness there is a slow change happening.

  • rate this
    -9

    Comment number 190.

    This is too simplistic. What about people whose mental state makes them want to die one day and not the next? Is it right those people die when depressed, even if it might be possible to overcome if they keep living? It often takes more courage to choose to live. Death ought to be an absolute final resort in cases of extreme suffering. If you have family, friends, your life is not just your own.

  • rate this
    +4

    Comment number 189.

    I am generally in favour of assisted suicide, the problem I have with legalising it is by comparing it to abortion. While assisted suicide remains illegal it will continue to happen, as it does, in exceptional circumstances. Once legalised it creates the risk of it being a routine procedure where unwanted people are despatched as a matter of choice and convenience.

  • rate this
    -1

    Comment number 188.

    Your life,it seems,belongs to the Government from the moment you're born to the moment you die.Successive Governments of the last few decades have been steadily removing any rights & freedoms we used to enjoy.They won't give people the legal right to decide for themselves the time & method of their own death,but they reserve the right to end your life for you if they so choose.

  • rate this
    +5

    Comment number 187.

    I personally support euthanasia and assisted suicide. So does my father, who is also a GP. However, he has always said to me that whilst he does support the right to choose death over prolonged suffering, he could not, in the role of a doctor, actually carry the deed out. He took an oath to do no harm. So even if you have your mind made up re. this issue, there are still many issues to sort out.

 

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