A Point of View: The biggest decision


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

    Comment number 286.

    In reply to all the scaremongers warning us of the potential danger that assisted death might turn into a new lucrative business, HAVE YOU realised how big private businesses have long moved into private care provision like angry vultures providing for the most part very mediocre care profiting from the slow unnaturally prolonged life of our loved ones? It is time we grow up!

  • rate this

    Comment number 285.

    If they want to do this they can do this now so why is Will Self highlighting this? I don't believe this I think the terminally ill should be allowed painkillers sufficient to kill the pain even when they reach levels that might normally be considered dangereous (ie life threateneing - the threat of possible death is hardly a problem if you're terminally ill. This is what's civilised.

  • rate this

    Comment number 284.

    People like John Bird,the founder of the Big Issue, and Will Self ought to be the sort of people who represent us rather than the career consultants of corporate lobbies.
    As usual he cuts through the mush - sensible and considered approach

  • rate this

    Comment number 283.

    The right to end your own life is surely the most fundamental human right of them all?

  • rate this

    Comment number 282.

    In reply to yasuaki, I disagree that people should be forced to live for the benefit of their families or belief of others, any more than that people should be forced to marry, remain married, or die for the sake of others. It is not a case of weighing up the pain of others: it is a case of knowing when our own pain is too much to bear.

  • rate this

    Comment number 281.

    My life, my choice.

    Religion creates wars, it should have no place in this "debate".

    If someone lacks capacity there is already support, legally, to ensure they are not abused and their decisions made, at a time they had capacity, are upheld..

  • rate this

    Comment number 280.

    Yes - and if The State is too squeamish to address the issue of death, then it should be ashamed and it should step aside.

  • rate this

    Comment number 279.

    Issues about the NHS and longevity are distinct from the question about the right to kill oneself.
    There are different concepts appropriate to how they ought to be answered.

  • rate this

    Comment number 278.

    Assisted suicide is not just the right to die. That more or less exists already: you can commit suicide by yourself, doctors can and do withdraw treatment on dying patients and you can refuse treatment altogether if you wish.

    Even some cases of people helping loved ones die are given a blind eye by the police and courts.

    AS is a more complicated issue than right to die and needs real debate.

  • rate this

    Comment number 277.

    People will take their own lives whether it is a 'right', or not. So whether we agree that a person should be allowed to kill themselves, or whether we don't, is rather immaterial to the fact that people do. As an evolved, and evolving, society with complex moral values, we should default to compassion. Calling someone a criminal serves no purpose other than to make a painful situation worse.

  • rate this

    Comment number 276.

    As Will Self pointed out, most of us live far longer than our bodies are built for. With more than a quarter of us expected to live beyond 100 in the near future it becomes clear that this is an issue that needs addressing immediately. Anyone that has been to a nursing home or hospice cannot believe this to be wrong.

  • rate this

    Comment number 275.

    In no way should suicide be rejected in legally for religious reasons. However there should be a legal aspect to suicide if allowed. It should be only in certain circumstances when legally justified. Perhaps only when the persons quality of life due to illness is so low it will be an option. However, it is for the person to decide not doctors and suicide should always be discouraged.

  • rate this

    Comment number 274.

    it's my experience, the NHS assist people to die regularly by withdrawing nutrients and/or upping pain killer dosage. nobody bats an eyelid - because it's for the best. I'd contend we have assisted death already. the world hasn't come an end etc etc. religious groups and the legislature just need to catch up with society (as usual)

  • rate this

    Comment number 273.

    People are put on pathway schemes without their knowledge denying them the choice of if they wish to die or not.
    Yet if someone is in pain and wants to die taking their own life or being aided to cross over it is deamed as wrong and are pumped full of drugs until their body eventualy gives out ignoring their wishes.
    why is it ok for others to decided if we live or die but not ourselves?

  • rate this

    Comment number 272.

    Euthanasia previously existed in UK, it was the correct & moral thing to do

    At time of plague, if you got it, you would suffer most agonising death imaginable, so instead of watching sons/daughters/mothers/fathers/uncles etc dieing in extreme agony over 3 days, lives were rightly ended to prevent suffering.

    Is the NHS just to extend life, or is it to ensure minimising suffering

  • rate this

    Comment number 271.

    People should have the right to choose. It would be possible to devise regulations, policies and procedures to ensure people are making informed decisions that is not based on poor health and social care provision. If it was regulated and monitored properly, it may highlight the effects of health and social care cuts, staffing issues (not just doctors and nurses), limited availability of medicine.

  • rate this

    Comment number 270.

    I fully support Will Self's views. I've no intention of suffering for years in later life with declining ill health, dependent on state services and my loved ones. I long ago decided that if my quality of life in old age becomes progressively miserable, I will make the decisions for my end time, nobody else, just as I have at all the other stages of my years of living. It's MY life!

  • rate this

    Comment number 269.

    There is no freedom more fundamental than that to choose not to go on living for whatever reason (including depression / disillusionment with society) and no well-meaning medic nor religious expert has the right to deny me that or claim otherwise on my behalf. The fact that due to stigma, law etc we're not free to choose our 'check-out date' shows just how little say we have over our own choices.

  • rate this

    Comment number 268.

    I want and will exercise the right to decide when I die. I will do so based on what I think is right for me and what I think would be the wishes of those I love. I hope there is no conflict there.

    Looking from the other direction, if any doctor or hospital decides that it is time for me to go, without first securing my agreement or (if incompetent)that of my family, I regard that as murder.

  • rate this

    Comment number 267.

    absolutely agree with Marginalia.I do not agree with Will on lots of issues but this one I think is correct.The ONLY thing we have as a human being is the right to decide whether we live or die and thats why murder is the greatest crime,since the person has taken away my ONLY right.Religion has I am afraid, to take a back seat on this.


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