Should people be denied ‘choices’ at the end-of-life?

When parts of the Australian media recently applauded the double suicide of a well-travelled, well-educated Melbourne couple who were not ill but simply growing old, I think we all need to stop and wonder where this is all going.

Please, don't read me wrong; they have every right to put their case and to tell their stories. But they are not 'most of us'. The polls may show soft support for a law change, granted; but polls don't tell us anything other than the fact that most people feel emotionally disposed to want to somehow help people in difficult circumstances. To that, we all raise our hands!

If it were simply a matter of making sure that the best of care was made available for all but somehow also catering for the 'choices' of this elite, then maybe most of us would agree. Life is not simple; neither is this question simply about allowing for a choice to be made dead. There's much more to it than that; most of which is about consequences and risks.

What if it were not really our 'choice' at all? It's not. We can ask for many things from our doctor; we can make legitimate choices, where possible, between treatments and even the choice to refuse treatments, but if we ask to be made dead, we're really asking our doctor to make a choice to kill us or to help us to kill ourselves. In reality it is his or her choice, not ours and it comes with consequences.

That choice involves a value judgement. It requires the doctor, consciously or otherwise, to be in agreement with you or I that our lives are no longer worth living; that whatever it is that ails us, our worth as a human person is diminished to the point that 'dead' is better than living.

We set dangerous precedents when we allow one person to discriminate against another on the basis of a perception of the relative value of a life. None of us need to look too far to find in history and even in our current world the effects of such discrimination writ large.

Our elderly, sadly, have learnt to feel so. How many times have we seen and heard the word 'burden' used in the same sentence as the elderly? Those for whom we all owe a debt of gratitude; those for whom we should focus attention and support bordering on the extravagant simply because they came before us, nurtured us and helped form us. Burdens?

It is the acceptance, even unconsciously, of that kind of message that places already vulnerable people at risk of the suggestion: 'Well, Gran, there's always…' Even if they are never coerced to an early and unnatural death the very existence of that 'choice' can create both an expectation and a resident fear.

The very use of the term, lives not worth living, sends chills down my spine as it does many others who either live with a disability or care for someone who does. My Irish colleague, Kevin Fitzpatrick, a paraplegic who recently succumbed to the ravages of cancer would often tell a story that illustrates this well:

When non-disabled people say they despair of their future, suicide prevention is the default service we must provide. Disabled people, by contrast, feel the seductive, easy arm of the few, supposedly trusted medical professionals, around their shoulder; someone who says 'Well you've done enough. No-one could blame you.

A cautionary tale that invites us to think hard about what the reality that we would be condoning some suicides will have upon the young, the depressed and the lonely.

The euthanasia and assisted suicide lobby know these real problems (and others) well. For the most part, they do not deny that they are real (though I have met some that do). And, in so far as I accept the genuine nature of their concern, to their credit, they offer 'safeguards' designed, as we are told, to protect vulnerable people.