Online Book Club Discussion Summary: A Time To Live By George Pitcher

Are you in favour of assisted dying?  Would you like British law to be amended to allow euthanasia?  Or is the risk of abuse to the elderly, disabled and infirm too great a concern?

Most of my real-time Book Club members admitted, when we met on 28^th July, 2011, that they'd found this book on assisted-dying and euthanasia heavy going.  An easy read, it is not!  And not simply because of the topic.  I have always found George Pitcher's articles in the Daily Telegraph to be quite accessible.  However, I was not alone in finding his style of writing in this book somewhat over my head.  Sometimes it required a read and re-read to fathom his meaning.

DISTINCTIONS BETWEEN EUTHANASIA & ASSISTED-DYING

One of the issues he raised, which is, perhaps, important to state at the beginning of this discussion, is the distinction between euthanasia and assisted-dying.  The first is when one person is actively involved in bringing about the death of another person in the belief that death is preferable to their current quality of life.  This may, or may not, be a voluntary decision made by the patient.  The second is when the patient expresses a wish to die, and takes a lethal substance which has been supplied by another person who is not actively involved in the administration of the drug, and who may, or may not, be present at the time of ingestion.

INFORMED THINKING

The purpose in reading and discussing this particular book was so that we might be better informed on the subject, given the UK's current stance on euthanasia / assisted-dying, and Lord Joffe's and Lord Falconer's failed attempts to legalise it.  Whilst the majority of us in the Book Club were against legalisation, one member was strongly in favour.  She found Pitcher's arguments "petty" and one-sided, and disliked what she saw as his "snide comments".

She felt, also, that his description of the way in which he handled his father's (natural) death was self-congratulatory and smug: an "ego trip".  It appeared, to her, to elevate the importance of the carer's feelings over those of the dying patient.  We could only agree that if that were the case (no one else perceived it in this way) then such an attitude would be indefensible.  The patient's feelings should always be paramount. 

INDIVIDUALISM & FREEDOM OF CHOICE

This is not to say, however, that the patient's wishes should reign supreme.  "Freedom for us at the start of the century," writes Pitcher, "had become freedom for me by its close."  The sacrifices made by "the many" in two world wars, fighting for King and country, have been replaced by a culture of "if it feels good you should do it."  "Pick and mix" religion has resulted, and death has simply become another life choice: "convenience shopping for our own deaths."

LOVE, DEPENDENCY & BEING A "BURDEN"

Feeling a burden to one's family is cited by supporters of assisted-dying as being a good reason to change the law in Britain.  Whilst we all agreed that modern medicine and the practice of putting old people into residential care homes prolongs life beyond what would probably be its natural end, the concept of the elderly being "surplus to requirements" was abhorrent to us all. 

My father's situation was raised.  A member of MENSA (a society for those with an IQ in the top 2%) he is now in a secure home for dementia patients.  He also has macular degeneration so is nearly blind.  There's no question that life as he knew it is severely diminished.  Nevertheless, his face lights up when he receives visitors and, though he may confuse which member of the family he's talking to, he still delights in discussing past events with my mother and me (especially from his childhood) and he eagerly devours the chocolate bars and sweet creamy deserts we offer him.  Is this so very different from the value placed on the day-to-day experience of a ten-year-old?  Should we even be measuring it in comparative terms?

The Book Club member who supported a change in law thought otherwise.  She felt that her life (she is in her early sixties) had run its natural course.  "I've reproduced," she said, "and done pretty well everything I want to do."  But is that the sole purpose of life?  And what of her family? 

Pitcher begins his book with a piece written by the author Charlotte Raven.  Diagnosed with Huntingdon's disease, she welcomed the opportunity of killing herself and dismissed her husband's pleas as "instinctual rather than intellectual."  But I ask myself, what proportion of love can be classified as "intellectual"?  Mr Raven's preference was for "an angry and dependent wife rather than a dead one."  In the end, it was receiving a hug from a carer which restored to Mrs Raven a sense of worthiness; of being cherished.

A lively discussion ensued in the Book Club.  Would it be "loving" to drink a potion and end your life if you considered yourself a "burden" to your family?  And if that were the culture in which we lived, might families begin to resent the elderly, disabled or terminally ill who did not take this action, and lived on?  How soon, then, before governments began applying euthanasia to all elderly and terminally ill in order to save money for those whose lives are "more worthy"?  Surely any suggestion that human beings be "put down" is a complete denunciation of the sanctity of life, and reduces them to nothing more than an animal?  In making imperfect lives disposable, we come close the eugenics of Nazism, and diminish the value of the elderly, infirm and disabled.

PALLIATIVE CARE

British doctors and medical staff, according to Pitcher, are almost unanimously opposed to "any merger of the death industry with the healthcare system."  In other words, euthanasia.  Bound by the Hippocratic Oath to practice their art ethically in the best interests of their patients, they promise neither to "give a deadly drug to anybody if asked for it," nor to "make a suggestion to this effect."  Little wonder, then, that they are not in favour of anything that might compromise that ethos.

It appears, also, that palliative care - in which Britain is cited as a world leader - is far superior in those countries which do not support assisted-dying.  Morphine, properly administered, can considerably alleviate, if not virtually eliminate, pain, allowing patients to spend precious time with loved ones.  But palliative care, as Charlotte Raven has already highlighted, is about more than pain management; it's about imparting a sense of worth to a patient; it's about cherishing the wonder and sanctity of life.

True, there may be times when a patient expresses a desire to die.   However, Baroness Finlay, Professor of Palliative Medicine at Cardiff University, notes that: "Many move during the course of terminal illness from hope to despair and back again."

LEGAL ASPECTS & EXPERIENCES

And this, really, is the problem.  If we are to have the "dignity" in assisted-dying which is cited by its proponents as being vital, then those electing to be partakers of the service must be of sound mind.  That means that people like my father, with a progressive degenerative mental disease, would be ruled out.  A patient like Charlotte Raven, however, might be eligible.  And how would her family ever know if she might have had the change of mind she experienced?  Or if a cure might be found for her disease?

A chapter on the legal aspects and practices of assisted dying in Oregon, Switzerland and Holland painted a pretty damning picture.  The interval between receiving the lethal drug and ingesting it is shown, in Oregon in 2004, to be more than a month.  "It's clearly possible," writes Pitcher, "that, in the intervening period, patients could become depressed or be subjected to duress, however subtle, from relatives to end their lives, or indeed undergo a change of mind."

In Holland, the situation appears to be worse.  "How do around 1,000 people come to be put to death in Holland per year without having made a request to die?" asks Pitcher.  He goes on to show that Dr Els Borst, the Deputy Prime Minister who saw the bill through parliament, now admits that, "medical care for the terminally ill had declined since the law came into effect."

The Dignitas clinic in Switzerland has taken this a step further in making itself available to non-nationals.  The subject of a recent BBC TV programme presented by author, Terry Pratchett, it incited more than ten times the usual number of complaints from viewers.

Condemnation for the clinic is not confined to Britain.  Damned by its own countrymen as a "sordid and shaming aspect of Swiss society," proposals have been put forward in the Swiss Parliament to combat such "death tourism".  Questions have also been raised about the financial profits made by the Dignitas organisation, and what the £6,000 fee was being spent on.

WHERE DOES GOD STAND?

The reader is reminded, in the last chapter, of the price that Christ paid to give us liberty and life, and the suffering that he, a member of the Triune God, sustained to do so.  Modern secular thinking among supporters of euthanasia would have it otherwise.  So lest we think that suffering is a prerequisite of knowing God, we are led through a theological history lesson.

The Greek philosopher, Plato, has much to answer for, in George Pitcher's opinion, in this respect.  Four hundred years before the birth of Christ, his views on the unchangeableness of God were the foundation of what is known as classical theism.  The principle was that God was implacable - completely indifferent to our suffering - because any demonstrable feeling on his part would denote change in him - and thus counter his unchangeable nature.

The open theism which began to prosper in the 1980's, however, shows quite the reverse.  Any God who could watch the genocide of the holocaust in WW2 and feel nothing would hardly be worth knowing, let alone worshipping.  And so a new understanding was born, "evil is allowed but not desired by God," writes Pitcher, and though "he wills his best for us in the building of his Kingdom . . . his will can sometimes be thwarted."

To my mind this says all that there is to say on the subject of whether assisted-dying should be legalised or not.  Pointing to a recent case of attempted murder in the UK (a woman tried to smother the disabled husband she had nursed for years) it was heartening to see that although this criminal act required that the law be upheld (she was arrested and tried in a court of justice) clemency was then applied.  Sentenced to two years community service, she was not committed to imprisonment. 

Isn't this a mirror-image of God's justice?  The Ten Commandments expressly forbid the taking of life.  If we do so, we cannot be anything but guilty of contravening this law.  Justice requires that we judged.  In his mercy, however, God has already paid the price for our wrongdoing (through Christ's death) and he offers forgiveness and a clean slate to all who repent.  That includes those for whom no human mercy is shown.  Even had this woman to pay the full price required by the law of the land - a life sentence in prison - nothing (but her own lack of repentance) can put her beyond God's forgiveness.

Personally, this is the sort of law I would like to see continued in Britain in respect of euthanasia and assisted-dying.  Interestingly, the one member who had previously been in favour of a change in the law, found her convictions swayed by this argument.  "At least for now," she concluded.

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