Shaking Hands with Death

This posting is about terminal illness and assisted suicide and the recent lecture by Terry Pratchett on the same.

Terry Pratchett (assisted by Tony Robinson) recently gave a lecture entitled Shaking Hands with Death. It’s on BBC iPlayer (possibly only viewable in the UK), on Youtube, and you can read the Guardian‘s edited transcript. It is funny and moving. I recommend it.

Pratchett has posterior cortial atrophy, a variant of Alzheimer’s disease which currently effects his vision and motor skills while leaving his memory intact. Eventually, though, Alzheimer’s will deal with him as it does with everyone else who has it.

The burden of the lecture is that Pratchett wants to be able to chose the time and manner of his death, and wants anyone who helps him to do so to avoid prosecution. He says:

I would live my life as ever to the full and die, before the disease mounted its last attack, in my own home, in a chair on the lawn, with a brandy in my hand to wash down whatever modern version of the “Brompton cocktail” some helpful medic could supply. And with Thomas Tallis on my iPod, I would shake hands with Death.

Currently, the helpful medic (or any other helper) would probably be breaking the law. What Pratchett suggests is that there should be a tribunal which would pre-emptively exonerate such helpers:

The members of the tribunal would be acting for the good of society as well as that of the applicant – horrible word – to ensure they are of sound and informed mind, firm in their purpose, suffering from a life-threatening and incurable disease and not under the influence of a third party.

The sound mind and firm purpose are important to Pratchett, who prefers the term “assisted death” to “assisted suicide”. He tells his listeners how he wrote about suicides as a young reporter. The phrase the coroner always used was that a person had “taken his own life while the balance of his mind was disturbed”. What he wants is for a quick death to be available to those whose balance is level.

It’s hard to see how one could deny someone like Pratchett the opportunity to die in the comfort of their home. There would have to be precautions, limits which would put some helpers we might think were morally justified on the wrong side of any new law. I think limiting euthanasia to people with a terminal illness who are able to express their desire for it is one of those precautions: there would still be hard, tragic cases where we’d might wish the law were laxer, but the government must also protect the vulnerable from pressure to die.

Pratchett has his opposition: Archbishop John Sentamu says we must not listen to opinion polls or dying celebrities (though, we must, of course, listen to bishops). We should, says Sentamu, listen to disabled people. clairlewis, a disability rights activist, gives her opinion over at Heresiarch’s blog. Unfortunately, her arguments seem completely unrelated to Pratchett’s request.

The comment from someone called “KeepOut OfMyLife” puts it best, I think. Being poor and disabled is hard, and someone who is struggling to cope may consider suicide. Their desire to die could be alleviated if their standard of care were better. It would be negligent to hand these people the means to die without improving their care, just as it would be negligent to hand a gun to someone who was deeply depressed. But this isn’t the case that Pratchett wants the government to deal with. In fact, a government could (though, given the budget deficit, will not) improve care for people with disabilities and allow people with terminal illness to get help in dying when they chose.

clairlewis‘s argument appears to be that terminally ill people should not have what they want until disabled people get what they need. While I can understand her frustration that disabled people are ignored while Pratchett is able to use his clout to get a hearing, preventing Pratchett and others like him from having the death they want will not help anyone else.

7 thoughts on “Shaking Hands with Death”

  1. I think superficially Pratchett’s proposal and the issues that clairlewis is complaining about are unconnected, but in the real world of human interactions and politics, which doesn’t always follow purely logical rules, there is a relationship between the two. pterry is being very, very precise in making absolutely clear that he is not calling for any mass “euthanasia” of disabled people, which is good. It’s not that I think his argument is wrong, it’s just that there are factors he isn’t aware of.

    Like, when you set up panels of deciders to deal with medical issues, they are all people like Terry Pratchett, and not at all people like Clair Lewis. Pratchett, or possibly his friends and family if he becomes incapacitated, are starting from the position where they know exactly how to work that kind of system. He’d be able to prepare a case in a way that would appeal to the hypothetical panel, and the panel would take time to listen to him and would be generally inclined to consider him favourably in the first place. And if he didn’t get the decision he wanted, he’d get lawyers and the media involved and push until he did.

    It’s comparable to the whole ESA mess: in theory it’s not a bad idea to have a panel of experts assess people to see if they really need disability benefits. In practice, the people doing the assessing are incredibly biased against anyone who isn’t middle class, and anyone who has badly understood conditions like chronic pain or mental health issues. Their main incentive is to save money rather than to help people, both by handling the cases in a really superficial way and by denying as many claims as possible. And the bureaucracy is really a major burden to the people who most need the money. Which is bad enough when the issue is financial, but if they were directly deciding about life and death (as opposed to, say, whether someone has enough money for food and housing), it would be untenable.

    It’s a major risk that Pratchett’s proposal would in fact lead to more abuse and possibly murder of disabled people, and poorer standards of care for those who don’t want to die. Not because this is what Pratchett wants, because I sincerely believe he’s as much against that outcome as I am. But because he’s trying to implement it in a society that doesn’t really treat disabled people as human, especially not if they also come from the lower ranks of society.

    1. I think my problem is that, AFAIK, disabled people are not dying, or at least, no more so than able-bodied people. As far as I can tell, what Pratchett wants is a system directed towards people who are dying of their illness and want to chose when and how it happens. There must be people who are both disabled and dying of an illness, but in general I’m not seeing the connection here. Is your point that it’s not possible to draw clear lines between “terminally ill” and “disabled”, or that it’s a slippery slope from a system for terminally ill people to a system which will kill disabled people.

      I’m not sure I get the bit about Pratchett working the system. Pratchett’s tribunals are a bureaucratic barrier to death. If a disabled person fails to work Pratchett’s system, they don’t get assisted suicide: the default is that killing someone, or providing them with the drugs to kill themselves, is illegal or medical malpractice or whatever.

      1. My opinion does have something in common with a slippery slope argument, though I think it’s not purely that. I don’t think the distinction between disabled and terminally ill is quite as clear-cut as you’re making it, but I’ll leave that as an assumption for the purpose of discussion.

        One possible outcome of Pratchett’s proposal is that people who don’t have his sort of influence would simply never be able to tick the right boxes to be allowed to die, and I suppose that’s not really worse than the current situation where nobody is allowed to choose how they will die in the way he describes. But I am more concerned about the possibility that a person who isn’t well-regarded by society who may express a wish to die wouldn’t face nearly such rigorous standards of establishing that they are really in their right mind, that they weren’t pressured into it, indeed that they are really dying rather than disabled. Your image of handing a gun to someone already depressed is what I’m afraid of, even if the tribunals were set up with the ostensible goal of avoiding that.

        Right now, in the real world, if a person has a disability or a long-term illness and shows symptoms of depression, they are vastly less likely to be prescribed anti-depressants or otherwise get access to treatment than a physically able-bodied person who is depressed or suicidal. I fear that if Pratchett’s hypothetically sensible, admirable proposal were enacted, people in this situation would be encouraged to take the suicide option. Or more likely, not sufficiently discouraged, but that’s a still a huge moral issue if the person is in fact in a disturbed mental state, or if their suicidal feelings result from not getting the care and support they need.

  2. Given that you’re a paid-up atheist, I’m surprised you don’t link this more strongly to Christianity (maybe you’ve done the same elsewhere). It may not seem too surprising that the Bish is against, but is it not somewhat surprising that he makes no attempt to link his arguments to Christianity? He appears to be basing his arguments on what the “silent amjority” want – and if we listened to them, we’d have hanging.

    I’ve always assumed, without ever bothering to check, that if you are Christianity (or any other religion with a nice afterlife for the Good) then you have to have a prohibition on suicide, otherwise all the good folk would top themsleves quick before they sinned – after all, why not? But is there much in the way of biblical support for this? I just typed “suicide” into the blueletterbible and it produced nothing.

    1. The bish does worse than that: he’s magicked a silent majority out of no-where. Unless he has evidence to that the opinion polls he mentions were done badly, he actually represents a minority.

      The Bible’s authors don’t explicitly comment on the morality of suicide (unless you count this amusing series of Biblical references). Christian opposition to suicide arises from the notion that people (and especially Christians) belong to God, and that life is a gift from God. Here’s what the Catholic church says.

      1. The Bible’s authors don’t explicitly comment on the morality of suicide

        John Donne’s Biathanatos is probably the definitive work on the morality of suicide in the context of the Bible and the writings of the Church fathers. (The series of Biblical references you link to is only a tiny selection of the texts that Donne considers.)

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