The principle of assisted dying – and its practice | Letters

Taking into account Susan Hampshire’s article in your series on assisted dying (‘We wouldn’t let animals die in misery. Why should people?’: Susan Hampshire on why dying should be a choice, June 17), the problem with assisted dying is not the principle, but the practice. Reality is much more complex than imagined.

Hampshire says it has worked “perfectly well” in places like Canada and the US. In Canada, people with disabilities have chosen euthanasia not because of their disability, but because their disability benefits are so small that they cannot afford to live. One person, who could not find affordable housing compatible with his disability, said: “I applied for MAiD (medical assistance in dying), mainly because of the grinding poverty.”

In Oregon, in 1998, only 13% of people who applied for assisted death did so because they felt they were a burden to their family. Since 2017 more than 52% have registered because they felt like a burden, suggesting that once assisted dying is legalized, those eligible will feel increasing pressure to take advantage of it. Neighboring Washington state has seen similar trends 59% say they felt like a burden in 2022 compared to net 23% in 2009.

If this is what working “perfectly well” looks like, then we urgently need to reassess. Can assisted dying really be an autonomous choice, when end-of-life care in Britain is a postcode lottery at best?
Conall Preston
Researcher, Living and dying well

There is good reason for Julian Barnes to ‘hope’ that doctor-assisted suicide of people with terminal illness is the ‘thin end of the wedge’ and will later be extended to people who are not dying (‘The flight to Zurich sounds as the worst possible mini-break’: Julian Barnes on why Britain should legalize assisted dying, June 15). This shift has already happened in Canada and beyond Colombia. The slippery slope is real.

However, assisted suicide is difficult to apply to the condition Barnes fears most, late-stage dementia, where you “forget yourself before you die.” The problem is that dementia gradually takes away first the ability to consent to assisted suicide and then the ability to commit suicide. Those who are most affected are the least likely to benefit from it.

The fear of dementia does not end with assisted suicide, but logically leads to euthanasia based on prior decisions. In one case in the Netherlands five years ago, a woman was given a sedative in her tea and members of her family held her down as she struggled with the lethal injection. It was declared legal because she had signed a form sometime in the past. She once stated that she would like to die under these circumstances, even though she did not seem to want to at the time. Euthanasia for people with dementia is growing in the Netherlands. This is where the slippery slope leads, and it is a far cry from the “heroic” and “exemplary” ideal of death that Barnes begins with.
Prof. David Albert Jones
Professor of Bioethics, St Mary’s University, Twickenham; directorAnscombe Bioethics Centre, Oxford

Death, for those who know when it comes, is messy. My wife was diagnosed with breast cancer six years ago and passed away last year. Not once during those five years of palliative treatment, brutal and unrelenting as it was, did she feel like her life needed to end, or did she ask for it. Not out of some vain hope of healing, ending the pain, or some religious belief, but simply because every moment of the life she left behind remained as important to her as the life she had lived. Despite everything, she died with dignity and as herself. She did not require assistance in dying and remained in full control of her choices. Laws are there to protect us as a society and not to facilitate individual choices, which we all still have.
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It is entirely appropriate that prominent campaigners come forward and explain their reasons for wanting to change the law on assisted dying. However, are there any plans for a follow-up article that will convey the views of those opposed to changing the law? It seems biased not to do that. However sincere the beliefs of those interviewed and how well they have argued their case, I am not convinced that they have seen the recent BBC documentary Better dead? by Liz Carr (still on BBC iPlayer) and has carefully considered her perspective.
Hannah Pursey
Birmingham

It’s good to have a group of celebrities justifying their hopes for a change in the assisted death law. I would also like to see a similar change, but with an extra emphasis. I have had multiple sclerosis for over 30 years and now have significant mobility problems and other symptoms. For now, by some miracle, I can still push the pedals of our yellow tandem tricycle. Most days I enjoy rides with my husband on the riverside cycle path, promenade and around town in Aberystwyth, so life is positive in important ways.

But unlike some people with disabilities, I would definitely want the option of an assisted death if my MS worsens to the point where my life is one of helplessness and severe physical suffering. The emphasis in your articles was on a good and painless death for people who have a short time to live. However, with some chronic diseases, such as MS, it is possible for suffering to continue for a long time with no chance of cure through death.

I support the pressure group My Death, My Decision, which argues that persistent unbearable suffering should also be a reason for an assisted death. There are complex and difficult issues involved, but I would like to see carefully drafted legislation that covers both unbearable suffering and expected death in the short term.
Katherine Cuthbert
Aberystwyth, Ceredigion