Dying well

The Right Revd David James, Bishop of Bradford, responds to the current campaigns to change the present law and argues passionately against so-called assisted suicide

Di died a few days ago. She had suffered from multiple sclerosis for the best part of thirty years, spending the last eight of them in a Leonard Cheshire Home, where my wife and I occasionally visited her. Her husband and her children were frequent visitors and when they could they would take her out in a wheelchair; and there was a special place in church for her to sit in her wheelchair, neither at the back where she would feel an outsider, nor at the front where she would be exposed, but in the middle of everyone.

Di had the chance to end her life a year ago when she could no longer swallow, but she decided she wanted to go on living and loving and being loved not just by her family but by the staff in the care home as well. As so often happens, her helplessness and her vulnerability brought out all that is good in those she met. The way she and her husband lived out the ‘in sickness’ part of the marriage vows was quite awesome, and enormously inspiring to everyone who saw them together – ‘Where there is love there is God’.

People like Debbie Purdy from Bradford and Sir Terry Pratchett make the news as they seek clarification as to whether assisted suicide can be a legal option or campaign for a change in the law, but the Di’s of this world who, as they go through the valley of weeping use it for a well, are unheard and unseen.

I didn’t know Di well enough to have any intimation as to whether she ever contemplated ending her life prematurely to ‘spare’ either herself or her family, but I know my own mother who lived to be 88 would have ‘done the decent thing’ had she the chance, not because of any illness but simply because she lived for her family, wouldn’t have wanted to be any trouble to anyone, and would have wanted my brother and me to enjoy her worldly wealth sooner rather than later, and not have it ‘wasted’ on paying for people to look after her. Had she done so, we would have been utterly horrified.

Baroness Ilora Finlay is a consultant in palliative care. She wrote recently about her own mother suffering from advanced breast cancer and who decided that the end could not come soon enough and who made it clear that, had assisted suicide been legal, this would have been what she chose. She described how a conversation between her mother and the hospice chaplain transformed the situation:

‘Wise enough to realize there was no point talking about God to this agnostic lady and experienced enough to know we all have a story, he quietly and patiently asked Mum to tell him hers. And so he sat, this quiet, unassuming man, and listened, soaking up the years, as she told him her views and philosophy on life. And it was in this telling that it dawned on Mum that her decrepit body still held an active mind. Suddenly she realized that, if she wasn’t going to be allowed to kill herself, she had better make the most of what time remained.’

Her mother responded to palliative treatment and lived for a further four years that were ‘almost more precious than the eighty-four that had preceded them. Those four years we shared were the most precious gift. Without them, Mum would have missed what she described as some of the richest times in her life and we would have missed understanding just what an amazing person she was.’

Among the many medical conditions which can afflict us as we age is depression, but it creeps upon us without our realizing and is aggravated by other illnesses; and often, when people contemplate ending their lives, or express a desire that someone else should do so, it is the depression talking. Many people, who have wished for death as the only way out, have come through this to a late flowering in their lives which would not have happened had there been easy access to euthanasia.

I have an elderly relative for whom I am executor. She suffers from dementia and lives in a nursing home. For quite a time she would tell me that someone ought to shoot her; she would be better dead.

My faith tells me that I would be also…to be with Christ which is far better! She has now come through that depressed state and is happy and comfortable and looks set to reach a hundred. P.D. James wrote a one-off novel The Children of Men in which people drowned themselves in a state-sponsored ritual when they reached a certain age – an age which she has long since passed, as she continues to challenge and enthral with her murder mysteries.

A major purpose of the law is to protect the weak and the vulnerable, and this includes those who for whatever reason feel the need to take their own life or have someone else help them to do so; but the changes in the law, which those in favour of euthanasia want to introduce, add to the vulnerability of nearly all elderly people.

There are hard cases and, while we should not be seeking to keep people alive at all costs, I believe that these hard cases make bad laws. Caring can be costly and needs to be shared by society, and in particular we should be providing more support for those who for love’s sake sacrifice themselves in their caring.

During my ministry in Yorkshire I have visited people in six hospices. They are without exception places of peace, and are warm and life-affirming. They are not at all the sort of place you want to run away from. I think the hospice movement has been the greatest gift from the Church to this country in the past fifty years. They provide care holistically, and accept death as intrinsic to life — kind and gentle death (St Francis). I certainly have no qualms about going into a hospice as a patient if and when it becomes the best place in which to receive medical care. This is where to come if you really want to die with dignity.

Hospices also pioneered developments in palliative care, so that acute pain as our earthly lives draw to a close can be alleviated. About fifteen years ago a doctor in Winchester killed a patient, at her request, who was suffering from acute pain. I happened to have quite a few doctors in the church and they were horrified. They knew what he seemed not to know about the developments in the field of palliative care, which meant that she did not need to suffer as she had been suffering.

When we grow old or seriously i11 we lose control over our own lives, we are forced to become dependent on others for the very basics of life and we easily feel dehumanized and devalued in the experience. Baroness Finlay has suggested that people are sympathetic to euthanasia because they fear this loss. She says, `Today those who commend euthanasia usually frame their proposal around terminal or chronic illness. But in reality they base their case on personal wish alone, and see assisted suicide as another end of life choice’

W.H. Vanstone wrote movingly in his book The Stature of Waiting about Jesus when, particularly in Mark, he becomes helpless, passive — first as captive and then on the cross. And it is in this utter helplessness in his Passion that he most fully reveals God.

It is in our helplessness we are closest to Christ and `nearer, my God, to thee’ ND


The changes in the law

On 25 February, the Director of Public Prosecutions, Keir Starmer Qc, published the following criteria to be followed with regard to the prosecution of so-called assisted suicide.

The sixteen public interest factors in favour of prosecution are:

The victim was under 18 years of age.

The victim did not have the capacity (as defined by the Mental Capacity Act 2005) to reach an informed decision to commit suicide.

The victim had not reached a voluntary, clear, settled and informed decision to commit suicide.

The victim had not clearly and unequivocally communicated his or her decision to commit suicide to the suspect.

The victim did not seek the encouragement or assistance of the suspect personally or on his or her own initiative.

The suspect was not wholly motivated by compassion; for example, the suspect was motivated by the prospect that he or she or a person closely connected to him or her stood to gain in some way from the death of the victim.
The suspect pressured the victim to commit suicide.
The suspect did not take reasonable steps to ensure that any other person had not pressured the victim to commit suicide.
The suspect had a history of violence or abuse against the victim.
The victim was physically able to undertake the act that constituted the assistance himself or herself.
The suspect was unknown to the victim and encouraged or assisted the victim to commit or attempt to commit suicide by providing specific information via, for example, a website or publication.
The suspect gave encouragement or assistance to more than one victim who were not known to each other.
The suspect was paid by the victim or those close to the victim for his or her encouragement or assistance.
The suspect was acting in his or her capacity as a medical doctor, nurse, other healthcare professional, a professional carer (whether for payment or not), or as a person in authority, such as a prison officer, and the victim was in his or her care.
The suspect was aware that the victim intended to commit suicide in a public place where it was reasonable to think that members of the public may be present.
The suspect was acting in his or her capacity as a person involved in the management or as an employee (whether for payment or not) of an organisation or group, a purpose of which is to provide a physical environment (whether for payment or not) in which to allow another to commit suicide.
The six public interest factors against prosecution are:

The victim had reached a voluntary, clear, settled and informed decision to commit suicide.
The suspect was wholly motivated by compassion.
The actions of the suspect, although sufficient to come within the definition of the crime, were of only minor encouragement or assistance.
The suspect had sought to dissuade the victim from taking the course of action which resulted in his or her suicide.
The actions of the suspect may be characterised as reluctant encouragement or assistance in the face of a determined wish on the part of the victim to commit suicide.
The suspect reported the victim’s suicide to the police and fully assisted them in their enquiries into the circumstances of the suicide or the attempt and his or her part in providing encouragement or assistance.
The CPS Policy for Prosecutors in respect of
Cases of Encouraging or Assisting Suicide must
be read alongside the Code for Crown Prosecutors
and is effective immediately.