Assisted suicide – the arguments

Today Members of Parliament will vote on the Second Reading of a Bill which would, if passed, legalise assisted suicide (or dying, if you prefer), in the UK. It is estimated that, if passed, it would mean that around 1,500 would be ‘helped to die’ if it became law.

In 2010 I wrote an article for The Economist that rehearsed the arguments for and against assisted suicide (or dying, I’m trying to be even-handed here). So here’s a few extracts from the piece again –  which looks briefly at the state of play in Oregon, on which the bill is largely modelled and the Netherlands.

I’m still sceptical, for what it’s worth. I like the fact that the guidelines introduced in 2010 honour the love and affection of those who take difficult decisions about those they love and feel under unbearable pressure to help them die (we have no idea what we would do in similar situations) but do not give carte blanche to everyone to get rid of elderly or disabled relations who they just don’t want around any more. Case by case – it just seems a better way to look at this difficult area.

The Economist – July 1, 2010

THE argument over the ethics of assisting the terminally ill to die is sharpening, as two recent cases concentrate minds. On June 25th Keir Starmer, the director of public prosecutions, said that Michael Irwin and Alan Cutkelvin Rees would not be prosecuted for helping Raymond Cutkelvin, who had pancreatic cancer, die at a Swiss clinic in 2007. Prosecuting would not be in the public interest, he held: Mr Rees was motivated by compassion; Mr Irwin, a former doctor, was an elderly man; and neither had profited from the death.

At issue is whether it should be legal to help a sufferer who wants to take his own life, or whether this might put pressure on the sick, the disabled and the elderly to call it quits early. In February the Crown Prosecution Service (CPS) issued new guidelines on when someone might expect to be prosecuted for assisting suicide. Debbie Purdy, who has multiple sclerosis, had asked the courts to clarify whether her husband would be prosecuted if the couple travelled to Dignitas, a clinic in Switzerland, to end her life. Mr Starmer stressed that the guidelines did not decriminalise assisting someone to die or “open the door to euthanasia”, and that no case was absolutely prosecution-proof. But all sides welcomed the new stress on a suspect’s motivation.

Sir Ken Macdonald, Mr Starmer’s predecessor, likes the new guidelines, saying that they protect people at a vulnerable time in their lives who may feel they are a burden on their families. Like many lawmakers and doctors, he wants the door left open for prosecution, though he says that in practice few are or should be pursued.But many think the law should give greater certainty. Around 100 Britons have trekked to Switzerland to end their days at Dignitas. Other places too permit some form of assisted suicide, including Belgium and the Netherlands and two American states (Oregon and Washington).

Sarah Wootton, the chief executive of Dignity in Dying, a pressure group, points to polls showing that most Britons (including, she says, many disabled people) want a change in law. She argues that assisted dying can be regulated so that it does not endanger the vulnerable. The charity supported an unsuccessful member’s bill in the House of Lords in 2006 which proposed safeguards including a medical assessment by two doctors. A similar proposal last year by Lord Falconer, a former Lord Chancellor, also got nowhere.

Jane Campbell, a disabled peer who chairs the group Not Dead Yet UK, sees things differently. She acknowledges that there “might come a time” when legalisation could be considered. But now is not that time, she argues, because disabled people and those with terminal illness are seen, not as equal members of society, but as a “burden” on the scarce resources of the National Health Service.

A professor of palliative care, Ilora Finlay, also a peer, agrees. She says that better care at the end of life, including advances in pain relief, should allow more people to die naturally. She points to the increase in the number of those seeking an assisted death in Oregon, where it has gone up nearly fourfold since legalisation, and in the Netherlands, where it increased by 13% last year, with a significant rise the year before. (The increase in deaths has triggered an investigation by the health ministry.)

For all their differences, people on both sides of the argument agree that the new CPS guidelines are better than the vacuum they filled, and that clearer thinking about end-of-life care is welcome. But the tussle over assisted suicide will not go away. The Royal Society of Medicine devoted a day to it this week, and a decision on whether Dr Martin is to be prosecuted is expected soon. And once a country has legalised assisted dying the issue is not always laid to rest. Campaigners in the Netherlands are now pushing for elderly people who are “tired of life” to be helped to die too.


Book Review: Jewels of Allah, by Nina Ansary

As Iran and the West enter a detente phase, this subtle, intelligent book offers compelling insight into the role of women in Iran. Nina Ansary, an Iranian academic living in the US since middle childhood when she left her homeland at the onset of the Iranian revolution, concentrates on the situation from that crucial point onwards, but, crucially, also looks back at how women in Iran have sometimes enjoyed emancipation in the past. She brings to life women from Iran’s past, who have held powerful positions in the military, the judiciary and as businesswomen.

Ansary expresses an inconvenient truth – although women were emancipated in law by the Pahlavi regime, in truth because cultural mores had not caught up, the top-down policies did not work as well as had been hoped. The veil was banned, for example, but instead of emancipating all women, many stayed at home rather than venture forth without head-cover – thus driving them back into the home, rather than the objective. She draws attention to the ironic paradox that whilst women’s roles were supposed to be circumscribed by the Islamic Revolution in 1979, in many ways women continued to struggle for freedom and some of the steps the mullahs took underpinned that. (She also discusses the irony of the fact that many women, including feminists, joined the revolution against the Shah – and then regretted it.) The reintroduction of the veil, for example, meant that girls and women from stricter households could venture forth yet again – and did, in increasing numbers, meaning that they had access, crucially, to education. As Ansary says:

“The fact is that the so-called Islamization of education has proven to be responsible for generating unprecedented educational gains for the vast majority of the female population.” Classrooms were strictly segregated, leading to the unintended consequence that girls could learn, undisturbed by the demands of male pupils. Ansary also points out that textbooks were hardly changed, and continued to showcase women in professional roles, giving girls role models to which to aspire.

Girls and women, behind the Islamic curtain, continued their struggle, despite the threats of imprisonment in horrific prisons (in one of which, Evin prison, my own birth father was imprisoned for several years after the Revolution). Their role was bolstered during the Iran-Iraq war, Ansary also notes, when women filled the roles of men fighting on the fronts. As Ansary says:

“Perhaps the government’s failed ideology has been most obvious to a defiant female population that continues to boldly protest their enforced status of inferiority.” Girls and women played a crucial role in the 2009 uprisings, as Ansary says, despite all odds. Women also continued to run a number of important magazines – also crucial because women from all backgrounds, secular and religious, have worked together to combat misogyny. Ansary’s understanding of Islamic feminism is crucial to this middle section of the book.

This is an engaging, fascinating and beautifully written book, countering, as Ansary writes, “convenient half-truths” and expressing instead, as Ansary says, “the audacious history of women in Iran”. Anyone seeking to understand the troubled history of Iran should read it.

I read it with great interest, both as a feminist and as someone with Iranian roots through my birth father (and am grateful for receiving a review copy from the publishers). It gave me insight into the life of my birth family in Iran, in which women in the family had to see members in prison (and one executed) and were stifled, like others, as women.

The book started its life as an academic thesis, and as such is fully footnoted and rigorous. However, it is also engaging in its tone and suitable for all readers. I recommend it whole-heartedly.

Jewels of Allah, by Nina Ansary, published by Revela Press.

Katharine’s own book, Blood and Water, about her search for her Iranian birth family, can be found here: