Prof Suzanne Ost
This blogs considers the case of Anne, recently reported to have received an assisted death at the Dignitas clinic in Switzerland because she was tired of life and the digital age. I reflect on the implications of this case and the question of whether it can be legitimate to permit assisted dying on the basis of such existential suffering.
Right now more than perhaps ever before, assisted dying is a hot topic. We continue to await the Supreme Court’s ruling in the well-publicised case of Tony Nicklinson, who sought a change in the law to enable him to have a medically assisted death. Lord Falconer’s most recent attempt to bring about legislative change to permit a medically assisted suicide where a person has six months left to live, the Assisted Dying Bill, will soon be the subject of what will no doubt be a fierce debate in the House of Lords. And we now hear of the case of 89 year old Anne, a former teacher and Royal Navy electrician, who utilised the services of the right to die organisation Dignitas to have an assisted death in Switzerland in March 2014 not, it is reported, because she was terminally ill, nor because she was suffering from an incurable, painful illness. Rather, it seems that the primary reason for Anne’s desire for an assisted death was because she was tired of life, in particular, modern life and living in the digital age. She is quoted in an interview for The Sunday Times as saying that ‘… People are becoming more and more remote… We are becoming robots. It is this lack of humanity… At my age I feel that I can’t adapt, because the new age is not an age that I grew up to understand’. An independent individual by nature, Anne also appeared to have become frustrated by the effects that ailments brought on by old age were having on her previously active life and her wish to die became more fervent after she underwent a period in hospital in 2013 because of heart and lung disease.
This would seem to be an example of a desire to have an assisted death based on existential suffering, or, in other words, being ‘tired of life’. Cases such as this test the boundaries of laws under which some form of medically assisted dying is lawful, and test how far those in favour of a right to die are prepared to take their arguments. For instance, if the primary basis of someone’s pro-assisted dying position is that of respecting individual autonomy and acting out of compassion, can it be acceptable to grant person X, who is terminally ill with cancer, a right to die, but not to do the same for person Y who suffers from multiple sclerosis, who is expected to have at least another five years of pain and suffering to endure? And if persons X and Y should be given the right to die, what if person Z’s suffering caused by her being tired of life is as intolerable to her as X and Y’s suffering is to them? Should she not also be granted this right on the basis of respect for her autonomy? If there is no available treatment to lessen existential suffering, it might be lessbearable than some physical and psychiatric illnesses which are treatable.
On the other hand, is allowing Person Z an assisted death an example of how, once assisted dying is permitted, it gradually becomes easier to permit assisted deaths in more cases, thereby placing the vulnerable at risk, as argued by Dr Peter Saunders of the Christian Medical Fellowship? It may be significant that the law in Switzerland only prohibits assisted suicide carried out for reasons of self-interest. Dignitas’s own guidelines require that a person be suffering from hopeless or incurable illness, unbearable pain or an unendurable disability, guidelines which Anne’s case must have been considered to have complied with. If a law is broadly stated, whether it prohibits or permits assisted dying, does this make it more likely that what would once have been considered a step too far can gradually come to be seen as permissible? We should also pay heed to the recent warning from a leading expert on psychiatry and old age that in nine out of ten elderly people suffering from depression, the condition goes undiagnosed. Should requests from people in a similar situation to Anne ever lead to a lawful assisted death if there is a danger that they are brought about by undiagnosed depression? Would a rigorous psychiatric assessment of individuals who request an assisted death avoid this possibility?
Whether existential suffering should be an acceptable basis for a lawful assisted death has been a controversial matter for Dutch society in recent years. Dutch law permits a medically assisted death (euthanasia where the doctor causes the patient’s death or assisted suicide where the patient is assisted in carrying out the act causing her death) provided certain criteria are met, criteria which have been interpreted as requiring that a medical condition has led to unbearable suffering, causing the person to desire an assisted death. If Anne had been a Dutch citizen, she would thus have failed to satisfy the requirements in order to have a lawful assisted death in that country. However, this position has been challenged. In 2010, an ‘Accomplished Life’ Initiative was founded by a citizens’ action group, demanding that individuals over 70 who were tired of life should have the right to an assisted death. At the same time, Albert Heringa assisted in the suicide of his stepmother, 99 year old Maria Heringa, who was tired of old age and concerned about her increasing loss of control over her life. He made a video-recording of what occurred and this recording was subsequently shown on a Dutch television network. Mr Heringa was prosecuted for assisted suicide and, in October 2013, he was found guilty of this offence. However, he received no punishment from the court since it was concluded that he was motivated to act because of his love for his stepmother.
In a jurisdiction such as the UK, where there has been a continued high level of public support for a law permitting some form of assisted dying and the publication of a prosecutorial policy for cases of assisted suicide, together with a series of high profile cases such as those of Daniel James, Debbie Purdy and Tony Nicklinson, Anne’s case provides much food for thought for legislators. If the law is to be changed, do we draw the line at permitting assisted deaths where an individual’s suffering is caused by a terminal, medical condition? Will such a line, if it is drawn, not be challenged by someone such as Anne, who argues that her suffering is as unbearable, albeit that it does not stem from a medical condition, and that her right to autonomy should equally be respected?
Suzanne Ost (@SuzanneOst3737) is Professor of Law in the Law School at Lancaster. She researches in the areas of medical law and ethics and child sexual exploitation. She is the co-author of Medicine and Bioethics in the Theatre of the Criminal Process and is the Editor-in-Chief of the Medical Law Review.
You can find out more about Suzanne’s research at http://www.lancaster.ac.uk/fass/law/profiles/suzanne-ost