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How many assisted deaths are too many?
One striking argument made during the defeat of the UK’s proposed assisted dying law was that the projected figure — that it would account for 1 per cent of all deaths — showed that the law was either too cavalier or else perfectly judged, depending on the perspective of the speaker. Canada, whose medical assistance in dying (Maid) programme is the subject of pro-life demonology, has a 5 per cent figure.
The defeated UK law would have covered a relatively tiny share of deaths — people of sound mind with a terminal diagnosis of six months or less. The proposal ended up in an unlovely no man’s land: not as far-reaching as the general public consistently says in polls that it wants, but too far-reaching for its parliamentary critics. Might that suggest that somewhere between 1 per cent and 5 per cent — Switzerland’s 1.5 per cent, for instance — might be the right target?
The answer is “none of the above”. The question was revealing of a broader flaw in the assisted dying debate in the UK, one that is useful not just for assisted dying advocates as they gear up for their next attempt to get legislation through, but for every country wrestling with questions of death and dying in the 21st century.
In 1970, 41 per cent of all deaths in the US — another country where assisted dying is debated, but at a federal level, not yet legal — were down to heart attacks, and in 1961, over half of Britons were killed by heart attacks. Today those figures are a fifth of Americans and a quarter of Britons. In both countries, dementia now kills more people than heart attacks.
A quarter of all Americans die in intensive care, with most of them dying due to the deliberate withdrawal of methods to keep them alive. This is a form of “assisted death” — it’s just one chosen by clinicians, for the most part when the patient’s wishes may have been known in advance but in some cases without even that.
It’s hard to imagine that anyone would seek an assisted death to avoid the risk they might die from a heart attack, and I think most of us would see that as a dreadful reason to do so, even if the percentage of people doing so was so small as to be immeasurable.
Wherever I have travelled in the world, I have met people who hope that they will have the right to die at a time of their own choosing. While I have never met anyone who wants to die to head off the risk of death by heart attack, I have met a very large number of people who do not want to die with dementia. These are people who do not want to lose their intellectual faculties and don’t want their families to have to spend years caring for them.
Countries without an equivalent of the Canadian scheme instead occupy a bizarre status quo. It is one in which the withdrawal of life-saving treatment after someone loses their cognitive faculties in intensive care is part of medical life, but where, if the same thing were to happen slowly outside hospital, you are on your own.
So “what percentage is the right one?” is not a particularly useful question. Assuming that advances in medicine continue, the number of sudden deaths, from heart attacks or following some kind of accident, will continue to decline, and the number of slow, lingering deaths will increase. If our treatment of and response to heart attacks continues to improve, by 2076 these will make up a trivial share of deaths. So we would expect the share of people availing themselves of a well-designed assisted dying law to rise. Almost none of that growing group would have been well served, or even included, in the law parliamentarians voted down last week.
Part of the UK’s problem is that the proposed legislation was so narrowly conceived that it could only ever be badly designed. Very few people will want or need to avail themselves of the right to die after having received a six-month diagnosis — a period when, in any case, many will die, having been either heavily dosed up with morphine or having slowly declined due to not eating and going “nil by mouth”. At no point in the debate over assisted dying did politicians seriously grapple with the question of what percentage of such deaths is too high.
Indeed, that debate often seemed to regard the fact we will die, and the circumstances in which we do so, as too unpleasant to be discussed. Other countries, and the defeated campaigners, should be willing, the next time the issue is debated, to have a far more open and candid conversation about the end of our lives.
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