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Updated: January 3, 2014 01:20 IST

Time to let go

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Margaret Drabble
Margaret Drabble

Advances in science are keeping us alive for longer and longer, but we are denied the right to die with dignity. It is grotesque

Back in the mid-70s, we were introduced to the notion of “medical nemesis” by the Austrian philosopher Ivan Illich. He warned us that doctors may do more harm than good, and that some diseases (which he labelled iatrogenic) were caused, not cured, by medical interventions. This doctrine has been widely accepted — we all know about the dangers of overprescribing antibiotics, about the risks of overzealous or misinterpreted scans, about the creeping medicalisation of childbirth — but its application to old age and death is what interests me here. One of Illich’s arguments in those days was that medicine, despite its apparent successes, was not notably increasing life expectancy. Alas, he was wrong. Artificially prolonged old age is the new iatrogenic malady.

We can’t switch on the news without being told we will live longer, work longer, and survive on diminishing pensions or overpriced annuities. Newspaper columnists tell us we are selfish and that the young are suffering from our claiming an unfair share of state support. They begrudge us our bus passes, one of the few well-earned consolations of age. As we move into our unwanted last decade, we will, entirely predictably, become lonelier and lonelier and more and more likely to suffer from dementia and more and more expensive to maintain.

It would be unfair to blame doctors or health professionals for our longevity, which may be attributed to causes other than surgical ingenuity and pharmacological innovations and deadly life support machines, but it is not surprising that many of us feel gravely disappointed by the help and relief on offer to us at the end of life.

Dignity

We look in vain for compassion, dignity, even common sense. We look in vain, despite what we are told, for adequate pain relief. Medical professionals seem far more interested in keeping alive barely viable premature “miracle” babies with a poor long-term prognosis than in offering reassurance to the growing and ageing multitudes who long to depart peacefully. They keep the babies alive because it’s challenging, and very few people dare argue that it’s not a good thing to do. They keep us alive because they are forbidden to give us what we want and need, and they are too frightened to question the law. There’s something wrong there.

Don’t blame us if we are cluttering up the system. What we want and need is simple. We want a change in the law concerning assisted dying and voluntary euthanasia, and help, if need be, to die with dignity.

The groundswell of opinion in favour of change is unmistakable. How often do you hear phrases like “you wouldn’t let your dog suffer like that”? Three-quarters of the population backed Lord Falconer’s assisted dying bill on its first reading in Parliament. The bill would allow people who are terminally ill to receive the help they need to die, if that is what they choose. But can we have what we want? No. The politicians won’t let us, the bishops won't let us, the health professionals aren’t allowed to let us. It’s grotesque.

Those suffering from incurable diseases need to be able to choose without penalty the help which they are at the moment denied. The elderly need to be able to plan ahead clearly, and to make their own choices about when their lives are no longer worth living. There seems to be some conspiracy to stop us thinking about the end game we all shall play. So we shuffle on, until it’s too late to make any decisions at all, and we become helpless pawns in the politics of deferral, and utterly dependent on the humiliating procedures that for all our rational life we so wished to avoid.

It is my hope that in my lifetime the law will change, taking with it the fears that add so much terror to death. How wonderful it would be, if we knew that we would not be obliged to contemplate the bodily and mental decay that threatens us all. That we could opt out, and make our quietus, not with a bare bodkin or a plastic bag, or by jumping off the top of a multi-storey car park, but with a nice glass of whisky and a pleasing pill — and so good night. How the heart would lift with joy at the good news. I don’t go for Martin Amis’s suicide booths, but I’m with Will Self all the way about the right to die when and how we want. When it’s time to go, let’s just go.

At the moment, it’s not that easy. My husband, Michael Holroyd, fondly believes that as the longest serving patron of the Dignity in Dying campaigning organisation, he will be allowed to die in peace, but no, the doctors, in mortal fear of Parliament, the law, the press and the General Medical Council, will be slavishly working to rule and obeying orders and striving officiously to keep him alive as they observe their archaic Hippocratic oath. It will be just like it was in the old days, when Simone de Beauvoir described her mother’s death, in the ironically titled “A Very Easy Death.” If a woman of her intellect and clout couldn’t prevent her mother from being hacked about by surgeons on her deathbed, what hope have we?

The best new year’s gift an ageing population could receive is the right to die. As the philosopher Joseph Raz argues “The right to life protects people from the time and manner of their death being determined by others, and the right to euthanasia grants each person the power to choose themselves that time and manner.” The right to die is the right to live. (Margaret Drabble is a novelist, biographer and critic.) — © Guardian Newspapers Limited, 2014

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Fantastic...!!

from:  Uma
Posted on: Jan 5, 2014 at 15:09 IST

I thank the renowned author for lending her voice to a most pressing
problem of our age. Society today is unbalanced: there is much
thought, debate and agreed norms of behaviour about human rights,
while one is able to exercise them, but there is no choice, no
dignity, no say, in how one can leave the world in a pain-free,
trouble-free (to oneself and to one's carer, who is usually the
dearest spouse - also equally old and frail), and dignified manner in
peace and happiness.

In trying to protect right to life and ensuring that the elderly are
not killed off when they are most vulnerable in their old age, the
state is unwittingly inflicting great suffering and indignity on the
very same people it cares so much about. It is high time old people
themselves and their family members, philosophers, sociologists,
doctors, lawyers, politicians, act together to evolve a balanced
policy which protects life while permitting a dignified end to life,
which is unavoidable. “My Life AND My Death.”

from:  D Mahapatra
Posted on: Jan 4, 2014 at 11:03 IST

Dear Margaret, I feel so sorry for you, and for your husband.
I must tell you a secret. The doctors, the pharmacological innovators,
the politicians, and us, the others, are governed by another, more
effective power.
It is called market. The person that goes with dignity ceases to
produce growth. On top of this, for the doctors’ associations to
publicly accept and assist death with dignity, it would mean to accept
that the curative aspect of their science is non-existent or a
complete failure —a cop-out.
Artificially prolonged old age as the new iatrogenic malady is a more
palatable pill for them to take.

from:  Al Gallo
Posted on: Jan 4, 2014 at 10:31 IST

I thank the renowned author for lending her voice to a most pressing
problem of our age. Society today is unbalanced: there is much
thought, debate and agreed norms of behaviour about human rights,
while one is able to exercise them, but there is no choice, no
dignity, no say, in how one can leave the world in a pain-free,
trouble-free (to oneself and to one's carer, who is usually the
dearest spouse - also equally old and frail), and dignified manner in
peace and happiness.

In trying to protect right to life and ensuring that the elderly are
not killed off when they are most vulnerable in their old age, the
state is unwittingly inflicting great suffering and indignity on the
very same people it cares so much about. It is high time old people
themselves and their family members, philosophers, sociologists,
doctors, lawyers, politicians, act together to evolve a balanced
policy which protects life while permitted a dignified end to life,
which is unavoidable. “My Life AND My Death.”

from:  D Mahapatra
Posted on: Jan 4, 2014 at 09:08 IST

There is no ‘right’ to be killed and there are real dangers of ‘slippery
slopes’. Opening the doors to voluntary euthanasia could lead to non-
voluntary and involuntary euthanasia, by giving doctors the power to
decide when a patient’s life is not worth living.

from:  Seema Johri
Posted on: Jan 3, 2014 at 22:03 IST

Definitely, this idea looks feasible from the author's perspective but
it will be difficult for any government to enforce the 'right to die'
concept because there is a possibility of misuse of any such law if
adopted.

from:  abhinav
Posted on: Jan 3, 2014 at 21:09 IST

Right on, Margaret. But not this year. What you're asking for demands too much intelligence, compassion, and courage from too many people. Like a lot of things the world desperately needs.

from:  Ashu
Posted on: Jan 3, 2014 at 09:40 IST
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