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Mary Warnock Naive About Euthanasia

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This weekend I've been at the Hay Festival (this year sponsored by the Torygraph). The highlight of Sunday's programme was Mary Warnock plugging her book 'Dishonest to God'. In it she argues a position I fundamentally agree with - that morality doesn't need to stem from religious belief, and a modern legal system is better articulated as a negotiation between people than as an interpretation of divine will. One of the questions at the end of the session related to Euthanasia - a subject on which Mary has got in to trouble in the past (largely undeservedly, in my opinion). On this occasion she repeated her not unreasonable view that people should have the option to 'pull the plug' on their own lives if the future becomes intolerable. But was she being naive in overlooking the fact that disability rights groups are almost universally against proposals to legalise medically assisted suicide?

 

From my own perspective, I would very much like the option of assisted suicide. I understand why the venerable Mary (now 87) and many of her peer group think they might prefer the option of a quick and painless death to a long, painfull, expensive and lingering exit. Lickily for them, they have yet to experience the joys of insititutional care. In our line of business we come across many examples of people working very hard for little or no financial reward, going the extra mile to care for sick people. But we also hear the horror stories. And the surprising thing is that the horror stories are not usually about sadistic doctors or abusive relatives, but stem from dehumanising bureacracy and the fact that there isn't enough money.

 

Mary's defence of assisted suicide depends on legal safeguards to prevent people being pressured into choosing death. My experience is that legal 'safeguards' are usually only introduced when everyone knows the system will go wrong, and are never resourced properly. A fairly recent example is the Mental Health Act 2007, which introduced new powers for compulsory treatment in non-hospital settings. The risks of overuse were pointed out by many groups at the time the new powers were enacted. As it happens the predictions were correct - the Care Quality Cimmission Report for 2009/10 states 'More than 6,000 CTOs have been made since the powers were introduced in November 2008, which greatly exceeds the number anticipated at the time the new legislation was introduced'.

 

More relevant in the context of the euthanasia debate is the effect that the extra demand placed on Mental Health Review Tribunals, which hear appeals from people who believe they are being wrongly detained or treated. 'In 2009/10, the number of applications to the Tribunal rose sharply, to 12,122 hearings in the year compared to an annual average of just under 10,000 in the previous nine years.' The result is that 'Patients and staff continue to report long delays between making applications to the Tribunal and the hearing and, in some cases, hearings have been postponed more than once.' Remember, this is for people who are already being treated against their will. So much for safeguards.

 

Mental Health Review Tribunals cost about £3000 each. Caps on legal aid for mentally ill people introduced in 2009 and the limited implementation of the new Independent Mental Health Advocacy services clearly indicate that the 'safeguards' that went with the new powers were perceived as 'unaffordable' almost at the same time as they were introduced. At any time, around 20,000 people receive compulsory treatment under the Mental Health Act, around 1/4 of them in the community. This compares to about 3/4 of a million people who have some form of dementia, costing the UK around £20 billion annually. Imagine the cost of the legal machinery that would be required to evaluate hundreds of thousands of cases relating to assisted euthanasia, and how this would stack up against the £20 billion a year the state could save by getting rid of all those inconvenient old people. Then ask yourself whether you'd feel reassured by 'legal safeguards'.

 

Mary Warnock is a brilliant moral philosopher, but I'm afraid she's overoptimistic about the willingness and capacity of our society to safeguard the rights of sick and disabled people. Of course we all have the right to end our own lives, but for the moment we'll have to carry on without the help of the state or the medical profession, because once that right gets handed over some people would never get it back.

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