From Socratic suicide to “assisted dying”

There are some moments when I feel even more glad than usual that I am not a Member of Parliament – and the debate over assisted dying is one of those.

My heart is strongly in favour of allowing this possibility. I was, I suppose, “lucky” in that my parents, who both had cancer, died relatively quickly, and with what seemed to be discomfort rather than terrible pain. But I cannot imagine what it would be like to watch someone you loved in appalling, uncontrollable and prolonged agony – still less what it would be like to be that loved one yourself. I am broadly won over by the brutal argument that, if we allow our pets to escape intolerable suffering, why do we not allow our fellow human beings the same escape?

I guess that I also have in some way internalized the ancient admiration for a “noble suicide”. From the Greek and Roman world there are few examples of those taking their own life because of frailty or terminal illness. The elderly philosopher Zeno of Citium might be one example (though traditions differ). Part of the explanation for those cases being so scarce is that “natural” death often came quicker back then, without modern, life-prolonging medications. And there are only a few signs of what we might call “mental health issues” as a reason for taking your own life (though there is no doubt a source bias here). Instead, most of the famous ancient suicides are presented as powerful acts of defiance or principled political opposition. They have a high moral value placed on them, even if the reality was far less heroic. The story of the death of Socrates from self-administered hemlock sets the pattern here. Plato’s account gives the impression of a gentle, gradually increasing numbness, from feet to head, which hardly interfered with his final contributions to philosophy. In truth, death from hemlock was, and is, quite different – with vomiting, diarrhoea and shortness of breath being more likely symptoms than peaceful, painless oblivion.

“The Death of Socrates” by Jacques-Louis David, after 1867

But, accurate or not, none of this is anything like the legal procedures around assisted dying that are now being proposed. I totally understand the need to have legal safeguards to ensure free will, consent and lack of pressure (the “being a burden” argument). And I don’t think it fundamentally alters my support for a change in the law. But the idea that the right to die might involve legal challenges and courtroom drama (when the person concerned is less than six months away from death) seems quite the reverse of a peaceful release from suffering. And I also can’t help wondering what effect this new “option” might have on the provision of proper end-of-life care for those who don’t want to take the assisted-dying route. Hospices are dreadfully underfunded as it is.

I have a question too about what used to happen in the past, though not so far back as classical Athens. I vividly remember the conversations between my mother and the medics when my grandmother was in her last few weeks in a rural cottage hospital almost sixty years ago. The phrase that still sticks in my mind came from one doctor: “she’s a very tired old lady, you know”. And I remember my Mum emphatically agreeing. I suspect that this simple exchange remains so memorable decades later is that it carried a big emotional punch, and that it meant more than it seemed to, even if I didn’t quite get it at the time.  I don’t for a minute imagine that Granny was actively helped to die (unlike, we are told, George V). But I now suspect I was witnessing a tacit negotiation, which meant (say) that the levels of the morphine doses were not very rigidly monitored. Maybe that’s not such a bad way to go, and I suspect a lot more of it used to happen.

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