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Me, the State and My Fate

Posted by Dr No on 20 July 2014

choice.jpgReality is merely an illusion, albeit a very persistent one.

Albert Einstein

Dr No has always rather liked Einstein’s observation on reality, reminding us as it does that things may not always be quite what they seem. As the material consumerist world grows ever more dominant in our lives, a touch of real reality, as in things may not always be what the seem, becomes ever more crucial to keeping a grip on things, especially those things which may or may not be what they seem. Nowhere is this more important than in the vital questions of our ending: how and when we die.

Such musings arise in the wake of the Lords’ debate on assisted suicide, and Dignity in Dying’s latest motif, #untiltheend. The Lords’ debate was by all accounts thorough and balanced, even if Dr No was irked by a tiresomely ill-informed peer who claimed her dying mother was denied proper relief because the morphine dose needed was illegal – there are no illegal morphine doses in palliative care, just timid doctors. DiD’s #untiltheend is the notion is that we spend our whole lives joyfully making decisions, exercising choice, being hot consumers, until the end, when the State, through the cold lock of law, forbids choice. The BBC news had an MP warbling on about how dreadful it was that the State should get in the way of choice. As a position, it’s nonsense.

For starters, the law does not object to suicide: suicide is permitted, but generally – there are notable exceptions, such as Baroness Warlock’s call for ageist cleansing - not encouraged. In a humane society, this is the right position, for all the obvious reasons, but it does rather take the thiopental out of DiD’s syringe, for the simple reason most of us do have a choice. Almost anyone can choose suicide. The terminally ill, like the rest of us, are legally at liberty to fall under buses, jump off cliffs, strap themselves to railway lines, take overdoses, wire themselves up to the mains, blow their brains out, or adopt any of the many means available online to engineer for themselves what the Incredible Dement once famously called ‘a result’. So the central DiD premise, that we lack choice at the end, is simply wrong. The State already allows, but does not encourage, those facing unbearable suffering to kill themselves.

Rather awkwardly for DiD, because it suggests the Bill may turn out to be something of an empty boat in search of some passengers, although most of us do have the choice of killing ourselves, very few do. Eighty per cent of those surveyed may want the law changed, but, going on current evidence, precious few of those eighty percent will in practice embark on the journey themselves. Perhaps the eighty percent are actually rather keener on doing the assisting than the dying – who knows? Perhaps those who support changing the law to allow assisted suicide consider the Bill’s marginality – only a few will choose to check out early – can be argued in its favour. Perhaps the Bill is about ending discrimination against those who want to check out early, but are blocked by want of means, even if, on present evidence, there aren’t hordes jiggering around of the banks of the Styx, begging to be bundled the boat that goes only one way.

These, then, are the curiosities that strike Dr No. The Bill is in effect an enabling bill to extend a choice that most of us already have, but few of us choose to take, to those who, for whatever reason, want the choice, but lack the means. The allegedly high cost of checking in, or rather checking out, at Dignitas (who provide an assisted suicide ‘service’) are not that high – currently around £5250 – not much more than a typical funeral (something over £4000). If Dignitas do the funeral and administration as well, the total cost rises to £7875, but the home funeral costs are saved, meaning the cost attributable to checking out are closer to £4000. Yet so very few people travel to Dignitas – last year (2013, Dignitas figures) 29 British residents booked themselves in for ‘a result’. The curiosity is almost a paradox: so many want the law to change to allow choice, yet so few take the already available choice.

Perhaps that’s the thing: many people want the choice, but most won’t exercise it. Maybe we’re overrating the importance of choice; in effect, the choice of assisted suicide is an empty choice, a choice that many want but few need. Yet the empty choice comes with a hidden payload: it changes perceptions. What was taboo – assisting a death - now becomes legal. A threshold has been crossed, a space has been entered the furthermost bounds of which we cannot yet see, a genie is in flight and we know not where it will land.

We may enjoy choosing what brand of cola to buy, but we manage many of the big things in our lives without any choice whatsoever. Certainly, none of us chooses to be born. None of us chooses our potential as delivered in our genes. None of us chooses the childhood nurture, or lack of it, delivered, or not, by our parents. None of us chooses – though some may have a hand in – the mortal illnesses that will carry us away. We manage these big things delivered on a plate, with no say at all in what arrives. Some even go much further, saying that all choice is an illusion, a human vanity that denies – depending on belief – the hand of God or fate.

Perhaps, after all, choice, like reality, is an illusion, albeit a rather persistent one. Whether we are religious or not, Dr No suspects most of us know what the Bible means when it talks of ‘A time to be born, and a time to die’, even ‘A time to kill, and a time to heal’. We manage many big things in life even though they are determined not by us nor by the State but by fate. As the Bard said, ‘There's a divinity that shapes our ends, Rough-hew them how we will—’. Perhaps we would also be wise not to meddle with our ends, through the illusion of choice.


Hi, yesterday’s NY Times article spoke of the hardships faced implementing digital medical records in hospitals What do you think about digitizing MRs directly to mobile phones, making them available to doctors via their mobile phones or iPads? What would your advice be on how it would best work?

Hi, yesterday’s NY Times article spoke of the hardships faced implementing digital medical records in hospitals What do you think about digitizing MRs directly to mobile phones, making them available to doctors via their mobile phones or iPads? What would your advice be on how it would best work?

Yeah, it happens me sometimes. I think it s a choice. The same as in your life. You always have a choice and it depends on you to save or ruin the day by having it.

I'm trying to leave my state, i am trying to go to nowhere.

Sometimes I believe there is no state that can be trusted and that there is no better place. We should consider staying at home.

Choosing suicide really scares me. I am not sure this should be allowed because probably there is just an impulsive action. You should live your live no matter what. No problem stays forever. Furthermore, you have no right to make your dearest persons to suffer.

Very good ending and I totally agree with you that everyone speaks about this, but very few or none exercise it.

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