Saturday, 12 July 2014

Lord Carey gets it wrong

Lord Carey, the former Archbishop of Canterbury is in the news today because he remains a member of the House of Lords and has indicated that he will support the Assisted Dying Bill "in the face of the reality of needless suffering". He has obviously decided that there are clear guidelines between needless and needful suffering. He obviously believes that there is no right and wrong in matters of life and death despite that bit in the Bible about thou shalt not kill, because that is what assisted dying does.

I have also seen a quote from the campaign for dignity in dying, "an assisted dying law would not result in more people dying, but in fewer people suffering". Well the first part of the quote is simply a waste of time because we all know that everyone is going to die. As for the second part, we expect medical science to conquer suffering. Where we are let down is not in the control of terminal pain, but by the suffering that is caused by the malpractice of basic care to those who are vulnerable. If you don't believe me take a look at 'care home abuse' in a search engine.

Dr Carey should know better because if he wants to break one of the ten commandments with his exceptional circumstances then what about the other nine? Can I covet my neighbour's wife if I don't get my tea on time or if the other woman is exceptionally beautiful or talented? Pick your own exceptional circumstance.

Change the world


  1. "we expect medical science to conquer suffering." We do? First I've heard of it. Medical science will continue to improve, but there will always be some degree of suffering, and physical pain is not the only form that it takes. As to the failures in care at a variety of establishments, of course they occur and of course they should be addressed, but what does that have to do with the Assisted Dying Bill? The purpose of people pursuing the right to die in circumstances where they may require assistance is not to avoid bad standards of care, but for a person to be able to end their life when it provides nothing but suffering for them and their loved ones.

    In terms of commandments, of course you're right. The commandment is not to kill, and if you take that as your absolutist moral framework then there are no exceptional circumstances. But that's why a list of 10 rules is ridiculously inadequate as a moral guide, and why most people don't in fact use it - including the majority of Christians. Very few people consult a bible to decide whether an action they see is moral or not.

  2. Thanks for your comment 'Eric'. I don't normally allow anonymous comments but I'll make an exception for you. Yes, I expect medical science to conquer suffering. They can even induce comas. Some analgesics suppress the respiratory system and consequently death may be a side-effect but medics with their primum non nocere attitude (first do no harm) are presently looking to alleviate pain and not to kill people. This is literally a vital distinction.

    You are right that suffering is not just physical. Lord Carey would now have us believe that an arbitrary 6 months to live is a guideline that should allow a person to die. Not 7 months.

    However I, like you, would not see this as a significant guideline when mental suffering may be so much greater. And that is what it has to do with assisted dying. Lord Carey has his view that life is not longer sacred but something to be disposed of in exceptional circumstances. The next debate in the House of Lords may concern other exceptional circumstances that relate to 12 months or 48 months or mental illness. I can see the case for exceptional circumstances everywhere.

    Whether some Christians don't follow the Ten Commandments does not do justice to those commandments. They may find extenuating circumstances for their actions but that doesn't mean that breaking a commandment is right.

  3. The point has just been made on the Daily Politics show that doctors are now able to keep people alive 'for ever and ever'. The argument goes that as technology has advanced it is time to let people choose to end their life. This isn't the bill going forward. It isn't about allowing people to die who may live 'for ever and ever', it is about those who are terminally ill and have less than six months to live. I can see the next stage in 'guidelines' has been reached. I suspect there are some who would vote to give this choice to anyone for any reason, after all, don't we have common sense?

  4. I disagree with your use of the word "conquer", but you later use the word "alleviate" which is rather more appropriate.

    Just because something exists as a continuum does not imply that the correct places to draw lines are only at one or other end of the continuum, nor that any other place is "arbitrary". Putting the religious argument to one side for a second, at the moment there are clearly some individuals living lives full of suffering and with no prospect of productivity or joy, but who being personally incapable of ending their own lives are forced to remain alive since their loved ones would be committing a criminal act by assisting them in doing so. This is to most people a bad thing. On the other side there is the potential for a system which will allow people to be pressured (in a variety of ways, actual and perceived) into taking their own lives when that would not otherwise be the choice that they would make. Clearly this also would be bad. Some of us argue that there is a point between these two extremes which minimises the possibility of the latter (although it would be impossible to utterly rule it out - we're talking about reality here), while providing the possibility of relief from pointless suffering. (And yes, I know you'll object to the use of the word "pointless" here, but remember we're setting aside the religious argument for a moment). Those of us that aim for "least harm" therefore think that this is the right approach to take. Is it really doing no harm for a doctor to stand by and let someone continue to suffer?

    Going back to the religious argument, the 10 commandments are not the only rules in the bible. I strongly suspect that you do not even aspire to adhere to all of them, and therefore that you, like everybody else, are not in fact deriving your morals from that book, but are deciding which bits you can live with and jettisoning the rest. As soon as you use some form of "interpretation" to decide which bits those are, you demonstrate that fact and lay yourself open to the same sorts of accusation you're currently levelling at George Carey.

  5. Thanks 'Eric'. I have posted your comments again but why don't you lose the anonymity?

    You have to remember that we are talking about the control of terminal pain and in this sense the word conquer is not such a bad way of looking at, especially if induced coma is available. The control of pain is a complicated issue and there are many other ways of alleviating pain. I don’t know where you live Eric but I would bet that your local hospice has a great reputation and has frequently helped to write the words ‘died peacefully’ in the obituary columns.

    Suffering is even more complicated than pain and this means that there are in practice many ways in which it can be treated, and quite often all that is required is a conscious decision to think differently. As Shakespeare put it (paraphrasing from memory) nothing is either good or bad but thinking makes it so".

    I do enjoy writing blogs and replying to comments but on occasions it has not been particularly pleasant and that is why I don’t usually allow anonymous comments. I would like to continue this conversation but would you mind losing the anonymity and keeping to one or two points at a time?

  6. How much information will satisfy you in terms of "losing my anonymity"? My name is indeed Eric and the link on my name is to my blog which has my picture in the comments. That doesn't necessarily mean that I want all of my political/religious views known to any prospective employer that chooses to Google me, in case that influences their choices even when those views would have nothing to do with the work involved. To be clear, I am not ashamed of my views, but don't wish them to negatively affect my work life.

    As to the number of points, there were only two, beyond expressing an opinion about the use of the word "conquer". But let me return to that. I object to it because it implies a completed objective - that if medical science will "conquer suffering" as you state, there will therefore be no suffering. I do not think you really believe that to be the case, but the use of the term allows that idea to sit in the background, obscuring the very real fact that suffering will always remain, regardless of how good medical science gets. The last hospice I encountered was indeed a very good place with terrific, motivated and compassionate staff, but their best efforts did not achieve what I would regard as a peaceful death, and there was a significant amount of suffering, both for the patient and his loved ones. Although there was no prospect of recovery and the patient was in an agitated and debilitated mental state, the law as it currently stands meant that he could not be assisted to die to relieve his suffering, and instead the only thing that could be done was to stop treating him and to render him unconscious until his death, caused by drowning from fluid in his lungs. I don't know what one experiences in that state, but I can tell you that it did not have the appearance of an experience that I would describe as "peaceful". I therefore think that the action of the doctor (putting the patient under purely to wait until he drowned) caused more harm than ending the patient's life at that point would have.

    As to the suggestion that "quite often" one can simply choose to think differently in order to avoid suffering, I would like you to provide an example to support that assertion. Since you used the phrase "quite often", your example will need to be of a reasonably common circumstance in order to justify it.

    I have more points to make (including the observation that you completely ignored the last one in my previous post), but you asked for just one or two, so we can come back to those.

  7. As long as Eric is your real first name, and the photo on you blog really is of you, that's OK. The problem I have is with people hiding behind anonymity thinking that this gives them carte blanche to say things that they'd never say in person face to face, and maybe using several different aliases to sow confusion.

    About the main matter at hand: we seem to be going over old ground. You feel that conquer is the wrong word to use even when medically induced coma is available, even when 'died peacefully' is commonly written in obituaries. I think we should agree to differ. I have worked in hospices and know how successful they are. I know that we are human and pain is part of life. I know that when we make 'guidelines' they will be shifted by subjective choice. The next time you read 'died peacefully' please think of those who wish the law to apply to anyone who wants to end their life for any reason, because that is where we are heading, partly because we are all 'intelligent' people able to make intelligent choices, and partly because 'primum non nocere' does not seem to matter.

  8. The reason we're going over old ground is that you used a term which is open to a wide degree of interpretation in a foundational premise of your argument. However, let me see if I can summarise. Your argument seems to be (correct me if I'm wrong):
    1. Medical science has advanced to the point that nobody needs to suffer significantly at the end of life
    1.a. Where people do suffer they can "quite often" avoid it simply by changing their perspective on it
    1.b. Suffering is inevitable, so where it can't be avoided people should just suck it up and deal with it.

    My response is that:
    1. You've already conceded that physical pain is not the only type of suffering - your argument therefore needs to address that, which it doesn't currently. Also my own experience provides a counterexample to your claim.
    1.a. This is an assertion currently without evidence or example, despite being asked for - I'm still hoping you'll provide something
    1.b. My characterisation of this view is based on your "we are human and pain is part of life" and maybe unduly uncharitable, but it seems somewhat lacking in empathy - I'm not sure you'd say "we are human and pain is part of life" to someone experiencing the gradual, painful and cruel shutting down of their bodily and/or mental systems.

    I'm also somewhat puzzled by your absolutist stance on "harm" compared to your sanguine approach to "suffering". I think that allowing suffering when in a position to reduce it comes quite close to being definable as "harm", and therefore I have difficulty reconciling your opposite stances on the two.

    Your latest includes an unsubstantiated slippery slope argument ("that is where we are heading"). It is true that slippery slopes do exist, but it is not axiomatic that when there is movement in a particular direction it inevitably leads to further movement in the same direction. You need to justify why it is you believe that if some standards are set for assisted dying (particularly as statute) that they will automatically be relaxed at a later date.

  9. Hi again Eric. I’ll try to answer all your points.

    I did say that we expect medical science to conquer pain. I thought we could agree that if coma is induced and the pain neurons aren’t firing then conquer would be apt. So in controlled circumstance I really don’t see the problem in using the word ‘conquer’. I also thought that it wasn’t too much to think of pain being conquered if someone dies peacefully as is often the case. Yes pain is part of the human condition but doctors have many weapons in their armoury.

    However your summary is not quite right. 1. You say that I think that ‘nobody needs to suffersignificantly…’Medical science may have the ability to conquer pain but that isn’t always the case. Sometimes people die and don’t even see a doctor. 1a Perspective / the psychology of pain is really important. Soldiers carry amputated limbs, sports people play on with broken bones. Pick your own examples where pain doesn’t seem to matter. 1b I am wary of using the word ‘suffer’ because it is such a subjective word and I am not sure how to define ‘inevitable’ because I have l been trying to emphasise pain reduction or control. We are talking about the terminally ill with ‘6 months’ to live and I don’t remember any examples in which patients could not be given an appropriate level of medication to alleviate ‘suffering’.

    I am not sure why I ‘conceded’ that physical pain is not the only type of suffering. It is fairly obvious to me that it is not. Indeed, I mentioned that the various types of suffering may be used to further the slide on that slippery slope to allowing anyone to take their own life. As for the frequency of avoiding pain, I would say that if you want to debate that sentence then the most debatable word is avoid. Bang your elbow and you rub it. That’s called the pain-gate theory to ‘avoid’ pain. Have an emotional thought and think of something else. Take a tablet to reduce your particular ‘suffering’. I’m not sure why I am telling you this because I am sure you can give your own examples of reducing or avoiding pain, and any of these three examples are very frequent.

    I’m only half-way through your latest comment but we do seem to have reached a point where we must agree to differ. I am not really concerned about the finest definition of each word I use. I am interested in telling in emphasisng that life is important, too important to leave to people who are emotional or distressed or in pain. We may have many areas in which we can agree. I may supply just as much morphine to someone who needs it, and that person may die, but my intention would always be to reduce their pain and not to kill them. And there we are worlds apart.

    I was watching the Commonwealth Games a couple of days ago and the commentators were all in agreement that sports psychology was vital to improving physical performance. If psychological input can (and does) produce physical benefits then can you see that psychological support is just as important in everyday life? If I tell you that you are looking good then you feel better. It happens all around us. The pleasure or pain we derive from any encounter is multi-faceted and one of those facets is psychological.

    I didn't think there was any other conclusion to the slippery slope when those who argue for the right to die use examples of people who can live indefinitely. I don't think I need to substantiate it as it is self-evident that a law which allows those who have 6 months to live would have to be extended.

    I don’t think I have replied to all your points but there are rather a lot of them. I am sorry if you inferred that I like people to have pain. I don’t like people to have pain and have emphasised pain control. I hope my position is clear and would like to draw a line on our communications. I hope this is alright with you as I think we have gone as far as we can and should agree to differ.

    1. Your response to my 1. Well, of course. Did you really think I intended to include everyone in all circumstances in my summary, rather than just those under discussion - the terminally ill under a doctor's care? 1.a. again, yes those examples all occur, but what do they have to do with the situation of the terminally ill, in terms of their ability to simply think differently about their suffering? In any case your two examples (sports and soldiers) are not of people thinking differently, but of people being unaware of their pain, mostly because they're pumped full of adrenalin. Your argument was about the terminally ill, but none of your examples have any obvious bearing on people in that situation.

      " is...too important to leave to people who are emotional or distressed or in pain". That's why proposed legislation would involve a number of independent psychological evaluations. But also, you're denying people self-determination, and saying that you know better than they do what is right for them. Now THAT'S a slippery slope! Where does THAT end?

      I'm unsurprised that you're "...not really concerned about the finest definition of each word...". That approach allows definitions to alter subtly as the argument progresses and makes it harder to bring logic and critical thinking to bear. For instance you've lumped everybody campaigning for a change in the law into one when you say "...those who argue for the right to die use examples of people who can live indefinitely". Really? They ALL do? Or just some of them? What proportion? Enough that if the law changed they would still be able to carry off further changes? Are you confident of all of that, or have you just not really thought about it, and it's just the impression you get? Because you stated it very confidently. In fact, you called it "self-evident". However, that's just a way of avoiding backing it up. So, a law for 6 months would "self-evidently" have to be extended? What about 12 months? Would that also need extending? By your logic every time period would need extending. Presumably that's also the case for abortion. Once we have abortion at 24 weeks that will "self-evidently" get extended to 28 weeks, all the way up to just before birth. Except that of course that's not true, is it? It was completely illegal, then it was 28 weeks, now it's 24. Please explain why your logic works for assisted dying but not for abortion. Or, since you don't appear keen to continue this conversation, at least think about it, critically, as though you were on the other side of the fence.

  10. The liberal in me forced me to publish even after numerius requests to keep to one or two pounts and two requests to stop comments. This time I struggled to get past your first line as it refers to a previos comment. Cheers"Eric".