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ss triple helix - Christmas 2011,  Is it really choosing to die?

Is it really choosing to die?

key points

Responding to the BBC Documentary 'Choosing to Die' the author argues that assisted suicide is not an expression of autonomy but rather a capitulation to death.

The programme's biased editorial line did not allow serious and considered exploration of alternatives such as hospice care.

Media bias towards assisted suicide is now commonplace but offers nothing to soften the horror of death outside of Christ. When it comes to dignity in dying – the author argues that true dignity does not come from assisted suicide but rather from good palliative care.

Richard Hain comments on 'Choosing to Die' Terry Pratchett's physician assisted suicide documentary for the BBC.

To my frustration, I missed the original broadcast of Terry Pratchett's well advertised documentary 'Choosing to die'. Terry Pratchett's books line my shelves in serried ranks, despite the fact that I find both the narrative line and the literary quality of the stories inconsistent. Perhaps what makes them attractive – and leads so many, like me, to buy book after book – is what they reveal about Pratchett's own character. The stories are full of warmth and humour. They are shot through with a love for mankind in general, and most of the individuals in it in particular. Whatever one feels about them as literature, it is impossible to read any of the Discworld novels without developing an affection for their author.

This same compassion and warmth shone through in Pratchett's documentary, as he accompanied two individuals with life-limiting conditions on their final journey to Switzerland for assisted suicide. From the moment he met them at their homes in England, to the moment he said farewell to one of them and sat and accompanied the other while he died, it was clear that Pratchett cared deeply for them, despite having met them for the first time in the making of the documentary.

It is a matter of public knowledge that Pratchett himself suffers from a form of dementia that he expects to progress relentlessly until it causes his own death. Pratchett's own 'journey', as he considered whether he felt physician assisted suicide was right for him, was a sub-theme of the documentary that was handled sensitively and well.

I am a palliative care physician working exclusively with children. I have a strong academic and practical interest in ethics and recognise the validity of a distinction between euthanasia and physician assisted suicide. So I did not begin to watch the programme with any firm prior moral conviction about the latter. But by the end, I found my views had resolved into a clear feeling that, whatever other ethical arguments there may be, any claim that assisted suicide is an expression of autonomy is a false claim.

The editorial line was clear and unabashed; that physician assisted suicide is a good thing towards which the United Kingdom should strive to move. For me, however, this clear narrative contrasted markedly throughout with the feelings of those taking part in the documentary. Pratchett referred to the death of one of the individuals as a 'happy event' - but to me as a viewer it didn't feel happy.

The death took place in a soulless generic living room housed within a unit on an industrial estate. His wife, who was physically present in the room at the time, seemed curiously excluded from the proceedings; much more so, indeed, than the doctor who was assisting the suicide. While the doctor sat close and comforting, the patient's wife appeared profoundly ill at ease, almost poised to flee, caught perhaps between her love for her husband and an instinctive urge to run away. Pratchett himself stood awkwardly on the edge of the tableau, demonstrating an endearingly English discomfort at being present at what should have been a private and emotional scene. Afterwards, Pratchett dubbed the suicidee 'a brave man', an imputation of heroism which seemed at odds with his scripted assertion that the death had been a happy event.

To be fair, much of what made it seem cold and clinical was beyond the control of those facilitating the suicide, dictated by controls put into place by the Swiss government. For Swiss natives, the procedure would have been carried out at home; it is only foreigners who are condemned to this sort of motel-room death. The Swiss authorities, explained Pratchett, wanted to make sure uncontrolled deaths were not being conducted in secret isolation. For me, what was disappointing about the documentary was that alternatives to physician assisted suicide were not seriously considered. A nod was given to good quality hospice and palliative care, in the form of Pratchett's interview with a retired cab driver in the advanced stages of motor neurone disease. The cabbie's insistence that his life was still fun was self evidently true. It shone from his face and sounded in his laughter. Death was conspicuous in the cabbie's conversations by its absence. Instead, he seemed effortlessly to illustrate a triumph of life over illness, and freedom over physical frailty. He radiated the joy of his physically constrained life. Combined with Pratchett's own gift for putting people at their ease, this joie de vivre resulted at one point in a dialogue in which Pratchett encouraged the patient to describe the route he would take on a cab journey given to him by Pratchett. The cabbie unerringly described the route, then paused and grinned before asking Pratchett for the fare!

Despite Pratchett's attempts to find it, triumph and freedom and humour were conspicuously absent from conversations with the other patients. One of the patients admitted 'I feel I have no choice'. He seemed to see assisted suicide as an unavoidable solution to a problem; what emerged for me was a sense of his feeling utterly beaten by his disease, made worthless by incurable illness. Furthermore, despite Pratchett's assertion that this was 'an heroic act', both patients showed a curious lack of interest in the feelings of those around them. Each admitted that his family was unhappy about the decision they had made, but seemed to dismiss those feelings as irrelevant. Again, Pratchett's use of the term 'heroic' to describe it perhaps owed more to his own generosity than to any merit in the act of assisted suicide.

Pratchett himself made the only allusion to another of the alternatives when he said: 'My wife says that she wants to care for me. But I'm not sure she knows much about assisted dying'. Perhaps not, Terry, I wanted to yell, but she does know about love and caring, and probably quite a lot about dementia by now. And she is certainly an expert in Terry Pratchett. She knows what it will mean, and she knows she wants to do it – as do many, many people caring for family members who are terminally ill.

So, to me there was a contrast between the editorial line taken by the documentary and what came over intuitively as the real feelings of the people involved. It's always a risky business second-guessing other people's feelings, of course. But to me, this documentary did not leave me with any sense that physician assisted suicide was an expression of autonomy. To me, it seemed simply what was left for people who felt there were no longer any choices they could make. And one choice is, in fact, no choice at all. I was left with an overwhelming sense of greyness, sadness, loss and failure.

There was a moment of light when one of the two patients said he thought Switzerland was beautiful and rather wished he could spend some time looking around. But no, he said wistfully, I have an appointment. They did not seem to me the voice, or the words, of a man who felt himself to be free.

UK media - choosing their words carefully

Since 2008 the BBC has screened five programmes portraying assisted suicide in a positive light. The BBC and others such as Dignity in Dying seek to manipulate the emotions of their viewers/readers through carefully chosen language.

Taking the M case as an example – the BBC reported that the judgment was a 'refusal to allow M to die' as though it was against the will of M; as though M desires to be allowed to die and is frustrated by the decision to maintain and support life. Perhaps more accurate reporting might state the judgment was a refusal to allow M's life to be ended.

In this reporting issues of autonomy are glossed over and there is a conflation of the concepts of actively killing a relative and allowing that relative to die. These are of course quite different ethical concepts.

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