Allow to die, or kill?

Another dispute between parents who wish their child’s medical treatment, however hopeless, to continue, and the hospital doctors, who judge that treatment is burdensome and pointless and should be terminated, has just been decided by the court in favour of the doctors. Treatment was “withdrawn” and the baby (“Baby OT”) died next day. In his column in today’s (23 March) Guardian, Marcel Berlins debates the appropriateness or otherwise of such painful cases being decided by the courts and concludes, a little reluctantly, that they probably should, until someone devises a better arrangement.

I’m a little surprised that Mr Berlins didn’t also discuss what is unarguably a much more offensive feature of these decisions.  When the courts agree to the withdrawal of treatment, in cases where the treatment is the only thing that’s keeping the patient alive, terminating the treatment, e.g. by turning off the ventilator, is all that the law permits.  The doctors may not administer a lethal injection or a lethal dose of some oral drug to hasten death and minimise suffering.  In some cases the patient may linger on for days, eventually dying of thirst and starvation rather than of the condition which is incapable of cure and which will eventually anyway cause death.  There’s even a lively debate over whether artificial feeding by tube constitutes ‘treatment’ which in some cases may legitimately be ‘withdrawn’, obviously and inevitably resulting in the patient’s death.  Defenders of this grisly paradox argue that withdrawing treatment is morally acceptable even when everyone concerned knows that it will result in death, provided that the treatment is not stopped with the intention of causing death.  Those of us who were denied the benefits of education by the Jesuits may be forgiven for gagging on that.

In an interview yesterday on the BBC radio Today programme, the Most Reverend Peter Smith, Roman Catholic Archbishop of Cardiff, talked about his church’s position on cases of this kind.  The interview is no longer available on the BBC website, but here are my notes on what he said, made while listening to him:

Must not kill an innocent person under any circumstances — there’s no moral justification for that. But when it comes to the end of life, we wouldn’t take a vitalist [?] view that somebody must be kept alive by the most extraordinary means. The Church’s view, the moral view [sic] is that if the treatment needed to keep the person alive is burdensome or futile, we wouldn’t take the view that you must always continue it to keep the person alive because it’s absolutely pointless.

The Most Revd. Peter SmithSo you may do something to a patient which you know will result in his death, but you may not actually take any direct action to hasten death.  The point of withdrawing treatment is so as not to subject the patient to treatment that may cause suffering and loss of dignity, but you may not then administer a drug that will have exactly the same effect: sparing the patient unnecessary suffering and loss of dignity after the withdrawal of treatment by hastening his inevitable end.

But, the Archbishop might say, to administer a lethal injection would constitute euthanasia; and anyway “there’s no justification for killing an innocent person in any circumstances“.  But to stop feeding a helpless patient is to kill him just as surely as giving him a lethal injection:  it just takes longer and is likely to cause more suffering.  It’s still by any rational definition euthanasia.  How starving a man to death can be morally and theologically acceptable, when a quick and painless injection that achieves the same result but spares the patient days in agony is deemed to be ethically wrong, is quite beyond me.  It surely puts sophistry and unfeeling ideological doctrine before common humanity, and as such is morally repulsive.  It’s an irony that the Most Revd. Peter Smith — formerly, by the way, the hot tip to succeed Cardinal Cormac Murphy-O’Connor as Roman Catholic Archbishop of Westminster, but now regarded as perhaps too ‘liberal’ for the job — should provide such a public example of doctrinaire heartlessness in the same week as the Pope’s comparable pronouncement condemning the distribution of condoms, from large to small condoms in the campaign against HIV/AIDS and STD symptoms in men: pimple on penis, etc, almost certainly causing uncounted additional deaths and unmeasurable avoidable suffering just by what he said.

It’s only fair to say, though, that it’s not only Roman Catholics who are unfazed by the idea of withdrawing a patient’s treatment in the knowledge that death will result, but can’t quite bring themselves to accept a quicker, more merciful but more activist way of achieving the same result.  Many members of the medical profession and some lawyers seek to protect their delicate consciences by drawing the same bogus and hypocritical distinction.  Arthur Hugh Clough (1819-1861) no doubt thought he was being wittily satirical when he wrote, in The Latest Decalogue:

Thou shalt not kill; but needst not strive
Officiously to keep alive.

It would be nice to believe that Clough would have been distressed to think that all these years later his Latest Commandment was being taken literally. (The rest of his Latest Decalogue is equally pointed and worth reading, although less well known.)


9 Responses

  1. John Miles says:

    Absolutely right.
    When a dog’s life’s no longer worth living you take it to the vet and have it humanely put down.
    Deny it food or water and the RSPCA’ll be after you.

    Brian writes: An excellent analogy, John. A clincher!

  2. Phil says:

    Great minds – Clough’s couplet immediately came to my mind when I read your account of Smith’s comments. 150 years on, it still stings.

    Brian writes: Absolutely. The whole Decalogue is splendid. It’s a shame that Clough is virtually forgotten.

  3. Tim Weakley says:

    We’re getting away from the original subject of this thread, but you asked me to post the following piece, so here it is. I hope this isn’t a gross breach of copyright!  The verse is one of those composed by the late Maurice Bowra, Warden of Wadham College (my old college) for 32 years, which were never published in his lifetime – mostly for good reason – but were made known to his inner circle of cronies. Some cruelly libel his friends, some obscenely libel his enemies. They were published a year or two ago as ‘New Bats in Old Belfries’. This is one of the few non-scatological ones. The editor’s footnote says: “M.N.Tod (1878-1974), Fellow of Oriel 1903-1947), University Reader in Greek Epigraphy 1927-1949, was a scholar of international renown and a Presbyterian of deep religious belief.”   I think the ‘squeeze’ referred to is epigraphers’ and archaeologists’ slang for taking an impression (in what?) from any inscription, bas-relief, etc, that can’t be moved or is too big to pocket – someone will surely correct me.

    Marcus Niebuhr Tod

    I sing of Marcus Niebuhr Tod
    Who found the autograph of God.
    Carved on a Sinaitic cliff
    He found Jehovah’s hieroglyph.
    A casual glance assured the date
    As BC 1698.
    Convinced that no epigraphist
    Had entered it in any list,
    The worthy Marcus looked around
    And found in fragments on the ground
    An interesting Hebrew text
    Concerning this world and the next.
    With scrupulous and loving care
    He joined the pieces lying there,
    And with a scholar’s zeal restored
    Words written by the living Lord.

    ‘Go, worship other gods than me:
    I feel the need of company.

    ‘And copy bird or beast or fish
    In wood or stone, if that’s your wish.

    ‘Rightly or wrongly, take my name:
    To me it’s very much the same.

    ‘If toil on weekdays you must shirk
    Then keep the Sabbath for your work.

    ‘If what you want’s a good long life,
    With parents keep continual strife.

    ‘Kill anyone who worries you:
    It’s easier and safer too.

    ‘And if your neighbour’s wife is free
    Of course commit adultery.

    ‘If others have what you have not,
    Why not take steps to steal the lot?

    False evidence against a friend
    Brings much advantage in the end.

    ‘If someone has what takes your eye
    Ask, and you’ll get it by and by.’

    These mystic words did Marcus find,
    And laid them carefully to mind,
    But not before upon his knees
    He knelt and took a loving squeeze.
    When in the ‘Epigraphic Year’
    The learned saw the work appear,
    They pressed the ill-considered view
    That here at last was found the true
    Editio Princeps of the Ten
    Commandments given unto men,
    Which Moses cast upon the ground.
    This text, they claimed, had Marcus found.
    But Marcus did not welcome this
    Improbable hypothesis,
    And thought that it was far too bold
    For any prudent man to hold…

    Perambulating Oriel Quad
    I thought of Marcus Niebuhr Tod.

    Brian writes: I’m most grateful to Tim for contributing this wonderful piece by the immortal Bowra.

  4. Barry M says:

    ” and anyway “there’s no justification for killing an innocent person in any circumstances“. 

    I also heard the Archbishop on the radio and this phrase struck as surely the moral and perhaps Christian attitude should be that there is also no justification for killing the guilty, never mind the innocent. Or just pull on the rope Archbish?

    Brian writes: You make a good and interesting point. But either way, the Archbishop’s formula seems absurdly absolutist. To obey it, you would need to be a committed and uncompromising pacifist, since almost any form of military service, even in a just war as defined by the Catholic Church, may involve killing enemy soldiers, airmen, etc. (mostly individually “innocent”) and also in many circumstances innocent (and guilty) civilians. It would also — in my opinion, but apparently not the Archbishop’s — rule out discontinuing treatment of any patient whose life depends on that treatment, however burdensome and humiliating the treatment and however certain the impossibility of the patient ever recovering sufficiently to regain any quality of life, since the inevitable and known consequence of switching off the life support machine is his death. So that’s killing him.

  5. John Miles says:

    All jolly good fun, but…
    But some of us are tempted to think that, for all the alleged eccentricity of his alleged religious beliefs, Marcus Niebuhr’s work on Greek epigraphy was a much more important contribution to scholarship than anything the “immortal” Bowra ever managed to achieve.

  6. John Miles says:

    Thou shalt not steal; an empty feat, When it’s so lucrative to cheat.

    Smith, Hoon, McNulty and Co?
    Brian writes: Not sure that it’s fair to call what they have been doing “cheating” when they stayed, apparently, within the rules. They seem to have taken advantage of the rules which lays them open to the charge of having been greedy and unscrupulous. Perhaps that’s just splitting hairs. There is however a more important lesson to be learned: that when you grossly under-pay people for doing demanding and responsible jobs, as we under-pay our MPs, you get inadequates doing them.

  7. John Miles says:

    If it’s not cheating, perhaps it’ll do until some cheating comes along.
    Your’re very likely right to suggest that none of these Right Honourable Worthies has actually broken any rule.
    Isn’t that precisely Clough’s point?

    Grossly underpaid?
    It’s only fair that MPs, like everybody else, should be paid enough for them to live reasonably decent lives.
    But they don’t do all that badly even today, by most people’s standards anyway.
    How much do you think we need to pay to attract a less inadequate class of person?
    Would it work anyway?
    Pay peanuts, they say, you get monkeys.
    All experience suggests that offering more peanuts merely attracts greedier monkeys.
    Just look around!

    Anyway, who goes into politics for the money?
    Ask any of them why they chose to go into politics and they’ll tell you they want to serve their country or mankind, to make life better for other people, to change the world or to save it, etc etc etc.
    No doubt some of them are actually telling the truth.
    Never a tasteless word about such trivial side-issues as pay, perks, power or pensions.

    Reminds you of the cloud-cuckoo, long-gone days of my youth when, only a few days out of school, I – like you, I daresay – was asked the dreaded question, “Why do you want to be an officer?”
    “Because I honestly feel, sir, I could make a bigger contribution to the service if I succeded in becoming one, and I feel I’m able to do the job, and I’ll always do my very best. Sir.”
    I never met anyone who had the guts to say, “Because the pay’s better and so’s the food, the uniform’s nattier, and it’s probably more fun to lord it over your fellow man than vice versa.”

  8. John Miles says:

    “Andrew Grice’s incisive article on MP’s expenses (11 April) repeats the oft-quoted observation that MPs’ lavish expense claims were, by implication, a quid pro quo for decades of having their salaries held back. This spin is now being widely touted by our parliamentarians as they seek to strengthen their negotiating position later in the summer. The facts do not bear out this version of reality, which is rapidly becoming accepted across the media.
    The figures show clearly that MPs have done rather well over the past three decades. Much of this is due to a series of one-off adjustments paid to them every few years, in addition to their annual increase.
    In 1978, an MP had a salary of £6,897. Today it is £64,766, a hike of 940 per cent. By comparison, an old-age pensioner was getting £19.50 a week, or £1,014 per annum, in 1978. This year, the old-age pension stands at £95.25 or £4,953 a year. Their income rose by only 490 per cent between 1978 and today. Had their income kept pace with that of MPs, they would now be paid upwards of £180 a week.
    Pensions are a good yardstick precisely because they have risen in line with inflation, allowing for the odd fiver sweetener from the Chancellor a few years back. Had MPs’ salaries moved in line with inflation, their present pay would be just under £35,000 per year. Should they get the £10,000 extra they are angling for, their pay will have increased at considerably more than twice the rate of inflation since the 1970s.
    William Coupar.” 

    It’s difficult to believe Mr Coupar’s figures are altogether accurate, but does he have a point?

    Brian writes: I have no idea whether these figures are accurate: they could be, as the shabby way in which pensions have been held down by being related to the cost of living instead of to average movements in wages and salaries is well established. However my point about the inadequacy of MPs’ pay was nothing to do with any comparison with pensions or other categories of income. I’m simply concerned to point out that as a matter of easily ascertained fact, what we pay MPs fails to attract the outstanding political leaders of the past. Of course other factors are also involved — the emasculation of parliament by the executive, the abysmal opinion of politicians held by a large majority of the electorate (a true chicken-and-egg situation, of course), and the growth of the constituency work-load which has converted most MPs into over-worked unqualified untrained local social workers, for example — but it seems obvious that the pay and even the current allowances are quite inadequate to compensate really outstanding would-be politicians for the long hours, the inadequate provision of secretarial and research facilities (look at the contrast with Washington DC and Brussels!), the potential damage to marriages and family life, the uncertainty of tenure, the dependence on the Whips, the back-biting and back-scratching, and the enforced company of such a large number of no-hopers. Governments get away with murder because most MPs aren’t up to the job of holding them to account. We’d get better MPs if we paid them a lot more (and perhaps abolished the more ridiculous allowances) even though other reforms would also be needed for any real improvement.

  9. william coupar says:

    Ref John Miles query of my stats for MPs and pensioners rewards in my Independent letter .  The figures I used for 1978 are  directly sourced from a government statistical document. The 2009 figures are of course current. The key point I was making was NOT to hold pensioners up as hard done by ( subject of another debate) but  to debunk the now standard view that MPs had to fiddle because their pay was held back.
    MPs have had several one off adjustments to keep them up with other middle class professional salaries. Their pay is a classic illustration of the degree to which the pay of the top 25% have pulled away from those at the bottom.

    If you compare MPs pay with that of say a lawyer or city accountant of course they are ” being held back”. If you compare them with someone whose income is rising with inflation then, equally clearly they have done very well.

    I have no problem with MPs getting paid what they do, provided they publicly  go on the record to say these three further propostions.

    a) “The relevant comparisons for me as an MP is the top quartile and I need to keep up with that group.”

    b) ” Therefore there  is no justification to compare my reward with those in the bottom quartile.”

    c) “Since I do not want to appear a hypocrite I promise never again to say that Britain is becoming a more unequal society !!”

    William Coupar