The value of life

In my previous essay I wrote about value, mainly in the context of Bitcoin. But, we attribute value not only to currencies, objects or services, but to our very lives. And it is here that there can be quite a lot of argument and very muddled thought. A supposed absolute value of life is used to support a religious view that neither abortion or euthanasia can ever be justified. Despite significant public protest, Poland's extreme and autocratic government has very sadly decided to implement law bringing the practical possibility of abortion virtually to an end. By contrast, at the end of last year in Argentina, another predominantly Catholic country, mainly because of huge protests on the street, a more enlightened view gained sufficient ground to enable a change in the law. Now, abortion for any reason up to 14 weeks of pregnancy will be permitted, so diminishing the agony and deaths caused by back-street abortionists. It makes Argentina something of an exception in Latin America.

But, even in the UK, there is still pressure to restrict the rights which already exist and there is still no real progress on euthanasia.  Those opposing the idea of assisted dying are, generally speaking, religiously motivated, although use other arguments instead. There are two main ones - the slippery slope argument and that we now have palliative medicine which can take away the misery of a prolonged and painful death.

I have never quite seen the validity of the first of those arguments, but it appears on the Kings Fund site under the name of Baroness Finlay of Llandaff, a professor of palliative medicine at Cardiff*. It presumes, without quite saying so, that any subsequent change to the controls proposed to be included in any legislation permitting assisted dying would be, per se, unjustifiable. And she assumes that this would happen. But either our democratically elected Parliament later agrees an easing of the controls applied to allow assisted dying by the initial legislation or it doesn’t. We can't tie the hands of a future democratically elected parliament and neither should we. But, equally, we cannot demand that proposed legislation be thrown out now simply because, if it comes into law, it may be changed at some time in the future.

The second argument, the wondrous nature of palliative medicine, is also usually wheeled out by the Baroness. Every time she does so, however, other doctors write to the Times saying that their experience is that, when palliative care works, it is indeed wonderful, but that very often it simply cannot work for a particular illness. So then Baroness Finlay is unfortunately living in a make-believe world in which euthanasia is not needed.

For those seeking a change in the law to allow assisted dying (subject to very considerable safeguards), it is of course a matter of compassion. This appears to be an emotion strangely absent in many with fixed religious opinions. Their religion seems to override what we would commonly think of as normal empathy. And because of the existing law, many people suffer very badly and suffer unnecessarily. At the moment it is possible to commit assisted suicide in Zurich. This though requires that the person is not only sufficiently healthy to take the medicine when they get there - e.g. still having the ability to swallow - but also to undertake the journey. Which means in turn that one cannot leave the decision to the last moment. And this implies the need to commit suicide earlier than necessary. Not to mention the cost of all this - in Switzerland - for the person and, usually, a friend or relative. And of course, upon the return of the accompanying person, there is the considerable likelihood of an investigation by the police here, with regard to the independence of the decision made.

So then, those who have in the past proposed this change in the law say it is an matter of compassion, but they also claim that it is the right of everyone to choose when to die, when to be obliged to continue living after life has become unbearable because of pain, lack of independence or even its imminence, is not right. Nor is it reasonable to require the person to die alone and without the help that might prevent suicide itself from being another - and final - act of suffering. After all, committing suicide without pain is not easy without the cocktail of medicine that only a doctor can provide. I am not convinced that I would have the courage to make use of such a law, but I would be glad to know that it existed.  And according to the polls, an overwhelming majority of the population shares this view. Indeed, the last time such a bill was introduced into Parliament, it was supported by two former archbishops - Desmond Tutu and George Carey (the former Archbishop of Canterbury) - but not the current incumbent. And not Baroness Finlay of Llandaff.

But even intellectuals who are not religiously motivated can find themselves in a pickle about the value of life. My learned friend, the former Supreme Court judge, Lord Jonathon Sumption, has got himself into trouble (again). A fortnight ago, as a guest on a television discussion programme presented by a stage four cancer patient, it was understood that Sumption had said that the presenter's life was worth less than that of others. M'lord explained that he was trying to say that because the elderly have less life ahead of them (including that of the presenter), this automatically meant that their lives were inherently less valuable than those who were younger. A curious argument. He evidently did not understand that valuation, especially of a life, has no mathematical formula. Instead, each of us arrives at our own different estimate of the value of a person's life based on many subjective factors. Life does not have an intrinsic value; it only has the value we ascribe to it.

Of course, the nice people at NICE have the concept of a Qaly (Quality Adjusted Life Year). This is a measure used to determine whether or not new drugs would give enough of a boost to a suffering patient to make it worth-while to buy them for the NHS. It combines the expected extended lifespan with the quality of health during that time. And it is in reality about rationing, rather than saying how much a life is worth. In fact there has been a recent policy change in the NHS to say that age as such should not be taken into account when considering treatment. The only question is how beneficial that treatment will be for that particular patient, granted the nature of the treatment and any pre-existing conditions which may reduce its effectiveness.

So then, I do not think that many people would adopt Lord Sumption’s simplistic and very rigid views. Indeed, I would think that, if forced to choose, many people would value Sir David Attenborough’s life, even at age 94, more highly than that of, say, a convicted murderer in his twenties. The value of my own life only exists to the extent that value is attributed to it, either by me or by others. And, as one lawyer to another, I have to say that I don’t value my own life any less at my present age than I did when I was a callow youth. And I don’t suppose that, deep down, he does either.

Paul Buckingham

28 January 2021


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