Is there a difference between “suicide” and “assisted dying”?

The Assisted Dying Bill that comes before the House of Commons would “enable competent adults who are terminally ill to choose to be provided with medically supervised assistance to end their own life.” This is the fourth attempt in recent times to change the law on this matter.

If this Bill were to be passed, English law would be significantly altered. As a consequence, assisted suicide would become more accessible and more socially acceptable. The law is a teacher and, if this Bill succeeds, society would be taught a distorted conception of the human person and of the medical care that would be afforded the gravely ill.

The title of the Bill, the Assisted Dying Bill, is an immediate cause for concern and signals underlying issues. The word “suicide”, with its negative associations, has been airbrushed from the title and replaced with the more neutral term “dying”. Indeed, “suicide”, defined as “the action of killing oneself intentionally”, which is the true and central concern of the Bill, is altogether absent from its text.

The proponents of the Bill seem to understand that it is impossible to be morally indifferent to suicide. As Albert Camus famously wrote in his 1942 essay Le Mythe de Sisyphe: “There is only one really serious philosophical question, and that is suicide.” This claim might be an exaggeration, but even so, it is a salient reminder of the abiding presence of suicide in human discourse and thinking.

Whether one takes one’s life with only six months to live or perhaps six years to live, suicide can never be viewed as a casual act lacking significance or consequences. Suicide cannot be reduced to a matter of purely philosophical abstraction or merely mechanical action. Thus, deciding on this course of action with a dated signature at the bottom of an Assisted Suicide declaration is to trivialise the meaning and intention of a suicide.

Although in most cases, suicide is a solitary act, it is, nevertheless, one that has repercussions both for the bereaved and for society at large. Families often suffer greatly as they struggle with conflicting feelings after a relative’s decision to kill themselves. Clearly, an act of suicide reaches far beyond the individual victim and carries within it the potential to scar many others. And it is surely not fanciful to imagine that this would be the case for at least some of the bereaved in the wake of an assisted suicide. Of all human actions, a suicide, although easy to describe forensically in terms of its physical finality, profoundly challenges our basic understanding of what it means to be human and alive. The disturbing and ambiguous violence of suicide makes it not merely an act of personal despair but one which carries a wider social significance.

It is clear that those who are arguing for assisted suicide have a strategic interest in attempting to simplify the issue. By using a linguistic sleight of hand, the term “suicide” is replaced with the softer term “assisted dying”; and, thus, an act of intentional violence is co-opted and absorbed into a natural process to which we will all one day experience. Thus, the use of apparently benign terminology masks the true reality of what is being proposed in this Bill.

Refined and rational debate becomes more difficult to conduct when language becomes this semantically elastic. If we can no longer agree with any confidence on the proper use of terms, if the accepted meaning of words that anchors them to a true description of reality is severed, then meaningful discussion will risk being lost in a fog of euphemism and emotive language. When this occurs, the civilising power of language, which should bind human beings together and act as a cohesive glue enabling us to express our thoughts and ideas in a rational way, begins inevitably to dissolve and weaken.

In their quest for the ultimate expression of personal freedom, the advocates of assisted suicide make a visceral appeal to the concept of “choice”. This concept is often expressed in the colloquial form of “I’m free to choose whatever I want, so long as I do not physically or mentally harm another.”

In this context, “I” takes the form of a supreme and autonomous moral agent who has slipped the ties of social responsibility and determines every instant of his or her own life and death. This atomised, self-determining individual, cut adrift from any coherent moral tradition or sense of human interdependence, constructs moral responses from any emotional flotsam and philosophical jetsam immediately to hand.

This understanding of “choice” has largely replaced the long-held moral conviction, shared across times and cultures, that such a decision can only be meaningful and an authentic expression of human freedom, if the choice is for the good, for virtue and for social solidarity. In this understanding, our dignity as human beings is best expressed when we chose that which ennobles us and makes for human flourishing, while at the same time allowing us to grow in friendship with each other and God. Using this paradigm, it is hard to see how selecting assisted suicide could be a real choice for human freedom and the common good.

Although assisted suicide is popularly presented as a choice to die with dignity, it is difficult to see how this act could be considered as worthy or honourable. The decision to kill oneself is unlikely to derive from some romantic appeal to a Platonic ideal of dignity. It is, in fact, much more likely to have been conceived in fear of dependence on others, combined with a feeling of hopelessness at the perceived failure of society to protect and support its most vulnerable members.

Suicide is being marketed as a matter of consumer choice which, its advocates believe, can operate independently of any moral context. In other words, it will become just one more medical option among the many choices presented for consideration to a terminally ill patient; and no particular option will be given a greater or lesser moral weight than another for fear of prejudicing the patient’s freedom of choice or of limiting their moral autonomy.

Yet, even while such distorted understandings are in common circulation, the belief persists that most suicides are best understood as acts of despair. They are not, as they are sometimes portrayed, acts of existential courage. Although suicide can be considered as the final act of someone who believes that there is nothing to hope for, we currently have a far greater understanding of how behavioural, psychosocial and mental pathologies might contribute to suicidal ideation. For these reasons, most civilised societies have sought to offer genuine help to the suicidal, to offer them hope, to alleviate their suffering and to do everything possible to save their lives, while at the same time recognising the painful sequelae of a suicide on family members and friends.

Until now, there has existed a social consensus that all lives, even the most misshapen and broken, have an inherent value that should be respected and protected. This value or moral hallmark seeks to protect every person from exploitation and violence. In this way the intrinsic value of a human person is in no way dependent on social status, acquired abilities or mental capacity, but, rather, exists as a natural concomitant of one’s inalienable humanity.

The fact that human beings have the potential to recognise this essential value and to decide how it should best be protected, distinguishes them from every other living creature. No other animal can conjure an abstract thought, or reflect on what it means “to be or not to be”, and to articulate that thought using the languages of philosophy, art or science. Following profound and complex deliberation, human beings are able to act on such a thought in a way that is not merely instinctual or reflexive. This is one of the most distinctive and determinative qualities of the human person. Furthermore they have the capacity to express moral outrage, to hope, to love or even to pray, all features which differentiate them from other animals, this giving them a unique position in the natural world and an undeniable moral value.

Suicide, even when carried out in the most sanitised and medically controlled environment, is an act of violence against this ineffable value. The founder of the Hospice movement, Dame Cicely Saunders, understood this fact. She famously said to those in her care, “You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die.” This is why she included suicide prevention as a crucial element in Hospice care, together with the provision of effective pain control and social support. Those who entered the hospice did not abandon all hope, but found that, even in the face of suffering and death, there existed a compelling hope, a true compassion and a proper care level of medical care.

The pressing issues for society are threefold: the access to palliative care, the availability of hospice provision and the financial support of agencies involved in the care of the terminally ill and dying. These are the issues that our politicians should really be arguing for and not the establishment of new structures designed to end the lives of ill people. The onus is on those who argue for assisted suicide to prove that proper palliative and hospice care fails to meet the needs of the gravely ill.

Our sick and dying require access to the latest scientific palliative interventions and not to doses of toxic drugs.  They depend on doctors who still live by the pre-Christian Hippocratic oath, “to give no deadly medicine to anyone, even if asked, nor to suggest any such counsel” and not on medical attendants who intend their death by chemical means.

The Assisted Suicide Bill fails not only on terms of basic human morality, but also on its own internal logic. It discriminates between those people who are suicidal and will be permitted medical assistance to end their lives and those for whom such help will be forbidden. Thus, assisted suicide will be allowed for a certain category of people, in this case, those with terminal illnesses, but will be forbidden for other categories, for example, the young and physically healthy.

It would be reasonable to ask why, if assisted suicide is such a good action, an act of mercy, an expression of an individual’s right to choose when and how to die, then why should this right be restricted only to those adults with terminal illnesses? Why should the right not be extended to, for example, a young man who is suffering from depression or an elderly woman who does not want to live in a care home? Could it be that the Bill is making the implicit judgement that those people who have a terminal illness are of less value than other people, that their lives are not worth living and that they do not merit the same care and protection from society as other categories of people?

A stark choice lies before society on September 11^th when the House of Commons debates and votes on this Bill. The choice is between fashioning a culture where the suicide of the terminally ill is considered a legitimate instrument of medical provision, or of defending and fortifying the established moral bulwarks of medical ethics so that it may continue to care for human life until a natural death supervenes. The choice is between denying that the enigma of suffering and pain are part of the human condition, or of accepting them as inevitable realities that we should strive to alleviate and cure by proper means, while, at the same time, being able to recognise that they are pregnant with redemptive meaning. The choice which faces us lies between a strictly utilitarian description of the gravely ill as burdens, or, by contrast, of valuing them as our brothers and sisters, human beings of equal and in some ways of greater value than the merely healthy.

Few choices that face human beings are really a matter of life or death. The choice before all of us on September 11^th is exactly that.