The assisted dying bill is an undignified mess

Literally life-changing legislation needs a parliament at its best not its worst.

George Pitcher

George is a visiting fellow at the London School of Economics and an Anglican priest.

A parliamentary committee meets, sitting at wooden raised desks in a wood panelled room.

The bill committee meets.

The first clue came when MP Kim Leadbeater’s private members’ bill passed in the House of Commons at the end of November. She came outside to greet pro-euthanasia campaigners like she was emerging as a winner from the Big Brother house, in tears of joy, whooping and hugging and high-fiving, with prime minister Keir Starmer gurning awkwardly in her wake.

For her and her supporters, this was indeed great news. But these optics were far from great. It was as though she was celebrating the consequence of the legislation she’d introduced: “Whoa! Wonderful news everybody! We’re going to be allowed to help people to kill themselves.”

It’s not a good look, even to those who may wish for such assistance. Where was the dignity, the key word that assisted-suicide lobbyists have appropriated for their cause? Not in this carefree triumphalism, this cork-popping celebration of the prospect of death-on-demand.

Since then, the bill’s faltering passage through parliament has been characterised by this absence of dignity, a kind of cowboy rustler pushing a herd of supporters in a single direction, towards statute. And this lack of dignity matters. Not just because it is, literally, the most life-changing legislation any of us will see in our lifetimes, but because the dignity of parliament matters very much indeed.

I don’t mean the ritual flummery, the state opening by the monarch, people marching about with wigs and sticks, Black Rod and all that. I mean dignity in the sense with which we honour our democracy, the way in which we frame our legislature seriously and with due process.

Leadbeater presents as a good person and there is no apparent evidence to the contrary. But she is an inexperienced parliamentarian. Her selection for the seat of Batley and Spen, now Spen Valley, was rushed through in 2021, memories remaining acutely sharp of the murder of her older sister, Jo Cox, in the constituency in 2016. And, naturally, she has sat on the Government’s backbenches for less than a year.

Her inexperience of parliamentary process and scrutiny has shown. Committee hearings have been rammed with those who support assisted suicide and held in unseemly haste, such is the rush to get it into law. Before her bill’s second reading, she described it as having the strongest safeguards in the world, each patient requiring a sign-off from a High Court judge. When this proved impractical, the judge was replaced with a social worker, which apparently was “even safer”. So, safer than even the strongest safeguards in the world?

But more worrying still is how the passage of the bill has been factionalised. Leadbeater has alienated the mild-mannered by calling opposing voices “noise”, which is a bit like lamenting that a debate should have two sides at all. And she’s called those who disagree with her “unconstructive” and complained that opponents have “mobilised”. Well, duh. That’s how parliament works. Indeed, it’s part of its dignity, rather than a simple inconvenience for an MP in a hurry.

The media have noticed this lack of respect for procedure. I’m not sure that there’s ever been such resistance to proposed assisted-suicide legislation in the public prints before. Even the Guardian, which might be relied upon to see it as a progressive cause, has turned more than ambivalent. Only columnist and assisted-suicide flagbearer Polly Toynbee is available for a piece that amounts to saying we should move along, there’s nothing to see here and Leadbeater’s bill is doing just fine.

She, too, claims absurdly that opposition is only coming from people who oppose assisted suicide. Well, blow me down. Try as I might, I can’t trace her complaining that Lord Falconer’s supposedly independent Commission on Assisted Dying of 2011 was both funded and packed with his cause’s supporters.

In passing, it should be noted what an underminer of parliamentary dignity is Falconer too. He has claimed that justice secretary Shabam Mahmood’s opposition to the bill should be discounted because of her “religious beliefs”. Mahmood is a Muslim. For a constitutional lawyer, Falconer shows scant regard for our constitution. We might as well say that his views should be discounted because he’s a progressive secularist.

One might expect PM Keir Starmer to bring some quality to this, as an alleged stickler for legal procedure. It remains a mystery, as a supporter of the principle, that he’s left assisted suicide to a private members’ bill. If he really wanted it, it should surely be a Government bill. Cynics among us wonder if he has honoured a promise given to the terminally ill Esther Rantzen with token support for a private members’ bill, but knows it will fail.

Again, lack of dignity. If dignity in dying means anything since it was misappropriated as a campaign slogan for assisted suicide, then it should be accompanied by dignified debate and amendment in parliament. This bill has provided precisely the opposite. Let it die.

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Article

Belief

Care

Creed

4 December 2024

4 min read

Understand what we thirst for

Whether for water or meaning, it’s a primal force.

Helen Cowan

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A child wearing a wool hat holds a glass and drink water from it.

Johnny McClung on Unsplash

Quenching thirst is a global problem. It can also be profoundly personal, impaired by illness. For nurses, it can be ethically and emotionally difficult, when treating dying patients. But is there ultimate relief?

Thirst is the subjective sensation of a desire to drink something that cannot be ignored. The world is thirsty; globally, 703 million people lack access to clean water. That’s 1 in 10 people on the planet.

Thirst is a life-saving warning system that tells your body to seek satisfaction through swallowing fluid. It works in partnership with other body processes - such as changes in blood pressure, heart rate and kidney function - to restore fluid, and salt, levels back to where they belong. Failure of any part of this beautifully balanced system leads to dehydration (or water intoxication), and perhaps to seizures, swelling of the brain, kidney failure, shock, coma and even death.

Sometimes it’s difficult to quench thirst, because of problems with supply. According to the World Health Organization, at least 1.7 billion people used a drinking water source contaminated with faeces in 2022. Sometimes in war, water is weaponised, with systematic destruction of water sources and pipes. Water laced with rat fur, arsenic and copper has meanwhile been reported in prisons across the USA.

At other times, there may be “water everywhere, but not a drop to drink” because of individual problems with swallowing. As a nurse, some of my most heartbreaking moments have been when I have been unable to fulfil a need as basic as a patient’s thirst; when even thickened fluids have led to intense coughing and distress, and a realisation that I can only moisten mouths and give so-called “taste for pleasure”: very small amounts of a favourite liquid or taste using a soft toothbrush, or a circular brush gently sweeping around the mouth and lips to release some of the liquid - even, and especially, at the end of life when the patient is unconscious.

Difficulties in drinking are common in dementia when fluid can seem foreign and swallowing a surprise to the system. It’s thought that over 50 per cent of people in care homes have an impaired ability to eat or drink safely; 30 to 60 per cent of people who have had a stroke and 50 per cent of those living with Parkinson’s may struggle to swallow.

Other conditions that may affect swallowing include multiple sclerosis, cerebral palsy, and head and neck cancers. Diabetes is characterised by a raging thirst owing to problems with insulin (diabetes mellitus) or an imbalance in antidiuretic hormone levels (diabetes insipidus). In intensive care, patients are predisposed to thirst through mechanical ventilation, receiving nothing by mouth, and as a side effect of some medications. But thirst is a “neglected area” in healthcare, writes palliative care researcher Dr Maria Friedrichsen.

“Knowledge of thirst and thirst relief are not expressed, seldom discussed, there are no policy documents nor is thirst documented in the patient’s record. There is a need for nurses to take the lead in changing nursing practice regarding thirst.”

Is there another thirst that is also being missed in nursing, and in life in general – a spiritual thirst, beyond the physical desire to drink? In his book, Living in Wonder, writer Rod Dreher argues that humans are made to be spiritual, and that a critical sixth sense has been lost in a “society so hooked on science and reason”. We humans crave love in our deepest selves; we have an insatiable thirst for everything which lies within – and beyond – ourselves. Auschwitz survivor Viktor Frankl, who was later appointed professor of psychiatry at the University of Vienna, became convinced that human beings have a basic “will for meaning.” “The striving to find a meaning in one’s life,” he wrote, “is the primary motivational force in man.”

In the harsh sun of a Middle East day, an ancient story of a man and a woman encountering each other at a water well illustrates this dual thirst for water and meaning. The man, Jesus, thankful for a drink of water given to him at the well by an outcast Samaritan woman, said that “Everyone who drinks this water will be thirsty again, but whoever drinks the water I give them will never thirst. Indeed, the water I give them will become in them a spring of water welling up to eternal life.” In that midday sun, such imagery made a powerful statement.

Being mindful of spiritual thirst when drinking water is something also captured in a Ghanaian proverb and pictured perfectly in the many birds that drink by gravity, so tipping their heads back when they swallow.

“Even the chicken, when it drinks,

Lifts its head to heaven to thank God for the water”.

Unsatisfied thirst is part of the human condition, we long for something more; it’s living proof of our immortality, says French poet Charles Baudelaire. Despite his Olympic success, athlete Adam Peaty said that society didn’t have the answers he was seeking, and that a gold medal was the coldest thing to wear. He “discovered something that was missing” when attending church for the first time, and now has a cross with the words “Into the Light” tattooed across his abdomen, symbolizing his spiritual awakening. We are more than mechanical machines with physical needs. We are rather gardens to tend in a dry and thirsty land, with souls in need of intensive care.