This article appeared in the November 2008 edition of the Catholic Medical Quarterly
Duty to die, License to kill, Where next?
On the 19th of September, Baroness Mary Warnock caused widespread outrage by telling The Telegraph that people with dementia have “a duty to die”. She went on to state that pensioners in mental decline are “wasting people’s lives” because of the care they require and should be allowed to opt for euthanasia even if they are not in pain. She insisted there was “nothing wrong” with people being helped to die for the sake of their loved ones or society.1
She told the Daily Telegraph: “If you’re demented, you're wasting people’s lives – your family’s lives – and you're wasting the resources of the National Health Service.
"I feel there's a wider argument that if somebody absolutely, desperately wants to die because they're a burden to their family, or the state, then I think they too should be allowed to die… there's nothing wrong with feeling you ought to do so for the sake of others as well as yourself.”
“If you’ve an advance directive, appointing someone else to act on your behalf, if you become incapacitated, then I think there is a hope that your advocate may say that you would not wish to live in this condition so please try to help her die.
“I think that’s the way the future will go, putting it rather brutally, you’d be licensing people to put others down.”
The Telegraph quotes figures showing that there are 700,000 people with degenerative diseases such as Alzheimer’s in Britain. By 2026 there will be one million dementia sufferers in the country, costing the NHS an estimated £35billion a year. It is too easy for the young to see the elderly as a problem. We do so at our own real peril.
The creation of an ethical debate which sees the elderly competing for resources with the young is not new. Every time the issues of public sector pensions and fuel poverty are raised, a main issue is that younger ‘haves’ do no want to pay higher taxes to support older ‘have-nots’, even where the latter have contributed to the state in tax and labour all their lives. Many of today’s ‘haves’ are seemingly incapable or realizing that they may well be tomorrow’s ‘have-nots’ by sacrificing the future in order to pay for the present, a proverbial act of selling one’s soul to the devil. Similarly the issue of doing away with one’s elderly relatives or indeed patients for pecuniary gain has been implicated in many murder trials.
Baroness Warnock is not, it seems, advocating compulsory euthanasia for the elderly. However, that a request for euthanasia should be respected on the grounds someone fears being a burden upon others is ethically questionable, especially where vulnerable individuals could be ‘shamed’ into planning their own early departure. The duty to die has been seen in the past as a ‘next step’ in an argument that voluntary euthanasia is represents a step onto a slippery slope from what is morally acceptable to what is morally unacceptable. The newspapers talked of the agonizing decision of whether an old person should be supported to sell their home to pay for nursing care, when this money could be ‘better’ spent on the grandchildren’s education. Is this self-sacrifice or societal pressure? Did she jump? Was she pushed… or invited to jump?
An uncomfortable criticism can be made of we who object on the grounds of the sanctity of life. It lies in the statement of His Holiness Pope Pius XII, “The prolongation of life” on November the 24th, 1957. 2
“..consequently, if it appears that the attempt at resuscitation constitutes in reality such a burden for the family that one cannot in all conscience impose it upon them, they can lawfully insist that the doctor should discontinue these attempts, and the doctor can lawfully comply… one must apply in this case the principle of double effect and of voluntarium in causa.”
The extension of this argument has sometimes been that a poor family is not ethically obliged to starve in order to pay for expensive life prolonging treatment, such as dialysis. However, the injustice in Baroness Warnock’s argument is that the frail and infirm individuals whom she would allow to ‘make way’, are not necessarily being paid for by those who are younger. There is an implicit injustice when a generation that struggled to support both the young and the elderly is now not only abandoned by their successors but urged to ‘do the honorable thing’. They are being given the option to give away their own lives that next generations may prey on their property, a financial cannibalism more evocative of the stone-age than the 21st century.
The idea that a Mental Capacity Act ‘guardian’ or someone with lasting power of attorney should consider it their duty to refuse treatment on behalf of a patient purely on grounds that a person has dementia is also a dangerous step towards involuntary and non-voluntary euthanasia. This is a step which is embodied in the very concept of, “Licensing people to put others down.”
2. Pope Pius XII, “The prolongation of life” (Nov. 24, 1957) The Pope Speaks 4: no.4, 1985, p.397