The Latest Decalogue

We pass from last week’s dreams to, this week, The Dream, via politics.  On Wednesday May 27th in Edinburgh the Scottish Parliament debated the Assisted Suicide (Scotland) Bill (it was knocked back by 82 votes to 36), and on Saturday May 30th in Glasgow the Royal Scottish National Chorus and Orchestra performed Elgar’s Dream of Gerontius.

While it is not illegal to commit suicide in Scotland, it is not lawful to assist someone to do so.  This is what the Bill seeks to change.  I thought it would be worthwhile to give the Assisted Suicide (Scotland) Bill close scrutiny.  It’s not a lengthy document – 20 pages, including the 9 forms that it would be necessary to fill out if one chose to go down the assisted suicide route.  It’s worth talking through the forms, because this gives a sense of what it would mean in reality if the Bill were to become law.

You start by filling in “Preliminary declaration of willingness to consider assisted suicide”.  It’s a very simple form: name and address, date of birth, medical practice name and address.  You sign and date a declaration that you are willing to consider requesting assistance to commit suicide.  You need to be registered with a medical practice, and over 16.  You need to be making the decision voluntarily having been neither persuaded nor influenced by another person to make it.  At this stage, you can be in perfect health.

The preliminary declaration must be witnessed.  The Witness Statement is the next form.  Name and address, date of birth (over 16 again), signed, dated.  You must be acquainted with the applicant, but not a relative, spouse, in-law, civil partner, or cohabitee.  You mustn’t stand to gain financially from the proposed suicide, and you mustn’t be a doctor or nurse providing care to the person in relation to their illness or condition.  The same disqualifications apply to proxies and persons providing assistance in the act of suicide, “licensed facilitators”.

Next is a “Note by Registered Medical Practitioner” to state that the first two forms have been accurately filled in.  Name and address, signed, dated.

Now at least a week must elapse, for reflection.

Next is the “First request for assistance in committing suicide”.  Name and address, date of birth, medical practice name and address, signed, dated.  You declare that your quality of life has become unacceptable, because you have an illness that is either terminal or life-shortening, or you have a condition that is progressive and either terminal or life-shortening, and you see no prospect of any improvement in your quality of life.  The apparent distinction between an “illness” and a “condition” is not explained.

Next form is “First registered medical practitioner’s statement on first request”.  Name and address, signed, dated.   The doctor is not being asked to make any kind of value judgment as to whether or not the first request is justified, merely that the first request form has been properly filled out and that the information it contains is “not inconsistent” with the facts currently known to the doctor.

Next form is the “Second registered medical practitioner’s statement on first request”.  This is essentially the same form as the above.  The second doctor needs to interview the applicant.

At least 14 days must now elapse.

Next form is the “Second request for assistance in committing suicide”.  Name and address, date of birth, medical practice name and address, signed, dated.  This is largely a repetition of the first request with the additional declaration that you have arranged to have the services of a “licensed facilitator”.

Next form is the “First medical practitioner’s statement on second request”.  Name and address, signed, dated.  This is essentially the first statement reiterated.

Next form is the “Second medical practitioner’s statement on second request”, and another reiteration of the first statement.   Name and address, signed, dated.

That completes the form-filling.  The act of suicide must take place within two weeks of the second request, or the procedure is no longer legal.

This walk through the form-filling allows us to draw some conclusions about the proposed process. They can be drawn quite independently of any ethical opinion one might have.  It is clear that the Bill is proposing to legalise assisted suicide on request.  To qualify, all you need to have is a condition that is life-shortening and which, in your opinion, renders your quality of life unacceptable.  I can’t think of a single significant chronic pathology that does not shorten life and diminish its quality.  Implicit in the wording of the forms is the idea that it is the patient, not the doctor, who can best evaluate his own quality of life.  As politicians are wont to say, “This is all about choice.”

The second thing to note is the way in which the patient’s loved ones have been removed from the process.  Indeed, they are disqualified from the process.  They have been replaced by a bureaucracy, as depicted by the forms.  An entire new discipline with its associated industry is being created; we might call it “thanatology”.

On Saturday I went to The Dream.  Based on a text by John Henry Cardinal Newman, Elgar’s is an intensely personal, religious and indeed Catholic work.  I think of it as a hymn to palliative care.  We meet Gerontius, first on his death bed, then when he has passed beyond death.  We experience the palliation of his fear.  I like to think of Gerontius’ Guardian Angel as a palliative care nurse.  Sir John Barbirolli recorded Gerontius in 1964, with Dame Janet Baker singing the part of the Angel, but he had first performed it in Sheffield in the 1940s, with Kathleen Ferrier in the role.  Apparently she sang with such searing intensity that the composure of the bass soloist David Franklin was shaken.  The thing about the voices of both Ferrier and Baker is that they are remarkable instruments.  I like to think of Baker’s voice as the “ex-Primrose” Guarneri viola of 1697, while Ferrier’s is the Archinto Strad of 1696.  The voice of the viola is dark, mellow, compassionate, and palliative.  In this context, there is a poignancy in Ferrier’s death in 1953, from metastatic breast cancer, at the age of 41.

On Saturday evening, Sarah Connolly was the Amati viola of 1600.

Who can say what he might think, or wish for, in an extremity of condition?  Who would not have compassion for someone moved to put an end to the torment of a loved one?  Who indeed would not wish our parliamentarians well in trying to clarify the law?  Yet I cannot believe compassion will ever be captured in a series of bureaucratic forms.  No matter how clever your jurisprudence, the next unique situation will always confound it.  It’s like the Heisenberg Uncertainty Principle.  The closer you scrutinise something, the fuzzier it becomes.

It is not behovely for one who has not been put to the test, to make sanctimonious remarks about the sanctity of life.  Yet recently I’ve had a strange experience.  Walking by a field of rapeseed, stopping to gaze at a river, standing under the burgeoning leaves of a Scots pine, I’ve become aware of a palliative sense of companionship, quiet, friendly, benign.

Maybe it’s just a dream.

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