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[00:00:00] The Why Curve, with Phil Dobbie and Roger Hearing.
[00:00:03] It's a question of life or death.
[00:00:06] Should we have the right to choose to end our lives without our helpers committing a crime?
[00:00:11] Or does this open a window to older or disabled people being pressured to die because it suits their family?
[00:00:17] It's a long-running debate, but now a bill to legalise euthanasia is before Parliament for the first time in a decade.
[00:00:23] And there's a strong chance it will pass.
[00:00:26] There are clear guardrails in the proposed law, but are they enough?
[00:00:29] Or are we at the risk of killing for convenience?
[00:00:31] The Why Curve
[00:00:35] So I actually have looked at this bill, which has got a few stages to go.
[00:00:39] It's at the second hearing at the moment.
[00:00:40] That's right. I think it's yes to all.
[00:00:41] It's going to go to the committee, then it's going to go to the third hearing.
[00:00:44] But there's a vote coming up.
[00:00:45] Right.
[00:00:46] A substantial vote.
[00:00:46] And I just, I mean, it is, it will pass.
[00:00:50] Yes.
[00:00:50] Are you sure it will pass?
[00:00:51] Well, it's because it is the most convoluted process imaginable.
[00:00:56] Well, they've got to.
[00:00:57] Well, have they?
[00:00:58] But I mean, it's to such a point where, you know, almost, I mean, you've got to go to court for a start.
[00:01:03] Yes. Oh, yes.
[00:01:04] So, I mean, it's not something that's going to be there for everyone.
[00:01:07] It might be a handful of people a year.
[00:01:09] But you wonder, in reality, how many people are suffering in terminal pain who want to end their lives?
[00:01:15] And it's probably hundreds, maybe thousands.
[00:01:17] You're not going to go to court.
[00:01:18] It's a vast number of people.
[00:01:19] But, well, but also, you know.
[00:01:21] I'm saying it is quite a number of people.
[00:01:22] Well.
[00:01:23] So, for all of those people to have to go to court, just so that we are satisfied that they've not been cajoled into this process.
[00:01:32] But you won't get it through unless you've got the guardrails.
[00:01:34] That's the point.
[00:01:34] Unless you've got these kind of things.
[00:01:35] And they are in pain.
[00:01:36] So, we are saying, well, okay, we're going to make sure you want to die.
[00:01:39] We've got to go through.
[00:01:40] We're going to get judges.
[00:01:41] We've got to get all this paperwork sorted out.
[00:01:43] You just keep on enduring that pain while we satisfy ourselves that we are not ending your life on this time.
[00:01:49] So, you think we should say, yes, it's fine.
[00:01:50] Carry on.
[00:01:50] Well, I just feel like this bill is – well, I mean, I think there are places like the Netherlands where it's far easier.
[00:01:55] And I think this bill is just going for the longest, most bureaucratic process.
[00:01:59] Because it's the only way to get it through.
[00:02:00] It's a very English way, very British way of coping with it.
[00:02:02] It's the only way to get it through.
[00:02:03] There's such opposition to this.
[00:02:04] And there's so many people who think it's opening the door to a point where, gradually,
[00:02:10] people become more and more used to the idea.
[00:02:12] And then, you know, there's dear old granny who is getting on a bit.
[00:02:16] She's not – you know, she's demanding a lot.
[00:02:18] She, you know, she's a bit inconvenient.
[00:02:21] You know what?
[00:02:21] We're not going to tell her.
[00:02:22] She kind of feels under pressure.
[00:02:24] Same with a lot of disabled people.
[00:02:25] And that's the worry.
[00:02:27] Once you open a door, it's actually quite hard to keep it only just open a jar.
[00:02:31] Well, I mean, it is literally – I mean, with this law, it's only just open, isn't it?
[00:02:36] Because you've got to squeeze through so much bureaucracy to get the door open.
[00:02:39] It's reassurance to the people who have those doubts.
[00:02:41] That's the point.
[00:02:42] Yeah, but it's not reassurance to those people who are feeling the pain.
[00:02:45] And they will just end their life by the way it means they can.
[00:02:48] So I feel like if you're mobile but in immense pain,
[00:02:52] you're more likely to tuck yourself off a tall building rather than wait for this whole process to go through.
[00:02:57] Or you just go off to Dignitas and, you know, nobody – you know, you have to travel abroad to do it,
[00:03:02] which is what a lot of people are doing.
[00:03:03] Which is what's been happening.
[00:03:04] That's right.
[00:03:05] Exactly.
[00:03:05] So in a way, it's recognising the fact that people are already de facto breaking the law.
[00:03:10] Right.
[00:03:11] And I feel like this does nothing to remedy that because it's putting such an elongated price.
[00:03:17] But anyway –
[00:03:17] Let's talk to someone we've spoken to before, in fact, earlier this year when the idea was beginning to surface a bit.
[00:03:24] And he was talking to us, Dr. Sam Carr, about really the problems in terms – ethical terms as much as anything –
[00:03:32] and our attitude towards dying.
[00:03:33] But now we thought it would be good to get him back because we've reached a point where there is, as you say,
[00:03:39] a law, convoluted or otherwise.
[00:03:40] It is there.
[00:03:41] It's on paper.
[00:03:42] It's a real potential.
[00:03:43] And as you think, it might pass.
[00:03:45] So we thought it would be a good idea to get him back and say, you know, are the guardrails enough?
[00:03:49] Or do you think they far too much?
[00:03:51] Anyway, it's Dr. Sam Carr.
[00:03:52] He's a lecturer at the Department of Education and the Centre for Death and Society at Bath University.
[00:03:56] He joins us now.
[00:03:57] So, Sam, I mean, do you share my thinking that this bill is just a very cumbersome, slow process
[00:04:04] and it's not really going to change too much?
[00:04:06] If you're in a great deal of pain, you're just going to take whatever means you can
[00:04:09] rather than, for example, going to court, for goodness sake?
[00:04:12] Yeah, I mean, I guess you could say it's a move in the right direction,
[00:04:16] but not very far at all in that direction.
[00:04:19] I guess, yes, I probably would agree with that because it's really cumbersome.
[00:04:23] But it's the only way, Sam, isn't it?
[00:04:25] You're going to get past the people who have expressed really great concerns and doubts about it.
[00:04:30] And you get the impression, certainly from the coverage, there are a lot of people out there,
[00:04:34] perhaps the elderly, perhaps disabled people, who think this is just a way of,
[00:04:38] A, avoiding paying for proper care for them, palliative care.
[00:04:43] It's a way out of that.
[00:04:45] And also, once you open this door, you know, it's going to be much, much wider before long.
[00:04:50] The caveats will drop away and it'll become what a lot of people don't want,
[00:04:54] which is people feeling under pressure to end their lives by their family or society.
[00:05:00] We'll give you a chance to talk in a second, Sam.
[00:05:02] I mean, we've invited you along.
[00:05:04] I feel like we should give you the chance to talk.
[00:05:05] But let's very quickly, the process is, under this bill, if I make a request for assisted dying,
[00:05:10] there's an assessment by a doctor to make sure that I was, you know, it's genuine
[00:05:15] and I haven't been coerced into it, amongst other things,
[00:05:17] and I am indeed in pain and I, you know, I'm not going to recover.
[00:05:21] There's then a second opinion and then it gets court approval.
[00:05:24] If it's approved by the court, then your doctor gets an approved substance.
[00:05:30] And that doctor then has a pretty harrowing for the doctor.
[00:05:32] The doctor has to wait for you to die.
[00:05:34] Well, I guess, you know, that is part of the whole medical process.
[00:05:38] But, I mean, all of that is a very long, cumbersome process.
[00:05:42] Yep, it is.
[00:05:43] But I think in all countries where assisted dying is legalised in various different ways,
[00:05:51] there are similar kinds of processes in place.
[00:05:55] And I guess they're meant to be there to sort of, I think, protect the doctor's back
[00:06:00] to try to make some sort of, draw some lines in the sand in what is an incredibly grey,
[00:06:07] sketchy kind of area with so many subjective elements to it,
[00:06:10] that it's very difficult to be sure about many of these things.
[00:06:15] And like you said, doctors are in a difficult position because often they've got to make the subjective judgment around,
[00:06:21] do we agree that this person is suffering enough, is likely to die within the next six months?
[00:06:28] None of those things can be absolutely sure.
[00:06:31] So there can be a lot of difficulty in making these quite subjective things in some way objective.
[00:06:39] And in a way, that's the challenge.
[00:06:41] Do you think this is a good law? Do you think it's well drawn up?
[00:06:48] I would answer that differently depending on the perspective I look at it from.
[00:06:51] In terms of, well, how sure can we be that we did the right thing,
[00:06:55] which is often what happens in sort of retrospectively looking back on these cases.
[00:07:00] It's moving towards, okay, what other countries do.
[00:07:04] Like in the Netherlands, Belgium, the same kind of thing happens.
[00:07:06] You still need a doctor's verification that, yeah, this person is definitely suffering, in my opinion,
[00:07:13] and I believe this is the right way to put them out of their suffering.
[00:07:17] You still have to have that in place.
[00:07:19] And so I suppose you can see the benefits of it in that sense.
[00:07:25] But I also think that I'm not sure how much we've debated things like what kind of suffering,
[00:07:32] what does the suffering even mean here?
[00:07:33] Because suffering is a big part of this process.
[00:07:36] And inevitably, once you open the door to the idea that, well, suffering,
[00:07:40] intolerable suffering is something we would want to remove for people through assisted dying,
[00:07:47] you will eventually get a sort of evolution of what that suffering concept means.
[00:07:52] You know, it becomes bigger and bigger.
[00:07:54] Does psychological suffering count?
[00:07:56] Yeah.
[00:07:57] Is it only literally physical pain that counts?
[00:08:00] Could you be a Labour supporter who says,
[00:08:01] I've just lived through 13 years of a Conservative government?
[00:08:03] Could that be a Labour?
[00:08:04] Well, they've had the end of that intolerable suffering.
[00:08:07] It's just the rest of it.
[00:08:08] But you do get that debate as to what kind of suffering counts and doesn't count
[00:08:12] and who gets to say that other than the individual themselves.
[00:08:16] Well, that counts for a lot, doesn't it?
[00:08:19] What the individual thinks.
[00:08:20] So there was a case of Mr. Nicholson was a guy who was completely paralysed.
[00:08:25] He could move his head a little bit, his eyes.
[00:08:28] That was it.
[00:08:29] Not much of a life, you have to admit.
[00:08:30] He wanted to end his life.
[00:08:32] There was even a machine invented that could be loaded with a lethal drug
[00:08:36] and it could be digitally activated by a blink of his eye.
[00:08:40] He applied to the High Court and asked for a declaration that it would be lawful for a doctor to assist him in his dying.
[00:08:48] And if that was refused, he said it was the law as it stood was incompatible with his right to a private life.
[00:08:56] This is an interesting thing.
[00:08:57] A private life under the European Convention of Human Rights.
[00:09:00] I mean, the court refused on both counts and he died by just not taking food.
[00:09:07] So he died slowly, ultimately, of pneumonia.
[00:09:09] But what a way to die because the court decided that he didn't have the right to die.
[00:09:15] And yet he knew he was going to die anyway.
[00:09:17] So he just died slowly.
[00:09:18] And, you know, surely he has that right to choose.
[00:09:22] Yep.
[00:09:23] I personally would agree.
[00:09:25] I think, yes, you would think that.
[00:09:26] And it's very, very difficult for somebody else to say with more sort of conviction than you're saying yourself that yes or no, you're suffering.
[00:09:35] Well, you're not suffering.
[00:09:37] I agree.
[00:09:37] It's a very subjective thing.
[00:09:41] In the Netherlands, for example, the concept has evolved so much that people who are older, who even come under this banner that we're calling in a research group on part of tiredness of life, which is old people who are not necessarily dying of anything, but they've had enough.
[00:09:58] You know, they've had enough of living.
[00:10:01] They might have multiple complaints, but they're not dying.
[00:10:04] And life has become burdensome to the point where being alive is less pleasant than the idea of being dead.
[00:10:11] And a lot of older people are requesting assisted dying for that, for example, because they argue…
[00:10:19] Well, that wouldn't be allowed under the current law as drafted.
[00:10:23] Not in the UK, it wouldn't.
[00:10:24] But it's…
[00:10:25] Would it anywhere?
[00:10:26] Would it in Holland?
[00:10:27] Yeah, in the Netherlands, that has been, in small numbers of cases, a reason enough to say that somebody's suffering intolerably with being alive and they should have the right autonomously to decide that they want to end it.
[00:10:44] And in some cases in the Netherlands and Belgium, that's now becoming an acceptable reason for an older person to end it because it seems like the suffering of being alive just drags and dwindles.
[00:10:57] To the point where being alive is just a psychological torture.
[00:11:00] But isn't that in itself an indication that the ways we have to make old people's or disabled people's lives happier and better, we're not doing enough of that.
[00:11:12] You know, isn't that the argument one should be had?
[00:11:14] Continual episodes are pointless in the afternoon.
[00:11:17] Well, that's torture enough.
[00:11:18] But no, just, you know, the palliative care area.
[00:11:22] And this is what Wes Strachan, the health secretary, has been putting as his point of view and some controversially.
[00:11:28] But saying, you know, you're just effectively saying, well, we don't have to put so much money into or effort into making their lives better.
[00:11:35] Yeah, and that will always be the other side of the coin.
[00:11:37] So, yeah, in the example I just gave you, the other side of the debate is, well, we should be making older people's lives more meaningful.
[00:11:44] And if we did, this kind of suffering might not exist.
[00:11:49] Some old people will say, though, you know, I've just I've seen enough sunsets.
[00:11:53] They're not they're not that great anymore.
[00:11:54] I've seen enough.
[00:11:55] I've seen enough and done enough of X, Y and Z.
[00:11:57] Even my own family don't give me a meaning anymore.
[00:11:59] There's a complete lack of meaning and a real sense that my life's finished to the point where it's like running the marathon when you've already crossed the finish line.
[00:12:07] You know, you're continuing.
[00:12:08] That is a big line, isn't it?
[00:12:10] I mean, it's such a gray area.
[00:12:12] How do you determine?
[00:12:13] But I mean, but again, if that's what they want, why not?
[00:12:18] But that that surely that's the problem.
[00:12:21] That want word, because a lot of people say that this is going to open a portal to people being pressurized.
[00:12:29] Pressurized.
[00:12:29] Well, feeling pressurized, even if they're not being pressurized.
[00:12:32] It's always a burden on their family.
[00:12:34] And that, yeah.
[00:12:34] Well, and that then becomes a gray area as well.
[00:12:37] So so you're you're chewing up your, you know, potentially your kids inheritance in a nursing home.
[00:12:43] And you could say, well, I'm getting cajoled into ending my life because the kids want the inheritance.
[00:12:48] But actually, what turn that on its head?
[00:12:50] What if the kids aren't doing that?
[00:12:51] But you're thinking, you know, all this money is being spent.
[00:12:54] My life is miserable.
[00:12:55] I'd rather the kids had it because at least then I've got some meaning ending my life has some meaning because I'm giving them a better start.
[00:13:03] There's no way in the I mean that, you know, but what is the difference between you saying that and it being interpreted as are the kids are trying to pressure you because they're trying to get them that hold of their money.
[00:13:12] How do you prove either way?
[00:13:15] Yeah. And again, there is there is research on that in countries where assisted dying is legal, that family dynamics are very complex.
[00:13:23] And it can sometimes be the other way around in that the kids don't want you to make that decision.
[00:13:28] You know, they really want you to to stay alive for as long as possible.
[00:13:32] And they're also sort of prolonging every week of your life.
[00:13:35] And so they won't acknowledge or accept that.
[00:13:38] And so families can have huge disagreements over, yeah, the right or the wrong thing.
[00:13:43] And your autonomy becomes sort of kind of dictated a little bit by what your family's wishes are, too.
[00:13:49] Yeah.
[00:13:49] And so, yeah.
[00:13:51] Actually, get the state to pay for the nursing homes.
[00:13:53] That whole thing goes out.
[00:13:55] It's not a question anymore, is it?
[00:13:57] Yeah.
[00:13:58] Yeah.
[00:13:59] But it's also, you know, it's also just an emotional thing.
[00:14:02] You know, some people don't want to let go of their family.
[00:14:05] They don't want to let go of their dad or their mom, even though that person might be saying, look, it's my time and I'm ready and I want to go.
[00:14:12] And life is just not pleasurable anymore for me.
[00:14:16] But that might not be possible to comprehend for a daughter or a son or a grandchild or whatever, whoever it is.
[00:14:21] Or it might be seen that because they're letting them go, other people would say, well, you're just getting rid of your elderly relative for your convenience.
[00:14:29] It's the implication people put on it as well.
[00:14:31] Yeah, exactly.
[00:14:32] So there's so many complexities around that sort of just that angle alone, the sort of family difference of opinion and dynamic.
[00:14:42] So is the issue that we're trying to define something which is quite fluid?
[00:14:47] So, I mean, looking at some of the wording in the Dutch law, an explanation of it, this isn't actually, you know, written in the law, but it's on a site explaining it all, which says requests for euthanasia often come from patients experiencing unbearable suffering with no prospect of improvement.
[00:15:02] Their requests must be made earnestly with full conviction.
[00:15:05] They see euthanasia as the only escape from the situation.
[00:15:09] However, patients have absolutely no right to euthanasia and doctors no absolute duty to perform it.
[00:15:17] So that's saying it depends, doesn't it?
[00:15:20] But how do you deal with that in a court of law?
[00:15:23] It's the so many subjective terms.
[00:15:25] Well, then why should it go to a court of law?
[00:15:27] I mean, it seems to me that's saying this is a discussion between the patient and the doctor and no one is under either obligation.
[00:15:36] But what you want to make sure is the doctor, you know, doesn't get done for manslaughter at the end of the process.
[00:15:41] Yeah.
[00:15:42] And I think once you take it into the legal ballpark in that sense, a lot of doctors are very obviously very aware of that and rightly so, because it's their kind of it's their career reputation life and potentially in jeopardy if they're ever deemed to have made a bad decision, which has happened in the past in countries like the Netherlands.
[00:16:03] So, yeah, there's also a lot of research on how comfortable are doctors with this and not many of them often are because it's so gray.
[00:16:12] But also their whole training and indeed, you know, they still take the hypocrisy.
[00:16:16] Saving lives.
[00:16:17] But, you know, first of all, you save life in a way.
[00:16:21] Isn't there and I know some doctors feel this is perverting their calling because they now have to get it right to kill someone, in effect, to make them dead.
[00:16:30] And that's a very different thing than what they are trained to do.
[00:16:35] And even so even going through this law, which is, you know, which is going through Parliament, someone still has to conduct the deed at the end.
[00:16:44] It must be very difficult for doctors.
[00:16:45] Have you spoken to them, Sam?
[00:16:47] Have you got any sense of what their feeling is?
[00:16:49] Certainly some of my colleagues have talked about exactly what you just said, really.
[00:16:54] There's a real difference or conflict inside a doctor around the idea of, well, am I sort of the protector of this person's autonomous wish to die?
[00:17:03] Or am I a sort of protector of the right to prolonging life at all costs, no matter what?
[00:17:10] And there is a bit of a catch-22.
[00:17:13] The doctors are caught between in relation to those things.
[00:17:15] Is my goal here to just protect this person's autonomy and to sort of allow them to fulfill the wish around their life ending?
[00:17:23] Or, yeah, is my duty to prolong that life for as long as possibly I can?
[00:17:28] I think you can go right back to, like, ancient Greece, like Hippocrates, the old Greek physician, who said the purpose of medicine for him was to do away with suffering of the sick and lessen the violence of disease.
[00:17:41] And I guess you've got to think about whether you interpret that as sort of helping someone to die.
[00:17:46] Is that how you interpret that or not?
[00:17:50] The old cure, I suppose, in a way.
[00:17:52] Yeah.
[00:17:52] But, I mean, that is brilliant, isn't it?
[00:17:54] Because, I mean, that's a very easy definition.
[00:17:56] You are there to remove the suffering, either by making life better or by ending life.
[00:18:03] Exactly.
[00:18:03] And in some cases, death is the medicine.
[00:18:06] Death is literally the medicine.
[00:18:08] And maybe you're doing that well.
[00:18:09] But I don't think all doctors see it that way.
[00:18:11] And so, and you can't necessarily expect them all to see it uniformly.
[00:18:15] So there's a difference of opinion between doctors.
[00:18:19] And two doctors might have radically different opinions, too.
[00:18:22] And I guess we'll see that in the UK if this comes into fruition.
[00:18:26] Well, there'll be some who say, I won't do this.
[00:18:28] There will be some, I guess, as has happened with issues of abortion, for example, in the past, where they said, no, I'm sorry, my conscience does not allow me to do this.
[00:18:35] Yeah.
[00:18:36] Yeah.
[00:18:37] And that would be difficult.
[00:18:38] So I've seen, you know, different terminologies.
[00:18:42] Are they the same thing or do you see a difference between assisted dying and assisted suicide?
[00:18:48] Are they just different terminologies for the same thing or is there a difference?
[00:18:52] Well, as I understand it, assisted dying and assisted suicide seem to be the same thing.
[00:18:57] I suppose the only difference might be that assisted dying is that you are actually in the process of dying already.
[00:19:04] Yeah.
[00:19:05] Or at least we've deemed it to be that.
[00:19:06] So you've got a terminal disease.
[00:19:07] Yeah.
[00:19:08] And just shortening it.
[00:19:09] Yeah.
[00:19:10] Well, under the law, it's six months, isn't it?
[00:19:11] Or something, I think.
[00:19:12] That's right.
[00:19:13] So you're just hastening the process that you've deemed as already happening.
[00:19:18] Whereas suicide, that isn't necessarily.
[00:19:21] Yeah.
[00:19:22] You've got a miserable life.
[00:19:24] Yeah.
[00:19:24] And the argument for that would be, well, if we, I mean, definitely in that case, if we don't assist you with that suicide, you are going to do it yourself.
[00:19:31] Well, I mean, you may not, of course.
[00:19:33] If you have the ability.
[00:19:34] If you have the ability.
[00:19:35] Well, it's, you know, there's always a way, isn't there, if you are so drawn.
[00:19:39] But you'd hope in that case that then there can be circumstances found to solve that problem.
[00:19:44] But then, you know, there's, we don't seem to be too concerned.
[00:19:47] You know, we're very concerned about saving lives when people talk about dying.
[00:19:52] We don't seem too concerned about the quarter of a million people who are living on the streets in the UK who are, you know, I imagine most of them are having a thoroughly miserable life as well.
[00:20:02] And you would have thought would be on suicide watch because how long are you going to put up with that?
[00:20:06] And even if they don't decide to commit suicide, how many of them die from the cold in winter?
[00:20:11] You know, we've got double standards, haven't we?
[00:20:14] Yeah.
[00:20:15] And I guess you're absolutely right.
[00:20:16] We're privileging certain kinds of suffering at the expense of others.
[00:20:20] And this might well open debate about, yeah, the very nature of suffering.
[00:20:24] What is it?
[00:20:25] Whose matters?
[00:20:27] Who gets to decide who's suffering and who isn't?
[00:20:31] And maybe the quality of life because it just occurs to me, we've been talking a lot about older people, essentially.
[00:20:38] Yeah.
[00:20:38] But there are a lot of disabled people.
[00:20:41] People in stages of needing enormous amounts of help to keep going and potentially suffering along the way.
[00:20:49] And that, it seems to me, is a really interesting area because it goes to what we consider to be life that's worth living, a life that's worth living.
[00:20:59] Mm-hmm.
[00:21:00] And we're getting to some very difficult territory here because famously, of course, under Nazi Germany, there was an actual term in German, a life not worth living, which is why they imposed their euthanasia policy, which was obviously not for life.
[00:21:13] Not having blue eyes.
[00:21:14] Well, one of them is.
[00:21:15] Lots of reasons.
[00:21:17] But the thing there, it seems to me, Sam, is, you know, we've got to decide what we think life, you know, what is the quality of life?
[00:21:26] Yeah.
[00:21:26] How much important is life per se?
[00:21:30] And then the extent to which we make that life worth living comes back to the palliative care thing.
[00:21:35] But with a lot of disabled people, I know that there are a lot of disabled campaigners who are very wary of this, opening up this area, because it puts them in a, you know, what is the quality of the life of those people?
[00:21:47] Yeah, I've read, I've also read, like, people's personal objections to this, based exactly on what you just said, really, from disabled people who argue that, yeah, there's a risk here, in terms of us defining what quality of life is and isn't.
[00:22:01] And making judgments on those kind of things.
[00:22:05] It will open the door to that, too, I think, for sure.
[00:22:09] But if you're in a situation, though, I mean, I wonder whether there can be boundaries drawn.
[00:22:15] Interestingly, without her being aware that we were talking about this week, my wife and I were talking about this very subject this week, as to if I was involved in an accident and I was, you know, paralysed, unable to communicate.
[00:22:28] She said, in your case, if you were unable to talk, life would not be worth living.
[00:22:34] And I was, well, you know, being able to think all right, maybe.
[00:22:37] But, yeah, she might have a point.
[00:22:39] Whereas her life might be actually improved by the circumstance.
[00:22:42] But, I mean, she said, you know, if you're in a situation where you're paralysed, would you want to live?
[00:22:47] She said, because I should know that.
[00:22:48] And I said, well, you can know it, but it's not going to change the law.
[00:22:51] But, no, of course I wouldn't.
[00:22:53] And I know that, you know, in Dutch law, they do try, don't they, to sort of like have almost like a premeditated statement.
[00:23:03] You know, like, for example, you can have a do not resuscitate medallion if you are, you know, in a medical emergency.
[00:23:11] But, you know, maybe something like that, you know, in this set of circumstances.
[00:23:14] Yeah, you know, finish me off.
[00:23:16] I'm happy with that.
[00:23:17] I don't want to live a life.
[00:23:19] So you make the choice before you get into that situation.
[00:23:21] So you make that choice as a sound mind.
[00:23:23] Is that a better way forward?
[00:23:26] You know, yeah, I mean, in the Dutch case where I was talking about earlier, people who get to a point where they are, they've lived so long that even though they're not terminally ill, life has become a burden.
[00:23:39] I've got a colleague at the University of Liverpool.
[00:23:41] She always says that actually there are good examples of some older people who, even though they really suffer when they get to that point, they rediscover some kind of meaning even within that suffering.
[00:23:54] And she's given me some great examples of people that have done that, even though those people never thought they could.
[00:24:00] You know, so it's kind of like they find some sort of light in a deeply dark place.
[00:24:04] And so she always says we've got to be careful that we're not too impulsive in relation to deciding this is it.
[00:24:11] It's over.
[00:24:12] There's no way I could ever find a way through this or there's no way I could ever deduce another drop of meaning from this.
[00:24:17] But some people do.
[00:24:19] And her argument is always not to be too hasty when people are really suffering, not to think that that's absolutely it.
[00:24:27] The other side of the coin is there must be a point where you do think, yeah, it's absolutely it.
[00:24:31] There's no way I can get anything positive out of this anymore.
[00:24:34] It's nothing but hell.
[00:24:36] But there's always that debate.
[00:24:38] Where there's life, there's hope.
[00:24:40] That's the kind of phrase, but that's what it is.
[00:24:43] Well, Stephen Hawking, a man who couldn't communicate in a wheelchair.
[00:24:46] But lived a very full life.
[00:24:47] Yeah.
[00:24:47] Yes.
[00:24:48] So maybe it takes us time to rediscover hope and light.
[00:24:53] But, yeah, maybe giving up on it too quickly.
[00:24:56] You can see why people make that argument at least.
[00:24:59] Well, Sam, you've looked into this a lot, obviously.
[00:25:01] You've spoken, you're at the centre of study in this.
[00:25:04] Do you feel, you yourself personally, that we do need a law like this?
[00:25:10] And that despite everything we've said about the risks and the attitudes towards life and the potential, I suppose, for downgrading palliative care because of this,
[00:25:20] do you think on balance that this is where we should be going in legal terms right now?
[00:25:55] It's convinced me that, yeah, they want this and this is right for them.
[00:25:57] And I see no reason why our country shouldn't move towards the direction of opening that door for those people.
[00:26:05] So, yeah, I do see that.
[00:26:07] I do see that.
[00:26:09] So it's better than the situation in Florida where the wording is in the state law, every person deliberately assisting another in the commission of self-murder, as they call it.
[00:26:19] That's a very emotive language, isn't it?
[00:26:21] Self-murder shall be guilty of manslaughter, a felony of the second degree.
[00:26:25] So, I mean, that's very clear, isn't it?
[00:26:27] I mean, they've got no room for movement at all.
[00:26:29] Florida is full of old people, of course.
[00:26:30] Yeah, exactly.
[00:26:31] Who probably, you know, a lot of people would want to end their life.
[00:26:35] But my concern is that with the law as it's drafted, it seems like it'll be a very slow process.
[00:26:40] And ultimately, the arbitrator, the person who's playing God in all of this, is a judge.
[00:26:46] That's true for sure.
[00:26:47] Yeah, and there are definitely issues with it that make it cumbersome and clunky and maybe will, over time, evolve into something slightly better than the form it's currently in.
[00:26:59] But as I said at the beginning, at least it's a move in the right direction.
[00:27:03] So how would you like to see it develop, Sam?
[00:27:05] Are you saying it's clunky?
[00:27:08] Can you think of a form of legislation?
[00:27:10] Would you say that what's going on in the Netherlands is perhaps the best that we can go to?
[00:27:13] Could we get the courts out of it, I reckon?
[00:27:18] I mean, we want your answer, not mine.
[00:27:20] But it's a medical question, isn't it?
[00:27:23] Not a legal question.
[00:27:25] It is a medical question, I agree.
[00:27:27] And I think sort of fusing the courts and the medical system in that way clearly does create some real dangers in lots of ways.
[00:27:37] So yeah, I would agree on that.
[00:27:38] I think I would agree completely on that.
[00:27:40] But at the same time, the courts have been brought in many times in the Netherlands over particular cases.
[00:27:48] And I don't know that you ever will avoid that if someone does decide, well, that was murder.
[00:27:53] I don't believe that was actually a correct judgment that physician made.
[00:27:57] Or I believe that person was coerced or pressured.
[00:28:01] I think there'll always be those kind of accusations made because of the difference of opinion that we've already talked about can exist between families and individuals, doctors, etc.
[00:28:13] So I don't think even the Netherlands and Belgium have it perfectly.
[00:28:18] They still have these sticking points and these challenges.
[00:28:23] So you want a much more open system.
[00:28:25] And I think that makes sense because if somebody does coerce somebody into it and then they are killed, that whole process is murder, isn't it?
[00:28:35] Yeah.
[00:28:35] And there's legal proceedings for that.
[00:28:38] This is sort of like, well, okay, here's a law that makes it relatively easy where you're double-checked by the medical profession, but you get what you want ultimately.
[00:28:46] And it's then found that through that whole process, the doctors were misinformed or ill-informed and there were people, forces at work to try.
[00:28:55] Then you bring the courts in.
[00:28:56] Then you bring the courts out.
[00:28:57] Yeah, either before, during or after.
[00:28:59] But probably at the end, you say, yes, this is a case of murder.
[00:29:02] You would coerce the individual.
[00:29:05] You fooled the doctor.
[00:29:06] This was all a ruse to kill this person.
[00:29:10] That is a case of murder.
[00:29:11] And then you bring the courts in and the person goes to jail for a very long time.
[00:29:16] Yeah.
[00:29:17] And I'm not 100% sure of our rationale for why a high court judge, every single case, needs to sort of arbitrate and sort of have the final sign off.
[00:29:27] I'm not sure of the rationale for that.
[00:29:29] I'd be interested to see that.
[00:29:31] They would be very detached from the circumstances, wouldn't they?
[00:29:33] All right.
[00:29:34] Well, let me push back on this because I'm not clear on it myself.
[00:29:38] But, I mean, let me paint you a picture of a nightmare scenario of, I don't know, a generation hence.
[00:29:42] You know, you get to a point where anyone, you know, right, just a bit over 75, getting towards 80.
[00:29:46] It's kind of expected in society that, you know, mum or dad starts thinking about, you know, do you really want to still be around in a bit?
[00:29:54] You know, and there's almost a kind of understanding, a normalization.
[00:29:58] Oh, yes, you know, you're going to be terminated soon.
[00:30:00] There'll be a whole thing.
[00:30:01] And if you don't, oh, that's a bit strange.
[00:30:03] Do you really want to burden your kids and hang around when there's this alternative?
[00:30:07] You're looking very worried about all this, Hodge.
[00:30:09] Well, you know, I'm 63.
[00:30:10] What can I tell you?
[00:30:11] But I just, in my mind, almost can see that as a potential, a kind of, you know, generalized.
[00:30:18] Euthanasia.
[00:30:19] Euthanasia program that people just accept they reach a certain age.
[00:30:23] Oh, yes, I've had my time.
[00:30:24] And it's just everybody in society expects that you will, you know, have euthanasia parties.
[00:30:29] I don't know.
[00:30:30] But I just worry that we could get to that stage if this goes through.
[00:30:34] You're a long way from that with this law.
[00:30:35] But what do you think, Sam?
[00:30:36] Is that a possibility?
[00:30:38] That is definitely the argument that I hear from those that really strongly disagree with the idea of this.
[00:30:44] Is that, yeah, is this basically just, you know, the old sacrificing the old during COVID arguments that came up?
[00:30:50] It's like we've only got limited resources.
[00:30:53] Let's treat younger people before older people.
[00:30:55] Let them pile on the streets.
[00:30:58] Pile up the bodies.
[00:30:59] It was the minister, allegedly, who said that.
[00:31:01] It was that kind of valuing certain kinds of life over and above others.
[00:31:06] And, yeah, you can, I mean, yes, you can see why some people would be concerned about that in the world that we live in.
[00:31:13] And I don't think you can say that they don't have a legitimate concern.
[00:31:17] I think they do.
[00:31:18] You think that could happen?
[00:31:19] That sort of thing could happen?
[00:31:20] It's not implausible in the world that we live in, is it?
[00:31:23] That in 100 years we could wake up.
[00:31:25] We won't wake up.
[00:31:26] But that could be a feature of being human.
[00:31:30] But I would actually find that really sad because it would mean undervaluing the sort of deep old age part of life, which may well have value that we just haven't tapped into.
[00:31:43] And so, yeah, that would be a really sad direction.
[00:31:47] And potentially with disabled people, too, because, again, you know, we've reached the stage, hopefully now, where more and more and more disabled people are provided for so they can, you know, fill a proper position in society.
[00:31:59] They can do things, you know, whether it's making sure that there's disabled access.
[00:32:03] We've moved in that way.
[00:32:05] Yep.
[00:32:05] And this might be a sort of move backwards of saying, well, hang on a second.
[00:32:09] Do we really need these people almost?
[00:32:12] Yeah.
[00:32:12] And I guess we have to be very, very careful that that's not the sort of the tide that sort of swells in this particular movement towards what we're moving towards.
[00:32:22] If it did go in that direction, yeah, I wouldn't be for that at all.
[00:32:26] Well, that would be driven by cost, wouldn't it?
[00:32:28] Yeah, money is at the root of this.
[00:32:30] For looking after the ages, looking after the disabled, that would be the factor that would determine that.
[00:32:38] So hopefully we don't get to that stage.
[00:32:40] But if we're putting a price on life, in effect, which is what we're doing, that's the real problem here.
[00:32:45] We're trying to decide the value of life in lots of different ways.
[00:32:49] But one of them is financial, isn't it, Sam?
[00:32:51] I mean, you can't not be if you're looking after people.
[00:32:54] Yeah, I mean, if the driver for this were mainly financial, I probably wouldn't support it as much as if the driver were a sort of real deep respect for dignity and autonomy.
[00:33:06] If that's the main driver, I'm for it.
[00:33:11] If it were predominantly a resource and economic decision, I think I'd be less for it, for the reason you just talked about, I think.
[00:33:19] Yeah, yeah, because it's the start of a thin end of a wedge, isn't it?
[00:33:23] Yeah, Sam, last time we spoke to you, we came to no conclusion whatsoever.
[00:33:26] I mean, I feel like we're in the same boat, except for the fact we have moved forward in that we do have this bill.
[00:33:33] And it may be unsatisfactory, but at least it's moving forwards.
[00:33:37] There will be evidence, there will be cases.
[00:33:39] This will throw up a whole load of circumstances.
[00:33:41] So there will be more real cases for discussion.
[00:33:44] And out of that, the law hopefully will be fine-tuned and we can move forward in a sensible direction.
[00:33:50] That's the great hope, isn't it?
[00:33:52] Yep.
[00:33:53] I think so, yeah.
[00:33:54] And I hope that we do.
[00:33:55] But what we've talked about today, it flags just how much there is to consider.
[00:33:59] Yeah.
[00:34:00] And why this is going to always be relatively…
[00:34:03] Contentious.
[00:34:03] Yeah, really contentious.
[00:34:05] Yeah.
[00:34:05] Well, Sam, thank you for taking us through it again.
[00:34:08] But with something concrete, at least now, to be considered.
[00:34:11] Yeah.
[00:34:12] And maybe we'll talk again next year if it goes through.
[00:34:16] Maybe by then there will be some case law.
[00:34:17] Who knows?
[00:34:18] Good to talk, Sam.
[00:34:19] Thank you.
[00:34:20] Good to talk.
[00:34:20] Thanks.
[00:34:21] Take care.
[00:34:21] Cheers.
[00:34:23] Well, next week…
[00:34:24] Yes.
[00:34:24] We've had all the farmers in central London taking their tractors in, protesting about the government trying to impose this inheritance tax on farms.
[00:34:34] Yeah.
[00:34:34] But it's part of a thing that farmers, in any case, you know, it's a sort of conventional wisdom, farmers are never happy.
[00:34:40] They're always grumbling.
[00:34:42] I mean, it's just a thing.
[00:34:43] Which you can understand.
[00:34:44] I mean, it's a difficult life, you know, get up God knows what hour to milk your cows or whatever it is.
[00:34:49] And then you get accused by the eco-lobby of using terrible chemicals on the land that destroys all the wildlife.
[00:34:56] And, you know, the government incentives to keep going are less and less.
[00:35:00] Yeah.
[00:35:00] Because we left the EU.
[00:35:01] You've got the supermarkets trying to screw you down on price.
[00:35:04] Absolutely.
[00:35:04] You know, I mean, the question is, do we want to be self-sufficient in food?
[00:35:08] Do we need to have a homegrown food industry?
[00:35:11] Surely the answer to that has to be yes, doesn't it?
[00:35:13] Well, you'd assume.
[00:35:13] But it's more and more difficult for farmers for various reasons.
[00:35:16] And you get these mega farms.
[00:35:18] It seems to be the only way it can work.
[00:35:19] You can't do it on a small scale, is what we hear.
[00:35:23] So I thought it would be interesting to talk about, is it worth being a farmer in Britain in the 21st century?
[00:35:29] Does it make sense economically?
[00:35:31] Is it a life people want to have?
[00:35:33] And what are the alternatives?
[00:35:34] Yeah.
[00:35:34] And if we are going to be more fuel self-sufficient, are we doing it that way?
[00:35:37] Food self-sufficient.
[00:35:38] Are we doing it the right way?
[00:35:39] Yes, absolutely.
[00:35:41] I mean, you know, should we be putting up greenhouses and, you know, producing more crops domestically rather than, you know.
[00:35:48] But doing it in a way that is somehow not damaging the environment, which is a major thing in and of itself.
[00:35:53] You know, if you use the wrong kinds of fertilisers and weed killers and pesticides, then you're harming it.
[00:36:00] All right.
[00:36:01] Well, we will deconstruct farming.
[00:36:03] We will.
[00:36:04] In full next week on the podcast.
[00:36:07] Join us for that.
[00:36:07] Thanks for joining us today.
[00:36:08] This has been The Y-Cave.
[00:36:09] We'll see you next week.
[00:36:10] Bye.
[00:36:11] The Y-Cave.