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Whose death is it anyway?

In a capitalist society euthanasia is not just a personal choice, says BEN PARANKULANGARA

MOMENTUM for legalising “assisted dying” — the now preferred term for euthanasia — is gathering apace. Much of the debate has been framed in terms of “conservative” opposition and “progressive” support, leading to an assumption on parts of the left that we should be in favour of altering the law.

It is argued that doctors’ traditional adherence to the Hippocratic oath, which forbids them from taking actions aimed at harming rather than healing the patient, is outweighed by developments in medicine that allow human lives to be prolonged far beyond what our ancestors could have expected and for people to be kept artificially alive in conditions that may be painful, humiliating and without hope of recovery.

Certainly it would not be without precedent to change the oath. Few modern medics swear by Apollo. More significantly the original oath forbids doctors from conducting abortions, a clause now widely disregarded.

A “religious versus secular” argument has also raged on the topic, with religious figures pointing to the importance of the sanctity of life while others reject this on the grounds that it is only compassionate to help end the suffering of people in excruciating pain if that is what they wish.

Recently that divide has become blurred. While the major churches in this country oppose assisted dying, the last week has seen support for it from such different religious figures as retired archbishop and anti-apartheid legend Desmond Tutu and former archbishop of Canterbury George Carey, a Thatcherite who has been vocal in supporting the current government’s attacks on social security.

Lord Carey followed the “merciful” line, saying that “the old philosophical certainties have collapsed in the face of the reality of needless suffering.”

For Tutu preventing needless suffering was also a concern — it is, of course, central to this entire debate — but he also considered wider social questions, including whether keeping the terminally ill alive whatever their quality of life was a valid use of resources and how a traditional role of physicians as “healers of life and easers of death” has been eroded by what he sees as a refusal to face the reality that we all die, and at some point it is time to let go.

None of these questions is invalid. But while many on the left support euthanasia there has so far been little attempt to deal with this issue as Marxists.

Almost all defences of assisted dying are posed in liberal terms emphasising personal choice and individual autonomy. 

Not things Marxists oppose but, as we have seen elsewhere in the NHS, the context in which a choice is made can be as important as the existence of a choice in the first place.

Some argue that opposing assisted dying discriminates against the disabled or terminally ill, for example, because we do not criminalise suicide — but many of those seeking assistance to die are physically incapable of committing suicide.

This rapidly runs into problems. It is true that suicide is not a criminal offence — there would certainly be no point in prosecuting it. 

But nor is it an ordinary choice. If someone attempts suicide and is not successful, we make efforts to help them and convince them not to try again.

If someone is found dying from a suicide attempt, we try to save their life. And those with responsibility for someone deemed at risk of suicide — even in the case of murderers or child-abusers in prison, to whom we are hardly sympathetic — are expected to do all they can to stop this happening.

Modern liberal capitalism does all it can to promote the myth of free choice for the individual, but in the case of suicide many of us still acknowledge that killing yourself is a sign of needing treatment and help, at least in most cases.

Euthanasia as currently proposed in Britain would restrict this choice to terminally ill adults considered rational enough to make the decision — though similar legislation in the Netherlands and Belgium has rapidly been extended to other groups. Children as young as 12 may request euthanasia in the Netherlands while in Belgium there is no lower age-limit at all, so long as parents consent.

Terminally ill adults who make a rational decision to die — who could argue with that? Control over one’s death empowers people whose control over their lives has been taken away by illness.

Except the idea that people are autonomous, rational individuals who make choices in their own interest is liberal, not Marxist. People make their history, but not in circumstances of their own choosing, as Marx once said.

Fundamental to a Marxist social analysis is the question of relative power. Few on the left would buy the liberal notion that when a worker gets a job, she or he is entering entirely freely into a contractual relationship with a capitalist on equal terms.

The power is all on the capitalist’s side, at least in countries with capitalist governments and especially where mass unemployment is the norm as here. 

The worker is more often than not forced into the “choice” by their circumstances — the need to feed their family and so on.

The issues surrounding assisted dying are far more complicated than an abstract individual making an informed choice. The emotional and social complications are huge.

People have families and friends. Very ill people are often extremely dependent on these. It is well established that many of the terminally ill or seriously disabled feel themselves to be a burden on their loved ones — opening up the possibility that some will choose to die from a sense of guilt.

In the cases of unscrupulous relatives — or those who may not have loved ones to care for them — the chance of being guilt-tripped into such a supposedly free decision grows.

In Britain today, care for the elderly is hardly comprehensive and often extremely costly. Thatcherite housing policies have also left a generation struggling to afford somewhere to live. 

Here we have another means of guilt-tripping people into death, even if unconsciously. People realising that the cost of their care could swallow up their house or savings, which they had hoped to pass onto their children in a property-dominated society, could also decide it’s time to die.

We live under a regime that rails ceaselessly against “scroungers” — the supposedly workshy, who are often disabled. The poison-drip of capitalist rhetoric — undermining people’s confidence, convincing some of society’s most vulnerable that they are worthless, an unnecessary financial burden on society — further corrodes the environment in which people may face this deadly “choice.”

Ministers have not yet gone so far as to quote Herman Goering’s slander of people too disabled to work as “useless mouths,” but some of Work and Pensions Secretary Iain Duncan Smith’s language has not been far off. And even in nazi Germany killing the disabled was excused as the compassionate thing to do.

This is not to say the advance of modern medicine has not raised profound questions about end-of-life care and even on the definition of life itself. 

But the prejudiced, penny-pinching, profit-hungry capitalist system — one which far prefers to throw the vulnerable on the scrapheap than pay for their care — is not one we should trust an inch on these questions.

Marxists, ultimately, do not hold that individuals exist in the sort of isolation which the assisted dying lobby seems to take for granted. People are social animals, mutually interdependent. 

The socialist movement itself has always been about building a society in which we look out for each other and look after each other, not one where we leave people to die.

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