The relief of suffering is a noble enterprise, but in contemporary Britain, the creation of a new bureaucracy is even nobler, or at any rate easier.
The next bureaucracy to be created is the office of a personage who will be called the Voluntary Assisted Dying Commissioner, himself to be a former High Court judge or person of equivalent rank (and salary). Naturally, he will need a staff, and his staff will need a staff: there is no point in being a chief without Indians.
This new position is required by the Terminally Ill Adults (End of Life) bill that will soon pass into law. This bill is perfectly drafted to create more employment than it will relieve suffering. Although the ostensible purpose of the bill is to assist terminally ill people who wish to end their own lives, it will, in reality, be either dangerous, because its provisions and safeguards are so cumbersome that they will be ignored, or ineffectual, because the same measures are so lengthy to comply with that few people will benefit from the passage of the law. Most people will die before the forms can be properly filled in.
The bill states that persons over the age of 18 who are reasonably expected to die in the next six months from physical illness (the bill makes no mention of suffering) may apply for assisted suicide. Two doctors, independently of each other, must assess patients to assure themselves that they have a settled desire (undefined in the bill) to die, that they understand the alternatives, and that they have not been coerced in any way.
Clearly, whether a patient has a “settled” rather than an impulsive or short-lived wish to die is not the work of an afternoon or a single short interview. Investigation of whether a patient is under undue influence of any kind, if taken seriously, is likewise not the work of an afternoon, and indeed can be quite lengthy.
Under present conditions, obtaining an appointment with a doctor can also be more than the work of an afternoon. Moreover, it is now quite rare for any doctor to have the kind of intimate knowledge of his patients that will allow him to make quick judgments as to the requirements laid down in the bill. Doctors in England are now like the river in Heraclitus’s famous dictum: it is difficult to consult the same one twice. The framers of the bill seem to have been under the impression that general or family practice is carried out as it was sixty years ago, when a family doctor might have been presumed to know not only his patient, but his patient’s family and other circumstances. To find a doctor with such implicit knowledge would now be difficult, and to find two impossible.
Moreover, even if they could be found, their knowledge would not, according to the provisions of the bill, by itself be sufficient. Only those doctors with certificated training in the assessment of mental capacity to request assisted suicide, and similarly certificated training in the recognition of physical, psychological, and financial abuse, would be permitted to sign forms attesting a person’s eligibility for assisted suicide under the law.
While no doctor is obliged under it directly to take part in assisted suicide, he is obliged to point a patient who requests it in the direction of someone who will: to become Pontius Pilate.
But what is this certificated training, and who provides it? Here is an opportunity for entrepreneurs of a new bureaucracy to set up training schemes. Who is to pay for them? The doctors themselves, in which case, will they want remuneration for signing assisted suicide certificates? That, surely, would be very sinister. The government, via taxpayers?
The patient must make two declarations of desire for assisted suicide. The bill does not state how far apart in time they must be, but after the first, there is to be a cooling-off period of seven days, and after the second, such a period of fourteen days, as if assisted suicide were a hire purchase agreement.
Once the two doctors have signed the certificates, they must pass them on to the office of the Voluntary Assisted Dying Commissioner, or his deputies, who must ensure not only that they have been filled correctly, but that the information they contain, such as that the patient requesting assisted suicide has not been coerced in any way, is veridical: in other words, the Commissioner must carry out the same investigations as the doctors.
That is not the only duty of the Commissioner: he must report annually on the working of the bill. Even with artificial intelligence, the report will require human labour, probably that of a dedicated department.
Some of the provisions of the bill are sinister. While no doctor is obliged under it directly to take part in assisted suicide, he is obliged to point a patient who requests it in the direction of someone who will: to become Pontius Pilate. Moreover, doctors are specifically permitted under the bill to mention it to patients who have not thought of it themselves: “Have you ever thought of shuffling off this mortal coil, Mr. Smith? We can help you.”
The bill also makes provision for so-called “advocates” for people, such as those of low IQ, who can explain the whole bureaucratic procedure to them, which they might otherwise not be able to understand. Such advocates will be paid (but of course will need professional training).
Naturally, there will be pressure to extend the provisions of the bill. Why limit the relief of suffering to the last six months of life? If it is suffering that you wish to relieve, it would be far more logical and efficient to intervene earlier, perhaps even years earlier.
As it presently stands, and as it most likely will pass, the bill will aid few to die, at least if its provisions are taken seriously. Ex hypothesi, the patients have only six months to live; three weeks of that will be taken up by cooling-off periods; obtaining the certificates from doctors will take several weeks (unless, as is possible, a paramedical sub-specialty of euthanasiasts is created).
On the other hand, the bill will have created a bureaucracy, however many or few the beneficiaries, and bureaucracies rarely disappear for lack of work to do. Indeed, they are more likely to tout for business than disappear of their own accord, just in case anyone should question their right to exist.
The purpose of a bloated state is to create work for itself, not to relieve suffering.