Gilderdale's trial was horrific but necessary to retain a vital principle
Issue 31, August 2010
English woman Kay Gilderdale is the mother of Lynn Gilderdale. Lynn contracted ME as a 14 year old and was cared for by her mother for 17 years. After her daughter's failed suicide attempt in December 2008, Mrs Gilderdale was charged with attempted murder after confessing to giving her daughter more drugs. A jury found her not guilty of attempted murder in January 2010. She was then given a 12-month conditional discharge for her previous admission to aiding and abetting the suicide of her 31 year old daughter. The story of the Gilderdale trial was aired in New Zealand on TVNZ's "Sunday" on May 16th 2010.
It is dangerous, especially for the vulnerable, to think that assisted dying is the only way to take control of death.
When Terry Pratchett described, in his Dimbleby lecture last week, his father's cheerful macho stoicism – when all the tubes are in and "I'm no good to anybody, tell them to switch me off" – I recognised something of my father's own attitude to death in the last couple of decades of his life. But when death actually did loom, he wanted to live. I know because, rather brutally, I asked him. When he finally knew he was dying, he complained that it was boring but never that he wanted to speed the process up. When I look back I see a man whose strength of will kept him alive well beyond the doctors' predictions – he lay in a coma for two weeks. All I was aware of was that my understanding of what was going on – his reckoning with his life and accepting his death – was very limited, and perhaps will be until I reach the same moment of my life.
So my starting point for stumbling into the complex argument of assisted dying is humility. Very few of us – if any – can fully understand the significance of death, our deep fear of it and how we develop mechanisms to shield ourselves from that fear. It is hard to disentangle our understanding of a loved one's death from our own trauma of bereavement. This is the most complicated of all areas for the law to step into, dealing with motivations and responses which are partly foreign even to ourselves.
But I was persuaded by Kay Gilderdale's interview on Panorama last week explaining why she had helped her daughter to die. Perhaps the director of public prosecutions' guidelines expected later this month should be significantly changed to sort out the muddle: how could a bereaved mother be put through the agony of a trial for attempted murder? I was confused.
I went to talk to doctors whose working lives are with the dying. They have witnessed thousands of deaths and I was looking for calmly dispassionate wisdom. It worries me that current debate is in danger of being steered by unusually dramatic cases, and by people terrified by their own deaths, desperate to erect strategies of control.
Death is the ultimate loss of control and it's why a society which so values autonomy is peculiarly ill-adapted to face the obvious fact that we all die. The danger is to think that assisted dying is the only meaningful way of taking control of your death. This is why polls show so much support for assisted dying; who is going to say no to questions about whether you think you should have control over your death? But those working in palliative medicine argue passionately that their work is all about providing the patient with control and choices as they live their last days.
"My life, my death, my choice," declared Pratchett. But this slogan is deeply deceptive; there is nothing to stop anyone committing suicide. The point Pratchett was making was quite different: "My life, my choice, you kill me." The autonomy much celebrated by those in favour of assisted dying is predicated on depriving those who assist them of autonomy. The one requested to assist is in an impossible position: if they want to kill a person, the law will be rightfully suspicious, and if they don't want to kill, but do so because they have been requested, they have effectively been coerced.
There's another problem buried in Pratchett's rhetoric. His father felt that when his life "was of no use", there was no point in it. It's a familiar sentiment; but how have we managed to generate such a widespread social norm that the value of your life lies in its usefulness? This is dangerous. How do you define "use"? Does that mean anyone who is not economically productive is no longer useful? Was my father "useful" as he lay in a coma? Well, perhaps more than I realised at the time; he gave relatives time to adjust to his departure.
Similarly, "I don't want to be a burden" reflects another cultural preoccupation – independence. But dependence is just as fundamental to our humanity, and dying makes this obvious. How comfortable we are accepting our dependence on others is bound up with the quality of our relationships. Does someone just love me when I am living a full, active, purposeful life or do they love me for my own sake?
None of this is easy. What dying exposes is the brittleness of making one's identity and selfhood the central life project. Perhaps it is part of why so many successful people argue that assisted dying is a clear-cut issue; they have constructed a self predicated on autonomy, achievement, and worldly recognition. Once you've lost such fictions of the self (they can only ever be partial truths) what is left?
The answer to that question can contain no generalisations, according to the palliative care consultants I spoke to. But they know all too well the surprises dying can contain. Unbearable situations can be transformed – not always, but they can. People will still die, but the necessary elements of death – the goodbyes, the thank yous, the reconciliations, the I love yous – can ease the process and they can take time. That sense of possibility needs to be recognised in this public debate because all the terms such as "dignity", "suffering" and "pain" are deeply subjective; they are felt, not objectively measurable. And perceptions of experience can change.
Disturbingly, a consultant told me that it was increasingly necessary to reassure patients that he wouldn't euthanise them. Already the public debate and the popularity of assisted dying is ratcheting up the anxiety of the dying. The relationship of trust with medical staff – crucial to effective care – is being compromised. It's not hard to see how seamlessly the prevalent fear of being a burden among the elderly could morph into feeling it was their duty to die.
The danger of a new law to allow assisted dying is that no one has adequately found a way to ensure the safeguards needed to protect the vulnerable. It is estimated that in the Netherlands, where assisted dying is legal, one in five are euthanised without consent. In Oregon, there has been a fourfold increase in the number of assisted deaths in the last 10 years. A consultant argued that the number who actually want assisted dying (when the crunch comes) are "vanishingly small" and that has to be balanced against the considerable cost of large numbers of people being exposed to subtle forms of pressure – quite apart from the fundamental shift in the role of the doctor, with profound and unintended consequences.
Finally, we should never be naive. Relatives can want loved ones dead; the dying are demanding of time and energy. Their deaths can release huge financial resources. Situations can be immensely hard to read; loving families can be murderous, apparently conscientious doctors can have a taste for killing.
Kay Gilderdale's trial must have been horrific for her, but what we must see in it – and be grateful to her for undergoing this ordeal – was the English legal system working at its best. It cannot be routinely accepted that relatives can kill. It needed the interrogation of the legal system for us to be assured that this had been an act of immense compassion. A hugely important principle vital to the protection of many, many thousands of people has been maintained.
This article was originally published in The Guardian on Monday 8th February 2010.
Madeleine Bunting is a Guardian columnist and associate editor. She writes on a wide range of subjects including politics, work, Islam, science and ethics, development, women's issues and social change. Reproduced with permission.
Copyright Guardian News & Media Ltd 2010.