The will to live.

    Mangling together two philosophies that have dominated UK
    politics during the past 50 years was always going to spew out some
    dangerous ideas. The first philosophy is the public provision of
    “cradle to grave” support for our citizens. Overlapping this more
    recently has been the belief that a government’s “success” should
    be judged by the degree of choice extended to individual
    citizens.

    It naturally follows that the “manglers” believe that policies
    affecting the manner of one’s death should also fit comfortably
    into both philosophies. In other words, they embrace the state’s
    role in helping us leave this life in as pain-free and dignified a
    manner as possible. However, they also want to satisfy the desire
    to allow individuals to exert the maximum influence about how they
    die. A worthy aim – but littered with pitfalls.

    For instance, Lord Filkin, the constitutional affairs minister,
    talking to the Alzheimer’s Society in April, described his latest
    proposal for living wills thus: “When faced with a degenerative
    condition like Alzheimer’s (these) can provide some reassurance and
    a sense of empowerment in the face of difficult and distressing
    circumstances”. He went on to talk of “giving people a much needed
    element of control”.

    There’s a rather hackneyed mantra that originated from the
    Conservative PR guru Tim (now Lord) Bell, that “perception is
    reality”. Unfortunately, it encourages too many political activists
    of all parties to believe that most people are too stupid to spot
    rubbish when it is emptied all over them.

    If you doubt this, just ponder for a moment the decision taken by
    ministers to change the name of the proposed legislation affecting
    living wills from the Mental Incapacity Bill to the Mental Capacity
    Bill to help calm the critics of the first draft.

    And what about the words “living” and “wills”? These “wills” are
    not about living; they are about dying. And however you dress it
    up, surely what these “wills” may require is that a carer hastens
    the death of their charge? Some go further and would regard
    themselves as, effectively, murderers.

    But at this point I hit a barrier because in many policy areas, I
    am a serial “mangler”. Hence, I feel seriously challenged by the
    question of choice – or, more accurately, control – over how and
    when an individual chooses to die.

    At the same time I recognise that the political pursuit of giving
    us all more control over our own lives and deaths hits the buffers
    when one acknowledges that there are times when none of us will
    enjoy that luxury.

    This fact is much more obvious on a daily basis to carers and
    health professionals than to most of us. For we can largely avoid
    thinking too much about the consequences of losing the mental or
    physical capacity to care for ourselves and others.

    In our society, it is now perfectly possible for large swathes of
    the population to have little or no knowledge or contact with the
    seriously ill, the mentally ill or handicapped and the dying for
    much of their lives. And we are all, of course, fooling
    ourselves.

    Of course Lord Filkin did not talk about people “fooling
    themselves” but talked about giving a “sense” of empowerment. But
    it is much the same thing. It is an admission that his aim is to
    make a highly vulnerable person feel better by knowing that an
    instruction exists that will mean, when they lose control over
    their own minds and bodies, they will not have to endure for
    long.

    It is only natural to feel – and want to express – such sympathy.
    Until, that is, one envisages the scene, apparently sanctioned by
    Durham Council, where a carer is “instructed” to stand and watch
    someone quite literally choke to death. I could find no mention in
    the minister’s speech of sympathy for the carer’s plight.

    In the UK, not only have medical treatments advanced rapidly, but
    also the belief that we are entitled to a healthy, pain-free life.
    These are issues for medical staff dealing with the terminally ill;
    not for others who care for them, certainly not for councils, nor,
    if possible, for judges.

    The sooner that those charged with caring for our most vulnerable
    people start campaigning for safeguards in the redrafted Mental
    Capacity Bill the better. To wait for the first legal case to give
    clear guidance may enrich quite a few lawyers. But I would not give
    it much chance of fostering relationships of total trust and
    confidence between cared for and carers.

    Sheila Gunn is a political commentator and a Conservative
    councillor in the London Borough of Camden.

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