The Duty to Die

First Things discusses a concept that is supposed to be gaining ground in the UK: the duty to die. The key concept in Duty to Die is to remove control over life extension therapies from the doctor to policy.

Dr Brian Keighley, chairman of the British Medical Association Scotland, said in some cases tens of thousands of pounds were spent on drugs to extend cancer patients’ lives for relatively short periods. Speaking ahead of his organisation’s annual meeting, the GP said the country had to debate the merits of these kinds of aggressive treatments and the effects they had on the NHS budget. But he stressed any decision had to be made at a society level, rather than being left to doctors.


“Who pays the piper, calls the tune”. When medical care becomes socialized, medical decisions are inevitably made by the government. People may disagree over whether this is a good thing, but that it is so should not be in dispute. In 2009 the Daily Telegraph talked about a new option for people on public health care. All expense-paid assisted suicide in Oregon.

Imagine that you have lung cancer. It has been in remission, but tests show the cancer has returned and is likely to be terminal. Still, there is some hope. Chemotherapy could extend your life, if not save it. You ask to begin treatment. But you soon receive more devastating news. A letter from the government informs you that the cost of chemotherapy is deemed an unjustified expense for the limited extra time it would provide. However, the government is not without compassion. You are informed that whenever you are ready, it will gladly pay for your assisted suicide.

Think that’s an alarmist scenario to scare you away from supporting “death with dignity”? Wrong. That is exactly what happened last year to two cancer patients in Oregon, where assisted suicide is legal.

Barbara Wagner had recurrent lung cancer and Randy Stroup had prostate cancer. Both were on Medicaid, the state’s health insurance plan for the poor that, like some NHS services, is rationed. The state denied both treatment, but told them it would pay for their assisted suicide. “It dropped my chin to the floor,” Stroup told the media. “[How could they] not pay for medication that would help my life, and yet offer to pay to end my life?” (Wagner eventually received free medication from the drug manufacturer. She has since died. The denial of chemotherapy to Stroup was reversed on appeal after his story hit the media.)

The Telegraph writer, Wesley Smith argued that depressed and terminally sick patients could be bullied or hustled into assisted suicide as a quick way out of their anxieties. The issue had personal some resonance. Early this year I organized a visit to one of the people upon whom a character in my novel was based. He was dying of metastatic prostate cancer and I felt it was best to schedule the trip with one of the boys from the old time while he was still relatively well. But the patient was resolutely determined to keep control of his destiny. He drove us through a lot of New Zealand’s North Island on the strength of a GPS I bought as a gift which steered us through the back roads, often through outrageous shortcuts before landing us on the main road.

About a week ago he died in Cebu City, not as I first thought, because he wanted to return to his birthplace for the end, but on a “last adventure” as his wife put it. He been feeling well enough to visit friends and risked the trip; the pneumonia came and he was dead in a day. The manner of his passing reminded me of Leo Tolstoy, who when he was 82 finally nerved himself to embark on his lifelong dream of becoming a wandering ascetic. He didn’t get far before falling ill of pneumonia at the train station of Astapovo.

The ultimate irony would be if “assisted suicide” turned out to be not some affirmation of the ‘freedom to end your life’ as much as a ploy to dump the dying offstage to save money to buy the votes of the living. The notion that we need the government’s permission to be free or drink poison seems funny when you think about it. Dr. Keighley’s argument that “any decision had to be made at a society level, rather than being left to doctors” is one more rejection of the idea that the individual, not the state, owns his life. Back in the day people thought they owned themselves and this was one reason why slavery was regarded by some as an abomination. If everyone owns himself, then no one may own him, unless of course, we are talking about men in groups. Then it’s alright. Today, there are altogether too many people who think they need government permission to die, or worse yet, to live.

Every man has a property in his own person. This nobody has a right to, but himself.” (John Locke, Second Treatise on Civil Government)

“The reason why men enter into society is the preservation of their property.” (John Locke, Second Treatise on Civil Government)

“Life, liberty, and property do not exist because men have made laws. On the contrary, it was the fact that life, liberty, and property existed beforehand that caused men to make laws in the first place.” (Frédéric Bastiat, The Law)

“We acknowledge God only when we are conscious of His manifestation in us. All conclusions and guidelines based on this consciousness should fully satisfy both our desire to know God as such as well as our desire to live a life based on this recognition.” (Tolstoy at Astapovo)

This is all seditious stuff now. But to own your life means you have to grasp it both hands and run with it. Can a man be free to give up his freedom? Can humanity have the liberty to offer up his freedom to government? You decide.