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What Britain's Assisted Suicide War Should Teach Us.

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Culture wars do nothing to correct social problems and, by distracting from the underlying challenges and focusing on one contentious issue, actually exacerbate social ills and prevent practical solutions from gaining traction. This should be common knowledge; under the weight of the abortion debate in the U.S., delivery of women's reproductive services beyond abortion remain uncertain, erratic, and regional. In the past few decades we've witnessed the deafening calls against abortion drown out all discussion of other reproductive health needs.  Contraception, sterilization, condom use, sex education, tubal ligation and other reproductive services like basic testing, check-ups, and pre- and post-natal care have, for women's choice advocates, had to take a back seat in the defense of abortion rights.  Yes, some improvements have been made but after a disappointing summer of health care reform defeats, women's rights groups have had to admit that new strategies are necessary. A resonant scenario is playing out in the U.K. over the legality of assisted suicide.  Since multiple sclerosis patient Debbie Purdy won a case during the summer that would allow her husband, Omar, to legally accompany her to Switzerland should she choose to end her life, the country has been mired in an emotional, star-studded, increasingly strange war over assisted suicide. In Britain, "assisting suicide" is prosecutable, but supporters, like Purdy, have successfully argued that assisted suicide is not the same as aid in dying.  Those who are sentenced to death by a fatal disease, they say, are not committing suicide - they're already being killed by cancer, MS, or other illnesses - but ending the unbearable suffering that their disease has caused.  But in the midst of all the noise, such distinctions are hard to make. Since July, Director of Public Prosecutions, Kier I-wouldn't-characterize-myself-as-a-bleeding-heart-liberal Starmer has been working to revise the prosecutorial guidelines on assisted suicide.  It's been a resoundingly thankless job.  "Anti-euthanasia" and/or "pro-life" organizations have successfully dogged his efforts to the point of standstill.  He can do no right, as the situation stands.  Into the debate maw have jumped countless well-meaning but colorful and high-profile individuals. Sir Terry Pratchett, one of Britain's most acclaimed authors, publicly voiced his support for assisted suicide in August.  Noting that he had been diagnosed with Alzheimer's disease, Pratchett said:
'I believe that if the burden gets too great, those who wish should be allowed to be shown the door,' he said. 'In my case, in the fullness of time, I hope it will be in the garden under an English sky. Or, if wet, the library.'
Another author got into the act in January.  Swaggering Martin Amis suggested that the best way to deal with the encroaching "silver tsunami" of elders would be to make assisted suicide legal and convenient.  "There should be a booth on every corner where you could get a martini and a medal," he said. And just this week, famed British broadcaster Ray Gosling (pictured above) admitted in a BBC special that he had smothered his suffering lover decades ago with a pillow.  His partner was dying of AIDS and the two had made a pact that should the suffering become unbearable, Gosling would do whatever was necessary to spare him from that suffering.  Gosling now faces legal questioning. (UPDATE: Gosling was arrested for questioning today.) Even the BBC, seemingly accustomed to accusations of bias, is not exempt from getting drawn into the assisted suicide war.  They are promoting "euthanasia" say the accusers, many of whom are MPs. All this attention on the issue of assisted suicide has made for some widely-read and sensational news.  But, as Peter Beresford blogs at the Guardian today, the war over assisted suicide has done little to address the practical, non-contentious issues surrounding assisted suicide. Beresford asks, "Why isn't the same political and media interest given to palliative and end of life care, carers and social care generally as to assisted dying?"  At first it's a naive-sounding question.  Isn't the purpose of a culture war to drown out subtleties?  But his asking makes patients' rights advocates again face the fact that they haven't yet learned their culture war lesson. Un-nuanced debate has pitted organized, emotional, resource-rich "pro-life" groups against the legalization of assisted suicide, leaving supporters of end of life choice to run around flapping their hands.  As we saw in the U.S. over the summer, however ridiculous it may sound to accuse government of wanting to kill the vulnerable in society, such accusations have traction when grasped by the busy-body media and dished to the uninformed public.  Beresford continues:

We know that the former [palliative and hospice care, caregivers] all are under pressure and have inadequate support. Specialist palliative care services are underfunded and unequally distributed. Much-valued hospices are increasingly at risk of closure, rather than blossoming in number, while carers are still treated by the government as a resource to be exploited, rather than as family members to be supported.

The failure to bring social care policy, provision and funding into the 21st century is at last making the front pages, but what the headlines make clear is the failure of all the political parties to work for any sustainable consensus for the future.

Beresford's solution?

The appalling lack of skilled advocacy services in England is a major problem. Policy-makers and politicians are happy to talk about providing more information, but when it comes to the ongoing guidance, support and advice that people want – and that can only really be provided by an independent, trained advocate – there is much less political will. Such advocacy has serious cost implications, but in the long run can save lives and money.

What is most needed now is a safe space for an inclusive discussion about social care, including palliative care and assisted dying, which truly involves the widest range of experience and opinion. Then we may begin to get somewhere.

Wishful thinking!  When you're in a culture war, there is no DMZ.  And everybody is an "independent advocate."  Who do you ask for that safe space?  The government?  The media?  The church?  The medical profession?  Because other end of life care issues have been framed into the assisted suicide debate, they can't be addressed in a rational, meaningful way.  Is the solution increased public education?  A broader coalition for patients' right?

I don't necessarily have an answer but neither does Beresford.  Clearly the same ineffective strategies of old - like interjections from high-profile advocates, and raising volume and tone to match one's opponents - don't work.  The lesson from Britain is this: what patients' rights advocates are doing now to win the discussion back from the war on assisted suicide isn't working.  New thinking is necessary in both Britain and the U.S.