Speech given to the 2014 biennial conference of the World Federation of Right-to-Die Societies, held in Chicago in September 2014
I greatly appreciate the opportunity to open this important discussion on "old age rational suicide". And, I strongly believe that there are two major reasons why this subject should be considered now by the World Federation.
First of all, the population of the world - especially, in Europe and North America - is getting older. For example, in the UK at present, there are about 1.4 million people (in a total population of close to 64 million) who are 85 years old or older. And, it is forecast that, within twenty-five years, one person in twenty, in the UK, will be in this group of very elderly people.
Personally, I was delighted when I learnt last year that the eighth edition of Mosby's Medical Dictionary, published here in the United States in 2009, defined those who are 85 years and older as being "old-old". As I am now 83, I look forward to becoming "old-old" - it is like a respectable badge of honour!
And, the second important reason to discuss this subject, in my view, is that as many right-to-die societies around the world only focus on changing the law, in their countries, to provide the option of "assisted dying" (in particular, I think of "medically-assisted suicide" when this expression is used) for those who are defined as being "terminally-ill" (that is, likely to die within six months), it is also vital to remember that very many elderly people increasingly suffer from various medical conditions for much longer periods of time, and, realizing that they cannot expect to live many more years because of their advanced age, they will naturally want to seriously consider that departing this worldly existence is perhaps much more attractive than struggling on.
The first right-to-die society in the world was established in the UK in 1935. Initially called the Voluntary Euthanasia Legislation Society, it was founded by a group of physicians, senior lawyers and distinguished clergymen (I like to stress this because today it is often the official medical establishment and the major religions which are the main opposition we face!). In 1969, it simply became known as the Voluntary Euthanasia Society (VES).
For many years, the main objective of VES was "to make it legal for a competent adult, who is suffering unbearably from an incurable illness, to receive medical help to die at their own considered and persistent request" - thus, this policy included all tragic medical situations and all adult ages. It did not focus just on the "terminally-ill". However, when VES was renamed Dignity in Dying, in 2005, it was decided - perhaps for tactical, political purposes? - to simply campaign, in England and Wales, for this group of unfortunate suffering adults.
Fortunately, although some people in my country do not like to think of themselves as being "European", other right-to-die societies and countries in our region of the world do not limit themselves in this way, and, in my view, they set a fine example which the rest of the world should follow. In particular, I think of what is possible today in Belgium, Luxembourg, Switzerland, and The Netherlands. These European countries make no distinction between, for example, "the terminally ill", "the severely disabled", or "suffering old people", when it comes to providing medical assistance to die to these individuals, if this is their expressed wish. In these enlightened countries, quite correctly in my view, it is possible today for such compassionate, professional help to be given to all competent adults who are suffering unbearably from documented medical conditions.
The Society for Old Age Rational Suicide (with the easy-to-remember acronym of "SOARS", especially as many elderly people, often confined to long periods in bed, develop bedsores!) was established in the UK for the two main reasons mentioned above - on December 10, 2009. This date was picked because December 10th is recognized globally as international Human Rights Day, and what might be called the "legal basis" for SOARS' existence is a statement from the European Court of Human Rights which, in April 2002, declared that "In an era of growing medical sophistication, combined with longer life expectancies, many people are concerned that they should not be forced to linger on in old age or in states of advanced physical or mental decrepitude which conflict with strongly held ideas of self and personal identity".
The initial four Supporters of SOARS were Angela Farmer, Nan Maitland (who, in her 85th year, unfortunately suffering increasingly from osteoarthritis, courageously ended her life in Switzerland in 2011), Liz Nichols, and myself (at present, we do not have paid-up members, only "registered" Supporters). Our logo is the derelict West Pier in Brighton and Hove, a city on the south coast of England, which was once a place of great excitement and pleasure - like the lives that many of us oldies have led!
While SOARS fully supports Dignity in Dying, and Friends At The End, in their respective well-organized efforts to change the law in the UK, its main objective at present is to start a discussion (it is too early to really think of a large, well-funded national campaign) on the logical possibility of "old age rational suicide". Perhaps, at this point, I should say a few words about the use of the word "suicide" in our title. Traditionally, even in our global right-to-die movement, many shy away from this word. But, in SOARS, we also want to stress the word "rational". Antagonism to "suicide" is mainly due to religious forces which once decided that this act was sinful. SOARS wants to reclaim it as being a rational and positive act when a mentally competent, elderly individual has carefully considered the main pros and cons for wanting to stay alive. When someone in their 80s or 90s, who is suffering unbearably, has a legalized medically-assisted rational suicide, it should make sensible people think not why did that individual do this, but why did they not.
Of course, for an old age rational suicide to legally happen, it would be essential to have strict procedures in place - and, SOARS suggests the following:
Two physicians certifying that the individual is mentally competent, and had extensively considered all possible options.
Every elderly person requesting a medically-assisted suicide being interviewed by an official, independent legal witness, experienced in family matters, to ensure that they are acting on their own free will and are not being pressured by relatives or friends.
There would be a two-month waiting period between a request for suicide being made and the necessary medication being provided (for this to be taken in the presence of an experienced medical professional - it is important to stress this - if not, if only an inexperienced relative or friend is present in such a suicide, there is a great danger that mistakes will occur).
And, detailed reporting to a central government office, by all those involved, would be necessary.
At present, the main activities of SOARS are to provide speakers for talks to interested groups in the UK, to hold six-monthly public meetings in London (every Autumn, there is an Annual SOARS Lecture), to produce a six-monthly Newsletter, to determine the degree of public support for the concept of old age rational suicide (by commissioning regular, national opinion polls), and to help those of its Supporters, who qualify for such assistance, to travel to Switzerland. On the SOARS website (www.soars.org.uk), you will find much information about the concept of "old age rational suicide", the full results of these opinion polls, copies of the Newsletter, summaries of each of the Annual SOARS Lectures, useful links to other relevant websites, and details of how anyone can make contact with us.
In general, the British public seems to support the possibility of old age rational suicide. Since 2010, there have been several national opinion polls. These have been conducted by ICM Direct and ICM Omnibus (an organization which does extensive research for the media, such as The Guardian newspaper - one of our most liberal British papers - and Channel Four TV News, as well as for many businesses and institutions in the UK), with the assistance of Kindle Research (which provides further analysis of the data collected).
The first of these opinion polls was commissioned by SOARS in July 2010 - this was initially done at the request of the BBC for a radio programme it was making called "Choosing a Time to Die" (which was broadcast in September that year). This telephone poll, of 1,009 adults throughout the UK, showed that - as expected - 78% were in favour of terminally-ill, mentally competent adults being legally allowed to receive medical assistance to die. But, of particular interest to SOARS, regarding whether very elderly, competent individuals who are suffering from a variety of medical problems (that they would not die from) should also be legally allowed to have medical help to die, there was a 67% support, with only 19% opposed, and the rest uncertain. This was truely an excellent result for SOARS!
Then, in March 2011, two further ICM-Kindle Research national polls were undertaken. The first, of 1,008 individuals interviewed by telephone, showed that 76% were in favour of a competent, terminally-ill adult receiving medical assistance to die (only 12% were opposed). And, most importantly, 66% agreed with the possibility of old age rational suicide, with only 18% opposed (the rest were still uncertain). The second poll, of 2,024 individuals, was conducted online. This revealed 73% support for helping those who were terminally-ill, and 60% in favour of similar assistance for the very elderly with serious medical problems. Two possible explanations for less support, from the online poll, are that those participating in this poll were considering the moral and legal implications more carefully and that the lack of an interviewer (as in a telephone poll) removed any pressure to give a socially correct answer.
In March 2013, ICM and Kindle Research repeated both telephone and online polls nationally. The first, of 1,002 individuals interviewed by telephone, showed that now 70% agreed with the possibility of old age rational suicide. And, the second poll, involving 2,000 persons online, repeated the 60% result of March 2011.
This degree of support for old age rational suicide, over four years, was much greater than had been expected - these particular questions had never previously been asked in any poll in the UK. These results reinforced SOARS' belief that there must now be a serious discussion, in the UK, about old age rational suicide as well as the possibility of medically-assisted suicide for those who are terminally-ill. And, these opinion polls, commissioned by SOARS, will be repeated every two years or so, especially as the results do generate considerable media attention.
Ever since its establishment in December 2009, there has always been much media interest, within the UK, in SOARS and its activities. The major national newspapers have reported on our opinion poll results, as have national and local radio and television programmes. More recently, SOARS is increasingly mentioned in newspapers outside the UK (for example, in The New York Times on July 21, 2013), and on international television (such as in a Voice of America programme which was broadcast globally for several days in November 2013).
And, when an elderly British individual decides to publicly talk about their forthcoming rational suicide, mainly for medical reasons, this event has also received both extensive national and international attention. Nan Maitland's suicide in Switzerland in 2011 was initially reported exclusively on the front page of our Sunday Times (the main quality weekend newspaper in the UK), with the title "I choose death over dwindling old age": within a few days, similar reports appeared in publications in Australia and South Africa. And, last April, the medically-assisted suicide of Anne, an 89-year old lady, who was increasingly suffering from angina, and who flew with her neice from south England to Switzerland, was also covered by the media throughout the world, especially as, before she left the UK, Anne spoke frankly and extensively about her present views on the modern world.
One area of increasing concern, especially in the Western world, is the fear of dementia. SOARS strongly believes that a medically-assisted rational suicide should be a serious option for all elderly individuals who unfortunately develop dementia as long as they have the mental capacity to make this choice - thus, it is reassuring, especially within our British National Health Service, that more and more attention is being given today to an early diagnosis of this disease. In March 2013, SOARS was involved in assisting an 83-year man, suffering from early dementia, to travel, with his wife, to Switzerland, for him to die there. When his death became public several months later, when his widow spoke out about his rational suicide, there was extensive media interest. For example, in The Times, published in London, there was the headline - "Aided suicide will increasingly be choice of dementia patients". Later, last February, one of our British national television news channels had a week-long coverage on dementia, and reported that 61 per cent of its viewers agreed that there should be the possibility of competent individuals, with this disease, having control over their deaths.
Other medical reasons, in the past four years, for elderly Supporters of SOARS to travel from the UK to Switzerland, for an assisted suicide there, have included Parkinson's disease, increasing deafness and impairment of vision, multiple sclerosis, macular degeneration, and peripheral neuritis.
Following my presentation to you today, you will be hearing from representatives of organizations in other European countries (especially from The Netherlands and Switzerland) about how competent, elderly individuals in these lands, who have come to the stage of what succinctly can today be called "A Completed Life", can now receive medical assistance to die, if this is their persistent request. I have been extremely impressed by what the two large Swiss organizations (EXIT Deutsche Schweiz, in Zurich; and EXIT Suisse Romande, in Geneva) have decided democratically to do, in recent times, to assist their elderly Swiss members.
And, it is important to thank Dignitas, in Zurich, EX International, in Bern, and Lifecircle, near Basle, for the manner in which they are willing to help suffering non-Swiss nationals. In particular, all three organizations have provided very dignified and professional assistance to elderly foreign individuals who have carefully decided that, after much intelligent consideration, they wish to end their long lives in a way which is best for them (and, often, for their families).
Many elderly people die slowly, with different parts of their bodies breaking down at varying rates. According to the Office for National Statistics, in the UK, for the vast majority of elderly people, death is currently preceded by an average of ten years of chronic ill health. There is no recovery from being "old-old". And, many old-olds, if they had the choice, do not want to live to the bitter end. They realize that they have very few natural years left to them - and they become very realistic and philosophical about dying. Many of them will have enjoyed their long lives on Earth, but, now, they know that it is time to leave the party. Sensibly, they balance their quality of life against the remaining quantity of life. Some, having lived lives where they had considerable control over what they did, may even compile a "balance-sheet", a final "stock-taking" to evaluate everything, especially their health, their degree of energy, and their self-esteem.
For so many people today, death - for someone who has passed the "old-old" point in time - is rarely dignified. Many will die in hospitals or care homes, where their lives are shaped by rules and regulations. Gradually, the number of "bad days" will increasingly exceed the number of "good days". Why should such competent, elderly people - who so wish to continue to be in charge of their existence - be forced to hang on? I really believe that the possibility of legalised "old age rational suicide" could become the civil rights issue of the 21st century. And, finally, could we even think the unthinkable, and see Governments, around the world, become willing to help such determined individuals to have this legal option, while, at the same time, saving a great deal of money in not needing to provide all kinds of unwanted care services?