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The champions of lawful assisted suicide tend to have sunny dispositions. They assume that all is basically well with society. They assume that the legislation they propose will operate in a fundamentally humane social context, where patients can usually rely on the generous support both of health care services and relatives. They assume that procedural safeguards are all that is needed to guarantee genuine patient autonomy. And they assume that one can tell an authentic, free choice by its persistence.

But this is largely well-heeled fantasy. According to Help the Aged, about half a million older people are being abused in Britain at any one time, two-thirds of them at home by someone in a position of trust. More than half the theft and fraud against older people is committed by their own children. The scale of the problem has been confirmed by Britain's most senior police-woman, the former Chief Constable of South Wales Police, Barbara Wilding, who has reported "an increase in abuse of the elderly, which often takes place behind the closed doors of the family home". She said that this would become "the next social explosion".

As for the quality of professional care, Baroness Neuberger wrote in Not Dead Yet: A Manifesto for Old Age (Harper, 2008) that those "care-assistants" who delivered most of the hands-on care of the sick and elderly are poorly trained and poorly paid-"short-term employees doing dirty work for little money and no emotional and ‘respect' reward". This "miserable reduction of care workers into harried, time-watching automatons — with no time for human interaction — is corroding the quality of care all the time".

This is the actual social environment in which the legal right to assistance in suicide would often operate: one where the elderly and the chronically ill are often neglected, malnourished, isolated and even resented. This is the inhumane social context that would inform the autonomy of ailing individuals and move them to persist in an authentic choice to stop wasting space and die. Formally speaking, of course, such choices would be entirely free; but theirs would be a freedom evacuated of hope by a characteristically impatient, often callous, and sometimes hostile society.

The proponents of the right to assistance in suicide are naive to suppose that the humanity of British society can be taken for granted. They are also naive to infer that the granting of a legal right to die would legislate patient suffering away. It won't. Mistakes will be made, and even assisted suicides will be botched. After all, we're talking about the world of human activity, where perfect solutions are not known to dwell.

In sum, the flies that stain the rational ointment of a mooted right to assisted suicide are as follows. Very likely it would be just a temporary Oregonian stopping-place on the road to Dutch-style voluntary euthanasia. It would open up intractable arguments about the conditions of eligibility, which would invite the libertarian solution of granting arbitrary individual autonomy and killing on demand. This would serve to undermine positive care for the lives of others, lift legal and social prohibitions that protect individuals from self- and socially-destructive passions and jeopardise such a humane social ethos as we now have. This ethos is neither as extensive, nor as deep, nor as secure as the sunny liberalisers suppose. Nor would their preferred solution to the problem of patient suffering be as perfect as they imply. For sure, the concern to maintain society's commitment to supporting human worth in adversity, which underlies this argument's opposition to changing the law, is one that many religious people will share. But it is also one that fuels majority opposition in non-religious bodies such as the House of Lords, the Royal College of Physicians, the Royal College of General Practitioners and the British Geriatrics Society. Opposition to making assisted suicide lawful really can't be brushed disingenuously aside as the manipulative child of religious conspiracy.

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