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Sadly, there is a fate worse than death
What’s in a name? One of the many minor annoyances of contemporary life is that people change names for no obvious reason. The first time I noticed this was when the Dr Barnardo’s Homes charity became Dr Barnardo’s in the late 1960s, and then Barnardo’s in 1988; many others have followed. The Octavia Hill Housing Trust named after the great Victorian philanthropist, suddenly became Octavia in 2001, and the Royal Mail astonished the world by renaming itself Consignia, and then shamefacedly changing back again only 17 months later. And so on.
It is all very irritating. However, I have to admit that occasionally a change of name might be good. It was right for the Spastics Society to rename itself, even if Scope was hardly the most inspired of choices; the word spastic had become a term of abuse. Similarly it was right for all concerned to drop the distasteful word mongol and to insist on the term Down’s syndrome instead.
So last Monday, when the Voluntary Euthanasia Society announced it was changing its name to Dignity in Dying, I restrained instant indignation for a moment to wonder whether there isn’t perhaps some point in it. Names do matter; they affect the way we think.
Euthanasia is an alarming word. It ought not to be; strictly speaking it just means a good death, which is what we all hope for. However, it has come to mean rather the opposite; it has all kinds of terrible connotations with bad deaths, with murdering people because of their race or mental infirmities, or with hastening the deaths of the elderly sick without their consent. There have been some horrifying cases recently of nurses killing geriatric patients more or less to tidy up their wards.
Possibly for the trivial reason that both words are Greek and begin with “eu”, euthanasia has come in a confused way to be associated with eugenics, which is even more alarming. And eugenics is one of those overloaded words that silences argument and stifles thought. A great deal of unnecessary confusion and anxiety surrounds the word euthanasia; this in part explains the passionate resistance to Lord Joffe’s various versions of his bill on assisted dying; he has had to revise it, reducing its scope and — tellingly — eliminating the phrase voluntary euthanasia.
The society’s new name describes what we all want, whatever each of us may mean by that. Unfortunately dignity in dying is something you cannot choose in this country. It is a matter of luck, and if you are unlucky your dying will be drawn out, painful and frightening, like Diane Pretty’s. It is illegal deliberately to help someone to die. Last week’s launch coincided with the haunting story of Dr Anne Turner, who went to Switzerland to die on Tuesday with the help of a doctor, surrounded by her grown-up children.
Her story is a perfect reminder of why the law must be changed in this country. Turner had seen her mother die in pain with inadequate morphine, she had nursed her dying husband through a terrible degenerative disease, and she had recently been diagnosed with another.
Knowing what lay ahead she tried to commit suicide at home, but failed; clearly suicide isn’t easy even for a doctor. In the end she went to a clinic in Zurich where the charity Dignitas gave her a lethal solution of barbiturates to swallow. That meant that she had to be well enough to do so and fit enough to travel to Switzerland. So she had to go to her death earlier than otherwise she might have done. The day of her death she was talking and singing with her children. Had assisted suicide been legal in this country she would be alive today.
Turner was a member of Dignity in Dying; the day after her death another member and former chairman of the charity announced that he was being investigated by the police, after having said publicly that he had advised five terminally ill British people to commit suicide in Switzerland in the same way as Turner. He is Michael Irwin, the brave campaigner and doctor who was struck off the medical register last September for planning to help an old friend die rather than face a painful death from cancer; he says he is quite prepared to go to prison.
It should not need brave trips to Switzerland or the courage of campaigners who break the law to restore to us our freedom to choose our own death. We hear ceaselessly these days of our right to choose, but when it comes to one of the most important there is no choice at all, apart from a lonely and perhaps botched suicide.
I cannot understand why people are so squeamish about death, unless they have strong religious views. As my eccentric mother-in-law used to say, death isn’t the end of the world. In her case this was distinctly odd, as she was irreligious and envisaged no world after death. But what she meant is that there are things much worse than death, which are, so to speak, the end of one’s own world. One of them, surely, is a drawn-out dying, increasingly cut off from one’s world by increasing pain, disability and dependence. To prefer death in such circumstances is not to deny the value of life — rather the reverse. It is because one loves life that one does not want a living death.
Joffe’s new bill, which will soon have its second reading in the Lords, is now too limited. It deals only with “indirect assisted dying”, in which a doctor may give patients a prescription or oral barbiturates to kill themselves. Given the careful safeguards and constraints in the bill I would not be afraid to include directly assisted dying, in which a willing doctor may kill consenting patients themselves (as often happens in practice); some patients, when they decide they wish to die, are no longer physically able to take their own lives.
The only constant counter-argument seems to be another of those phrases that silence argument and thought — “the sanctity of life”. It is good and indeed essential to respect the absolute value of other people’s lives. But one does not have to think of one’s own life, at every stage, as sacrosanct, if one is not religious. It is what it is, and it is one’s own. As my mother-in-law said, death isn’t really the end of the world.
The Sunday Times | Sunday, January 29, 2006 | Comments (0)
Byte by byte, our identity is being stolen
Years ago sophisticated travellers in far-flung places used to smile indulgently at simple tribal people afraid of having their photograph taken. It seemed that in their ignorant way the tribal folk feared that their identity itself was being given for ever into the power of the photographer and his strange machine, to make whatever spells he liked. As it turns out, they were right and are having the last indulgent smile, if not exactly the last laugh, on us.
Our identity — or rather countless aspects of it — is being taken from us in countless new ways by information snapshots. It is complex and frightening. What is deceptive is that each individual loss seems quite trivial; it seems a small matter to hand over elaborate details to a bank, an insurance company, a mortgage company, a credit card company. But every time we make a trivial transaction, we make many of these details available to countless others, both legally and before long illegally.
It makes me feel faintly anxious when an unknown voice in a cinema booking office, on hearing my postcode, gives my exact address. What else does she know? What else could she know if she made the effort? Or if she were dishonest? It is alarming. The ether, or the virtual ether, is heaving with private details about all of us, like the accumulating rubbish in space. All that is as nothing, however, compared with the efforts of the state to steal our identities. What’s worse is that the rate of theft — for it really is a kind of theft — seems to be increasing fast.
On Friday it emerged that 24,000 young people aged between 10 and 18 have their DNA profiles stored on a nationwide database, even though they have never been cautioned, charged or convicted of an offence. Their genetic identities have been stored by the state for absolutely no reason.
This came out because a diligent MP took the trouble to find out for a constituent why a boy who was wrongly arrested in a case — please note — of mistaken identity, had his DNA profile taken and stored by the police. It seems that of the 3m DNA profiles now held by the national database, nearly 140,000 are from people who have never been charged or cautioned. Why? Worse still, this is perfectly legal. Why? Yesterday it was reported that records of all criminal convictions, and of all cautions, will remain on police files for 100 years, from April onwards. Chief constables have suddenly overturned the principle that offences can be “spent”. This puts paid to the chance of living down youthful indiscretions and turning over a new leaf.
Our medical records are to be made widely available on the new National Health Service computer system, under the Care Record Development Board, for all kinds of NHS employees to obtain, not to mention snoops and hackers. Last week the British Medical Association’s family doctors’ committee, to its great credit, decided that patients should be asked to consent, formally, to having their records entered on the new database.
Earlier the government was offering NHS patients the choice of opting out of this, but the GPs voted to require explicit consent, meaning explicit agreement to opt in. It seems extraordinary that there was ever any assumption that this extremely important matter need not necessarily be taken to parliament, and that we might just as well give way passively to the erratic powers of IT. But such is the temper of the times.
Our masters (and mistresses) seem determined to know more and more about us, right across the oceans and the ether. In this country we are still being threatened with ID cards, which might hold all sorts of information on those dark and shiny strips.
In the US the Department of Justice is even now trying to force Google, the internet search engine, to hand over records of what people have been looking for when they visit the site. Specifically they asked for a list of terms entered during a single week, and 1m randomly selected web addresses. Google is valiantly resisting this extreme invasion of privacy but Microsoft and Yahoo! have already complied. Good for Google one must say; but it is unlikely that even Google will be able to resist the Goliath of the US Justice Department.
Those who have nothing to hide, people always say, have nothing to fear from releasing all these personal details (voluntarily or otherwise). That is a terrible mistake. It is to misunderstand the importance of privacy in human affairs and it’s to ignore the constant threat of hackers.
It is also to underestimate the importance of error in human affairs, most particularly in computer use. One of the worst things about all these databases is the mistakes they make and then disseminate far and wide. Credit checking agencies, for instance, regularly make bad mistakes, as people with good credit who get wrongly listed as bad debtors will tell you. It is very hard to discover such mistakes or to reverse them.
IT is one of the most powerful tools and at the same time one of the most serious problems for public services today. The police and the Crown Prosecution Service, for instance, have had serious problems with IT interface and as for the NHS computer system, one can only call it an expensive disaster. The much vaunted electronic booking system is a year behind schedule and the entire £6.2 billion NHS computer system is in danger of collapsing, according to a recent leak from a civil servant. Would you seriously trust such a system with details about a mental illness or an abortion? It now emerges that there is a great deal of identity fraud surrounding the tax credit system; one would have to be daft to file tax returns online.
Perhaps I seem unduly cynical about police information systems, but there is always human error. In the trial of the Notting Hill rapist, for instance, it emerged that the rapist had originally been ignored as a suspect because a Home Office computer inaccurately reported that on the date of one of the offences he was still in jail. More recently we have the disgraceful confusion over lists of sex offenders.
I hardly know which is worse — a state that is good at getting and guarding our personal records, or one which is pretty bad. But either way, the time has come to think carefully and publicly about how we want to use technology to stop the recording eye of Big Brother stealing our identities.
The Sunday Times | Sunday, January 22, 2006 | Comments (1)
England is waking up to the patriot game
Last week was another Big Concept week for new Labour. First we had the prime minister touting respect, yet again, in his exciting recycled Respect Action Plan, and then we had Gordon Brown, not to be outdone, touting Britishness in an exciting new policy agenda, yet again. None of us particularly objects to respect or to Britishness, but it is slightly irritating to have Blair and Brown trying so hard to flog them to us, rather as if they were trying to sell us our own grandmothers. And one does wonder why.
After Blair’s efforts earlier in the week to persuade us that the all-purpose panacea for social breakdown is respect, and that delinquents and problem families should start showing a bit of respect, or else, Brown made a grandiloquent speech to the Fabian Society, arguing that the only way forward in this competitive global world is Britishness, or — in a word — patriotism. We need, he said, “a clear view of what being British means and how you define national identity for the modern world”.
So he called, in his dour way, for a “British Day” on which the country can unite to celebrate its uniquely British values, which are apparently liberty, tolerance, inclusion and fair play. He demanded that the Union Jack should be reclaimed from the far right and, ideally, flown in every garden just as Americans fly the Stars and Stripes, to show how united and British we all are.
How I laughed when I read his speech and heard the solemn discussion of all this tendentious tosh on the radio, as if there were actually some content in it. The idea that Britishness lies in values that everyone on the planet believes in, apart from a few cannibals, is just verbiage. There is something truly comic about two grown-up, well-educated men like Tony and Gordon imagining that the public will be bamboozled by this meaningless posturing. And there is something distinctly comic about the crude statist assumption behind both men’s manipulations, as if the state could, or should, interfere in such subtle matters of feeling and attitude.
Like the feeling of respect, the feeling of Britishness is not something that can be whipped up in the great British public by meddling politicians, least of all when what they are trying to whip up is not for the good of the country, but for themselves.
In Blair’s case he feels a worrying lack of respect for himself, well corroborated in opinion polls, and so he is trying to associate himself publicly with the idea of respect, in an unsophisticated kind of adman dog-whistling. In Brown’s case, he feels a worrying excess of Scottishness, well corroborated in opinion polls, which might well stand between him and No 10, so he is trying equally crudely to make us associate him with Britishness. He is fooling around with our national sense of identity to support his own personal crisis.
Scottishness is a nail-biting problem for Brown. Generally speaking most people in England quite like the Scots, even though they seem to hate us. Surveys show we find their accents suggest intelligence and reliability. Politically speaking, however, this easy affection is disappearing fast, as Brown is well aware. Devolution in Scotland and Wales — fought for and introduced by new Labour — has much undermined our common sense of Britishness and fostered instead a new and rather irritable sense of Englishness in the South. Meanwhile Scots feel more Scottish and less British than at any time since 1707, according to some surveys, led astray, possibly, by films such as Braveheart.
More importantly the English public is at last beginning to sit up and take notice of the famous West Lothian question — the problem first identified by the then MP for West Lothian, that Scottish MPs at Westminster can vote and carry the Commons on domestic policies such as education and health that don’t affect them or their constituencies. The government has increasingly relied on the Scottish vote to push through purely English legislation, against English votes, and yet the reverse is not true; English MPs have no say over comparable Scottish affairs.
This is obviously unfair, as is the fact that more taxpayers’ money goes to Scotland, per head, for public services than in England, following the old Barnett formula. Devolution has only made this long-standing injustice feel worse.
In response, a feeling of English separatism is growing; the English hardly need Scotland and Wales and would be much freer and richer without them. It is not only those on the far right, now, who complain of the number of Scots at Westminster and their undue influence. Devolution as of now is plainly unjust. Scottish MPs are overmighty and a Scottish prime minister at Westminster, post-devolution, would find himself in a false position.
Remarkably slowly England’s voters are beginning to wake up to all this. The higher their perception of it becomes, the lower will be Brown’s chances of arriving at long last at the summit of his smouldering ambition. So he has to persuade us somehow that he is not all that Scottish at all. No, he’s British. We’re all British (though this leaves out the awkward position of the Northern Irish, who aren’t exactly British.) He might even fly the Union Jack. But these questions are not going to go away.
There are ways of resolving them, of course. Why not try genuine devolution? Why not make the Commons English and only English? Why not create a new upper chamber to deal with matters British? But there is no personal incentive for Brown to promote any of that.
Trying to promote a vacuous Britishness as a way out of this problem is unlikely to succeed. That is partly, by a rich irony, because our national sense of identity, our Britishness, has been undermined by Labour party policies, both before and after Blair — by (among other things) the traditional left-wing contempt for patriotism; by the resulting suppression of national history; by the suppression of national traditions for fear of giving offence to newcomers; by aggressive multiculturalism and by fast mass immigration.
The big ideas of Britishness and national identity are now much too fragile to serve the purposes of an ambitious socialist like Brown. There is some justice in that.
The Sunday Times | Sunday, January 15, 2006 | Comments (22)
They should tell the truth about drugs
Poor Charles Kennedy is not alone in his unhappy struggle with the demon drink; Britons lead the way in drinking themselves to death, according to the headlines on Friday. In more sober language, figures published in The Lancet last week showed a steep recent rise in Britain in deaths from cirrhosis of the liver (commonly caused by drinking too much), whereas the rate is falling fast in most other European countries.
In the 1950s England and Wales had by far the lowest rates of liver cirrhosis deaths in western Europe and Scotland’s rate, although higher, was still relatively low. That has changed completely; in the 1980s the death rate went up fast and in the 1990s it rose by two-thirds in England and Wales and doubled in Scotland. These alarming increases affect both men and women across all age groups and are accelerating.
Writing in The Lancet, Professor Robin Room blamed the UK government for turning “a determined blind eye to the problem” and for failing “to make the reduction of the population’s alcohol intake a policy goal. Through the new alcohol licensing law, and the new official guidance on it, the national government has also done its best to tie the hands of local government on this issue”.
It would be unfair to blame the government for whatever it is that makes people drink so much. But it is certainly fair to blame Labour for making it so much easier to drink, regardless of the explosion in underage drinking. It is fair to blame it for the extraordinary licence that it seems determined to legislate, for reasons which remain obscure. Not only does it seem to wish us to drink night and day; it has also tried to press us to gamble more and to relax about cannabis.
Now, not surprisingly, ministers are being driven to backtrack. Tessa Jowell was making recantatory noises about gambling and its dangers last week and Charles Clarke felt obliged on Friday to hint at a humiliating U-turn on cannabis; he appears to be thinking of turning it back into a class B drug — David Blunkett had downgraded it in 2004 to class C — because of “recent” medical evidence about links between cannabis and serious mental illness.
Actually, the evidence is not all particularly recent. It has been becoming clearer since the mid-1980s that cannabis is associated with serious and long-term mental illness, particularly schizophrenia and psychosis, as well as short-term motivation and memory problems — just as it has been clear for years that hard drugs, alcohol and nicotine can cause terrible damage, too. What is recent is that people like Clarke have begun to believe it.
He belongs, as I do, to a generation that did not believe anything our elders and betters said about drugs, because it was quite clear that they did not know what they were talking about. Our elders disapproved of drugs not on medical but on moral grounds and were quite prepared to repeat scare stories and deliberate disinformation without evidence. Neither they nor we knew anything about the real damage that even soft drugs could do, and it was obvious that some self-appointed experts were too partisan to trust.
Besides, I have known many people who have taken hard drugs over long periods without becoming addicts. Similarly, young people know that hundreds of thousands of people take ecstasy every weekend without, apparently, any ill effects. Considering the numbers, the few deaths involved have been statistically insignificant and young people are well aware of that and become less and less prepared to pay attention to exaggerated warnings.
I did not believe the most serious warnings about cannabis until two years ago when the teenage son of some people close to us had a frightening psychotic episode after smoking a lot of “skunk” at a party. Like most London teenagers, he and his friends had always smoked weed without obvious ill effects, but skunk is much stronger than the cannabis of my youth.
Overnight this boy became paranoid, anxious, disoriented and depressed; his psychiatrist said “skunk psychosis” was becoming common and it is true that most teenagers will know of someone who has suffered it. This boy recovered in about six months and has given up drugs; even so, research published in November last year suggests that just one such episode is likely to be the precursor of mental illness later.
It was, of course, irrational of me to be convinced of the dangers by one instance and, of course, most people are not. Young people tend to think they are immortal and that risk is for other people. We know that only some smokers get cancer or coronary artery disease and that only some people become alcoholics. Different drugs affect different people differently and this confuses people about the risks. They know the risks vary according to the individual, but they don’t know how.
It seems increasingly clear that genetic predisposition is important. Research published last year by the Institute of Psychiatry found that one in four cannabis users is genetically predisposed to become mentally ill as a result of smoking it and is 10 times more likely to suffer psychotic disorders than other smokers. The problem with genetic predispositions is that for now, at least, little is known about them. Apart from family history, there is for the most part no way of identifying individuals with particular predispositions.
All this presents an intractable problem, especially for libertarians. It seems wrong to restrict the freedom and pleasures of the many because of uncertain risks to the unknown few — to ban alcohol because some people will become alcoholics, for instance. In any case it is almost impossible. Prohibition did not work in America and the illegal drugs trade is out of control across most of the world, even in places such as China where dealers and users are executed.
However, we can tell the public the truth, as far as it is known, scrupulously and strikingly. This is most unlikely to happen. Public health campaigns, when not merely ineffectual, have all too often been manipulative or untruthful, on subjects from Aids to nits.
Perhaps there could be a new career for Kennedy in public health education — very liberal, very libertarian.
The Sunday Times | Sunday, January 08, 2006 | Comments (0)
Cherie and other blessings of our time
Tis the season to be jolly. That is not always easy in these cold, dark days. On the bestseller list this Christmas was a jeremiad called Is It Just Me Or Is Everything Shit? and a right-wing think tank published another more elevated one called Decadence. I myself on this page have held forth in this glum spirit from time to time. All the same there truly is a great deal to be jolly about, at least in this country. So this new year my resolution is the one made for me long ago by a favourite headmistress: count your blessings.
There are plenty of them even in the most unlikely places. Take the prime minister, for instance. However angry he may make us, on the left and on the right, he is at least a top politician who has not got his snout in the trough. Britain’s leader is not personally corrupt, or so I believe, and in the world today, not least in Europe, that is a most remarkable and wonderful thing.
We might have had Chirac or Mitterrand or Schröder (scandalously now working for that Russian stooge company Gazprom, after signing a pipeline deal with them just before leaving office) or the pork barrel in which American politicians have their trotters sunk. We take it for granted that our political leaders are not like that.
Tony Blair may have fibbed to us and helped various rich cronies but it was not for personal gain (and what’s more it has all emerged through a free press and due process). The worst anyone can accuse him of personally is getting a couple of cut-price watches from Berlusconi, and he did pay for them what the mandarins told him to even if it was not the proper price.
He has accepted some faintly unseemly hospitality in sunny climes but the point is, surely, that we know about it — politicians here have to account in great detail for what they give and take — and Blair has had to give some money to charity instead. When David Blunkett bought a few shares that he probably should not have done, it was a resigning matter; there are still high standards of financial probity in public life. This is an extraordinary blessing.
Then there is the great blessing of Cherie. Her follies have reminded us that some of the supposedly great and the good are only human and just as misguided as the rest of us, if not more so. She also reminds us, in a sort of marital guilt by association, not to be unduly impressed by her husband and his cronies — another blessing.
At the time of Christmas shopping and the January sales, the cry goes up that we are hopeless, soulless materialists, pathologically commercialised, addicted to shopping malls and slaves to Mammon. There may be some truth in that, but it is also true that shopping makes the world go round. It is shopping, commerce and capitalism and the choice and tat that go with them that have enriched the peoples of the world, and certainly of this country, extremely fast. What’s more, many people — although not enough — have come to realise that for all its faults, capitalism has been the great liberator.
Poverty in Britain today — bad though it is — is nothing like the widespread poverty that shocked me in my childhood in the West Country, and that in turn was as nothing to the poverty that my mother witnessed as a girl before the war: she regularly saw children going to school with a scrap of bread and lard and without shoes.
Mature capitalism has gone a long way to defeat poverty and the result is that millions of people whose parents and grandparents were poor can shop till they drop. Never before have people been able to afford so much — so much varied food, so many designer clothes, so many cosmetics and treatments and technological toys, since their basic needs have been met. We are richer and healthier and have more pleasures and interests than ever before. Mammon has conferred many blessings.
What’s more the curses of affluence, such as factory farming, junk food and excessive waste, are something that everyone is aware of. If history is any guide, then greater prosperity and greater knowledge will enable people to deal with the problems of affluence. Meanwhile, the tragic, murderous errors of socialism and communism have been exposed; the evils of capitalism are at last understood to be much less. One hundred years of disastrous intellectual and political experiment have been discredited.
Almost the greatest blessings that I can think of personally are medical. Fifty years ago antibiotics were a newly invented expensive rarity in this country. Painkillers were primitive, anti-psychotic drugs were nasty and anti-depressants were not much better. A heart bypass or a liver transplant was almost a miracle only a few decades ago. If you were seriously ill there was little that could be done.
Now ambitious surgery, extraordinary drugs and wonderful painkillers are taken for granted to the point where there is a national scandal if a new cancer drug is not given to someone who wants it. We have forgotten that not so long ago, in my living memory, people died in long-term untreated agony, here in this country. Now we daily expect new miracle drugs, such as statins which will do for coronary artery patients what 1960s anti-depressants did to depopulate mental hospitals. There are bifocal contact lenses — and it was the invention of spectacles that extended and improved people’s working lives and fuelled the industrial revolution — and before long there will be smart pills to repair the brain and stem cells to repair any body part.
The main reason why the National Health Service has so many unmanageable problems is that there is so much good new treatment and that we are all living so much longer. This may be a mixed blessing, but it is surely a blessing.
Once you start counting blessings it is encouragingly hard to stop. It is true that there are grave international problems; it is true that people here are often depressed by cynicism. But the cause and the cure lie in the same thing — greater public knowledge, greater public openness and greater accountability than before.
We are all more aware of what goes on, which should be exhilarating as well as depressing; humans have been successful in solving the problems they have identified. New technologies and new inventions have always appeared to solve old problems; goodwill has always existed to try.
Happy new year.
The Sunday Times | Sunday, January 01, 2006 | Comments (0)
