Having read the speeches of the Lords spiritual, I wonder why they concentrate so much on the matter of autonomy, as though absolute autonomy is what is at issue in the question of assisted death. Surely, this is an exaggeration. No one is claiming absolute autonomy for anyone, nor is there, so far as I can see, a denial of responsibility for others in the proposal to allowed a limited form of self-determination in regard to the time of death. Indeed, I should have thought that that is precisely what such provisions would do -- that is, express our responsibility for those who are suffering. I am amazed, though, that our Lords spiritual do not think that such compassion is an overriding consideration in the debate. Lurking in the background is the hoary old slippery slope, but they are the only ones sliding down it!

Eric MacDonald

The problem is that I never hear an alternative, given that the advance in medical care, and the known limitations of palliative care relief will lead this situation to become ever more frequent.

Yet again, the Church is utterly out of touch. No wonder it so often is ignored.

Having looked not only at the statements of the Lords Spiritual, but at several other statements to which they were responding, the focus is on autonomy because the debate has been about autonomy. No one seems to question the moral call for compassion, nor for the best possible pain control. The issue as debated is whether the rights of the patient to compassion include the rights to ask (and some would say to demand) this final step of another, specifically the health care professional.

As a practicing hospital chaplain in the US, I can say with conviction that in most discussions of medical ethics in the institution autonomy does trump other values. I've always considered this an American trait, but I may be selling other successors of English common law short. In any case, while we discuss other values - "First, do no harm;" "Act in the best interest of the patient;" "How does this affect other patients?" - the patient's right to what the patient wants (and the authority of the appropriate surrogate to do what that person says the patient wants) almost always carries the day. Rare is the clinician with the moral fortitude to refuse and resign from the patient's care.

I'm also well aware of this broad, grey moral area. The line between allowing a patient (or patient's surrogate) to refuse an intervention, even when the refusal will result in death; and intentional assisted suicide, is difficult. The line between continuing to increase pain killers even though they hasten death, and active euthanasia, is murky. Essentially, they're matters of personal intention and social understanding of which is the intent, and which the second unintended consequence. In most cases, it's the social understanding of the patient (hopefully), the patient's representative, and the practitioner.

We all agree on the need for compassion. I personally don't want autonomy to trump all other values. I also don't want people to suffer without apparent end. In the midst of this, those of us in the field do our best, in constant prayer, to muddle through.

I couldn't agree more.