Euthanasia: The Slippery Slope is Real

Earlier this month King Philippe of Belgium signed a law that extends euthanasia to children. His confirmation of the new law comes after both houses of the Belgian parliament overwhelmingly approved the controversial measures. The most recent vote, in Belgium’s lower house, produced a clear majority in favour of the law (86 votes to 44).

syringeEuthanasia is nothing new for Belgians. The process, whereby a doctor injects a lethal drug into a patient, has been legal for adults since 2002. The ‘safeguards’ in their law specify that an adult only qualifies for euthanasia if their illness is incurable and their suffering is unbearable. But a closer look at some recent cases shows that these guidelines are interpreted very loosely.

In September Nathan Verhelst was legally euthanased after his sex-change operation went wrong leaving him with “unbearable psychological suffering”. In December, deaf twin brothers Marc and Eddy Verbessem, who were beginning to go blind, were legally euthanased claiming they couldn’t bear the thought of not being able to see each other again. Now, terminally ill children in Belgium can request euthanasia with parental consent.

These developments represent a clear case of a “slippery slope” whereby small, incremental changes have morphed the original law into something much broader – and more dangerous – than was ever intended.

In the UK there is currently a serious attempt to legalise “assisted dying”. The former Lord Chancellor, Charles Falconer, has introduced legislation that would license doctors to supply lethal drugs to the terminally ill to assist their suicide.  His Bill is backed by the campaigning organisation Dignity in Dying (formally the Voluntary Euthanasia Society).

Parliament has debated and rejected this issue on many occasions over the last ten years. This time, however, in order to make the measures appear more palatable, Lord Falconer and Dignity in Dying will emphasise the ‘safeguards’ contained in the bill that would limit assisted suicide to those who are terminally ill with a prognosis of six months or less to live.

But these safeguards – much like those in the Belgian law – won’t work. For starters, prognosis for terminal illness is impossible to predict accurately and the scope for error can extend into years.  The truth is that no safeguards will be failsafe.  Even Lord Falconer himself conceded this point when he discussed his proposal on Radio 4’s Today Programme, saying: “I don’t think you can ever have a system that is completely watertight…you can’t be sure [that safeguards will work].

This should set the alarm bells ringing. Perhaps if we were discussing regulations on food packaging we could play the averages. But we are not. This is life and death. Being cautious is not merely advisable, it is vital. When the person sponsoring the law admits the safeguards can’t be watertight, it’s time to think again.

Beyond the legal questions, assisted suicide prompts serious questions about the nature of healthcare. At the heart of the doctor-patient relationship is the understanding that a doctor’s primary duty is to care for and protect his patients. Regardless of the situation, a patient must know that his/her doctor will first and foremost seek to do only what is in the patient’s best interests.

That is why the major medical bodies – the Royal College of Physicians, the Royal College of General Practitioners, the Royal College of Psychiatrists and the British Medical Association – all oppose legalising assisted suicide. As The College of Physicians stated explicitly, a doctor’s duty of care for patients “does not include being in any way part of their suicide“.  What’s more, opinion surveys among medical professionals regularly find at least two-thirds against assisted suicide.

Advocates of assisted suicide refuse to admit the real risk of extension. Claims on the Dignity in Dying website state that, “the slippery slope argument lacks evidence and is illogical” and that it does not stand up as “an argument of any real value.” In light of the evidence from Belgium, it’s now hard to see how this response can stand up.

Evidence from Belgium shows exactly how quickly a law, supposedly limited to terminally ill adults, is rapidly extended to any age and any prognosis. Such a law does not extend choice in healthcare or drive up standards of care, nor does it empower patients. Looking at Belgium, the vulnerable are less protected and ending life has become normalised.

As we continue to debate the issue of assisted suicide in the UK, we should be mindful of the Belgian example where the legal ‘safeguards’ are interpreted loosely and the scope of the law has been broadened far beyond its original intent. The slippery slope is very real.

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Insights on Africa

Over the last few weeks I was fortunate to have spoken at two conferences in Africa: the first was the Sankalp Africa Summit in Kenya; the second was the 7th AfrEA Conference in Cameroon. I thank the organisers of both conferences for extending me an invitation to speak, and engage in very stimulating conversations about the future of the continent.

At both conferences I was presenting findings from Insight on Africa, a Legatum Institute report published at the end of last year.

Below is a summary of some of the points I presented.

Firstly, the way in which we think about national success and development needs to include more than just economic growth. Growth is an important part of a nation’s prosperity, but so too is the freedom of its citizens, the quality of its education system, the availability of healthcare, the presence of democratic institutions, and the strength of society.

It is important to not only realise this, but also to measure it. Data, when used correctly, can change behaviour. And as the Nobel Prize-winning economist Joseph Stiglitz said: “What you measure effects what you do. If you have the wrong metrics, you strive for the wrong things.”

A detailed look at two topics covered in the report—demographics and corruption—shows how these issues have the potential to profoundly affect the continent’s future.

Demographics

  • The total population of Africa has broken the 1 billion mark and is set to double by 2050. AfricaAverageAge
  • 40% of the population is under the age of 15, making Africa the “world’s youngest continent”.
  • By 2030, Africa will have the lowest dependency ratio of any region (meaning the largest ratio of working age adults to the rest of the population).
  • Higher life expectancy combined with lower infant mortality are major contributing factors for this trend, usually referred to as the ‘youth bulge’.

This scenario presents an opportunity, a challenge, and a threat for African countries.

The opportunity is the prospect of back to back generations of working age adults. The potential for economic growth and development for the continent is staggering.

The challenge is this will mean more people to educate, more competition for jobs, and more demand for healthcare. This will be a major test for even the most effective African governments.

The threat can be summed up in one word: employment. This point was made very well by the Nigerian finance minister who has estimated the Nigerian economy will need to grow at 8-10% annually to meet the growing need for employment. Without jobs for this generation we may see growing instability, violence, and even conflict. The 2011 World Development Report stated the predominant reason given by young people for joining rebel groups and gangs was the lack of other opportunities. The devil makes work for idle hands.

Over the coming years, the likely result of this is the emergence of “two Africas”: one which is able to cope with the influx of young workers into its economy, and one which is not.

Corruption

  • The African continent is thriving with business opportunities and investment potential. AfricaCorruption
  • Africans are optimistic about this: three-quarters of the African population perceive that their environment is a good place for entrepreneurs.
  • And yet, data show there has been no marked change in perceived levels of corruption over the past five years.
  • This is despite improvements in governance and democracy-related indicators.
  • Take Kenya, South Africa and Namibia as examples. All three countries are democratic and score among the highest in Africa on governance indicators including rule of law. And yet, these countries all perform among the lowest on measures of perceived corruption (see graphic).

Corruption matters not only because of its corrosive effect on a country’s political system and its impact on everyday life, but also because of the extent to which it complicates the business process. It adds an additional deterrent to external investment in a region that is already at the bottom of the World Bank Ease of Doing Business Index.

That said, there have been improvements. Sub-Saharan Africa was one of only two regions in the world that attracted increased FDI flows in 2012, a year when total global FDI flows fell by 18%.

Since the drivers of corruption across Africa are very different, anti-corruption measures must be tailored to each specific situation if they are to be successful, comprising measures beyond simply passing new legislation or appointing anti-corruption bodies. Also, it is important to bear in mind how any anti-corruption measures may affect the business climate.

In Ghana, for example, the government is creating two ring-fenced funds that will only be used to smooth the impact of future variations in the price of oil. This will have the benefit of providing a level of control over the strength of the country’s currency, and is intended to help Ghana avoid the so-called ‘Dutch disease’. A similar approach was adopted by Norway in the 1970s.

Technology is Good

MobileProgressI’ll be the first to admit that I’m not great with technology. I’m not a regular blogger; I’ve only just started using WhatsApp; I only occasionally post to Facebook; I don’t know what a Google Hangout is; and LinkedIn is still a bit of a mystery to me (“Facebook for grownups” seems to be the best description I’ve heard).

Notwithstanding my limited engagement with social media, I do find myself deeply thankful for the role technology plays in my life, especially social media. The last few days offer some good examples…

Sat in the North Terminal of Gatwick airport on Monday morning waiting for my flight to be called reminded me of being sat in the same rows of chairs many years ago waiting to set off on family holidays. I decided to send a group WhatsApp message to my family which started a back-and-forth as we reminisced about those holidays (and it provided an opportunity to make some jokes at the expense of my dad’s infamous holiday bum bag)!

A few minutes later my eldest brother messaged me to ask for my flight number so he can track my journey on the FlightRadar24app. Traveling for business is often a lonely experience but the thought of loved ones keeping watch over my journey brings reassurance and peace. Upon arriving in Cameroon I received a picture of my flight map from my brother with the words “tracking you flying past the Bavarian Forrest…”. FlightTracker

I woke on the first morning in Cameroon to find an e-mail in my inbox from my wife. She sent me a picture of our daughter wearing a new teddy bear towel with the caption: “Show Daddy my teddy towel!”. The worst part of travelling often in being away from family so these little messages are treasured.

My reason for traveling on this occasion was to speak at a conference. Although the internet connection at our venue was decidedly patchy, I was been able to refresh my twitter feed a couple of times through the day. Twitter is now my primary source of news and comment and it’s great to be able to keep up with events from around the world. My feed today was dominated by the situation in Ukraine and with the Oscar Pistorius trial. Also my oldest friend Ray – who also happens to be the world’s biggest Beyoncé fan – has just come back from a concert and is rather excited about it!

Sat on my hotel balcony in Yaoundé, Cameroon I’m able to share my view with family and friends. Whilst Instagram is open I have a look back over old pictures: my children over the years; places I’ve visited; holidays; family; friends; occasions; life. It’s wonderful to be reminded of these things and also worrying how quickly they’ve been forgotten. Were it not for this visual record I suspect most of these memories would remain buried in the distant corners the mind.

I call my wife via Skype and catch up on what’s happening back home. She’s at a play date with our daughter and what sounds like 600 other toddlers. We manage a quick catch up before she has to dash away. I can’t wait to be home tomorrow.

All of these little interactions make me incredibly thankful for the way technology has brought me closer to those who are far away. I love that, although I’m on a different continent, I am able to experience events from back home whether they’re my children’s bath time or my best friend’s Beyoncé concert! Technology is good.