Comprehension questions and tasks. 1. Did Valerie have financial or rather moral reasons for becoming a surrogate mother?

1. Did Valerie have financial or rather moral reasons for becoming a surrogate mother?

2. Can any woman become a surrogate mother?

3. Why do not all surrogate arrangements work well?

4. Discuss the advantages and disadvantages of a surrogate arrangement.

Don’t Leave it to the Doctors

By Hugh Dickinson

Society has to tackle the complex and fearful moral issues raised by euthanasia

“Thou shalt not kill, but need’st not strive officiously to keep alive.” We water down the 10 Commandments under the pressure of practical living and comfortable dying, but there comes a point when the police start asking questions.

Examination of 1, 200 deaths on Merseyside over three years suggest that 130 of them were “caused” by doctors.

Four cases are being taken up by the Crown Prosecution Service. A young man in a coma after an asthma attack had food and drink withdrawn after eight weeks, although close relatives were convinced he was conscious and capable of communicating by eye movements. An 80-year-old woman was denied intravenous fluids which could have kept her alive.

There is a whole list of other cases. We don’t know the clinical judgments which led to those decisions and hundreds like them, nor how much pressure came from financial or institutional considerations. Money, resources and beds may be a legitimate part of the equation. But how do relatives or the general public know?

Consider Gerald’s case. A 90-year-old with cancer, ulcerated legs and acute panic attacks, he is in constant pain and often on the border of dementia.

He sits in the day room of his “home” in misery, with tears dripping down his raddled cheeks whenever anyone is kind to him.

In January, he was taken into intensive care and brought back from the edge of his final release by a medical team who worked all night on him. “A small miracle”, said one satisfied young doctor. Not for Gerald. For him death would be the miracle.

There are thousands of Geralds in geriatric wards and nursing homes, many lost in dementia or senile depression. There are many others enduring the unendurable: incurable and terrifying diseases; gross congenital flaws; traumatic mental conditions.

As the population ages the number of cabbage human beings is going to increase and the ethical issues of rationing life and death are going to press in on us with increasing urgency.

Who should make the decisions of life and death? Some people say life and death belong to God and no mortal can presume to preempt God’s role. Life is sacred – whatever that means.

However, even the most intransigent absolutist has to acknowledge there are cases where a choice for death is the lesser of two evils. Once that is conceded we are on the familiar slippery slope of wedge arguments.

Some distinctions are helpful. There is a gradient: suicide; assisted suicide; voluntary euthanasia; involuntary euthanasia; accelerated death from necessary palliative treatment – the “double effect”, accelerated death under cover of palliative treatment (with benign or malign motives) – and murder.

All the way almost the gradient, imponderable questions of motivation are posed. How do we know what a person really intended, patient or doctor, particularly if the patient is dead? Does an earlier intention while of sound mind carry more weight than a later one expressed in dementia? Can people sensibly change their minds at the last moment?

The problems of euthanasia are complex and fearful, but it is too late to draw a line in the sand and say it is immoral and illegal under all circumstances. It is already widely practised by doctors, and assisted suicide is increasingly common and increasingly, if tacitly, approved.

There are too many cases of such pain and misery that even to read of them makes you weep and pray for a quick release for the sufferer. Instinctively, we all know that in this case or that case, assisted death really is the better thing. But is it the lid to Pandora’s box, as many believe?

We can’t act on that instinctive moral insight because we fear it will unlock the floodgates for all the other malign consequences that lurk in the wings.

So we pretend it isn’t happening and hope doctors will have the wisdom and compassion to let it happen quietly behind the scenes as most do already.

But the Merseyside study shows that among the benign releases there are some less happy involuntary deaths.

The genie is out of the bottle, and the doctor is in the dock. If our society is going to take on the issues of life and death – as I believe we will have to – one basic principle must be followed.

We must not leave it to the doctors. Not because they are not trustworthy (although the 10 per cent of deaths attributed to them in the Merseyside study might make us pause), but because the decision does not belong to them.

Their clinical evidence and judgment is, of course, indispensable. But there are other social, family and legal factors that must bear upon every case about which doctors do not have any privileged judgment.

Even more important is the need to preserve at all costs the complete trust of the patient in their doctor as the mediator of life and health.

It is high time we built on our experience of ethical panels with legal, social work, psychiatric and lay experts working alongside doctors not only to relieve them of a burden that should not be placed on them, but also to protect their professional integrity. (Abridged)

From The Daily Express