Marketing assisted suicide

A striking feature of the current UK debate about assisted suicide legislation is not the substance of what is being discussed but the way in which it is discussed. Here I outline some of my own observations.

First things first – what is assisted dying?

The Dignity in Dying campaign has argued for years that what it calls assisted dying is not the same as what is called physician assisted suicide in many other countries. The rationale is that assisted dying refers to people who take their own lives at a time when they can be considered to be dying, while assisted suicide refers to people who take their lives at a time when they are not believed to be dying. There is no justification in law for this distinction and indeed the campaign is aimed at changing the Suicide Act 1961 to decriminalise assisted suicide. It is as illogical an argument as the one that says people seeking assisted suicide are not suicidal – as if there is something called being suicidal that is different from wanting somebody to help you kill yourself.

Some of the slogans and jargon used by campaigners echo this fallacious argument. Even the acronym MAiD refers to medical assistance in dying rather than medical assistance to die. The slogan “It’s not about shortening life, it’s about shortening death” nods at the same logic, as if the last six months of one’s life are really the first six months of one’s death. Of course, this line is rather undermined by the Right to Die slogan – the claimed need for assistance to die (as if any of us had a choice) going against the suggestion that the only recipients will be those who are already dying.

What’s the argument?

Rather subtler is the appropriation of words like compassion and dignity. “Compassion” and “compassionate” are used freely as if all other deaths are a horror show and all opponents of assisted suicide are heartless in consigning people to what journalist Polly Toynbee has called a torture chamber. It has been a masterstroke to appropriate the word dignity to assisted suicide (Death with Dignity, Dignity in Dying, Dignitas) with its dual referents of avoiding demeaning experiences and maintaining personal standing. Its success depends of course on not mentioning the realities of the process of assisted suicide. So campaigners make no mention of complications associated with the assisted suicide process (distressing symptoms like retching, long delays in dying, recovering consciousness). In fact this is of a piece with a certain evasiveness about the nature of the assisted dying process more generally (see my notes on the Leadbeater bill)

Negative campaigning about palliative and end of life care form a part of the repertoire of assisted dying campaigners. It has elements of omission and commission.  It does not refer to research that shows a huge majority of people regard palliative care services as treating the dying with dignity and respect. Few go quite as far as journalist Polly Toynbee (again) who has claimed twice in the Guardian newspaper that a research report from the Office for Health Economics estimates that 17 people a day die in what she calls unrelieved agony or unimaginable pain when in fact the research did not quantify pain at all.

Another tack is simply not to mention palliative and end of life care at all. Baroness Meacher got the ball rolling with her remark that “Some people have to choose between suicide, suffering or Switzerland.” Less alliteratively and more inaccurately Kim Leadbeater announced the launch of her bill by saying” Today, somebody with a terminal condition and very little time left has only bad options. They can suffer in misery and often in great pain as their illness takes their life and dignity from them; travel to Switzerland- usually alone – if they are wealthy enough to pay for it; or take matters into their own hands…”

Marketing rather than critical appraisal of the case

Campaigners frequently site opinion polls suggesting the majority of the public is in favour of assisted suicide. It’s a claim that deserves some scrutiny. I have been impressed by how many people I discuss this with have a ready opinion and how few of them have reviewed any of the International evidence or reviewed the recent bills – McArthur in Scotland, Falconer in the Lords and now Leadbeater. So this idea is encouraged by polling – that you can have a view “in principle” without knowing what is being proposed in practice. It’s a bit like saying you approve Brexit or reform of the NHS “in theory” without knowing what they actually entail.

There’s a reason such polls are popular with organisations like Dignity in Dying. It is not widely recognised that opinion polling has its origins in marketing. For that reason it was criticised early after its appearance for its tendency to reduce complicated matters to facile either/or stances: an early critic said:- ”Doctor Gallup does not make the public more articulate, he only estimates how in replying to certain questions it would say yes or no or don’t know. Instead of feeling the pulse of democracy Dr Gallup listens to its baby talk.” More recently it has been said that like advertising, “political polls are increasingly associated with attempts to manipulate public opinion, tailor messaging in superficial ways, and inform public relations strategies.”

Even more obviously out of the marketing playbook is the use of celebrity endorsement. It seems to go almost without questioning that actors, writers and TV presenters, and now even the daughter of a TV presenter, should have their views given prominence by the media. Why? The question is not why such public figures think what they do, but why their views are so widely broadcast. The answer resides in market research. Celebrities have an effect on the attractiveness of a proposition in a number ways. One way is by direct association with their own perceived attractiveness – what I call the “Why would I want to smell like Johnny Depp?” question. Another is that they give cultural meaning to the product they are endorsing. In the case of assisted suicide what they’re endorsing implicitly is not what they are endorsing explicitly – not the assisted dying process itself but the nature of the debate, one in which personal opinion is more important than careful critical appraisal of evidence and personal choice is privileged to the exclusion of other considerations.

Why it matters

The style of debate outlined above does not encourage critical appraisal of such evidence as there is, and its polarising influence means that important but nuanced arguments are not aired properly. For example, if there is a tension between allowing individual choice for some people while exposing other people to risk then how do we evaluate that trade-off? In other words, how much damage to one group of people is justifiable in the name of benefit for another group? There is another unresolved question that is reminiscent of the so-called ecological fallacy. Because a whole population is exposed to assisted suicide legislation we cannot assume that the proposed beneficiaries of the legislation (those who would otherwise have to face an unpalatable death) will actually be those who avail themselves of the opportunity of assisted suicide. We are pretty clear that unassisted suicide rates don’t go down; do we know about rates of undesirable deaths of other sorts?

My conclusion – marketing tactics have brought with them a superficial approach that has an undesirable influence on the form and content of debate in an important area of public health policy. It is much to be regretted that they have been embraced so whole-heartedly by proponents of assisted suicide.