Older Lesbians, Gay Men and the ‘Right to Die’ Debate
| DOI | 10.1177/0964663917693916 |
| Date | 01 October 2017 |
| Published date | 01 October 2017 |
| Subject Matter | Articles |
Article
Social & Legal Studies
2017, Vol. 26(5) 606–628
Older Lesbians, Gay Men
ª The Author(s) 2017
Reprints and permission:
and the ‘Right to Die’
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DOI: 10.1177/0964663917693916
Debate: ‘I Always Keep a
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Lethal Dose of Something,
Because I don’t Want to
Become an Elderly
Isolated Person’
Sue Westwood
Keele University, UK
Abstract
This article considers the ‘right to die’ debate from the perspectives of older lesbians and
gay men, drawing upon data gathered for a PhD in law. My argument is that older lesbians
and gay men are multiply disadvantaged (a) by an increased risk of feeling that life is not
worth living due to affective inequalities (inadequate informal and formal social support)
and (b) by a denial of access to the right to die both under such circumstances and/or if
they wish to resist the normativities associated with a passive, medicalized death. I argue
for the need to distinguish between a wish to die because of deficiencies in the care
system and a wish to die in order to control how, when and where one’s life ends. My
analysis highlights the contextual contingencies of ‘vulnerability’ in relation to the right to
die and interrogates the heterosexist and disciplinary reproductive normativities
underpinning the notions of ‘natural’ deaths.
Keywords
Assisted dying, euthanasia, inequality, older lesbians and gay men, ‘right to die’,
vulnerability
Corresponding author:
Sue Westwood, Keele Law School, Keele University, Keele ST5 5BG, UK.
Email: s.westwood@keele.ac.uk
Westwood
607
Introduction
The ‘right to die’ is the subject of considerable legal, ethical, clinical and political debate
(Yeung, 2012). With an ageing population, and more people living longer, but not
necessarily with a good quality of life in their final years, the debate has expanded to
include its implications for older people, particularly those with dementia (Tomlinson
and Stott, 2015). Yet older1 people’s voices are rarely heard in the debate (Lamers and
Williams, 2016), especially those of older lesbians and gay men. This article addresses
this knowledge gap, by analysing the narratives of 12 older lesbians and gay men who
support the right to die, many of whom have plans to end their lives2, taken from a wider
data set from a PhD law project (Westwood, 2015a).
My argument is that older lesbians and gay men are multiply disadvantaged by an
increased risk of feeling that life is not worth living due to affective inequalities (inad-
equate informal and formal social support), by a denial of access to the right to die both
under such circumstances, and/or by a denial of access to the right to die if they wish to
resist the normativities associated with a passive, medicalized death. I argue for the need
to distinguish between a wish to die because of deficiencies in the care system and a wish
to die in order to control how, when and where one’s life ends. My analysis highlights the
contextual contingencies of ‘vulnerability’ in relation to the right to die and interrogates
the heterosexist and disciplinary reproductive normativities underpinning the notions of
‘natural’ deaths.
In the first section, I locate older lesbians and gay men in the right to die debate. After
a Methodology section, I then describe and analyse the findings, before discussing their
implications, for older lesbians and gay men, older people in general, and the new
insights they offer to the wider right to die debate.
Older Lesbians, Gay Men and the Right to Die Debate
The right to die debate (Yeung, 2012) is not just about the right to die; it is also about the
right to be assisted, either indirectly or directly, in doing so (Ost, 2010). Assisted dying
refers to providing physical assistance to someone who wishes to end their life (e.g.
obtaining the pills, lifting the cup to the mouth and so on). Euthanasia refers to ending
someone’s life for them (e.g. administering a lethal injection). In a systematic review of
the literature on patients’, carers’ and public attitudes towards assisted dying, Hendry
et al. (2013: 17) identified four main themes:
concerns about poor quality of life: unbearable suffering, dependency, burden and
loss of self, physical pain and suffering and fear of future suffering;
the desire for a good quality of death: autonomy and control and the right time to die;
concerns about abuse if assisted dying was legalized: the need for safeguards,
financial pressure, vulnerable groups and discrimination and the role of others in
decision-making;
the importance of individual stance related to assisted dying: moral or religious
views, personal experience of death or suffering, being for or against the avail-
ability or legalization of assisted dying.
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Social & Legal Studies 26(5)
Lamers and Williams (2016) in a Foucauldian analysis of older people’s discourses
about euthanasia and assisted dying (their sample demographic was not analysed for
sexuality/sexual identity) identified two further themes: dying inside and outside of ‘the
medical gaze’ (p. 1) and notions of a ‘natural cycle’ (p. 7) of birth and death, with dying
in older age preceded by physical and mental decline.
The right to die debate is intertwined with moral values (Cooley, 2007; Prado, 2013),
ethical dilemmas for healthcare professionals who might be required to perform the
assistance to die/euthanasia (Biggs and Ost, 2010; Huxtable and Mullock, 2015) and
‘dichotomized positions’ (Mishara and Weisstub, 2013: 427) between narratives of
resistance and empowerment (‘the triumph of autonomy’, Beauchamp, 2006: 646) and
contrasting tragedy narratives (‘so sad and desperate’, Andrews, 2015: 105). The debate
is not only abstract and theoretical, but has real implications for lived experience, as
evidenced in the growing body of case law (Bara and Vyshka, 2014; Tiensuu, 2015)
where people with chronic, terminal conditions have unsuccessfully petitioned for the
right to be assisted in dying, including Pretty v. United Kingdom (application number
2346/02); Merits, 29 July 2002; Bush v. Schiavo, 125 S. Ct. 1086 (2005); Haas v.
Switzerland (application number 31322/07), Merits and Just Satisfaction, 20 June
2011; R (Nicklinson) v. Ministry of Justice [2013] EWCA Civ 961. Notably, and by
contrast, in Canada, this year following Carter v. Canada (Attorney General), 2015 SCC
5, Canadian adults who are mentally competent and suffering ‘intolerably and endur-
ingly’ now have the right to receive medical help to die (to be enacted in 2016).
However, in many countries, including the United Kingdom, assisted dying is still
against the law.
Feminists have had long-standing involvement in the right to die debate (Wolf, 1996),
expressing concerns that the unwanted and/or unsupported in society might be encour-
aged to end their lives rather than the state addressing the systemic reasons for their
social exclusions and/or lack of support (Tulloch, 2005). They have also emphasized the
‘slippery slope’ argument: ‘if voluntary euthanasia is legalised, it will become impossi-
ble to make a distinction between voluntary euthanasia and non-voluntary or even
involuntary euthanasia’ (Ost and Mullock, 2011: 183–184). Many feminists are con-
cerned that ‘vulnerable people will be disproportionately at risk – that under the banner
of “choice”, women, the elderly and the disabled will be targeted for assisted dying (or
feel pressured into ‘volunteering’ themselves)’ (Kitzinger, 2015: 102). Some feminist
care ethicists take a particular stance: ‘feminist values of equality, inclusive justice,
caretaking, relationship and the interconnectedness of life impel us to struggle against
self-determined forms of death’ (Callahan, 2015: 112).
Other feminists have critiqued healthcare law, arguing that while narratives of (embo-
died) choice prevail ‘law also works to define the boundaries of permissible choices,
since some requests for bodily interventions are ruled out’ (Fletcher et al., 2008: 324).
The privileging of vitality and of respect for life claims (p. 329) can remove an individ-
ual’s right to exercise choice and control through ownership claims over her body. As
Fletcher et al. write,
Why is the fact that a person no longer values her living body not treated as sufficient reason
to justify the provision of euthanasia or assisted suicide? Why does law not accommodate a
Westwood
609
woman’s judgement that it is best to end a particular pregnancy at a given moment? These
familiar questions interrogate legal restrictions on bodily choices in reproductive and end of
life contexts. (p. 335)
With an ageing population and the increasing prevalence of dementia, especially
among women3, older people, especially those with dementia, have been increasingly
implicated in the right to die debate (Tomlinson and Stott, 2015) and feminists have
positioned themselves on both sides (Kitzinger, 2015). There are significant concerns
about the quality of formal care provision for older people (Equality and Human Rights
Commission, 2011; Osborn et al., 2014; World Health Organization, 2011). As Herring
has recently observed,
Older people are dying in poverty, freezing temperatures, and desperate hunger. So many
are neglected by their communities, abandoned by their families, living isolated, socially
excluded lives. For many, their last months or, if they unlucky, years are spent in care homes
marked by abuse, neglect, and over-medication. (2013: 496).
Feminists have long argued that, if older people want to die because of inadequacies
in care provision,...
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