The Dignitas Clinic in Switzerland assists both Swiss and foreign patients to commit suicide. People in support of this service would prefer to call it ‘assisted dying’. More than 100 UK citizens who gone to Switzerland to die with such assistance. They are often accompanied by their relatives. Assisting others to commit suicide is a criminal offence in UK, but so far there have been no prosecutions of the relatives. Responding to the case of 23 year-old rugby player Daniel James, who died in Switzerland in this manner, the Director of Public Prosecutions remarked that prosecuting his parents would not be in the public interest.

On 19 February 2009, a multiple sclerosis patient Debbie Purdy claimed partial victory after the Court of Appeal in London rejected her case. Ms Purdy had sought to establish whether her husband would be prosecuted if he helps her travel abroad to die assisted, in a country like Switzerland, where assisted dying is legal. The appeal judges ruled that she was not legally entitled to such advance guidance. To Ms Purdy and advocates of euthanasia and assisted suicide, the ruling was nonetheless perceived as encouraging – the Appeal Court had not ruled that relatives should be prosecuted if they assisted with such suicide arrangement.

Legalisation of ‘assisted dying’ is on the agenda in the UK. In May 1996, the House of Lords blocked an Assisted Dying Bill by just 148 to 100 votes after much public debates. Recently, Private Members of the Scottish Parliament attempted to put up a similar bill, proposing to give terminally ill patients the right to assisted suicide.

To this date, PAS remains highly controversial, but the tide of public opinion seems to be slowly shifting in its favour, at least in the UK. It must be a matter of time that a case like Craig Ewert would eventually prop up to stir a storm.

Mr Ewert was a patient completely paralysed with motor neuron disease and dependent on non-invasive ventilator. In September 2006, he

died in Dignitas Clinic after drinking a mixture of sedatives and using his teeth to turn off his ventilator. Canadian director John Zaritsky had documented his assisted dying process in his film Right to Die, and the process was broadcast live on Sky TV last year, with pre- announcement. New internet media like the YouTube helped disseminate the clip to wide audiences all over the world.

Critics branded this Sky TV programme as just another “Reality TV” stunt. Was it just “Reality TV”? Reality TV is a new genre of programs that features ordinary people in non-script scenarios, often monstrous or extreme in nature. The audience gets entertained by seeing the actions and responses of unpaid participants in treacherous contests or humiliating “coaching”.

Strictly speaking, the film Right to Die does not fall into the category of Reality TV programmes. However, they do have some similarities.

Lady Finlay, a professor of palliative care, said of the SkyTV programme, “This programme is broadcasting something which is very private, which is someone dying and which is illegal in this country.”

HKSPM Newsletter 2009 Mar Issue 1 P11

The Death of Craig Ewert: Repercussions and Reflections

Physician assisted suicide on air: Could it be right?Dr. Derrick KS Au,Hospital Chief Executive, Kowloon Hospital & Hong Kong Eye Hospital.Correspondence: ksau@ha.org.hk

Newsletter of Hong Kong Society of Palliative Medicine

HKSPM Newsletter 2009 Mar Issue 1 P12

The Death of Craig Ewert: Repercussions and Reflections

Here is the commonality between such pre-announced broadcast of assisted suicide and other Reality TV programmes: Both make voyeurism-like invasion of privacy possible. Indeed, seeing private life (and dying in this case) under extreme condition is an important part of the attraction.

Television Features Editor Michael Deacon strongly disagreed. He argued his case from the point of presenting all the facts for the public to judge: “Ewert’s assisted suicide upset some. And indeed it was an upsetting film. But that was no reason to remove it from our screens. If we are to have a serious debate about assisted suicide we must look at all the facts. And that means looking at some things we might rather not see.”

Mary Ewert, wife of Craig Ewart for 37 years, confirmed that it was their wish to bring this dying process to the public. She told the Telegraph newspaper, “The film is a wonderful tribute to my husband. I have absolutely no regrets about agreeing to leave the camera rolling as Craig died. It's what we both wanted…If this film gets people thinking about death and talking about it, that's all that Craig would have wished.” The intention was clear: Craig and Mary both wish the filming would get the public to think and talk about this death. Privacy was not their concern. They wanted to make a statement, and to stir public debate. They very much achieved the goals.

Could it be right in this case to broadcast the suicide act? It did have the consents from the patient and his relative. The broadcast probably did serve the purpose of generating public debates and making a statement. The question is, does the end justify the means? Take a different scenario, a depressed person out of job wishes to film his suicide to make a statement of protest against an unjust society, would the end also justify filming his suicide?

The pro-PAS camp should have no shortage of arguments to defend the broadcast. Assisted dying in the terminally ill person, unlike the suicide of a depressed unemployed worker, is not merely an act of political protest; the film was meant to lay the facts open for the public. It could help overcome social taboo regarding death and dying.

In reality, the nature of the film is probably somewhere in between (protest / advocacy vs. facts / taboo-breaking). A documentary with

such strong ideology and advocacy cause can hardly be a mere piece of fact-recording documentary. The filming of Craig’s final moments puts the case of assisted suicide in the best of lights, reassuring viewers that there is nothing to be afraid of. It is persuading, not just recording or reporting.

Even then, it may be argued that there is nothing wrong with ideology or cause-driven documentaries. We are in a pluralistic society. Conflicting values and perspectives should all enjoy freedom of expression.

Could the live broadcast of the assisted suicide of Craig Ewert’s be right? It could, but I would submit that, in balance of probability, it wasn’t. PAS is a complex issue with ethical, legal, medical, and social dimensions. It cannot be fairly treated by the documentation of a single ‘he died willingly and peacefully’ case. One particular case of affectionately produced and enthusiastically broadcasted PAS may seem innocuous, or may even be ‘touching’ to some viewers; whether the ramifications of legalising PAS can be appropriately comprehended and discussed with such sensational means is doubtful. The ‘slippery slope’ of PAS is real. Craig Ewert was not even a terminally ill patient. Frail and vulnerable non-terminally ill patients do not fare well if and when PAS becomes an ‘easy way out’ for health care professionals, the patients and their family. Even for the terminally ill patients, the Sky TV broadcast of Craig Ewert’s assisted suicide might well be doing them a ‘disservice’. Further to her remark on the SkyTV programme and privacy quoted above, Professor Finlay said, “I think it also perpetuates a myth that, somehow, to have a good death you have to end your own life and that is just completely untrue.” Indeed, once PAS becomes a ‘quick-fix’, the norms and values of health care will shift, and good quality palliative care is unlikely to be pursued with patience.

Newsletter of Hong Kong Society of Palliative Medicine

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