OBJECT AND BODY: Assessment Presentation

Assessment Presentation_BODY/OBJECT

OBJECT: Still Life Killing Time, Edmund Clark

Periodically there will be an outcry in the UK over the length of sentences and parole conditions imposed on violent criminals. ‘Life should mean life’ goes a common rallying cry amongst those who see prison not as a means of rehabilitation, but a mechanism of punishment, and perhaps secondarily a means of protecting the public. However the inevitable result of very long prison terms is of course increasingly elderly prisoners, and the fate of these prisoners in a system largely geared towards the young and the strong is a topic that is less often discussed. Although we know they exist (or we assume they exist) much of the discussion and debate around the penal system tends to focus on young and repeat offenders, not those who have been incarcerated for very long periods, and who may very well live out the remainders of their lives behind bars.

In Still Life Killing Time, Edmund Clark set out to explore the experience of inmates in the E Wing of Kingston Prison, Portsmouth, at the time the only dedicated prison wing for elderly prisoners. As the name implies the book is a series of still life and environmental photographs, taken around the prison’s communal areas and in prisoner’s cells. Originally setting out to tell inmate’s stories through portraiture as he had done in a previous project about young offenders, Clark turned from this approach to focusing just on still life photographs in response to the difficulty he felt about consent and the representation of violent criminals.

The result is a strange set of images, many of which are for me reminiscent of visits to elderly friends and relatives in their houses and care homes. Chintzy decorations, religious icons, cut out photographs of classic cars, royals and rather out of date celebrities. And yet little details come through that remind you of the context of these objects. What appears to be a fairly typical, if quite spartan, bedroom has to be reconsidered when one notices a book titled ‘Manslaughter United’ on the bedside table. A pin board covered in Celtic FC memorabilia is visually interrupted by a photograph of a famous murder victim, John Lennon.

Then there are the frankly depressing photographs of very institutional scenes; cells, waiting rooms, a chair lift, security camera monitors. A rota for newspapers, a list of daily activities punctuated by a ‘World mental health day’ sticker. These are still mostly ambigious images, many of which could exist just as easily in an old person’s home (or psychiatric hospital) as in a prison. The sense of visually criss-crossing between conflicting indications of what one is viewing is an unsettling experience, and one which somewhat reflects the genericity of all such state institutions.

As Simon Norfolk points out in his introduction to the book one has to remember that the owners of these objects and occupants of these spaces are not typical old folks, but people who have in many cases committed heinous crimes. And yet then as Norfolk also acknowledges there is also a sense of disconnection between what these people may have done in the past, and what they are capable doing now. If one views a core purpose of the penal system as being to protect the public from dangerous individuals, it becomes hard to see what purpose is served by incarcerating those who are unable to carry out simple tasks without supervision and instruction. One particularly sad photograph for example shows a list of instructions to guide someone (presumably suffering from dementia) through the steps they need to take to use the toilet.

Still Life Killing Time asks a lot of awkward questions, and it does it in an understated, quiet way which makes the sensation of looking at it all the more uncomfortable. The resounding message is that whatever crimes prisoners may have committed the attitude that we should simply lock them up and throw away the key is clearly not the right one, morally or practically, and that it’s impossible to ignore the responsibility for a certain level of care that the state takes on when it incarcerates people.

OBJECT: Arguments For and Against Euthanasia and Assisted Suicide

There are arguments both for and against euthanasia and assisted suicide.

Some of the main arguments are outlined below

Arguments for euthanasia and assisted suicide

There are two main types of argument used to support the practices of euthanasia and assisted suicide. They are the:

•   ethical argument – that people should have freedom of choice, including the right to control their own body and life (as long as they do not abuse any other person’s rights), and that the state should not create laws that prevent people being able to choose when and how they die

•   pragmatic argument – that euthanasia, particularly passive euthanasia, is already a widespread practice (allegedly), just not one that people are willing to admit to, so it is better to regulate euthanasia properly

The pragmatic argument is discussed in more detail below.

Pragmatic argument

The pragmatic argument states that many of the practices used in end of life care are a type of euthanasia in all but name.

For example, there is the practice of making a ‘do not attempt cardiopulmonary resuscitation' (DNACPR) order, where a person requests not to receive treatment if their heart stops beating or they stop breathing.

Critics have argued that DNACPR is a type of passive euthanasia because a person is denied treatment that could potentially save their life.

Another controversial practice is known as palliative sedation. This is where a person who is experiencing extreme suffering, for which there is no effective treatment, is put to sleep using sedative medication. For example, palliative sedation is often used to treat burns victims who are expected to die.

While palliative sedation is not directly carried out for the purpose of ending lives, many of the sedatives used carry a risk of shortening a person’s lifespan. Therefore, it could be argued that palliative sedation is a type of active euthanasia.

The pragmatic argument is that if euthanasia in these forms is being carried out anyway, society might as well legalise it and ensure that it is properly regulated.

It should be stressed that the above interpretations of DNACPR and palliative sedation are very controversial and are not accepted by most doctors, nurses and palliative care specialists.

Read more about the alternatives to euthanasia for responses to these interpretations.

Arguments against euthanasia and assisted suicide

There are four main types of argument used by people who are against euthanasia and assisted suicide. They are known as the:

•   religious argument – that these practices can never be justified for religious reasons, for example many people believe that only God has the right to end a human life

•   ‘slippery slope’ argument – this is based on the concern that legalising euthanasia could lead to significant unintended changes in our healthcare system and society at large that we would later come to regret

•   medical ethics argument – that asking doctors, nurses or any other healthcare professional to carry out euthanasia or assist in a suicide would be a violation of fundamental medical ethics

•   alternative argument – that there is no reason for a person to suffer either mentally or physically because effective end of life treatments are available; therefore, euthanasia is not a valid treatment option but represents a failure on the part of the doctor involved in a person’s care

Religious argument

The most common religious argument is that human beings are the sacred creation of God, so human life is by extension sacred.

Only God should choose when a human life ends, so committing an act of euthanasia or assisting in suicide is acting against the will of God and is sinful.

This belief, or variations on it, is shared by members of the Christian, Jewish and Islamic faiths.

The issue is more complex in Hinduism and Buddhism. Scholars from both faiths have argued that euthanasia and assisted suicides are ethically acceptable acts in some circumstances, but these views do not have universal support among Hindus and Buddhists.

‘Slippery slope’ argument

The slippery slope argument is based on the idea that once a healthcare service, and by extension the government, starts killing its own citizens, a line is crossed that should never have been crossed and a dangerous precedent has been set.

The concern is that a society that allows voluntary euthanasia will gradually change its attitudes to include non-voluntary and then involuntary euthanasia.

Also, legalised voluntary euthanasia could eventually lead to a wide range of unforeseen consequences, such as those described below.

•   Very ill people who need constant care or people with severe disabilities may feel pressured to request euthanasia so that they are not a burden to their family.

•   Legalising euthanasia may discourage research into palliative treatments, and possibly prevent cures for people with terminal illnesses being found.

•   Occasionally, doctors may be mistaken about a person’s diagnosis and outlook, and the person may choose euthanasia due to being wrongly told that they have a terminal condition.

Medical ethics argument

The medical ethics argument, which is similar to the ‘slippery slope’ argument, states that legalising euthanasia would violate one of the most important medical ethics, which, in the words of the International Code of Medical Ethics, is: ‘A doctor must always bear in mind the obligation of preserving human life from conception’.

Asking doctors to abandon their obligation to preserve human life could damage the doctor–patient relationship. Causing death on a regular basis could become a routine administrative task for doctors, leading to a lack of compassion when dealing with elderly, disabled or terminally ill people.

In turn, people with complex health needs or severe disabilities could become distrustful of their doctor’s efforts and intentions. They may think that their doctor would rather ‘kill them off’ than take responsibility for a complex and demanding case.

Alternative argument

The alternative argument is that advances in palliative care and mental health treatment mean there is no reason why any person should ever feel that they are suffering intolerably, whether it is physical or mental suffering or both.

According to this argument, if a person is given the right care, in the right environment, there should be no reason why they are unable to have a dignified and painless natural death.

OBJECT: Euthanasia and Assisted Suicide

Euthanasia is the act of deliberately ending a person's life to relieve suffering.

For example, a doctor who gives a patient who has terminal cancer an overdose of muscle relaxants to end their life would be considered to have carried out euthanasia.

Assisted suicide is the act of deliberately assisting or encouraging another person who commits, or attempts to commit, suicide. 

If a relative of a person with a terminal illness were to obtain powerful sedatives, knowing that the person intended to take an overdose of sedatives to kill themselves, they would be assisting suicide.

Legal position

Both euthanasia and assisted suicide are illegal under English law.

Depending on the circumstances, euthanasia is regarded as either manslaughter or murder and is punishable by law with a maximum penalty of up to life imprisonment. 

Assisted suicide is illegal under the terms of the Suicide Act (1961) and is punishable by up to 14 years' imprisonment. Attempting to commit suicide is not a criminal act in itself. 

Types of euthanasia

Euthanasia can be classified in different ways, including:

•   active euthanasia – where a person deliberately intervenes to end someone’s life, for example, by injecting them with sedatives  

•   passive euthanasia – where a person causes death by withholding or withdrawing treatment that is necessary to maintain life, such as withholding antibiotics in someone with pneumonia  

Euthanasia can also be classified as:

•   voluntary euthanasia – where a person makes a conscious decision to die and asks for help to do this

•   non-voluntary euthanasia – where a person is unable to give their consent (for example, because they are in a coma or are severely brain damaged) and another person takes the decision on their behalf, often because the ill person previously expressed a wish for their life to be ended in such circumstances

•   involuntary euthanasia – where a person is killed against their expressed wishes

Depending on the circumstances, voluntary and non-voluntary euthanasia could be regarded as either voluntary manslaughter (where someone kills another person but circumstances can partly justify their actions) or murder. 

Involuntary euthanasia is almost always regarded as murder.

There are arguments used by both supporters and opponents of euthanasia and assisted suicide.

Alternatives

There are alternative approaches and options for people with terminal conditions or those experiencing intolerable suffering.

For example, under English law, all adults have the right to refuse medical treatment, as long as they have sufficient capacity (the ability to use and understand information to make a decision).

If you know that your capacity to consent may be affected in the future you can arrange a legally binding advance decision (previously known as an advance directive).

An advance decision sets out the procedures and treatments that you consent to and those that you do not consent to. This means that the healthcare professionals treating you cannot perform certain procedures or treatments against your wishes.

Other countries

Active euthanasia is currently only legal in Belgium, Holland and Luxembourg. Under the laws in these countries, a person’s life may be deliberately ended by their doctor or other healthcare professional. 

The person is usually given an overdose of muscle relaxants or sedatives. This causes a coma and then death.

However, euthanasia is only legal:

•   if that person has made an active and voluntary request to end their life, and

•   it is thought they have sufficient mental capacity to make an informed decision regarding their care, and

•   it is agreed that the person is suffering unbearably and there is no prospect for an improvement in their condition

Capacity is the ability to use and understand information to make a decision. Read more about the capacity to consent to treatment.

In some countries the law is less clear, and some forms of assisted suicide and passive euthanasia are legal but active euthanasia is illegal.

For example, some types of assisted suicide and passive euthanasia are legal in Switzerland, Germany, Mexico and the American state of Oregon.