Even death is a consumer choice now

That's how it seems as a 19-year-old is given the go-ahead to die

The days of the doctor as king are over. At one time, the all-powerful physician would have decided when to switch off a life-support machine for a baby. Now, if parents dispute that decision, the doctor has to go to court for permission.

The days of the doctor as king are over. At one time, the all-powerful physician would have decided when to switch off a life-support machine for a baby. Now, if parents dispute that decision, the doctor has to go to court for permission.

Instead we like to believe that it is the patient who is king - and for an increasing number of people that means making decisions, not only about their medical treatment, but about their right to die. They use living wills to give instructions about whether or not treatment should be continued in particular circumstances. What horrifies them is the thought of becoming a "vegetable", with no control over mental or physical faculties. They see it as a fate worse than death.

But last week the High Court went a step further. It ruled that AK, a teenager suffering from motor neurone disease - a fatal nerve condition - should die when he loses his final means of communication, the blinking of his left eyelid. The 19-year-old wants doctors to wait two weeks and then switch off his artificial ventilation.

But AK is not a vegetable. True, he has lost his ability to speak and his physical movement has gone for good. But he does have his senses of touch, hearing and sight - and his mind. When the doctors switch off AK's machine, they will end the life of a person who can still think and understand - the very faculties that distinguish us from animals and make us essentially human.

Those who approve of euthanasia might argue that choosing when to die is AK's most important choice. That, they might say, is the very essence of AK's humanity.

Yet there is a lingering unease about this. We still expect doctors to save lives, rather than end them with the flick of a switch. But modern medicine has made this issue far more complicated. Today's treatments are not so much about saving the lives of patients like AK, but lengthening them. Doctors using advanced techniques, be they medication, or artificial feeding and breathing, are keeping alive people who would never have survived even 10 years ago. AK would have died without such treatment.

Until very recently, society has assumed that death is always bad; life, in whatever guise, was to be preferred and preserved. But today the focus is on the condition and quality of that life. Striving to keep a patient alive sometimes seems merely to prolong an agony. And when someone is going to die anyway within a month, say, easing their passing might not be such a dreadful thing to do, if that is their wish.

We instinctively feel it is far more morally dubious to carry out a deliberate act of killing, such as with a lethal injection, than it is to switch off a machine, when that is the only thing keeping someone alive. And we seem to have reached a stage where we think that actively letting someone die might be the right moral choice. For choice is what we all want nowadays - it is as if we behave like consumers even about death. We can pick the time that's right for us, and think it inhuman to damn a person by insisting he continues an agonisingly painful life. It would surely be a form of idolatry if we made life an absolute value to be sustained at all costs.

Yet in the case of AK, there is still, surely, some revulsion at the ending of this life. Here is a 19-year-old whose mind is still in working order. To paraphrase Descartes: he thinks, therefore, surely, he is. Like the best-selling French author, Jean-Dominique Bauby, his body might be locked in a diving bell but his mind is free to float like a butterfly.

The case that more than any other challenged our thinking about life and death was that of Tony Bland, a victim of the Hillsborough football disaster, who suffered terrible crushing injuries and never regained consciousness. The cells in the cortex of his brain were destroyed for ever. His doctors won permission from the High Court to withdraw food and liquids. Within nine days Tony Bland died. His consultant neurologist, Jim Howe, was unequivocal as to why that was permissible: the boy was no longer a person. He couldn't think; he was no longer a sentient being. There was no communication, no blinks, nothing.

Bland was not dying, of course; he could have lived for years. In the case of AK, his illness will eventually kill him, but, unlike Bland, he still has a mind capable of decisions and desires. Both were as much victims of technology - of advances in equipment and drugs - as anything else. It perpetuates lives that should be allowed to draw to a close. A lingering existence with prolonged suffering and excruciating and intractable pain benefits nobody and does not allow for the dignity of the patient. Choosing to die seems to put responsibility for AK's life back in his own hands - it seems to reinforce his identity as a person.

What usually enhances our lives, and makes us fully human is our ability to form relationships with others. Once AK has lost his blink, his communication with others has gone. For him, having a mind that is free like a butterfly is no longer enough. It is time to slip the surly bonds of earth. And yet ... allowing someone to die who is fully conscious of what is happening to him seems instinctively wrong. The only comfort for his family will be the belief that the court's respect for his wish to die gave him some final dignity.