Hazel McHaffie

Questions & Challenges for Right to Die

Literary questions for reading groups

For discussion
  • Q. Was a diary format an appropriate choice for this novel? How else might the author have dealt with Adam’s story?
  • Q. Joel becomes increasingly involved in Adam and Naomi’s lives as the disease progresses. What do you feel is happening here?
  • Q. Dr Curtis is seen as a friend and ally by both Adam and Naomi; how does the narrative develop this idea?
  • Q. What do you think Dr Curtis did in the final scenes? What gives you this sense?
  • Q. Naomi’s thoughts as she reads the diary after Adam’s death give depth and perspective to Adam’s personal account. How would the story have differed without her input? Would your view of Adam have been different?
  • Q. Serious issues can weigh a novel down. What techniques has the author used to lighten the tone?
  • Q. The theme of suicide recurs throughout the book. How psychologically plausible do you find the characters who contemplate it or carry it out?
  • Q. Would the story have been different if the reader had greater insight into the minds of Dr Curtis or Mavis or Joel?
  • Q. Lydia is a strong character in the life of Adam; Brendan less so. Discuss their significance in this story.

Moral and ethical questions

Right to Die revolves around the central theme of when and in what circumstances it might be permissible to assist someone to die.

Respect for autonomy
  • Q. Adam is an intelligent, mentally-competent individual, well aware of the implications of his diagnosis. He believes it is his right to choose the manner and timing of his death. What arguments could you put forward to counter his claim?
  • Q. He tells Naomi: ‘If Curtis could promise to help me when my time’s up, I’d probably keep going longer because I’d feel secure. If he won’t give that undertaking, I might have to decide sooner while I still have the capacity to do it myself.’ Discuss.
  • Q. A ‘good life’ with Motor Neurone Disease means one thing to Adam but something different to his neurologist who sees degenerative diseases all the time. What are the implications of this discrepancy?
  • Q. Adam asks his GP: ‘How will I know when it’s the right time to say enough is enough?’ What factors would weigh for you in such a situation?
  • Q. How much do the beliefs and opinions of a) his GP b) his neurologist c) his physiotherapist d) his mother, limit Adam’s autonomy? Is this ultimately helpful or unhelpful?
  • Q. To what extent should couple – or family-autonomy override individual autonomy?
Rights and interests
  • Q. Naomi, Mavis and Joel all have a personal interest in the timing of Adam’s death. What rights, if any, have they in the matter?
  • Q. Dr Curtis believes he has a right not to do anything which compromises his own moral principles. Dr Devlin says that patients ‘cannot be allowed to dictate the moral values of medicine.’ Whose rights should take precedence?
  • Q.Should the next-of-kin be allowed to overrule
    1. a patient’s request not to be resuscitated?
    2. an advance directive?
    3. a wish to donate an organ or the body to medical science?

    If so, in what circumstances?

Conflicts between autonomy and paternalism
  • Q. Even were assisted dying to be legally permissible, Dr Curtis says, he would still be reluctant to help Adam to die when he requests it. Should such paternalism be permissible?
  • Q.Consider the results if the GP had agreed to Adam’s request for help in dying
    1. shortly after diagnosis
    2. just before he went to Madeira
    3. as soon as he became unable to kill himself.

    In your judgement, at what point would that have been the optimal timing?

Confidentiality and the right to know
  • Q. Dr Curtis is scrupulous about preserving confidences. Neither Adam nor Naomi know the extent of the struggles the other is grappling with. Was this in their best interests?
  • Q. Naomi makes unilateral decisions about parenthood without reference to Adam because she doesn’t want to further undermine his will to live. Was she right to do so?
Balance of burdens and benefits
  • Q. Adam has to balance the burdens of his disease against the benefits of staying alive longer. His wife, his writing, completing his novel weigh with him. What things would persuade you to keep going in such a situation?
Ethical issues relating to assisted dying
  • Q. Adam says he doesn’t want to be cared for so expertly that his dying is ‘strung out way past the point of common sense.’ How far do you feel the availability of good palliative care influences opinion on assisted dying?
  • Q. Adam sees a huge paradox between abortion on demand and the legal prohibition against assisted dying for patients who are capable of deciding for themselves. Discuss.
  • Q. Dr Curtis says that causing death is not the same as allowing to die. Do you agree?
  • Q. What do you think he did in the final stage of Adam’s life? Do you approve of his actions? If not, why not?
  • Q. Adam’s mother, Mavis, holds strong and immovable religious scruples against assisted dying and suicide. How far should such beliefs govern what is legally permissible?
  • Q. The Most Reverend Wilberforce J J Kingsley’s thought-for-the-day outlines a distinction between the sanctity of life and the value of life which Adam sees as relevant to his right to die. Do you agree?
  • Q.The law currently prohibits assisted dying.
    1. Should it be changed?
    2. If so, what caveats should be applied to minimise the risks?
  • Q. Should there be criteria set for people who go abroad for assisted death or should the desire for death suffice?
  • Q. Animals can be put down to prevent or end suffering; humans can’t. Discuss.
Ethical issues related to Motor Neurone Disease
  • Q. How ethically acceptable do you feel it is to use stem cells from a) an embryo or b) an adult, to treat MND?
  • Q. Adam’s cousin, Milly, fears she might have inherited the same disease. What are the implications of offering screening to relatives in cases of inherited disorders?
Justice
  • Q. Adam says it is easier for someone in a persistent vegetative state or on a life support system to be helped to die than for him. ‘Where’s the justice?’ Discuss.
  • Q What does dignity involve for you?
  • Q. Adam argues that the money spent on his terminal care would be better spent on patients with some hope of benefit. Is this a sufficiently powerful argument for ending his life?
Virtue
  • Q. Would you say that Dr Curtis was a virtuous doctor? If not, how would you categorise his response to Adam’s need?