A majority in the House of Commons has provided David Cameron with the freedom to do over the next five years some of the things that he’s found difficult over the last five. One of the things that is set for reform is the law on inheritance tax, with the Tory manifesto having pledged to
take the family home out of tax by increasing the effective Inheritance Tax threshold for married couples and civil partners to £1 million – so you can keep more of your income and pass it on to future generations. (p 3)
(UKIP upped the ante on this, promising to get rid of inheritance tax altogether.)
How big an impact the Conservative policy would make is hard to tell: most people don’t pay inheritance tax anyway, and so raising the threshold would affect only a portion of the residuum that would pay it. But, still: we might ask whether such a policy is just. For sure, there will be some people for whom it’s attractive – archetypally, the sort of person who bought a property in a then down-at-heel part of London or Manchester a generation ago who finds that it is now something of a golden egg. But attractiveness in a policy will only take us so far. To answer the justice question, we need to look at the principles behind it. And once we do that, I’m not so sure that the policy is just. Indeed, it’s not clear that there’d be anything unjust about having a much higher rate of inheritance tax.
The reason for the claim that reducing the inheritance tax burden is unjust is straightforward: it means that those who were fortunate with their parents get a helping hand not available to everyone. The children of dentists will, at some point, receive a capital benefit that would not be matched by the children of dustmen. Since this difference is arbitrary – noone deserves rich or poor, thrifty or feckless parents – there is a case to be made that the just society would seek to smooth it out to as great a degree as possible. At least on paper, we might be tempted to think that a 100% inheritance tax would be a way to do this: it would ensure that noone benefitted at all from ancestral good fortune. In practice, there’d doubtless be all kinds of workaround that’d make such a high rate unenforceable – but the case might stand in principle.
Is the moral case, then, that easily made? Continue reading
Frank Van Den Bleeken wants to die. He is not physically ill, but claims to be suffering from persistent mental anguish, from which death will provide him with some release. And as a Belgian man, living in Belgium, we might ordinarily expect him to be able to take advantage of that country’s fairly liberal euthanasia laws. Whereas many of the assisted dying regimes around the world specify that the person who wants to die must be terminally ill to qualify, Belgium has seen several cases in which people have been helped to die for reasons that do boil down to psychological distress: in a couple of fairly well-reported cases, Marc and Eddy Verbessem were deaf twins who feared blindness and sought death on that basis, and Nathan Verhelst sought it in the wake of unsuccessful gender-reassignment surgery.
What makes Van Den Bleeken particularly newsworthy is this: he is a convicted killer and rapist. According to the CBC, he had argued that “he had no prospect of release since he could not overcome his violent sexual impulses and so he wanted to exercise his right to medically assisted suicide in order to end years of mental anguish”. It’s not clear whether the anguish came from being in prison, or guilt, or something else. This might make a difference; I’ll touch on that below.
What should we say about the morality of such a case? Continue reading
(Cross-posted from the Journal of Medical Ethics blog)
The Liverpool Care Pathway provides a rubric for managing the care terminally ill as they approach death. A helpful pamphlet explaining what it is and what it does is available here. Ideally, I’d quote the lot; but for the sake of efficiency, I’ll make do with an edited quotation:
What is the Liverpool Care Pathway (LCP)?
The LCP is a pathway/ document that outlines this best care, irrespective of your relative/ friend’s diagnosis or whether they are dying at home, in hospital, in a hospice or a care home.
Medication will be reviewed and any medication that is not helpful at this time may be stopped and new medication may be prescribed so that if a symptom should occur there would be no delay in responding.
It may not be possible to give medication by mouth at this time, so medication may be given by injection or sometimes if needed, by a continuous infusion by a small pump called a Syringe Driver, which will be tailored to individual needs.
It may not be appropriate to continue some tests at this time; these may include blood tests or blood pressure and temperature monitoring.
The staff should talk to you about maintaining your relative’s/ friend’s comfort; this should include discussion regarding position in bed, use of a special mattress and regular mouth care. You may want to be involved in elements of care at this time.
Diminished need for food and drink
Initially, as weakness develops, the effort of eating and drinking may simply have become too much and at this time help with feeding might be appreciated.
Your relative/friend will be supported to take food and fluids by mouth for as long as possible.
When someone stops eating and drinking it can be hard to accept, even when we know they are dying. It may be a physical sign that they are not going to get better. Your relative/friend may neither want or need food and/or drink and decisions about the use of artificial fluids (a drip) will be made in the best interests of your relative/friends for this moment in time. This decision will be explained to you and reviewed regularly.
This can be paraphrased further: medically futile treatment may be withdrawn; the main criterion for administering drugs will be symptom alleviation rather than life extension; some testing may be discontinued; it’s possible that there’ll come a point when artificial nutrition and hydration are no longer in the patient’s best interest, and they might be withdrawn if and when that point is reached.
None of this is particularly cheery; but death rarely is. Continue reading