Assisted dying, and Patricia Hewitt

Patricia Hewitt is campaigning for the right to die. She believes that terminally ill people who are mentally competent should have access to assisted suicide, and is calling for a Private Members' Bill in parliament to change the law.

Part of me wants to be cynical; she never said anything about this as Health Secretary, after all, when she might have done something about it directly. But then again, this is a genuinely cross-party issue, and if she can achieve something with her campaign, then all power to her.

I'm strongly in favour of the right of a terminally ill, mentally competent adult to decide to end their own life, as long as they make the choice freely and without being put under pressure. For me, that comes down to the core liberal principle of personal autonomy: my life is mine to dispose of, and not the state's to enforce. I do understand the serious practical arguments against assisted dying (how do we know that it's a genuine free choice?), but I would like to think that they can be overcome with well-drafted legislation and high quality medical care. And is it right to let a question of practicality defeat an argument that seems sound in principle?

Beyond all the political arguments, there's an important legal problem in the mix. Currently the law on assisting suicide is ambiguous. In particular, it's unclear whether a person who travels to Switzerland, to help a loved one get to the Dignitas clinic, is committing a crime. MS sufferer Debbie Purdy went to the Court of Appeal last month, arguing that the government had a duty to make the current guidelines more explicit. The court unfortunately ruled that the guidelines were adequate, so in fact, we're still in the dark.

So far, the CPS hasn't prosecuted friends and family who have accompanied patients to Dignitas, and quite right too. From the point of view of a person wanting to spend those precious last few weeks with a dying husband or wife, this is great news. For the legal system, it's not so helpful: only if a relative returning to the UK from Dignitas is charged and tried will we have a final answer as to whether or not it is a crime to go there to support a loved one.

I'm very uncomfortable with that situation. It seems very wrong for someone to be guilty of a crime if they have no way of knowing that whether their conduct is illegal until it finally comes to court! To me, that seems to be a serious breach of the rule of law, and I hope that if Debbie Purdy takes her case to the House of Lords (or the Supreme Court, as it will shortly become), they will decide to clear things up.

The current saga also sheds light on the cruelty and cynicism of so-called Care Not Killing, the campaign group against assisted dying. They have steadfastly opposed any attempt to clarify the law in this area. In other words, for the sake of their own political campaign, they are happy for an unfair ambiguity in the law to put terrifying pressure on terminally ill people and their loved ones, and potentially to rob them of their last chance to say goodbye. I think that's shameful; and I don't see much that's "caring" about their attitude.

Sir Liam Donaldson is a nutter, Part 2

Sir Liam Donaldson is the government's chief medical adviser. Recently, he's been arguing in favour of a new policy: a minimum price per unit of alcohol. That might get rid of the odd handful of dangerously cheap all-you-can-drink deals and promotions, but it'll also force sensible and moderate social drinkers up and down the country to pay more money.

You can argue the toss as to whether this is a good policy or not. Personally, I don't. But the main thing that bothers me is this: why does Donaldson see it as his business to come up with public policy? He's there to advise the government about medical science, so that they can come up with policy measures.

This isn't the first time that Donaldson has put forward ideas that are out of touch with reality. As I blogged last summer, his plans to cut the drink/drive limit for younger drivers were well-intentioned, but dangerous. But when a medical adviser unilaterally decides to invent sweeping measures that touch on licensing law, taxation and highways enforcement, it's not surprising that he comes up with junk.

Now, I'm not for a moment doubting Sir Liam's scientific expertise, and I'm not for a moment claiming that I could come up with any better suggestions of my own. But I would like to think that the state response to alcohol problems is formulated by the Department of Health on the basis of a lot of research and consultation, taking on expertise from a range of different sources. Just introducing something that the CMO dreamed up one evening at the pub is unlikely to make for good law - and if he does want to make the law, why doesn't he just stand for parliament?

Drink-driving: how to send completely the wrong message

The government's Chief Medical Officer, Sir Liam Donaldson, has urged ministers to cut the drink-drive limit to zero - but only for young drivers. For anyone older than 20, the current limit of 80mg per 100ml of blood will still apply.

At first glance, it seems like a good idea. Fewer young people will drink and drive, and we'll all be much safer.

But there's a very serious flaw in the plan. Even with the current 80mg limit, it's impossible to judge how much you can safely drink and still get behind the wheel. Every single piece of official advice says the same thing. I quote this from the Department for Transport's own website: "... the only safe option is not to drink alcohol if you plan to drive ... You can't calculate your alcohol limit, so don't try."

Unfortunately, if you have two separate limits in force, what you're doing is sending the message that it's somehow possible to tell between them. So whilst the under-21s might start to avoid alcohol completely when driving, older drivers will get the impression that it's alright for them to drink a little bit, so long as they stay within an 80mg limit which they can't possibly judge with any accuracy. Sir Liam may have his heart in the right place, but his comments seriously undermine the government's own campaign against drink-driving.

Just imagine the slogan - "Think! Don't drink more than a pint (give or take, depending on your height, weight, sex, ethnicity and personal alcohol tolerance) and drive."

Surely the right strategy would be to set a nominal but very low limit, perhaps half of the current one? It would be impossible to have an alcoholic drink worthy of the name and still be allowed to drive, but it would also protect people from getting arrested for having a trace level in their blood from a drink they'd had hours before. You could then send out a strong and consistent message to drivers of all ages: don't get behind the wheel unless you're completely sober.

This sort of thing happened during the debate on the smoking ban, and we're seeing it again. Government medical advisers may well be good at explaining the science to ministers, but they're extremely bad at coming up with actual policy!

Licensed to smoke!

Health for England, an advisory body to the government, is proposing to charge people £10 for a licence to buy tobacco. They want the process to be as complex and inconvenient as possible - a long form to fill in, a photograph, and a requirement to renew annually. Chairman Julian Le Grand said: "If you just make it that little bit more difficult for them to actually re-start or even to start in the first place, yes I think it will make a big difference."

Obviously, this is a proposal that's been floated by an interest group, and has a long way to go before becoming actual policy. But ominously, when asked about the proposals by the BBC, the Department of Health refused to rule it out.

This is all starting to get silly. First, a blanket ban on smoking, covering not only pubs (which non-smokers frequent), but establishments like shisha bars (which they generally don't). Now, a proposal which aims to make buying cigarettes as difficult and complicated as possible.

I really resent this nannying attitude that tries to use legislation to save people from themselves. Lib Dems supported the blanket smoking ban on the basis of the Harm Principle, and that's all very well - but the anti-smoking lobby doesn't really care about the Harm Principle. The main objective doesn't seem to be protecting non-smokers from other people's noxious fumes, but rescuing mature, adult smokers from their own lifestyle choices. When the ban was first debated, one of the most frequent arguments in support was that, by making it harder for smokers to light up, more people would be tempted to give up.

It would have been quite easy to cut down drastically on passive smoking without going as far as a full ban. Compulsory separate smoking rooms with extractor fans, a ban on smoking at the bar - that would easily have done the trick. And whichever way you spin it, shisha bars should always have had an exemption; they exist solely for the purpose of smoking! The sheer uncompromising nature of the legislation makes me very sceptical about the true motives of ban-supporters.

I quite like the idea that I can go into a pub and take in a lungful of clean, unpolluted air. But I also quite like the idea that, if I really am dead set on buying a pack of smokes to use privately, nobody can stop me. I hope it stays that way.