Joan Bakewell: Let's have a dose of reality about old age and illness

Both ends of our lives are under discussion right now. And we need to watch out for those who would encroach on these, the most private of our own decisions, unique to each of us: how we come to be born and how we die.

I am nearer the one than the other, having already exceeded my biblical three score years and ten. But then the Bible isn't much help in deciding such matters any more. The Ten Commandments, though pretty dogmatic about "thou shall not kill", don't run to "thou shall not choose embryos". Science has overtaken the wisdoms of antiquity in what it makes possible, whether that's selected embryos which will help to eliminate cancer from a family's inheritance, or appropriate drugs to help those terminally ill into an easeful death We are all, including legislators and the now so many ethics committees, flailing around trying to decide what is right. It was never easy in the days of Thomas Aquinas, who drew up rules of "the just war", defining when Christians had permission to kill and still be sure of heaven. How much more difficult today, when there is no common shared ethical ground.

What's more, the choices are now global. Diane Pretty, who in 2002 was denied help to die in this country, still had the choice of going to Switzerland, which has different rules. Since then, 40 more terminally ill Brits have followed her. The 62-year-old Dr Rashbrook, who couldn't have a baby by IVF in Britain, went to Russia, where she was treated by an Italian doctor. I don't know the Koran and the Sharia's take on medical procedures, but I am certain that rich Muslims who wished to defy the texts of their faith find easy recourse in the medical facilities of the West. Those with money have most choices.

But who is to decide? This week, decisions have been in the hands of the ethics pundits and legislators: the Human Fertilisation and Embryology Authority and the House of Lords, which today debates Lord Joffe's Bill to assist the dying. Their talk is full of human rights concerns, subjective judgements of what is or is not "quality of life", alarms from medical personnel and religious pressure groups.

Within all of this, two concepts outrage me. Those opposing change constantly rely on "the slippery slope" argument as irrefutable. Go this way, they argue, and in the end you find yourselves in the gas chambers of Nazi Germany; take this course and in no time we'll be having designer babies genetically engineered to be good at sport or win musical scholarships. This simply won't do. Nothing is inevitable about human progress or decline. We cannot know the future and are frequently surprised by it. Who in the 1960s would have imagined cigarette smoking would become the subject of such passionate disapproval and legislation now, at the very time when alcohol - once the target of American prohibition - was positively promoted by changes in the licensing laws? What makes communities of individuals decide vaccination and inoculation are fine, but that GM crops are loaded with too much risk? Human judgement isn't some hallowed library of wisdom, it is volatile, suggestible and often victim to the vagaries of the times.

Yes, there are slippery slopes and, yes, the gas chambers are a warning. If mankind once went that way, it has the potential to do so again. But compared with massive slaughter and inhumanity, the safeguarded wish to relieve the last moments of an agonising death seem of another order entirely, one born of compassion and respect for the individual's own capacity to determine their own life.

And that's the second concern that infuriates me, that old and ill people are particularly "vulnerable" and in need of protection against their own whims. Again, this won't do. The great majority of old people have a shrewd idea of their place in the order of things, often, especially if you're a woman, as a well-nigh invisible person whose concerns are usually disregarded by the thrusting younger generations. So lets have no pious talk of concern for the vulnerable as a way of denying old people what they say they want. Lets not allege that their brains have gone soft simply because they want to die rather than live an intolerable life. Lets not pretend they can be snatched by tender and abundant hospice care in idyllically restful settings - all leafy gardens and crisp white sheets - from the squalor of the protracted deathbed many of us have witnessed. What's needed here is a dose of reality.

Yes, the "vulnerable" do need protecting. Those avaricious families keen to see granny off and claim her money, those medical institutions in need of an extra bed, mustn't have their greedy way. But to be old, or to be old and ill, is not the same as being so vulnerable and helpless that your right to decide about your own life must be taken from you. The pressure to impose on older people what others think is good for them has to be resisted. They can and will increasingly speak for themselves.

We have been groomed by market ideology to think that choice is what matters: choice of schools, choice of hospitals, choice of consumer goods. Coming generations, secular in outlook and pragmatic about decisions, will want to exercise their own minds about what science makes possible. The choice of embryos that will eliminate damaging genes, the possibility of avoiding the last agonising moments, will not go away. Debates will recur, issues re-emerge. Life is a slippery slope, and it's a good place to be. We just need to keep our balance.

joan.bakewell@virgin.net