Saturday, 14 January 2012

Assisted Suicides and Slippery Slopes

Termination of Life on Request and Assisted Suicide (Review Procedures) Act” (2002

Euthanasia and physician assisted suicide in the Netherlands is regulated by the above act.  Patients must meet specific criteria in that the patient has a terminal illness and requests (and this must be persistent and over time) a termination of life, has not been influenced by others, the patients suffering is unbearable and hopeless, the patient has been informed of and refused all possible alternatives (including treatment), has received the consultation of two physicians and has been made aware of the applied method of ending life.

However The Royal Dutch Medical Association has now released new guidelines widening the interpretation of the Act to include: ““mental and psychosocial ailments” such as “loss of function, loneliness and loss of autonomy” as acceptable criteria for euthanasia. The guidelines also allow doctors to connect a patient’s lack of “social skills, financial resources and a social network” to “unbearable and lasting suffering,” opening the door to legal assisted death based on “psychosocial” factors, not terminal illness.

” The June 2011 position paper, titled “The Role of the Physician in the Voluntary Termination of Life” concludes that the “concept of suffering” is “broader” than its “interpretation and application by many physicians today.”
Included in a broader interpretation of suffering would be “disorders affecting vision, hearing and mobility, falls, confinement to bed, fatigue, exhaustion and loss of fitness,” according to the authors.”

“Alex Schadenberg, Executive Director and International Chair of the Euthanasia Prevention Coalition committee responded to the new guidelines, saying that in his view “the expansion of euthanasia and assisted suicide has been constant and deliberate.”
Schadenberg warned that what has happened in the Netherlands can—and will—occur in other jurisdictions, if euthanasia and/or assisted suicide is legalized.
When the Netherlands sanctioned euthanasia for emotionally ill patients in 1994, Karl Gunning, head of the Dutch Doctors’ Union warned the country of the “slippery slope” it was sliding down.
“We have always predicted that once you start looking at killing as a means to solve problems, then you’ll find more and more problems where killing can be the solution,” he said.”

Charles Falconer’s ‘Commission on Assisted Dying’ (5.1.2012)

has concluded that there is a strong case for legalisation of ‘Assisted Dying’ and those that have twelve months or less to live should be allowed to end their own life/commit suicide.

The document is  here - it is a lengthy document – some 415 pages – and I have not read it all.  To summarise, the document suggests that to be eligible patients must be over eighteen years of age with a diagnosed terminal illness and less that twelve months to live, has made a voluntary choice and not been influenced by others, has mental capacity to make an informed choice and their decision making ability is not impaired by mental health problems such as depression, the patient is fully assessed to determine eligibility by at least two independent doctors, made aware of all options for treatment, care and support and still wishes to proceed and must be capable of administering the lethal medication themselves.

Author Sir Terry Pratchett (who jointly funded the so-called independent report) has stated that the report does not go far enough.

It is of a course a recommendation and there is no likelihood of ‘Assisted Dying’ becoming enshrined in law – yet.  Are we following the history of the Netherlands where certain assisted suicides became permissible in the 1980s, as in the need to clarify assisted suicide in 2009  in the UK?

The seeds for acceptance of legalised suicide are being sown, slowly but surely.  Lord Joffe has made four attempts during 2003-6 to introduce bills to legalise suicide and all were rejected by parliament.  Margo MacDonald’s “End of Life Assistance Bill” was rejected by the Scottish Parliament in 2010.

The drip, drip, drip is leading to a softening of opinion, indeed a “YouGov" poll commissioned by Sky News found 69% believe the law should be changed, compared to 17% who want it to stay the same and 14% who do not know.”

It is a fact that I understand that some of those suffering a terminal illness experience unimaginable pain and welcome death to alleviate this suffering – indeed when my own father was dying in such circumstances – initially I prayed (selfishly) to his God that he might live and upon realisation of his suffering prayed that he would die – quickly.  In hindsight – I wish to God that the Liverpool Care Pathway (LCP) existed then.

However – as those that have read previous posts will know – I have great reservations regarding the LCP.  Its admirable origins are firmly placed in alleviating the suffering of cancer patients diagnosed to be in the process of dying and yet its tendrils have spread to encompass all diagnosed (or thought to be) near death.  It is my opinion that the slippery slope exists here already and I know of occasions where it was initiated inappropriately.  To me the declaration that “The LCP is only as good as the people who are using it” is an acceptance that mistakes are made – for indeed the LCP is assisted dying.

During research I found myself confused as to what my true opinions/beliefs were, for as said I witnessed the awful slow painful death of my father and witnessed the same in residents in my home – this prior to the LCP – and then I have seen those diagnosed as near death living for years after.

I guess my epiphany was found at the Christian Medical Comment for I found much solace, much wisdom here – and I would stress that there is no conflict of interest as I am an atheist – and I thank Dr Peter Saunders for his communication – please read his wise posts on  euthanasia.    

I am concerned that assisted suicide will in the future be legalised in the UK – I am certain that it will (in time) – for just as the slippery slope exists in the Netherlands – it surely will happen here.

Before I sign off – please view this Dutch doctor’s experience as  the agent of death and consider that she states that she has no problems with assisted suicide and yet it emotionally affects her.

What say you on assisted suicide?

Anna :o]


PS  Had great difficulty creating links here - the post developed a mind of its own -  also messiness in its format and structure - can't correct it!          

21 comments:

thingy said...

It certainly is a controversial subject. Interesting post. Thanks, Anna

Muhammad Israr said...

i think euthanasia will be a controversial topic forever... as someone said that assasination is the ultimate form of censorship, i think taking someone life does not feel right... well researched post... i used to study this topic in our univ bioethics course and we would have a lot of debate on it...

Dominic Rivron said...

I too saw my own father die slowly of cancer and as a result I am personally convinced of the case for the right to die with dignity. I think that whatever the law states there will be cases which make one think it should be different.

For example, I would be very unhappy if a situation arose where you got death from a budget NHS service as opposed to ten years of life prolonging treatment via private healthcare.

dr phil said...

Dear Anna,

I share your concerns about euthanasia, and the difficulties both ethical and practical. I am particularly grateful for the link to Dr Saunders blog. It is a new one to me, and very interesting on the subject of Christian ethics in medicine. I am a more liberal Christian than him but his blog on Prof Hawking is very relevant to the issue of euthanasia and life expectancy.

Dr Phil

Friko said...

Dear Anna,

I don't think there is a 'drip, drip, drip' thing going on in the media to 'soften' public opinion. For many years now I have been speaking to old people of healthy mind and reasonably healthy (for their age) body. every single one says: if I should ever be dying in unbearable pain/become a vegetable (their word not mine)/suffer torments which cannot be alleviated do not prolong my life. If you can, give me the means to kill myself.

That's without having a doctor present 'because they wouldn't help you anyway'.

I don't now how serious these phrases must be taken - I say them myself at times - but nobody wants to suffer. There is no guarantee that you won't suffer, hospices are few and far between and desperate for funds, hospitals are overworked and creaking at the seams (I know, I've often enough seen them from the patient's angle), a good 50% of nursing staff have lost the ability to see and hear the patient rather than how busy they are, how much chatting they need to do amongst themselves, and those stupid reams of paperwork they have to fill in.

I have been an in-patient so many times in the last twenty years and observed such unpleasant conditions, I am now terrified each time I have to be readmitted. OK, I won't make it into a horror story, I get helped and returned to civilisation each time. I'd hate not to have that option and would probably rather die than have to stay helpless and in pain, whether mental or physical.

Life isn't easy and we were never promised an easy time, but the living of it and leaving of it are our decision; I consider it to be my ultimate right.

On the other hand, having somebody else decide for me is totally unacceptable.

HyperCRYPTICal said...

Thanks for your comment thingy.

Anna :o]

HyperCRYPTICal said...

Israr

It is a difficult and controversial subject indeed. To refer to Friko’s comment – I am in agreement with her in that everyone has the right to take their own life, it is when that
person is unable to do this themselves and requires the assistance of others – then the water becomes muddied. It is an unenviable position to be placed in.

Anna :o]

HyperCRYPTICal said...

Dominic

You are correct in that it is everyone’s right to die with dignity and I would hope that all in the process of dying do so free from pain, dignity intact – but I know this is not so.

Dignity means many different things to different people and my fathers’ death lacked dignity, it was not his untreated pain (until his last day), not the nausea, not the vomiting, but the fact that part of his clothing was ‘missing’ to aid personal hygiene – this loss of dignity caused him more emotional pain and distress than his physical pain ever could. (The reason for this loss of dignity would not happen today).

However the issue here is of assisted death and I accept that the Liverpool Care Pathway is in a sense assisted death in that – when used appropriately – its aim is to alleviate pain and distress to those in the process of dying. But it is not always used appropriately.

My great concern is that if and when assisted dying becomes enshrined in law, the slippery slope will lead us to that of the Netherlands where “the expansion of euthanasia and assisted suicide has been constant and deliberate.”

It is true that “whatever the law states there will be cases which make one think it should be different.” Sadly this would also apply if assisted dying became enshrined in law and was used inappropriately. I read on one blog – I can’t remember which – something on the lines of “We have done away with the death penalty to ensure we don’t kill one innocent man – yet we are prepared to consider assisted dying/euthanasia….”

Anna :o]

HyperCRYPTICal said...

Dr Phil

The post re Prof Hawking is very relevant indeed and as said – I found much wise words on CMC. Will reread your new post in a mo’!

Anna :o]

HyperCRYPTICal said...

Friko

I too have heard and took part in those conversations you speak of – and not purely with the elderly. Indeed I had this conversation with my mother who requested that should she ever dement – I should tell her so she “could do things” with her insulin. However when the time came, I didn’t and couldn’t. How could I tell her that despite enjoying her life then, there were obvious (to me) memory deficits and that she was slowly walking down the path she dreaded? If I had told her – would she have done the deed – knowing and loving her as I did - I tend to think not. I do not feel guilty that I didn’t and would certainly have felt guilty if I had as the rest of her days (before dementia really took hold) would have been filled with sheer terror.

I do agree with you that everyone has the right to take their own life and indeed suicide is no longer illegal and it is a decision we must make ourselves and not be ‘assisted’ by others. There are many mean b******s out there that would happily push depressed souls over the brink and this worries me about assisted dying.

I have known one bridge jumper and I still think of him twenty years on and wonder if he changed his mind after that desperate moment he leapt – but if he did it was then too late and that again worries me about assisted dying – once a decision was made to end life would some folk feel unable to back out of it, even if they had changed their mind? Were they coerced in the first place? The questions go on and on.

It is true that hospices are few and far between and I would agree that a hospital is often a lonely, remote place in which to die and that palliative care within the patients own home is often patchy and fragmented and in some cases, almost non-existent.

At present there is no easy answer and it appears to me that the NHS is spending millions creating wonderful ideals around “a good death” and websites on which to promote these wonderful ideals - which is meaningless if the money isn’t there to provide sufficient nurses on the wards and in the community to carry out this care. Why not use the funds on patient care instead of website and the self-promoting, self-satisfying do-gooders who spout the “good death”? Rant, rant!

Sorry this became a rant Friko – but I do believe we are been softened up by those who wish assisted suicide to become legal – I really believe we are!

Anna :o]

Anonymous said...
This comment has been removed by a blog administrator.
HyperCRYPTICal said...

This was a test by me re a problem highlighted!

(Not in the habit of deleting comments unless the rare 'mucky' spam breaks through!)

Anna :o]

Isabel Doyle said...

If we were angels and not humans, there would be no cause for worry - Oh and we'd probably be immortal too - but we are human, we are not infallible and we are not above every immoral emotion either.

What you write about the Netherlands is frightening. A friend had a baby there about 7 years ago, who was sadly born with mild spina bifida. His parents had to BEG the hospital not to euthanise him, and in the end, the decision was made to allow him to live - by a committee.

yes, there needs to be some way to help those who truly wish to die and are not capable of taking action themselves, but I am not sure we know how to manage this at all.

Great post Anna

Jenny Woolf said...

Tremendously difficult of course. In theory, things may seem simple. In practice, less so. But actually I feel that it is a logical extension of giving patients rights to their own lives and health and care, to allow them assisted suicide also.

The problem comes when there are unscrupulous relatives who want to inherit - or desperate carers who can take no more.

On balance I am in favour, with tremendous safeguards. And my instinct tells me that it should never be the solution to emotional problems. A sensible decision is not possible when one is emotionally distraught.

Dave King said...

I very much go along with the broader definition of suffering. For me this is one of those subjects for which I have to be alone and away from arguments to really understand what I think.

HyperCRYPTICal said...

Isabel

When writing the above I was aware that those as young as twelve could elect termination (with parental permission) and vaguely aware of termination of newborns – your comment has made me research further – hence the new post.

I accept that there exists a dilemma in that those who decide to take their own life (as in suicide) are able to and those that wish to – but physically cannot – can’t receive the ‘assistance’ they require – legally.

It would require a truly just and moral individual to assist in these circumstances – whether inside or outside the law – and unfortunately not many of these individuals exist - for as humans we are easy swayed by others emotions and it is possible that we would relent to a persons wishes rather than offer time, conversation and importantly understanding of the persons predicament, and perhaps make them aware of other avenues.

Put simply we have all done things on the spur of the moment that we later regret.

Anna :o]

HyperCRYPTICal said...

Jenny

It is difficult and as said I do know that some experience unimaginable pain on a too slow road to death – where death is a certain outcome and alleviating this pain via the LCP is admirable, however I am also aware that the slippery slope exists in the sometimes all too soon or inappropriate initiation of the LCP.

With assisted suicide indeed a problem does exist if this decision is due to coercion or indeed the patients desire to relieve the ‘suffering’ of carers. How can we truly know if a person was coerced or altruistically inspired into making their decision?

And you are right – assisted suicide is not an answer to emotional problems or indeed those others listed in the broader terms of the June 2011 position paper – for you have to ask who is requesting these broader terms?

Anna :o]

HyperCRYPTICal said...

Dave

Erm, the broader definitions cause me great concern in that all natural human emotions appear to be encompassed within. Are we that useless as fellow humans that we cannot assist in other ways rather than assisting death?

It is true that life is not pleasant for all and it is also true that parasuicide is motivated by a desire to draw attention rather than a genuine wish to die. Sometimes we just need people to listen to us and I accept that some of us are not good at this.

Maybe we should be looking our ability/inability to communicate rather than accepting death as the only other alternative?

Anna :o]

MorningAJ said...

I feel deeply sad that some people who are facing an inevitable slow and painful death and feel the need to end their lives, currently have to 'go' early because they have to travel abroad before they're too ill to fly.

I believe absolutely that people should have the right to die when they want and the inability to do it for themselves shouldn't be a hindrance to them.

I suppose that'll make me unpopular in some quarters.

HyperCRYPTICal said...

MorningAJ

Your opinion is as valid as mine and you have every right to it and I do not see that it will make you unpopular (in some quarters).

It is true that dying is sometimes slow and painful and death cannot come soon enough, and I do not have any answers here. However after researching assisted dying in the Netherlands where unbearable suffering – as detailed in the original act – has now grown to encompass all social ills – I am concerned that life will become cheap and that some will consider death to alleviate the ‘suffering’ of carers and not their own.

Anna :o]

Anonymous said...

terry pratchet and lord falconer, are bursting there sides to bring in assisted euthanasia, or is it suicide but they already know it is already implemented with the liverpool so called care pathway, its a guilty way to try to hide the facts that back door euthanasia is taking place, they are helping this murderous government to blanket the immoral, starvation, dehydration, and syringe driven to death, to save money and bed blocking for them, if anyone was and looks like a cowboy pratchet does it stinks high heavens, fat falconer should be given the care dignity and gold standards, and fitted up with a priest or vicar to help him on his way to hell. and nobody would have a care in the world about him.