A Difficult Subject

Make no mistake about it………..Assisted dying is a difficult subject.

Indeed, as I have talked to people and listened to their thoughts and arguments, I have been constantly both amazed and frustrated by their misconceptions on the subject.  Many talk as though they believe those proposing a change to the law wish to make it compulsory, when actually the whole point is to provide a freedom of choice.  Others believe that if the law is changed, the government will stop spending on palliative care.  All evidence points to the opposite.

There are big issues about safeguarding people from malicious intent, usually from relatives, sometimes protecting people from themselves.  There are issues of morality and spirituality and there many issues which can only be described as smokescreens for people’s resistance to change.

Let me highlight a few that seem to me to be at the crux of the argument.

The most difficult and complex one is, I think, mental illness and more specifically depression.  In all the countries where some sort of assisted dying or euthanasia is permitted people must be mentally competent to make a decision.  Nobody I know of has a difficulty with that principal.  We are not talking about eugenics here.  However, let me cite two examples where reality gets more complicated

Firstly,  you make an advance decision…a living will and you say, if I ever loose my marbles and my body starts to pack up, I don’t want to continue.  Give me the injection!  You are entitled to make that statement of principal, advance decisions are legally enforceable, but when it gets to the specific circumstances, I can guarantee there will be arguments about whether it was this specific circumstance you had in mind.   So that’s one difficulty

And then there is depression.  The law presumes you are mentally competent unless somebody can prove otherwise and says just because you make an unwise decision you shouldn’t be considered incompetent.  But depression is a mental illness and it can be clinically defined.  But you know it really is quite understandable that people are going to feel depressed about coming to the end of their lives.  What has been termed appropriate sadness.  So somewhere in all that is a rather vague line on people’s mental competence.

Incidentally there is something new that is emerging called existential suffering.  Many in the medical profession are not aware of this. It’s the sort of spiritual distress that can occur as one confronts issues of existence such as living with the prospect of death, progressive disease, and greatly reduced independence.

So that’s mental illness, then there is the issue of feeling a burden.  Well, assuming you are not mentally ill, I would say that it could be a logical conclusion that you may draw about the value of your life, you may disagree………that’s what we are here to discuss.

There also the issue of suffering.  Now I’m not talking about pain here.  Pain can be managed in most cases, with the right skills from the medical profession.  No this about dignity and mental anguish.

Dignity I’ve found is something that the medical profession do struggle with.  They’re more used to dealing with indignities than joe public and it has to be said rarely are they on the receiving end.  Many people would say that if you go to hospital you’d better leave your dignity at the door. Well, I guess we are usually prepared to accept indignity if it’s short term and will lead to a better life.  But, we all have a personal idea of what is and is not acceptable here and when that indignity or indeed indignities are likely to continue forever, are not people entitled to say, Sorry I’m not prepared to put up with this any longer?

You may or may not be aware that there is Draft bill to change the law now under public consultation and this Bill has basically taken the recommendations of the Falconer Commission by proposing that mentally competent, terminally ill patients with less than 12 months to live are granted the right to an assisted death.  For me this is the true battleground of the debate and I guess it will be for the majority of the British population.

You may recall that 82% of the British population, or more correctly 82% of those who took part in the British Social Attitudes survey agreed when they were asked:

“Suppose a person has a painful incurable disease.  Do you think that doctors should be allowed by law to end the patient’s life, if the patient requests it”

You will notice that question talked a painful incurable disease, not a terminal disease, but other surveys that have sought to differentiate between incurable and terminal appear to have shown that terminal illness has more support that just incurable.

I would have thought, in fact I do think that those who need most help are not those where the end is in sight, but those condemned to intolerable suffering, progressive deterioration and an unending future.

Medical science is constantly improving and, as I said, pain control is getting better, so in many ways pain is not the issue here. It is the spiritual torment that comes from a recognition that your contribution to life is coming to an end and you only have to look forward to more indignity and the fear of being trapped in a body, unable to communicate with the outside world.

My personal view is that death is a spiritual thing.  True the medical profession retain a curiosity in the cause of death, and the process of dying is a medical issue but only when it happens slowly.  When it happens quickly through accident or something like a heart attack, medicine plays no part.

A while ago a friend of ours was sat at his usual place in the pub enjoying his beer and then suddenly he keeled over and died, he was gone and everybody said “What a wonderful way to go” no pain no mental anguish enjoying life to bitter end, if you excuse the pun. ………Funny isn’t it? We all recognise that as a good way of dying

And when those who have had to suffer interminably finally do come to the end of their lives, we say What a merciful release, I’m glad they are at peace now.  So the quality of life and death is important and there is in our minds a gift of death as much as there is a gift of life.

You may remember that passage from Matthew’s gospel where Jesus says that ‘he who lives by the sword dies by the sword’

It’s as though the way we die reflects the way we have lived; in conflict…..in pain…………in peace…with family and friends…or…all alone…….loved or unloved…with dignity….out of control.

The debate continues

There has to be a way of allowing individuals to have a humane death instead of enforcing human life at all costs. We seem to have become a society unable to deal with death leaving those who suffer extreme pain, anguish, distress, and no prospect of any improvement a miserable life and a miserable death. There is a time to live and a time to die and yet we can’t accept that or that the person experiencing this distress may be in the best position to know when it is their time to die. The Forum on the Unitarian Internet Fellowship (NUF) has been discussing this issue for some while and there is a poll included there. We are also including items on this issue in the NUF Newsletter and hope that more members will register on the Forum, add their thoughts and eventually take part in the poll. Framing new laws is, I recognise, complex. That Unitarians have been given a year to address the issue seems only right. I can’t be alone in appreciating the opportunity we are having to learn more from those, who have experienced the sensitive, complex and traumatic issues first hand, either as a loved one has died or as a hospice or health-care provider.

Joan

Tony Nicklinson – An alternative view

THIS POST HAS BEEN INCLUDED WITH SOME RESERVATION AS IT IS UNCERTAIN THAT IT COMES FROM A UNITARIAN SOURCE.  HOWEVER, THIS IS A DEBATE WHERE ALL ARE ENTITLED TO THEIR VIEW.

He died of pneumonia in a matter of days after refusing food. Why is that a slow and lingering death? There are plenty of old people who die from pneumonia contracted when in a weakened state. This is normal for many elderly patients. It is normal to take several days to die. He was an atheist of the evangelical God hating kind, and so were his family. His euthanasia campaign was directed against what he incorrectly saw as a religiously based legal code making euthanasia illegal. But the law against euthanasia is secular.

Arkletten

Terminally Ill or just a non-life threatening disease?

The Falconer Commission and the new Draft Bill (which is based on the Falconer Commission report) propose that only people who are terminally ill with a life expectancy of less than 12 months should be eligible for assisted suicide.  Is this adequate safeguarding or failing to help those most in need?

Of the places where assisted suicide or euthanasia is legal, only Oregon and Washington limit the law to terminally ill people.

Other than the practicality of it being easier to move the law forward by a small amount rather than a large one, what is the value of putting such a limitation on the change?

The medical profession recognizes that putting a timescale on the prognosis is at best an inexact science, though they cannot agree whether doctors tend to be optimistic or pessimistic.  It is clear that one of the tests before acceptance, and therefore a safeguard, is a settled intention .  That principal is accepted everywhere, recognizing that people have changes of mind especially under stressful conditions.  Those whose life expectancy at the time of any request is 3 months or less are unlikely to benefit because it will take that long to get the green light.

It seems the people most likely to benefit from being allowed to have an assisted suicide are those with long term prognosis of continued degradation in the quality of their life and no hope of improvement, whether their condition is considered life threatening or not.

Sometimes the benefit will be the knowledge that they can choose the time to bring their life to an end.  Evidence from Oregon shows that many who have been given the option do not, in the end, use it.  Others, we know, have gone Switzerland whilst they could still travel rather than wait a little longer.

There are conditions like motor neurone disease, multiple sclerosis and ‘locked in’ syndrome that are not in themselves ‘life threatening’ and yet the quality of life in the later stages is so abysmal that some would say these are the people who most need our help.

So,

 Does the restriction to limit any change to terminally ill people have any real value other than reducing the number of people eligible?  ……………….Probably not

Does the restriction provide help to those in most need?………………………….Probably not!

Tony Nicklinson – again

‘I was saddened to learn today of the passing of Tony Nicklinson, the brave campaigner for the right to die. The sadness many of us feel is surely mingled with strong indignation that a man suffering such anguish and who considered himself condemned by the law to ‘increasing indignity and misery’ should have been forced to die in this way? You may recall that after he lost the case in the High Court and so was denied the right to die with dignity as he and his family wished  he was seen sobbing in his wheelchair and his wife described him as ‘devastated and heartbroken’

As Tony correctly argued, it was a clear case of either respecting the autonomy of an individual who, being left unable to speak and move, considered his existence as ‘pure torture’ or following the cold legal precedents of three judges who did not have the endure the anguish and suffering to which they were condemning him.

Instead of having his clearly expressed wishes respected  Tony felt his only option was to  refuse food and medical treatment. This case surely must impel us to redouble our efforts to secure a change in the law to allow autonomous individuals suffering such unendurable pain and mental distress to die with dignity at a time and in a manner of their own choosing? In a civilised and compassionate society that day cannot come too soon.’ 

Feargus

A comment from the Maranatha Community

The Maranatha Community is a UK based Christian community

To tolerate assisted suicide under certain conditions or legalise euthanasia would bring about  profound changes in social attitudes to illness, disability, death, old age and the role of the medical profession.

The Common Good

Would not human life be degraded by changing the law to allow doctors to take the lives of people just because, at a moment in time, they didn’t want to live?  Surely there is something beyond personal autonomy that we might call the ‘common good’.

If you accept the principal that others are affected directly or indirectly by your own actions, then you must conclude no decision is should ever be taken in isolation and that those affected, immediately (such as family and friends) or in the long term (society as a whole) must be considered.

Perhaps we owe it to society not to devalue the sanctity of life by allowing people  to  think of themselves in isolation.

More on Tony Nicklinson

I feel this debate has to be read in conjunction with the ongoing case in court of patient ‘L’, whose family are asking for him to be kept alive but doctors are saying he should be allowed to die because his prospects of useful life are negligible. Presumably they will let him starve to death as they cannot intentionally take his life. The outcome of this judgement will be heartbreak for a family.
Compare this with the Tony Nicklinson case. He was conscious but his body was in a vegetative state. He asked to be allowed to die under medical supervision because his prospects of a useful life were negligible. This request was denied through the court but the decision was in favour of the doctors. Tony died – it is said of heartbreak at this decision.
It makes me wonder at what stage in a person’s condition do doctors feel they have the right to stop treating a person and allow them to die when further treatment is denied – tho usually means fluid and nourishment.
It also makes me wonder at what stage in a person’s condition do they prevent death by treating them. This is specially pertinent in palliative care.
End of life treatment and assisted dying are two issues that need a full and detailed debate. It is not enough for the medical profession to hide behind an argument that they are obliged to save life – simply because they often do not.
The medical profession should be at the forefront of the debate. They say it is for parliament to decide such things but really parliament should frame the laws based on discussion by all interested parties.
Much of the public heartache we now see is the consequence of what I think is an ostrich like approach taken by the BMA. Surely they should be offering draft recommendations to guide the debate.

Tony

Tony Nicklinson – more comment

I know it was unlikely that Tony Nicklinson would ever won his case to get doctors to help him die because this is too far a step from the existing law for judges to take, whether they wanted to or not.  But I hope those who argue against any change will feel very uncomfortable tonight.

Tony’s death highlights to compassionate people everywhere how difficult it is to deny the right, to those who suffer intolerably, to make their decision about the manner and timing of their death.

Medical Science could not find the answer to Tony’s problem and yet allowed him to suffer. I found it refreshing that his family was proud of his decision and though obviously upset it had happened, understood and supported his cause.

This matter is now being brought to a head and there will have to be a response from Parliament.  I only hope MPs  will not be fudge the issue in pretence that safeguarding people from others and themselves is too difficult to achieve. Surely  it is neither moral nor compassionate to condemn people like Tony Nicklinson to the sort of death he has just suffered.

Tony Nicklinson

Tony Nicklinson has now died having been committed to a slow and lingering suicide – thanks to the pomposity of some who seem to think they can judge on behalf of the human race (or at least those who are unfortunately living in the UK) on what is a human’s rights These very same people who have not fully experienced and thus understood  the conditions of Tony being locked into his own body unable to wipe the dribble off his face or wipe his own bottom claiming the prerogative of what is best.

A few years ago people were horrified when women had abortions –the pious claiming the gift of life. Now people can see that the gift of life is not always such a blessing and abortions though, conceding that some religious refute this – are, in general, accepted.

Death is part of life’s process. It can not be avoided or eliminated – no matter who you are.

Tony Nicklinson had a stroke. A hundred years ago he would have probably died. Medicine has improved beyond recognition. For the most part this is wonderful and gives many a new lease of life. But to others it is a life sentence of unbearable suffering and distress.

Tony’s crime was to be unable to move and consequently unable to administer for himself the lethal dose required to relieve him from his suffering.

Is this justice?

Legislation should be able to say that in these circumstances then the victim (and this is the only way I perceive him), should be able to nod his head, give a wink, or whatever he is capable of doing in assent for someone else to press the ‘trigger”.

If he was my loved one, I would consider it an honour.

Susie