h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

Other than by suicide, is it a human right to choose when to die? Should it be? Should that right be enshrined in law? Is it showing compassion, or is it the easy way out when life doesn't meet up to the rosy picture painted by the entertainment media? Is it showing us that as a society we can't deal with life's unpleasantnesses any more and would rather run away from them?

I'm not entirely sure than what you mean than 'other than by suicide', as surely baring the scmantics killing yourself is suicide by any other name?
A very, very, complicated morral issue, as able bodied people are able to comitt suicide, weather it be illegal or not, does this mean that individuals human rights are being infringed when those unable to comitt suicide unaided, are denied the right to 'assisted suicide'?
Does the 'protection', of the vunnerable, E.G., those with mental illness, provide a sufficient reason to deny the 'right' to kill onself for everyone else?
I'm not coming up with many/any answers here...

Well, tnat post came out in something of a rush and may be a little unclear.

Suicide isn't a legal issue any more - it's no longer against the law to take your own life (the moral and religious/spiritual issues around suicide are a whole nother argument).

Medical advances have made it possible to prolong lives and save lives which years ago would not have survived illnesses and trauma. I'm trying to find where one should draw the line between being able to take one's own life - suicide (which I personally think is wrong), and asking others to do it for you, either actively by administering a drug, or passively by removing a feeding tube or refusing treatment.

Do we really know enough about life to be able to tailor the time of its ending? Should we? Is it an admission of society's inability to help everyone who needs help?

I take it this was prompted by the woman in Florida whose feeding tube was removed, then reinserted?

I personally don't think that simply removing a feeding tube and starving them to death should be considered a legal means of ending someone's life. In the particular case of the woman in Florida, *supposedly* she didn't want to be kept in a persistent vegitative state. However, from what I've seen on the news, she does not appear to be vegitative, persistent or not. She is able to respond, although not in any *normal* way, with speech or appropriate body movements, but just looking at the short video of her, she is able to move her head slightly, her face had light in it when her parent (was it her mother?) was near, and although I certainly wouldn't say that she had a , there was a slight curl to her mouth such as if she was attempting to smile. She may not be leading the life she wanted to live, but I would hardly call that a vegetative state.

In addition, I don't think she had a living will which declared her desire to *not* have her life sustained by any artificial means. (I suppose I should research it to find out for sure) I think all we have is her husband's *claim* that she wouldn't want to live like this... a husband who is involved with another woman, from what I've heard. And wouldn't it be *convenient* for him if he was able to absolve himself of all guilt about his wife's death and move on to a life (marriage?) with this other woman, by saying the courts ordered his wife's feeding tube removed?

For that matter, how exactly do we define "artificial life support"? There are instances where inserting a feeding tube could not be construed to be an artificial means of sustaining life, but merely a way to provide nourishment while the body goes about healing itself.

What about breathing tubes? Could those be seen as artificial life support? Yes... and no. There are many fairly routine surgeries that require the patient to have a breathing tube at least during the surgery, and sometimes for hours or days afterwards. If there are complications, the same breathing tube that was used for surgery and recovery may become necessary for life support... and yet the patient still may very well recover and lead a normal life.

The clearest answer seems to me that if you're essentially using heroic techinques to sustain someone who would die within hours, simply for the sake of prolonging their life, then it's artificial life support, and in that case I agree that we have too much medical knowlege and are essentially able to keep a corpse breathing by pumping air in and out of it's lungs, and continually stimulate the heart to continue beating until the brain itself dies.

Of course that all depends on when you consider death to occur, too. There was a time when we would could only check breathing and heartbeat to confirm life or death, but now we know that the brain could still be alive. We know too much.

Even so, in the absense of breathing and a heartbeat, the brain will also die within a matter of minutes. Just wait until someone figures out how to continually stimulate the brain and provide oxygen to it artificially, bypassing the lungs and heart. The definition of when death officially occurs will become even more clouded.

Does anyone remember Diane Pretty?

http://news.bbc.co.uk/2/hi/health/1983457.stm

It's partly inspired by the Florida case and other cases such as Diane Pretty, but what prodded me into writing that first post was a piece on NPR this morning about a man who suffered severe burns and who begged doctors to allow him to die by not treating him. Of course, they refused. There was more to the story - something about a change in the law, but I was in the process of getting up and doing all that morning stuff like having a shower, so I didn't catch all of it. It may have been a local story and therefore wouldn't be archived at npr.org

I hadn't heard of the Prettys before and have never heard of her particular condition before, and yet from the way that article describes it, doesn't sound to me like she was suffering more than someone dying from pneumonia, probably less than someone dying from emphysema or congestive heart failure. Seriously, her biggest fear was coughing and asfixiation? And she was already in a coma for a few days before she died? I'm sorry, the article wasn't very clear about *when* the coughing and asfixiation occurs, whether it was a gradually progressive thing that eventually led to the coma, but if it was not until after she became comatose, she could hardly have been very aware of it (and yes I do realize that there is evidence that coma victims seem to have some kind of subconsious awareness of things that go on around them).

Regarding the burn victim, most people with severe burns *do* wish they could die, because the treatment is just so incredibly painful, must be continued daily for as long as it takes the burns to heal, and is like being sentenced to a daily torture ritual.

Some do die from their burns, but if they make it past the first few days (it may be some arbitrary amount of time, like 48 or 72 hours, I don't know), chances are that unless the burns become severely infected, with proper treatment they can survive, recover and live a relatively normal life. Of course, proper treatment helps not only prevent infection but also lessens scarring, too.

Perhaps we should be asking a different question - Are we wimps who can't handle the idea of personally going through any kind of suffering? Is this what modern medicine has done to us?

~~Here, take this pain pill, you won't feel a thing.

~~Those labor contractions starting to bother you? We'll get the epidural ready so you won't feel a thing.

How many of us reach for a bottle of tylenol/aspirin/ibuprofrin at the first twinge of a headache? What about insisting on being *totally* numb before having a tooth filled? And make sure they rub plenty of topical anesethetic on the spot where the novacaine will be injected, too, so that we can't even feel that.

So now we want the last moments of life to be totally pain free, when countless generations before us managed to brave whatever pain preceeded death?

I'm not uncaring about pain and suffering, and I wouldn't want to go back to a world where the only anesthetic available was a bottle of whiskey, and "here bite this bullet and hold still while we amputate your leg". It just seems like we've come to expect even the most excrutiating moments of life to be completely pain free, and it's just not going to happen in all circumstances.

Pneumonia?!

Lady Scott, the issue was not so much about how Diane Pretty died, but what kind of quality of life she had left to look forward to. Paralyzed from the neck and down, difficulties speaking, chewing and swallowing and - in the end - breathing - you can't compare that with someone with pneumonia!

We had the Nancy Cruzan case here. She lived in a town whose city limits run into ours. She was a close friend of my cousin, so we were all interested in the outcome.

A sad note is that her father hanged himself a few years after the court allowed them to remove her feeding tube.

A book has ben written about her case. It is called "The Long Goodbye: The Deaths of Nancy Cruzan"
http://hospicesect.org/library/docs/longgoodbye.doc
http://www.saintmarys.edu/~incandel/PP/240/Class21/index.htm
http://www.help4srs.com/health/n-cruzan.htm

I think that the quality of life issue is important. The woman in Florida has been in a coma for 13 years. And as we learned with Nancy, things that appear to be responses to outside stimuli actually aren't. I think that considering the length of time she has been in a vegetative state, it is unkind to criticize her husband for wanting to go on with his life. She will never recover. So the feeding tube isn't a measure being used while her body heals. It is an extraordinary measure used to prolong life.

In my opinion - go ahead and throw at me - allowing the woman to die would be an act of compassion.

Okay, the Florida woman has *not* been in a coma. She *has* been in a persistent vegetative state (PVS).

Being in a PVS does not mean that your can't move or react to stimuli. It solely means that you have lost all higher order brain function -- i.e., the ability to think. You can destroy the parts of the brain that are involved in thinking, and leave everything else intact, and the person is still theoretically capable of remaining alive for decades if cared for. Some people in a PVS don't even require feeding tubes, although most do, from what I remember. But a person in a PVS can still have the automatic, reflex responses to light, sound, and pain -- these things are generally absent in a coma (although it's worth noting that while PVS has a clear dichotomous definition, "coma" is a much vaguer term).

"Perhaps we should be asking a different question - Are we wimps who can't handle the idea of personally going through any kind of suffering? Is this what modern medicine has done to us?

....

It just seems like we've come to expect even the most excrutiating moments of life to be completely pain free, and it's just not going to happen in all circumstances."

I think you've hit the nail on the head Lady Scott. Not only do we have expectations of a perfect life, but we also seem to have expectations of control over all aspects of life and what nature might want to do with it.

Hubris.

I agree that people tend to have high expectations these days. Yes, sometimes people will say they want to die when really they mean they want the pain (or whatever) to stop. It isn't always possible for people to be clear headed & think ahead. In the burns case, I don't know enough of the details - I agree that the doctors should do their best to treat them - but perhaps the victim was going to be horribly disfigured & disabled & would prefer not to live like that. I recall the case of a policeman who became wheelchair bound after being shot & eventually committed suicide, being unable to come to terms with his disablement. Surely that choice was his right to make?

The problem is with patients who are unable to commit suicide unassisted and I would like to see some way of making this legally possible. The difficulty is all the safeguards needed to avoid patients feeling pressurised into it if they feel they are a burden on their carers.

Please forgive me Titania - As I was attempting to make very clear in my last post, I had never even heard of the disease before, and admittedly didn't do any research on it before I posted that. The only information I had to go by was what the linked article said about her condition, and the only thing it mentioned was the choking and asphixiation. They neglected to mention the other problems associated with it, apparently assuming that anyone who lived in the UK would be familiar with not only her story, but how the multitude of problems associated with the disease would affect her quality of life.

I've had pneumonia and yes, the coughing got to the point where I was choking many times during those months, so I could see that if it became worse, I wouldn't be able to breathe at all. I didn't make the comparison lightly, but given the sketchy amount of information in the article, the comparison seemed valid at the time.

From now on, I'll just refrain from saying anything about cases that I haven't heard of in great detail.

I think that if a person is able to make the descision to die consistantly over a period of time in a clear state of mind it should be allowed.
I think that if a person is unable to react to the world around them and has no chance of recovery then they may as well be dead - why prolong it?
I think that if a situation is curable then a person should persevere - but it is their right to choose not to.
I think that making it legal to remove treatment causing death but illegal to take life is hypocritical - the powers that be should make their mind up one way of the other.
I think that nobody can know the answer to this question they can only know what they as an individual think.

Sorry if I over-reacted Lady Scott, but there were links from that article to other articles, including one describing the disease in more detail.

I don't live in the UK, but I followed the case with interest. I might be a bit touchy since my father died in a similar way, from a disease called ALS.

(I know I don't have to any more with all these new fangled "new posts" thingummies but I just like to)

Two things concern me about the possible impliementation of euphasia, if it did come to practice I'd probably be one of the people who had to actually kill someone doing it. And I'm not sure that I'd be comfortable doing it.

Firstly we don't know how we'd actually react if we were in a terminal situtation, we don't know what we'd feel like until we are there. A consultant in elderly care once told me that when he began training in terminal care he assumed that he was in favour of euphanasia, but when he meet the people who were terminally ill, and talked to them about it, most of them told him that their persecpective on life had changed, they too, when they were healthy had thought that they would want to die if they were in their current situation, however when they were in this situation, most of them felt differently about it.

When people first find out that they have a disability they go through a phase in which things seem very bad, and they may want to die then. However as they go on, they come to terms with the sitatuation and learn ways of coping with their new situation. If we allowed people to ask for euphansia, in the first pharse then many people may kill themselves when they would learn to live with it,. Wouldn't that be a tragic waste?

A nurse in the terminal care of patients dieing of cancer, explained that nearly all of the patients who her for euphansia have problems that can be solved.

Withdrawing treatment is amazingly different from killing someone, withdrawing treatment is the right descion to make when the drawbacks of a treatment outweight the side effects. You can reverse that descion if it is regretted or if things work out differently clinically that you expected. (Ok with the exception of turning of a ventilator when someone is brain dead - but then they are already dead)

Elderly people may feel pressurised into making the decison to die, when they are simpley worried about being a burden on their family, or relatives may worry about the amount of money that their care will drain from the inhetritence.

One of my grandmothers friends was seriously ill, and her son was informed that she might not survive the night, he informed the nurses that her wishes were not to be kept alive, and could they perform euphanisa. They didn't, and she made a recovary - she had never expressed such a wish, but she remembered that her life insurance policy hadn't been paid recently and was due to expire the next week. If she had died the son would have benifited financially.

What I'm saying is that in many cases families stand to gain from the death, they are not always close, so they may not be able to make a descion for their realatives.

That was more than two reasons wasn't it?

I just think that we should provide better care for people who are elderly, or terminally ill, concentrate on making their last days bearable, rather than killing them.

I am not talking about killing people - just letting them kill themselves, I was offered an assistant to type for me as I dictated during my A-levels because some of my teachers were unconvinced of my ability to type (pah) My point is that if I can get help typing why can't I get help to commit suicide - neither are illegal acts (Though attempted suicide used to be punishable by death)

I did say in my origional post that the decision needs to be made over an extended period of time. Everyone has bad days some people have adjustment phases that could affect them for weeks or even months. But if someone says that they want to die every day for over a month and never contradicts themself then it seems unlikely that they are going to change their mind.

Pressure by the family is much more worrying. Wishing death upon another family member is such an alien concept I have trouble thinking about it...not sure...

But if you need help to commit suicide, then the person helping you is in current legal terms killing you. Or are you talking about not stopping people e.g. not stomach pumping?

On a slightly different tack, there can also be a lot of pressure on people not to commit suicide. It can be considered a very selfish act unless you are totally without friends, close relatives or other responsibilities. Difficult perhaps to stand back & let a loved one go.
On the other hand, we don't know of anyone who regrets committing suicide do we?

I agree that improving paliative care and so on is important for those who want to live as long as possible. But we should not make people feel guilty who choose not to live in suffering (mental or physical).

"On the other hand, we don't know of anyone who regrets committing suicide do we?"

True, but there are many people who have tried and failed to commit suicide, and who were subsequently glad they didn't get it right.