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

A couple who were ill but not terminally ill took themselves off to Switzerland recently where they were assisted in committing suicide.

(I confess that one of the questions I asked about this was 'did they get single tickets, and did they need visas?' but that is a flippancy and a distraction).

In Oregon (I think - or is it Montana) it is legal for a doctor to prescribe lethal amounts of drugs which can then be self-administered by terminally ill people. This being the States, the supporters of the death-penalty are up in arms about people commiting suicide.

Given the unpleasantness and pain which surrounds the final stages of most terminal illnesses, what is your view on euthanasia and assisted suicide.

Is it something which is too risky to permit, or the only sane response of a civilised society to over-medicalisation?

Ben

I'm personally strongly in favour of euthanasia. If someone is in pain and wants to die then it is immoral to cause them to suffer against their will based on (in my opinion) the superstitious belief that there is a God who actually "owns" their life and is refusing to let go of it until some "correct time".

As for "assisted suicides", I'm less keen. People can be in a situation where they are not terminally ill but want to die, but I don't think it's the right thing to do to allow them to end their life.

Why not?

As medicine gets better and better at keeping people alive, even if they are in great pain, surely it is more important to give people the power to kill themselves. I have just been reading 'Small Gods' by Terry Pratchett, which features the Quisition - who keep people alive for days for the good of their souls... Isn't your argument perilously close to that?

I could kill myself this evening if I wanted to, because I have the physical capability and resources to do so.

But if I couldn't, would it be right that I should be forced to live through pain, simply because I couldn't actually kill myself?

Ben

I should point out that my objection is not to Euthanaisa - killing those in pain, but to helping people commit Suicide - killing those in temporary angst.

Sometimes people, who are not in terminal pain, feel like they want to die, later they might change their mind. We shouldn't help those people die, we should make them relalise that they have friends and make them want to keep living .

Zag

I was once told by a consultant that no cancer patient need be in any sort of pain these days, as pain medication is very advanced in that field.

Look at if from the other side of the needle, I hope, (if I get one with some work and stop hootooing!) to be a in a couple of years. And I really don't think I would like to kill someone it goes against all the prinicpals of medicine. Yes if it was really sure that it was too end suffering, but I would never be sure that that was why they wanted to go, what if they were worried about nursing home fees or felt they were a burden on there family.

Also, and I know this is uncomfortable for many people but I'm not really sure that relatives are the most trustworthy people when it comes to making end of life descions. After all the chances are that they will be benifiting financially from the death of their loved one.

My Grandmother told me of one of her friends who had cancer, yet it was well controlled with pain relief and she still enjoyed her social life, was admitted to hosipital, whilst she was unconscious her son asked the doctor about euphansia, explaing that she was housebound and constantly in pain from cancer. The doctor told him that it would be illegal, and she regained consciuonsness and recovered well, when she got home she remembered that her life insurance had expired the week she was in hospital, had she died on the first day her son would have recieved several thousends of pounds.

Whenever anyone is diagnosed with a life limiting condition that means that they no longer can go on with the things that they enjoy doing, they feel depressed and useless. Then they begin to reasses their life, find other things that they enjoy and get used to it.. If people were allowed euphanaisa then many would request it inthe first stage, when if they went on living then they would get used to it.

I have met people who are bedbound who still do things they enjoy in life, still manage to be cheerful.

Also there's an issue of trust, would you really trust your doctor if he could legally kill you, yes there are legal safeguards, but would you trust someone you had never met not to fake your signature.

This issue with animals is different, many animals are destoryed because the owner doesn't want to burden the rspca, or can't afford the vets bills, ie for the benifit of people not animals.When we found out our cat had incurable illness the vet wanted to destory her even though she still had a good qualifty of life, she still chased ate will and didn't appear to be in any pain.

Many years ago I saw a documentary on BBC2 - mid seventies maybe. It concerned the case of an elderly woman in a nursing home. The nurses suspected that the woman's daughter was trying to persuade her to commit suicide. They had no proof though but contacted the police.

The police set up a hidden camera in the elderly woman's room and recorded during the daughter's visits. Some of what they filmed was shown in the documentary. You see and hear conversations between them in which the daughter explains to the mother that taking pills to end your life is what everybody does these days.

I found it rather chilling and it always comes to mind when the subject of euthanasia arises. It seems to me to be too short a step from allowing euthanasia to it becoming an expectation on the grounds that "everybody does it these days".

Beth

I really dislike hearing people (usualy in the "pro-life" brigade who have never hada days illness) say things like "they shouldn't be aloud to die until they have a chance to get used to a much lower quality of life".

I have had serious and debilitating health problems since 1992, and am still not "used to it". would you expect me to be kept alive indefinately even if the level of suffering increased to an unbearable level?

this is the fundamental question.

unless you can unconditionally answer yes, you are in favour of allowing an early death. the rest is just a question of how you ringfence it to prevent abuse (which already has to be done with "DNR" on hospital files).

I watched my parents die slow and painful deaths. They were miserable and praying for the end. D@mn straight I favor euthanasia!

I will happily admit that I have never had a days illness, and I aplogise for any offence I caused.

When I first started to do medicine I was pro euphansia, I am pro chocie on abortion, and anti death penalty, and a generally liberal sort, (I read the Guardian) and admire most laws in Holland.

Indeed when I first met people who had serious disbilities I often thought if I were them, I would want to commit sucide.

Would you deny that when someone becomes disabled, at first for some people, it seems that there life as they have known it is over, and they become depressed. Gradually they discover that there life is not one of misery, perhaps they take up new hobbies to replace ones that they no longer do.

This happened to my Grandfather, when he had to give up hillwalking due to hill health, gradually he discovered new hobbies, water colour painting, amougst others, and the inital depression has lifted.

Whilst this may not be true in your case it is true in a lot of cases.

Surely it could not be right to allow someone to be killed, in the intial few weeks after a diagnoses of serious illness, where things may seem worse than they are. Yes they may choose to kill themselves but the responsiblity of medical proffessionals should be to help them come to terms with their condition, to provide conselling, support groups, and someone to talk to.

I would aruge that withdrawal of treatment, such as DNR, is fundementally different from active euphaisia.

There comes a stage when providing a medical treatment may become futile, for instance if a person is terminally ill then providing resasutation may be pointless, as there is a very small chance that it would work, and even if a patient could resasutated,then it would not extend there life for more than a few days.

This is not activly killing someone. Of course there must be guidlines about the proper use of withdrawing treatment.

It is true that many, many people who have suddenly had the quality of their life "changed" for what many of us would think the worst find ways of making it worth living. In many cases they report that it is only since thir life changed they really began to appreciate life.

However, there are many others who don't manage this, so should we really sentence them to their miserable, possibly also painful life? I'm thinking specifically of Diane Pretty, who died a painful death in a way that she absolutely didn't want. I think part of her reasoning was that she didn't want her children to have to live through that.

I know that in her shoes, I would most likely make the same decision.

So I really believe that for people like her we have to clarify the rules on euthanasia to benefit them.

By the same token, it is perfectly reasonable for doctors and others to want to preserve life, it is after all our strongest instinct. And in cases where the person who is sick/ill has relatives or other outside influence pushing them to end their life, we have to ensure that they are protected.

And I'm not digging at you, Z, in fact it's not really a dig at all, but plenty of doctors I've encountered over the past few years are still patronising "we know best" and really really really can't accept that a patient (or the patient's family) know themselves or their relative better than the doctor does. I had the MMR discussion with my (German) doctor and he was so dismissive of my questions that I changed the practice. (just an examle - I've also found plenty of most excellent doctors, and am very happy with them)

And yes, there is a difference between someone who is really, genuinely tired of their life and wants to end it, and someone who is temporarily depressed. It's working out which is which that is the problem I would guess.

Rambling here...

I suppose I'm in favour of euthanasia (since if it's what I wanted I'd expect my family and phycisians to go along with my wishes) as long as we can protect the weak.

What is interesting about the approach in Oregon is that the drugs are prescribed ahead of time. Admitedly it seems that they are only prescribed in terminal cases, but I got the impression that suicide was discussed between the patient, the physician, and any other carers or relatives who they chose to involve in the discusssion. You might say that it was discussed as one of the care options, or one of the pain management options.

The patient is then given the prescription for the drugs which they are told how to use, and then it is up to them when and indeed if they use them. A significant number do not use them.

So the patient is given the option of a clean and painless suicide, they know exactly what form that death by suicide will take, and they are given as much control as possible in what must be the ultimately disempowering situation.

Ben

I don't come at this debate from the point of view of someone who is trying to imagine what it would be like to want to die and yet be unable to die...I can't talk about this subject except in from the context which I know will very likely effect me in a few (10, 20, 30, 5, 2, 1) years. My opinions are contradictory and I can feel myself already getting a little upset by the thought of this part of my future.

Euthanasia scares the hell out of me...I'm not morally opposed to it...in fact it is incredibly likely than in a few years time I will have to administer it.

My partner is disabled, he has a progressive condition that means he will gradually lose his balance (already gone), his coordination (gone from his legs going from his arms) and his feeling (although not his pain senses - that would be too easy, so far this hasn't got further than his big toes). It's an unusual condition that effects every person differently so it is impossible to predict how it will progress...but it doesn't do anything but progress.

Knowing this, and knowing him I am completely willing to end his life if it comes to a point where he feels he cannot benefit from living anymore (one benefit of a slow progressive illness means that we both have plenty of time to adapt to each new problem). I don't know when that point will be and nor does he so a living will would be pointless. He cannot get life insurance so I wont gain anything from his death. I am more than willing to face the legal consequences for this act.

And this is where the contradiction lies...no matter what I think about euthanasia morally...I think it should be illegal. I do not believe it can be legalised well, I think we would end up with a bad law which will legitimise abuse and murder. Euthanasia and assisted suicide in law will always come down to one person making a value judgement on another persons quality of life - I do not believe that can be legislated. I've also heard of the horror stories (mainly from my mum-in-law who work in home care) of elderly and vulnerable people being abused and manipulated by their carers, friends and relatives. One of the issues from this year comic relief was elder abuse (http://www.rednoseday.com/comicrelief/issues/elderabuse.shtml ) the stats on this frightened me - 1 in 10 older people victims of abuse, 1 in 20 abused by their relatives.

From where I stand I would be appalled if the law was changed to benefit me (and the people who assist in suicide are the people who would most benefit from a change in the law) and resulted in the deaths of vulnerable people...who are we trying to protect here? I don't want protection from the law, in fact I don't think I need it (I've not heard of a single case of someone being convicted for assisting in a legitimate suicide - even the widow of the man who became the first uk death tourist has been questioned and released and treated with utmost respect and dignity by the police http://news.bbc.co.uk/1/hi/england/merseyside/2933589.stm ).

So there it is - sorry it's a bit of a ramble...and I know that it doesn't make logical sense, it's too close to my heart to do that

Thank you for posting that Pencil Queen. I want to read it and re-read it. The issues closest to our hearts are often complex ones.

One of the priveleges of posting here on h2g2 is meeting people on-line who are willing to share their experiences with complete strangers so thoughtfully.

Ben

Pencil Queen, I've never thought of it like that before (the fact that you don't need protection but the vulnerable do)

I've read your post 3 times now, and I have to say I've changed my mind on this and I think the law is needed to protect the vulnerable more than to help those who want to die.



Thank you for sharing though, it is always helpful to get the view from the sharp end.

Should it be, then, to keep it technically illegal but decide on individual cases, in which the perpetrators of 'ideal' euthanasia would presumably be treated lightly? (which has occasionally happened.)

I doubt very much that it would become an undesirable, abusive pandemic if legalised. Certainly not because 'everyone's doing it.'

However I seem to have a fairly unpopular view of suicide. I view it in the same terms as 'embarrassing' things I did in the past- at the time, it was reasonable and I chose to do it freely. Context may have changed but I have to live with the consequences; hence I refuse to be embarrassed, ashamed or apologetic simply because my outlook was different.
I really do not consider suicide- however carried out- to be the 'ultimate in selfishness.' That is oversimplistic for one thing. If my outlook were *so* different that I couldn't see any possible improvement (note that would not mean there would *never* be one), 'looking on the bright side' is implausible. OK that does not have much to do with the subject, sorry. And I am all for help and support in favour of suicide; however I have heard some formerly suicidal people parrot how 'stupid and inconsiderate' it was, which makes me think only of alcoholism groups.

I would just like to make a couple of points to Z and any other doctors out there reading this thread.

first, all doctors sign up to the hipocratic oath. one major strand of this is to do no harm, but a surprisingly large number of doctors seem willing to cause unnecessary suffering by not listening to the patient, or by disbelieving their symptoms. this needs to change.

secondly, an awful lot of medicine is about slowing death so that you last long enough to recover. this is fine, and should definitely apply to suicide and euthenasia counceling and legislation. however there comes a point where you are not showing any improvement, and are just extending the suffering. at this point, the patient should be listened to, and be helped to live (or die) as they wish. obviously any legislation would need to be handled very carefully, to prevent abuse, but the same applies to withholding treatment or to DNR statements.

there is absolutely no reason why some form of living will could not be framed, allowing the individual to get help when they need it. Doctors already go to court to turn off the life support or to stop feeding, so why couldn't the individual go to court to be allowed to have help dying?

It's very flatering to be refered to as a but I'm not one yet, I will be in two years and three months though

I'm watching this with interest as I'm actuely aware that my opinions on this could change, and the chances are that they will.

Just one more point...

On the slippery slope arugument. When the abortion bill was first proposed the BMA assumed that it would only be used in four cases per year under current legistlation.

I think we should be looking at how individuals can make assisted suicide part of a living will legally. One of the concerns out of the many and heavy dreads going round the mind of the person who is asking for asssistance is what will happen to the person who assists them in their suicide. obviously checks and safegusrds are important but extending freedom of choice will not necessarily increase abuse of the elderly and infirm. Afterall the right of a parent to discipline their children is not the cause of child abuse we rightly see that as the problem residng in the abuser. There are peole who speed and drive drunk or kill people bcause they drive recklessly yet we do not ask for driving to be banned, what we do is screen and keep checks on those who drive.

"When the abortion bill was first proposed the BMA assumed that it would only be used in four cases per year under current legistlation."

Huh?

Four abortions a year, or four trials for breaking the law? Or what?

B
*prods stats for a living, when she is earning one*