euthanasia

Just checking

25 April 2014
Charles
4 Comments
Categories: Assisted suicide, euthanasia, suicide

In the good old days, death happened before we were ready for it. It struck untimely. Now, it creeps up, perhaps getting to us long after we have timed out.

Which raises the question: when is a timely death?

Journalist Matthew Parris is not alone in contemplating old age with trepidation. In a recent article he asked “How long do you want to live?”

It is a question my generation are the first in modern history to be asking ourselves in very large numbers. We ask it because we are among the first to expect — again in very large numbers — that our lives may be prolonged past a point when we may want or think we ought to live.

We will ask it, too, because we are the first generation among whom a majority no longer believes that suicide is a mortal sin.

I’ve decided to write myself a letter to be opened at the age of 75 and thereafter revisited annually. It sets out my criteria for carrying on. These are the criteria for me alone and I don’t apply them to others, who must frame their own.

Dear Matthew,

To the following eight questions a box is to be ticked, “yes” or “no”. The answer to some may obviate the need to ask some others. If the answer to either of the first two questions is “yes” then brush this letter aside and live on. If the answer to both is “no” then read no further, and reach for the razor blade.

1 Do you still, on balance and taking good times with bad, enjoy being alive?
2 Is there anyone else whose life would be devastated by your death?

The final six questions are not critical, but they may help you to decide in case of doubt:

3 Are you still of any practical use?
4 Are you more or less of sound mind? — in which case who is the prime minister, and multiply two by nine then subtract seven.
5 Are you more or less in possession of your physical faculties?
6 Are you still curious about the world? Can you get on a plane?
7 Behind your back, do people pity you?
8 Can you justify the cost to others, to the NHS and to your country of staying alive?

Full article here.

Never say die

13 November 2013
Charles
2 Comments
Categories: Assisted dying, Assisted suicide, Definitions of death, euthanasia, Featured

The Falconer Bill on assisted dying is making its way through the Lords before going on to the Commons, and the familiar debate rages once more. The usual suspects oppose it. They include senior doctors and lawyers and, you probably think, a lot of religious people, yes? And disabled people?

Actually, the stats show support for assisted dying as follows: 

  • * General population: 80%
  • * Religious people: anywhere between 60% and 80% depending on how you ask the question.
  • * Disabled people: 75% 

The principal players in the battle are, on one side, those who argue for personal autonomy and the right of anyone to die when they damn well please (terms and conditions apply), versus, on the other, those who seek to safeguard the interests of the vulnerable, whether elderly or disabled  — those who might come under pressure to do away with themselves. Should the Bill become law, there is the customary fear of slippery slopes and thin ends of wedges. It’s certainly true to say that the original Abortion Act never envisaged or intended that there should be so many abortions — but for all that, abortion rides high in the public’s favour.

The argument about assisted dying is one that needs to be heard; the law, when it comes, needs to be a good one. The eventual outcome is a forgone conclusion, of course. If it be not now, yet it will come. 

It’s perhaps regrettable that the Bill uses the euphemism ‘assisted dying’. What it means is assisted suicide – a doctor enables vetted people to kill themselves by handing them a fatal cocktail. One thing it is not is euthanasia, where it’s the doctor who does the killing. If the Bill becomes law, euthanasia will still be murder. 

Falconer’s Bill is pretty much a carbon copy of Oregon’s Death with Dignity Act of 2007. If you want to see how things are likely to pan out here in Britain, see how they have panned out over there. 

And if you want to find out precisely when you are going to die, click here. If you want to watch a US tv series showing people dying in real life, click here. 

The interesting thing about the debate about assisted dying is that it is taking place in the context of new science which is continuously calling for a reappraisal of the definition of death. At what point can we say that someone is dead? 

Take Ariel Sharon. Remember him? Prime minister of Israel. Had a huge stroke in 2006. Yes, that one. 

He’s still alive, lingering on in a permanent vegetative state (pic below). 

Once upon a time death was cardio-pulmonary death. Still is. But when technology made it possible sometimes to restore cardio-pulmonary function, but not consciousness, a redefinition was required. It’s called brain stem death. In nautical terms, the bridge has been wiped out, but the engine room is still humming. 

Brain stem death describes not loss of consciousness but the end of consciousness. Brain stem death is the point at which living organs can legally be harvested — and give a new lease of life to dying people. How dead is that? How dead are you when your heart literally goes, in the words of the song, on? A brain-dead pregnant mother nourished a foetus for 107 days and gave birth to a healthy child.

Which is why some people deny that brain stem death is death. 

Twenty years ago an MRI scan of a stroke patient might have shown them to be utterly dead.  Today, tissue plasminogen activator can restore them to unimpaired health. 

What price, then, the irreversibility of death? 

How would we define death in the as-yet hypothetical case of someone’s brain being transplanted from their dead — in a cardio-pulmonary sense — body into a de-brained but otherwise healthy body? 

Take it a stage further: if death is the cessation of life, what is life? 

Some people propose that death should be defined as the irreversible loss of personhood — the point at which you can declare that Elvis has left the building and ain’t coming back. Okay then, if so, when do you call time of death on a demented person? How do you address the matter of the still-beating heart? 

And yes, what constitutes “a person”? 

Over in America, Dr Sam Parnia is now reviving people who have died of a heart attack several hours after they have died, and he reckons that in 10-20 years’ time it’ll be possible to resurrect dead people after 24 hours. Parnia even proposes allowing a person who has died of, say, pneumonia, to remain dead while an antibiotic goes on working to kill the disease, and then, when they’re ‘well’ again, bringing them back to life. 

Understand this: brain death is nowhere near an event. It’s a process that takes longer than anyone thought. The brain goes on dying for hours after the heart has stopped beating. So: what levels of awareness do we retain after our death, and for how long? 

It’s science that’s altering the definition of death in the modern age. Many religions have, for centuries, thought of death, not as a full and final event, but as a time of transition. Science has not ruled out continuing consciousness. Sam Parnia, who has for years collected the recollections of the out-of-body experiences of those of his patients who have died for a short time, offers this caveat to those who think that the seat of selfhood is the brain:

“We always assume that all scientists believe the brain produces the mind, but in fact there are plenty who are not certain of that. Even prominent neuroscientists, such as Sir John Eccles, a Nobel prizewinner, believe that we are never going to understand mind through neuronal activity. All I can say is what I have observed from my work. It seems that when consciousness shuts down in death, psyche, or soul – by which I don’t mean ghosts, I mean your individual self – persists for a least those hours before you are resuscitated. From which we might justifiably begin to conclude that the brain is acting as an intermediary to manifest your idea of soul or self but it may not be the source or originator of it… I think that the evidence is beginning to suggest that we should keep open our minds to the possibility that memory, while obviously a scientific entity of some kind – I’m not saying it is magic or anything like that – is not neuronal.”

Lord, now lettest thou thy servant depart in peace…

22 October 2013
Charles
1 Comment
Categories: Assisted dying, Assisted suicide, euthanasia

An average 68 per cent of Canadians favour the legalisation of assisted suicide, but the Court of Appeal in British Columbia has just rejected it. Read more here. 

The arguments for and against assisted dying, assisted suicide, dying with dignity, call it want you will, will be with us for some time to come, but the outcome is already perfectly evident: in the end we’ll buy it. The debate we’re in now is very close in kind to the debate older readers remember from their youth about abortion. The big difference is that, aesthetically, letting old and very ill people depart in peace is much more ‘acceptable’ than aborting foetuses. 

In response to the recent setback, the Canadian National Post published letters for, against and don’t know. They illuminate the arguments well. Here’s a selection:

FOR

* There is no difference between refusing to give pain-killing drugs to patients dying in agony and refusing to assist them in ending their lives when these drugs are no longer effective. Both are unconscionable acts of prolonging torture. Our fellow citizens have no authority to decide when we give birth, nor when we die. Our lives are our own, and when or how we decide to die is up to us.

* Sane citizens must be given the right to die controlled and dignified deaths. If religious people wish to prolong the suffering of their loved ones in some perverted acknowledgement of the “gift of life,” fine, but do not impose that tenet on the rest of us. 

* The average life expectancy in 1908 was 48 years old. So the idea of living beyond our best-before date is a relatively new dilemma for the human race. I use the word “dilemma” because except for the fortunate few who will one day fall asleep and never wake up, most of us will experience a long, painful, debilitating, demoralizing, humiliating drawn-out demise. It’s time to rethink the end of one’s life.

AGAINST

* From legally assisted suicide, there is one short step to legal murder demanded by survivors who are not up to caring or even tolerating having to deal emotionally with death and dying.

* Yes, we all die, and the wages of sin is death. We do not want to suffer much while we are dying. But are not our doctors efficiently trained to control pain? God teaches us what dying with dignity means and it does not mean to kill oneself. It means to trust His promises and to lean on His Son for the forgiveness of our sins and in Him die in peace. That’s dying with dignity.

* We cannot just accept someone’s death wish and agree that their lives are no longer worth living. Instead, we must ease their suffering, provide comfort, and restore their sense of dignity and value.

* I am wary of any law that makes it easier for somebody to kill another person.

* It is time for the dying or suffering to accept the final burden of their own demise and not open the Pandora’s Box of state-assisted suicide. How long would the choice be theirs and not someone else’s?

DON’T KNOW

* I can imagine that if I were in excruciating pain from illness and the prognosis was dire, I’d want the right to be able to end my life — and quickly. However, that is not my situation and so it’s disingenuous of me to presume that I’d actually know what I’d want. This debate should only take place between people who are facing an imminent end to their lives, as well as their loved ones who are watching them suffer. Armchair philosophers should take their wise thoughts elsewhere.

When death is no longer the worst thing that can happen to you

27 May 2013
Charles
2 Comments
Categories: Assisted dying, Assisted suicide, Attitudes to death, End-of-life issues, euthanasia, Longevity

It’s not the worthy efforts of the members of the Dying Matters coalition that have raised awareness of the need to talk about death and dying. What’s actually got more and more of us talking is our personal experiences of the difficult and protracted end-of-life suffering of members of our families. Alongside twenty-first century death agony, extinction is the least we have to fear. Bring it on, goes up the cry, as, just this week, the Falconer Assisted Dying Bill passed its first reading in the House of Lords, Vermont became the fourth state in the USA to legislate for assisted suicide (let’s call it what it is, shall we, Charlie?) and in liberal (if that’s the right word) Switzerland an 80 year old woman in perfectly good health appealed to the European Court of Human Rights to be allowed to go now rather than get any older. She’s had enough, thanks. 

Live issues in this debate are: 1) what constitutes suffering; 2) the right of the state to limit personal autonomy and an individual’s right to self-determination; 3) the duty of doctors to write a prescription for those who ask for a chemical exit; and 4) the protection of those going through a depressive patch or who are susceptible to duress from predatory relatives, etc.

Over time, of course, this is going to reconfigure attitudes to funerals. 

In the context of all this, I was struck by the following letter in last Sunday’s Sunday Times:  

It isn’t just dementia that thwarts our plans. I also dread the disease that robbed me of my mother, and the thought of my daughter changing my nappies and enduring tyrannical rages  and repeated conversations fills me with dismay.

So strong are my feelings that five years ago I wrote a detailed advance directive,  had it witnessed, shared it with my family and lodged a copy with my GP. I take little comfort from this as it  appears that some people — who do not know me but  have some religious or ethical opinion — are insisting they have more rights over my  body than me.

Why should the limited resources of this tiny planet be used on my dribbling, deranged shell when I’ve requested otherwise?

Sue Parkes, Halesowen, West Midlands

How do you define ‘dying’?

22 April 2013
Charles
No comments
Categories: Assisted dying, Assisted suicide, euthanasia

Sarah Wootton, chief exec of Dignity in Dying, wrote in Friday’s Times about the case of Paul Lamb, who wants to be allowed to die:  

Dignity in Dying is not fighting for an unfettered right to die, but for the right of dying people to die well. We believe that right must be based on two core criteria: terminal illness and mental competence. Mr Lamb is mentally competent, but not terminally ill. Our proposed law would not help him. 

Any law must balance the rights of the individual against the needs of society. A small but significant minority of dying Britons are suffering unbearably, against their wishes, at the end of life. I am certain that we can implement a law that would give them the freedom to reduce their suffering without compromising the safety of potentially vulnerable people. 

Restricting the law to those with a terminal illness would protect those who have recently become disabled and have yet to come to terms with their situation, or those facing new and difficult, but ultimately controllable, symptoms of a chronic condition. It is also important that patients take the final action themselves. This ensures that they are in complete control of the decision about how and when they die. 

“I am not without a heart,” Wootton says, “but still I cannot fully support [Lamb’s] case.” 

Wootton is taking into consideration here the acceptability of right-to-die legislation to the public. What she wants, 80 per cent of the population wants. Extend the right to people who are simply fed up with living and acceptability plunges to just 40 per cent. 

She may also have been thinking about Belgium, where euthanasia has increased by 4,620 per cent in just ten years. 

In Belgium, there lived two identical twins, Marc and Eddy Verbessem. Both were born deaf. They never married, but lived together and worked as cobblers.

When they were 45 they were diagnosed with a form of glaucoma which meant that they would shortly go blind. When they learned this they were very sad and felt they had nothing to live for any more. They went to their local hospital and asked for euthanasia. The hospital said no.

So they went to another hospital. The doctors listened to their story kindly and empathically. They agreed with Marc and Eddy that their outlook was very bleak indeed and, yes, their lives had lost all value.  So they killed them with a lethal injection.

This happened a fortnight before last Christmas, 2012. It was entirely legal. 

Responses to Wootton’s article are interesting.

Simon Roue says: “Having the debate about whether people have the right to take their own life seems hopelessly outmoded in a society that de-criminalised suicide in the 1960s.” 

Robin Thomas says: “Sarah Wootton is right to draw our attention to the distinction between her campaign (for the ‘dying’) and Mr Lamb’s (for those living in hell). But ultimately I wonder if this is a distinction without difference? Are we not all dying, just some faster than others?” 

Mike Gratton says: “Frankly madam I could not care less whether or not you are with or without a heart. I have a terminal illness and my life is my concern . Keep your “conscience” to yourself. We sufferers feel the pain, not your conscience.”

 

Weighing the End of Life

8 March 2013
Charles
No comments
Categories: Assisted dying, Attitudes to death, euthanasia

ONE weekend last year, we asked our vet how we would know when it was time to put down Byron, our elderly dog. Byron was 14, half blind, partly deaf, with dementia, arthritis and an enlarged prostate. He often walked into walls, stood staring vacantly with his tail down, and had begun wandering and whining for reasons we could not always decipher.

Our vet said he used the 50 percent rule: Were at least half of Byron’s days good days? Or was it two bad days for every good? When you get to the latter, he explained, it’s time.

This conversation gave me pause for two reasons. First, what did Byron want? Was 50 percent good enough for him? How about 70? Or 20? There was, of course, no way to know.

Which brings me to my second reason for pause. When not serving as faithful servant to our tiny dog, I am a geriatrician. Because older adults have a greater range of needs and abilities than any other age group, and because there is a national shortage of geriatricians, I care for the frailest and sickest among them.

To many people’s surprise, most of my patients are as satisfied with their lives as they were when they were less debilitated. But this isn’t true for everyone, and some are eager to say they’ve had enough.

Read the whole article in the New York Times here. 

http://www.nytimes.com/2013/02/03/opinion/sunday/weighing-the-end-of-life.html?pagewanted=2

Seeing it through

24 August 2012
Charles
5 Comments
Categories: Assisted suicide, euthanasia, self-deliverance

In the summer edition of the Oldie magazine (strapline: ‘Everybody buys it eventually’), Mavis Nicholson discusses the case for the ‘right to die’. She says:

I had a conversation with an even more elderly chap than me, a GP all his working life, who was in very bad shape. He said he thought it was too potentially dangerous to allow people to choose their death or for relatives to have a say in the matter — or doctors and nurses for that matter. “It’s not that I don’t trust people,” he told me. “On the whole I do, though I think I am pretty wily and watchful as well.” No, he thought we should see it through to the end. “That’s what I have done in my family affairs,” he said “through all the trials and tribulations there have been in that quarter. I fought in the last war and saw that through with gritted teeth, I must admit. My job has been very full on, but in the end I am glad I have seen my way through the undergrowth and found life’s clearings, you might say. And I’ll see myself into the final clearing, I hope.”

Time’s up, take yourself out

16 July 2012
Charles
No comments
Categories: Attitudes to older people, dying, End-of-life issues, euthanasia, Good death, medical interventions in dying, self-deliverance

A theme that we like to explore on this blog is the way in which longevity has reconfigured the landscape of dying. The blessing of long life has its downside: protracted decline. We are likely to linger longer, much longer, than our forebears. There’s a physical cost in chronic illness and possibly, also, mental enfeeblement. There’s the emotional cost to the elderly and their families. And then there’s the financial cost, which the government has wrestled with and now kicked deftly into the long grass.

In the Sunday Times Minette Marrin wrestled with it, too. I’ll have to quote a lot of it because the ST website is paywalled. She suggests some interesting solutions:

Last Thursday the Office for Budget Responsibility (OBR) announced in a chilling report that the escalating costs of an ageing population will mean yet more national austerity. Pointing out that the proportion of people over 65, who now make up 17% of the population, will rise to 26% by 2061, it estimates many increased costs, in care of the elderly, health and pensions, amounting to an added £80 billion a year in today’s money.

In the next 20 years, the number of people over 70 is set to rise by 50%, reaching nearly 10m, according to the Office for National Statistics.

The OBR states that Britain’s public spending will be “clearly unsustainable” over the next 50 years, despite the spending cuts. So, far from care for the elderly rising above today’s inadequate standards, it is almost certain to fall further below them. There’s no money now and in future there’s going to be even less. 

Universal bus passes (which cost £1 billion a year), winter fuel allowances (£2 billion) and free television licences must go. 

Everyone must accept that their savings, including their homes, may have to be spent on paying for care in old age. There’s no universal right to leave one’s property to one’s children.

Taxes of all kinds must rise hugely, or else there will have to be a large hypothecated tax upon people reaching old age. Services to old people must be reduced … Health service care must be rationed for the very old. Palliative care of every kind should be available, but not ambitious treatments.

There should be fewer old people. I’ve often felt the best thing one can do for one’s children is to die before real infirmity sets in. The taboo against deliberately shuffling off this mortal coil, as people did in other cultures in the interests of younger people, is wrong. Most people say they never want to be a burden to others in old age; it would be good if more of us felt able to prove we mean it, by taking a timely and pleasant walk up the snowy mountain. Especially since there’s no money left. [Our bold]

Source

Assisted death — no

23 April 2012
Charles
No comments
Categories: euthanasia

George Pitcher is an Anglican priest and journalist. This is what he wrote about his mother’s death:

I tried to kill my mother in 1993. I didn’t attempt the act myself, you understand, but I asked a nurse to increase her morphine dosage to a lethal level, so that she might be washed away on an opiate tide. At seventy-five, Mum had been operated on for a brain tumour, but the cancer had spread uncontrollably and they had stiched her up and told us she hadn’t hot long left. My sister made her comfortable in her house, and when her condition nosedived, I took the train to the West country and found my sister taking a break in the garden. It was easy to see why. Mum was unconscious, but taking great, rattling last gasps of breath, her body clearly staging one last, hopeless rage against the dark.

When the nurse came that afternoon to change her morphine drip, I begged her, in tears, to bring this pointless suffering to an end. The nurse was lovely: patient and kind, but firm. No, she said, she couldn’t do that, but she held my hand and said that all would be well soon. Given all the fuss recently about nurses offering prayer for their patients, I recall that she also assured me that Mum would be “better” soon. It was an act of excellent and professional pastoral care.

She was right, of course – about the morphine dosage, I mean. That evening, the morphine faded and Mum regained consciousness for a few minutes. We could talk to her, hold her, say goodbye, tell her we loved her. She couldn’t speak, but she struggled to communicate with my sister and me, with her eyes and her smile. And I realized in awe that, in a final, selfless act of motherhood, she was comforting us, rather than the other way round.

I wouldn’t have missed that last exchange for the world and, of course, I will carry it with me, as a comfort and a revelation of the meaning of death, for the rest of my own life. But had the nurse been able to respond to my earlier pleas for release, we would have been denied those precious fifteen minutes. I shiver when I think of what I could have lost, had a medical professional not saved me from myself.