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There has been much debate in the UK recently regarding the choice facing terminally ill patients on whether they should be able to determine a right to die. It is a moral, ethical and practical minefield - is it ever right for another person to end the life of a terminally ill patient who is in severe pain or enduring other suffering? If euthanasia is sometimes right, under what circumstances is it right? Is there any moral difference between killing someone and letting them die by say withdrawing vital medications or fluids? Who should carry out euthanasia and where?
Having had a relative who died from Motor Neurone Disease - and two friends who died with Alzheimers and abdmonial cancer - all within the last 12 months - it is a issue I have struggled to resolve in my own mind and therefore I would like to open it to a the Arena for comment - not least because as podiatric practitioners we will be exposed to a fair percentage of the population who are terminally ill with any number of conditions.
For me, I think the choice should be with the individual concerned - should they have the capacity to make that choice in an informed, dispassionate manner. But what happens when illness is caused by trauma or acute disease such as severe CVA - should the relatives be able to choose? In a way they can presently - such as when deciding to terminate life-support systems. But where you you draw the line?
Personally I would like to endure to the very end - and experience everything and anything life has to offer, for good or ill. You only get to die once and I think I would like to be conscious - or as close as - when the time comes; not for any religious, moral, ethical or legal considerations, but just to experience what happens at the passing of life.
Having had a family member suicide (sufferer of MSA), I wish he would have had the choice. But to legalize it? Too many risks of abuse..like you say...where do you draw the line?
My dear mother reckons (81) every one should have legal access to a cyanide pill at age 60, and you choose to take it when you want. :-)
I look at it this way. I beleive that it should be my choice and that we as an individual people should be able to decide, just like we write a will we should be able with mediacal information be able to decide at which point enough is enough.
So at a certain age say 18 or 21 ie the age of legal drinking, when you can go to war for your country and vote we should be able to fill in a form which you have made the decision about your life if you ever got sick or had a major accident . If you choose not to fill in the form then you have stated that you want to be kept alive as long as possible as it is today.
I certainly think that we should be able to decide oursleves.
I would want the process to be a quick and painless as possible in an controlled enviroment.
The document that are referring to is a living will or Advance Healthcare Directive. This records what you want to be done if you become so ill or severely injured that you cannot speak for yourself.
If you do not want to be subjected to medical treatments & interventions which might prolong your life but result in a quality of life you would find unacceptable, you can make a living will.
That said, as with all wills, it is not watertight. My mother in law was told by 2 seperate solicitor firms that her will was incontrovertible, only to have it contested and ignored on her death.
The document that are referring to is a living will or Advance Healthcare Directive. This records what you want to be done if you become so ill or severely injured that you cannot speak for yourself.
If you do not want to be subjected to medical treatments & interventions which might prolong your life but result in a quality of life you would find unacceptable, you can make a living will.
That said, as with all wills, it is not watertight. My mother in law was told by 2 seperate solicitor firms that her will was incontrovertible, only to have it contested and ignored on her death.
Cheers,
Bel
But a living will not allow Euthanisia only stop treatment, I was meaning that at a certain point Euthanasia should be used if I had filled out a document stating that´s what I wanted if I was left in certain way after an accident etc.
But a living will not allow Euthanisia only stop treatment, I was meaning that at a certain point Euthanasia should be used if I had filled out a document stating that´s what I wanted if I was left in certain way after an accident etc.
Agreed. But it is the closest thing that you can get in instructing preferred treatment or no treatment in the event of you not being able to convey this yourself. Any document, at least here in the UK, requesting euthanasia would be completely ignored by the medical community all the time that euthanasia is illegal.
However, I do happen to be of the same opinion as you. It would be ideal to have the opportunity to express my wishes to die with dignity in advance.
...Personally I would like to endure to the very end - and experience everything and anything life has to offer, for good or ill. You only get to die once and I think I would like to be conscious - or as close as - when the time comes; not for any religious, moral, ethical or legal considerations, but just to experience what happens at the passing of life.
My father died at 56 y/o. We weren't asked but told (after continued and at times 'forceful' questioning) that no interventions to prolong life were to be used. Passive euthansia? Which my mother, sisters and I agreed with. We read to him, although he was unconscious, over a 2 day period, his favourite poetry & prose. Dad seemed to be less 'disturbed' when we were reading. I don't want to die, I'm enjoying life the more I am getting older, but hopefully I won't be subjected to life-prolonging interventions if I get to a certain point, also. My wife and I have made the 'pact' (like many other couples),
have a great day, mark
There seems to be a common argument that it is up to the individual to decide whether he/she wants to die. However this doesn't take into account that one is not just an individual but also a part of a family and community and that every life affects not just that person but also others. I believe a patient has a right to refuse treatment but not to actively kill themselves as their life does not belong to them only. From my own religious view I believe that life ultimately belongs to God and only He has the right to take it away.
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I wholeheartedly agree with all your statements here - especially the one about God. But to witness a loved one suffer, knowing that they are going to die a horrible prolonged death, does cause you to wish there was an easier way to ease that kind of torture. It is easier for the believer -1 Cor 10:13.
I´m not sure that a long prolonged debate about religion should occur here on PA, but I guess that it was bound to be mentioned with a thread start such as this. Before it heads in that direction I beleive that people should be very careful with their comments as not to offend anyone .
In Aus the 800lb gorilla in the room that no-one talks about is the fact that it is legal to manage pain by the administration of opiods, when the pain is high enough the doses administrered are going to kill some one, this is legal .......not as euthanasia but as palliative care for pain.....and as long as we don't make too much of a fuss about it, it all works out fine. I have seen it work beautifully with a very (potentially) painful death from pancreatic cancer. It is silly that we handle dogs and cats more humanely than people.
regards Phill
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..Before it heads in that direction I beleive that people should be very careful with their comments as not to offend anyone .
Too late.
Let's do a poll; God-believers, agnostics, atheists, others? I for one don't trust anyone who says that there "there definitely is a God" nor do I trust anyone who says "there definitely isn't a God"
Belief is different, like Podalog said "(he) believed". Fair enough!
I believe the problem behind any system implemented and used by humans is the fact that someone, somewhere is going to abuse, misuse or accidentally get the blasted thing wrong at some point. With an issue as final as euthanasia if the system goes a little wrong for one person, then that person is dead. Is there an acceptable error margin with euthanasia that we are willing to work with..?
So, where do you draw the line in the sand with regards to who qualifies and who doesn't qualify for the option to kill themselves..? Does anyone have the right to decide bar the person and their own family?
On the other hand, I very firmly agree with Phil Carter with regards to allowing someone a dignified, peaceful and gentle end in the case they are terminally ill. Who could deny someone that??
With regards to religion, you are welcome to your opinions. But surely your rules only apply to people that subscribe to your religion?
" I beleive that people should be very careful with their comments as not to offend anyone ."
Isn't that part of the problem? We are so UP TIGHT and INTOLERANT of things that we all feel we need to walk on egg shells least we OFFEND someone's feelings.
I say get a thicker skin and be an adult. Why would an honest discussion on how we view life and death and the world and our place in it possibly be HURTFUL or OFFENSIVE to anyone unless they are looking to be OFFENDED.
My take: Life is precious. Health is the MOST precious possession. Can or should anyone else have any say in the continuation (or not) of your life?
How about abortion? Is this not inseparable from a discussion on euthanasia? Is it not an individual who cannot speak and argue on his own behalf. OR- one who for whatever the reason wishes to end his own life (or a mother deciding on behalf of an unborn child?)
You either defend and protect life or you do not. You don't get to choose when and where and for whom. You have a belief that transcends various social situations or you do not.
It is inevitable that such a discussion as this raises personally held beliefs and brave of the OP to raise the whole point (not simply because of the belief issue).
I do agree with the above poster who suggests that such a topic needs airing, regardless of our religous sensitivities.
In regard to the issue of beliefs perhaps, if this discussion is going to go ahead, I can offer the following, hoping that it is helpful. (thought more than twice about writing this so hope it has some value)
In general, a persons belief, in relation to God, is something that will fall within a theological spectrum. A contributor to this topic needs to acknowlege this and acknowlege this to themselves. We may hold a view within a spectrum but this view is not "itself" beyond dispute. Disagreeing with someones view "in this thread" is not critiquing that persons own position with regard to the existence or not of God.
Indeed, discussion that can occur within the creative tension of the spectrum is healthy, indeed may even enable personal growth. Let's face it, whatever our belief now, we may will undergo re-evaluation if the cutting edge of the coal face is our life or death.
Euthanasia,well what a tricky topic!The word comes from the Ancient Greek for 'a good death' but what death by euthanasia can be a good death?I was with my father when he died in a hospice after a year of pain caused by a widely disseminated cancer,his death was very peaceful,I would say even serene,as my mother and I were sitting around his bed in the middle of the night.An air of amazing tranquility descended in that curtained off part of the ward which was dimly lit and very quiet when his breaths became shallower and shallower,almost imperceptibly until he breathed his last and was gone...his death was a good death.I feel very sorry for people who would go to some foreign land to drink a glass of poison and bring about a concocted death,there must be some better way for their lives to end.I want my life to end from the final illness I shall suffer from,and for it to end in peace with as little medical intervention as possible although I understand this may not be so,and I want it to end naturally.Jeffrey Jones.
My opinion is not intended to offend. My own thoughts on euthanasia are that our choice regarding selecting to end our lives should be just that. Our own choice. I have no God or higher power in my life. My life is my own to choose whichever path I decide upon.
I was blessed with two wonderful parents who gave their three children the confidence to enable them to have opinions which while considering the opinions of others also enabled us to trust in our own decisions & select what we believe to be right.
My father was a very proud although quiet man. His death in the year 2000 was not dignified or peaceful. Without unecessary details suffice it to say I can assure you given the choice he would without doubt have chosen to have quietly gone to sleep after saying his goodbyes to those who loved him. Not for a moment do I believe he would have wished for his loved ones final image of him to be what now remains.
Euthanasia: I would say yes. Given the person choosing has the ability to decide their own end.
Just my thoughts.
Regards, Mandy.
__________________
:)
twirly
Mandy Brooks
Brooks Podiatry
S64 0DE
Suffering a fondness for odd things.
“ Though the mills of God grind slowly;
Yet they grind exceeding small;
Though with patience he stands waiting,
With exactness grinds he all. ”
Wow, what an incredible topic. Something that made me sit back and think about it a little.
When someone is dealing with a life ending disease it's amazing how their whole thought process changes. You have two extremes, 1.) the person who wants to experience everything they are going to miss out in life, and 2.) the person who wants to just end it and get it over with so they don't go through the pain and suffering. I can see both sides and why they would want to do what they choose.
This is deifinitely food for thought. Thanks for the posting.
There seems to be a common argument that it is up to the individual to decide whether he/she wants to die. However this doesn't take into account that one is not just an individual but also a part of a family and community and that every life affects not just that person but also others. I believe a patient has a right to refuse treatment but not to actively kill themselves as their life does not belong to them only. From my own religious view I believe that life ultimately belongs to God and only He has the right to take it away.
Sorry but here in the UK we are a secular state. The Christian God doesn't make the laws. The rule of law is based on human morality.
What if I said I believe in the Jedi and the force? Yoda and Obi-wan had no problem in losing their earthly shackles Your religion is not necessarily mine.
The right to die at ones own behest is quite legal and in many cases moral. What is legally difficult to frame are so-called living wills ie writing a document that sets out the future circumstances in which you would prefer to die. These may well be circumstances in which medically "life" is quite "viable" but the individual is no longer capable of commiting the act themselves. How is not abused and who does the termination?
Thanks for the replies to date - interesting reading and indicative of the wider opinions in society. I think it inevitable that religion comes into the debate given its prominence in the issue generally. Those who have belief in an afterlife and/or an all-seeing, all-knowing diety are a powerful lobby in the euthanasia debate and should not be underestimated, but like many contributors, I think they are misguided simply because their basic premise is one based on superstition of which there is not one thread of evidence to support. Hopefully, in time, as we discover more about what is beyond our solar system, we will see the folly of our parochialism and discard the shackles that bind us to these primitive rituals and superstitions.
I was particularly touched by the case of Sir Edward Downes, one of Britains most respected conductors, who, at 85, had become virtually blind and deaf - and after learning that his wife had terminal cancer - decided to end his own life along with his wife at the Dignitas Clinic in Switzerland. They died peacefully and under circumstances of their own choosing. What is clear is that they were completely devoted to each other and had enjoyed a long and happy marraige of 54 years. Are we really saying that it is immoral, unethical and illegal to end one's life in this manner based on religious views only? There are serious considerations to take account of with assisted suicide - where, when, how, who - but I would have thought these could be relatively easily addressed with sufficient safeguards in place to prevent abuse either by the State of by individuals.
Surely quality of life is a far more important consideration than the duration?
Sorry but here in the UK we are a secular state. The Christian God doesn't make the laws. The rule of law is based on human morality.
And what is human morality and how do we decide what that is? Euthanasia is primarily a philosophical issue. Everyone has a philosophical worldview from which they interpret the world and to decide what is right and wrong. The position someone takes on this issue will be determined by their philosophy. You may think that the question of God to medical ethics may be irrelevant in the U.K but it is relevant to me. I do not accept the philosophical belief that everyone's life belongs to them to end when they please. My concience will not allow me to support active euthanasia and would seek to dissuade people from carrying it out. You and others may disagree with me - Fair enough, everyone to their own conscience. However I admit that I have never had to face this issue in real life unlike some people here. I can understand why some would support it for good and caring reasons however I could not support it in good conscience.
And what is human morality and how do we decide what that is? Euthanasia is primarily a philosophical issue. Everyone has a philosophical worldview from which they interpret the world and to decide what is right and wrong. The position someone takes on this issue will be determined by their philosophy. You may think that the question of God to medical ethics may be irrelevant in the U.K but it is relevant to me. I do not accept the philosophical belief that everyone's life belongs to them to end when they please. My concience will not allow me to support active euthanasia and would seek to dissuade people from carrying it out. You and others may disagree with me - Fair enough, everyone to their own conscience. However I admit that I have never had to face this issue in real life unlike some people here. I can understand why some would support it for good and caring reasons however I could not support it in good conscience.
Of course if you are not Christian you cannot be moral.
You have just explained why the state and its laws should be secular, thank you.
I did not mean to insinuate that non-christians cannot be moral. What I meant was everyone has a different morality and there is no such thing as a universal human morality which agrees in all areas.
__________________ "A thing may be too sad to be believed or too wicked to be believed or too good to be believed; but it cannot be too absurd to be believed in this planet of frogs and elephants, of crocodiles and cuttle-fish"
G.K. Chesterton
I can not agree with Podalog's last statement that there is no such thing as "Dying with dignity". My mother died with great dignaty (at the age of 104 years). As her family all stood around her bed she just closed her eyes and drew a few deep sighs and died. No strugle, pain or distress. I hope that when my turn comes I die in the same peaceful way. I am 80 yeard old by the way, so I might have too long to wait!! Joseph
[quote=Mark Russell;114931]
I think they are misguided simply because their basic premise is one based on superstition of which there is not one thread of evidence to support. Hopefully, in time, as we discover more about what is beyond our solar system, we will see the folly of our parochialism and discard the shackles that bind us to these primitive rituals and superstitions.
I wonder if it is possible to rationalise your way out of superstition?
It seems to me that that part of the brain involved with superstition has evolved and that being superstitious probably gives a survival advantage or possibly in dynamic tandem with the rational part of the brain it gives some survival advantage?
I have always considered that one of the reasons for a 'scientific method' was not because people can be divided into rational thinkers and magical thinkers but because all humans are a mix of the two. Peer review allowing others to identify shortcomings, including magical thinking.
However if I suggested that the existance of homeopathy is evidence of magical thinking I wonder how many 'rational thinkers' would disagree?
I consider myself to be pretty strongly in the ration thinking group but still find myself thinking twice about walking under a ladder. Usually I walk under it anyway unless I am feeling vulnerable (whatever that means).
By 'vulnerable' I means that there are certain psychological states where I am more likely to be open to magical thinking and similarly others where I am less likely to be open to magical thinking. Even though I always recognise my own 'magical thinking' I still, on occasions walk around the ladder!
Ah, Bill, this is beginning to sound like the kind of conversation we would have over a few beers in Sandy Bells - and I'm not sure if we would get much further even with the help of some fine lubrication. The nub of the matter is that we simply don't know what is beyond the end - in much the same way as we don't know what was there before we came. Maybe there is some form of reincarnation. If our thinking brain had developed sufficiently in vivo perhaps the whole business of birth would sound just as implausible to ourselves. Can you imagine being thrust out of that cosy environment into the world as we know it? The transition would almost seem as miraculous as the transformation of a caterpillar into a butterfly!
I've had, as I'm sure many other on Podiatry Arena have also, many experiences with patients that have told of phenomenon with a departed loved one - visual, auditory hallucinations - and although sceptics will point out that we could in certain circumstances, wish our brain to create such experiences - sometimes they are so real and/or unusual that they defy yet demand explanation. I remember a few years after my grandmother died, I was driving past the cemetery where she was buried - close to the Regional road in Fife - when incredibly the car - not the supercharged mini - seemed to slow down to almost walking pace (instead of 90mph) for a few seconds and I had the feeling of what I can only describe as a granular sensation passing through me. Instantly I was overwhelmed by a feeling that it was my Grandmother. It lasted for a few seconds and then the car was travelling at the same speed as before. I hadn't been thinking about her prior to the incident - I had driven the same stretch of road at least three times a week since she had died - and yet that is how it felt to me. I still remember it vividly and I can still offer no rational explanation.
I've heard a story from a husband and wife, who, after visiting Cheltenham several years after the death of his mother, both saw her standing opposite them over a busy road. She was standing still - just smiling at them. Both husband and wife are atheists - and general practitioners. Both saw the departed. Neither can offer an explanation.
What I do think is that the development of religious orders - of whatever "faith" - who claim to understand and own the territory of the unknown and unexplained - is extremely unhelpful and disillusionary. Do you remember Bob Main in Edinburgh - and his collection of Ouija Boards and tales of astral flying? I would probably lean towards the supernatural than any established religion, if I were to seek explanation for the unknown - but that is only my view. The fact that some religious leaders try and influence the euthanasia debate based on what they consider divine scripture is to me, as fantastical as belief in Santa Claus or the Tin Man.
Having said all that I came across this piece of writing I jotted down some years ago. Don't really think my views have changed all that much really.
Quote:
For there is only one life and it is so quickly spent; and when it has, we return to the void from where we once came and in a little small while, we are as unknown as we were before we came into this world.
Our children may spare us a thought when they are old and nostalgia is having its way with them. Then, they too die, and we, together with our lusts and our prides; our stupidities and our strivings and clutchings, are forgotten. Fore a few years more our only hope of memory is the chance reference a grandchild may make; we have become no more than the necessary adjunct to an adult remembering of childhood.
I remember thinking it rather bleak when I wrote it down; and I guess it still reads that way. But for the most part, I think it rings true. Maybe that's why religion is indispensible for so many.
All the best
PS It's all Syd's fault. He synthesised the ergot.
Why I changed my mind on assisted dying As a doctor I used to think palliative care was the answer. Now I realise that keeping people alive can be unspeakably cruel
Raymond Tallis
Quote:
This week, Debbie Purdy and I will be arguing for the legalisation of physician-assisted dying at the Battle of Ideas in London. A few years ago I might have been on the other side of the argument.
When I was chairman of the Committee on Ethical Issues in Medicine at the Royal College of Physicians, we twice considered Bills put forward by Lord Joffe proposing to legalise the choice of physician-assisted dying for mentally competent people with terminal illness who were suffering unbearably at the end of their lives. On the first occasion, we decided to oppose the Bill and on the second, because we were divided, we opted for neutrality.
The case for such a Bill to me now seems clear. Unbearable suffering, prolonged by medical care, and inflicted on a dying patient who wishes to die, is unequivocally a bad thing. And respect for individual autonomy — the right to have one’s choices supported by others, to determine one’s own best interest, when one is of sound mind — is a sovereign principle. Nobody else’s personal views should override this.
So where did my initial opposition come from? I was in thrall to numerous incorrect assumptions. But the evidence changed my mind.
Several of my assumptions related to palliative care. Wouldn’t assisted dying be unnecessary if the best palliative care were universally available? This is not true and I should have acknowledged this from my experience as a doctor for more than 35 years, when I treated patients whose symptoms were uncontrolled even when they had first-rate palliative care. International experience also confirms that palliative care fails some patients. For the last ten years, assisted suicide has been legal in Oregon under the Death with Dignity Act. Oregon has among the best palliative care of all the states in America and yet nearly 90 per cent of those seeking assisted dying do so from within those services.
I was advised that that the availability of assisted dying as an “easy” option would inhibit investment in palliative care. Again, international experience does not support this. In many countries, legalisation of voluntary euthanasia has been accompanied by increasing investment in palliative care services. In Oregon the proportion of people dying in hospice care has more than doubled since the Death with Dignity Act was introduced.
I also shared the worry that legalising assisted suicide would break down trust between doctor and patient. This is not borne out by the evidence. A survey of nine European countries put levels of trust in the Netherlands at the top. And this is not surprising: in countries with assisted dying, discussion of end-of-life care is open, transparent, honest and mature, not concealed beneath a cloud of ambiguity, as it is in the UK. And the knowledge that your doctor will not abandon the therapeutic alliance with you at your hour of greatest need will foster, not undermine, trust.
I was also concerned that legalising assisted suicide would take us to the top of a slippery slope leading to the involuntary euthanasia of people who do not wish to die. In fact, to use the ethicist John Harris’s phrase, if there is a slippery slope, legislation would apply crampons rather than skis.
In Oregon, where assisted dying legislation is close to the Joffe proposal, the numbers and kinds of people being helped to die have not changed over a decade. The Dutch experience was to me decisive. Rates of non-voluntary euthanasia (ie, doctors actively ending patients’ lives without having been asked by them to do so) decreased from 0.8 per cent of all deaths in 1991 (1,000 deaths) to 0.4 per cent in 2005 (550 deaths).
In the UK, a study published in Palliative Medicine this year found that more than 1 in 200 deaths were assisted, three fifths of which were cases of ending life without explicit request. This means that a few thousand people each year receive assistance to die. The present clinical, ethical and legal fudge — in which ploys such as continuous sedation, and starvation and dehydration, are used to get round the prohibition on assisted dying — is unacceptable.
As a geriatrician, I was also worried that assisted dying would be offered to, or imposed upon, those who are most disempowered. A very detailed analysis of the data in Oregon has shown that there is an under-representation of those groups and an over-representation of comparatively well-off, middle-class white people — feisty characters who are used to getting their own way.
These were the facts that prompted me to change my mind. Even those who accepted these facts still opposed legislation on the grounds that only a small minority of dying people would seek assistance and an even smaller number would use the prescription. Wouldn’t legislation prove a sledgehammer to crack a nut?
Well, I happen to believe that even small numbers of people going through unbearable hell are important. The availability of assisted dying would bring much comfort to many more sufferers than actually use it because it brings a sense of having some control.
Death from dehydration and starvation in patients who have no means of securing an end to their suffering other than by refusing food and fluids, or botched suicides, reflect the unspeakable cruelty of the present law. To accede to someone’s request for assisted dying under the circumstances envisaged in the Joffe Bill is not to devalue human life, or devalue the life of a particular human being, or to collude in their devaluing their own life. It is to accept their valuation of a few remaining days or weeks of life that they do not wish to endure.
As a result of the courageous action of Debbie Purdy, supported by Dignity in Dying, those who assist their loved ones on grim pilgrimages to Switzerland may be confident that they will not face prosecution. But we have a legal vacuum. Legalisation of physician-assisted dying is needed urgently.
Raymond Tallis is a writer and physician. His latest book is The Kingdom of Infinite Space: A Fantastical Journey Around Your Head (Atlantic Books)
Euthanasia - whose choice is it?
Your religion is not necessarily mine.
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