Assisted dying bill (TW assisted suicide discussion)

OP I am sorry that your mother had to endure so much. However I disagree entirely that anyone should who is ill should consider assisted dying in order to avoid (even if that is part only of their decision) causing distress to their relatives or leaving them with PTSD. Their decision if the option is available to them must only be based on how they want to live their last days, uninfluenced by the fact that their relatives aren’t coping well.

I think we are not ready yet for such a law - palliative care needs to be better, less of a lottery, and more widely available BEFORE an alternative such as assisted dying should be offered.

it’d be a damn sight cheaper and quicker to offer someone the injection as an alternative to crap palliative care, and I’d hate to think that investment into good end of life care is disincentivised

Totally agree with this. Also introduction of assisted dying will imo lead to terminally people even where is zero coercion from anyone being affected by the change in culture to think that they should choose opting to kill themselves by assisted dying , to save their children, families etc from the trauma of their natural death.

I think the "slippery slope" argument is valid. Look at countries where assisted dying is legal, some have moved a very long way from it applying to the terminally ill.

It basically invalidates the idea that all life is valid and that will permeate attitudes towards people with various disabilities etc.

No one is stopping you or anyone else from committing suicide

And how do you suggest they do that without access to the right drugs?

Thank you for replying to my post.

I can see why the medical team would have treated her the first time. But I'm still unclear why you think your mother would have preferred assisted suicide to being repeatedly treated for infections when she had the option, which she did not take, to ask the medics to treat only the symptoms of any future infection she developed without treating the infection itself. I don't want to pressure you to explain anymore though.

It does seem that with better care your mother's last days could have been more comfortable. I fully support better end of life and better palliative care. I can't support assisted suicide as the answer to some examples of poor end of life care now.

These cases are worrying. Especially where there are cancerdrugs that would help, are denied under the health care plan, but assisted suicide is offered instead.

What if this happened in the NHS where already certain more expensive but helpful drugs may be rationed or witheld.

(I still would like the option for myself under certain circumstances even while seeing how full of pitfalls it is though.)

Behind the data are horrific personal stories
https://dredf.org/some-oregon-and-washington-state-assisted-suicide-abuses-and-complications/

I don’t really think this report is surprising. Numbers have increased over time. From just a handful to a few hundred a year. That’s in line with what you see in other jurisdictions. Even if you assume everyone has cancer there are about 9000 cancer deaths per year so it’s a tiny proportion of people who are choosing PAS around 3%. Nurses roles have evolved a lot over the last 25 years. People feel more like a burden and worry about the cost of care, It’s hardly a shocker with the rise in cost of living more people are struggling and those that they could of relied upon previously to help have struggles of their own/ no free time. Also it’s possible people feel more able to be pragmatic nowadays. I don’t want a prolonged death and I don’t want to be a burden, I don’t see the two as mutually exclusive.

Ooops sorry meant to clear the quote,

Lets also not forget the avoidance or trauma for the loved ones who stay until the end and then have to live with the recurring nightmares and visions of what happens in those situations.

Victoria, Australia looked at this and found that there is no evidence that assisted dying has any less of an impact than natural death:

“While data about the experiences of families of people who access VAD remain limited, it appears that difficult bereavement outcomes of disordered grief, mental health and posttraumatic stress are essentially unchanged in comparison with the experience of natural death.”
https://onlinelibrary.wiley.com/doi/full/10.1111/imj.16278

I am so sorry for what happened to your mother and your family.

You often hear people say that good palliative care is what is needed which I feel angry about because we know full well that there will be so many instances where it won’t actually be available, and for someone like your mother the suffering was really too dreadful for any help.

I am for euthanasia for this reason but absolutely hesitantly because I feel sure that some people will feel pressured to die, and in time it will often be an expectation.

More on activism in Victoria, Australia by Dying With Dignity Victoria (DWDV)
to expand the legislation down the slippery slope…

”DWDV made seven key recommendations, including that the prognosis requirement and definition of suffering be widened. Suffering is too narrowly construed as people with intolerable physical or mental suffering who do not meet the prognosis requirements are excluded.
The organisation also wants a restrictive “gag clause” lifted. Registered health practitioners are prohibited from initiating a discussion about VAD with patients. No other area of healthcare requires patients to know their treatment options before consulting a doctor.
It said not enough doctors are providing VAD. Out of 35,000 medical practitioners in Victoria, only 208 had actively participated in VAD as of last June. This particularly impacts individuals, their families and carers, in regional and rural areas.
Institutions that object to VAD still have the power to significantly curtail people’s ability to access a medical service. This needs to change, DWDV said.
Victorians who lack the ability to make decisions at the time they become otherwise eligible for VAD, or who lose that capacity during the assessment process, are excluded from accessing VAD, and this also needs to change DWDV said.”

I agree 100% that in this situation it would be kindest to be able to go at the time of the patient's choosing.

This is what I want for my DM but the discussion was never had and now it is too late.

I already live with two chronic pain conditions, an also have dementia on both sides of the family. Currently I manage my pain using strategies it has taken me 20+ years to develop, plus lots of hospital appointments and medication. Should I develop dementia in the next few years those coping mechanisms go out the window. So I’m looking at 10-20 years of dementia plus chronic constant pain that I cannot control or cope with and ultimately even communicate to others. I consider myself incredibly vulnerable to ending up in this position and even more vulnerable to those who would wish me to stay alive as long as humanly possible, at great emotional, physical and financial cost to my love ones. Why is this not considered a fate worse than death? Why do people have to battle on to the absolute bitter end so others can feel their death has be properly “earned”?
I personally would be happy to sign a document every year stating the point at which, should I develop dementia, that I should like to end my life. The slippery slope argument is always pulled out against it, as things are I feel like I’m heading towards a slippery slope no one acknowledges.
I don’t expect assisted dying to be voted in. Government doesn’t really represent public opinion and the minority of people opposed are incredibly vocal.

US:
“Before 2016 there were only three States with such legislation (Oregon, Washington, Vermont) and one where assisted suicide was legal through case law (Montana). However, by 2021 there were ten jurisdictions with statute laws plus Montana where assisted suicide remained legal by case law. It is remarkable that, before 2019 neither Oregon nor any other jurisdiction in the United States had amended their law on physician assisted suicide. However, in the four years since 2020, there have been seven amendments to such laws across five states: in Oregon in 2020 and 2023; in Vermont 2022, and 2023; in California in 2022; in Washington in 2023; and in Hawaii in 2023 and an amendment has been introduced in New Jersey. This amounts to six out of the ten jurisdictions with such legislation. All these changes expand access, for example, waive waiting times, allow nurses to prescribe the lethal medication, or drop residency requirements. Until 2019 it had been possible to argue that there was ‘no evidence of a “slippery slope”’ because ‘The Oregon law has remained unchanged since 1997’. This is no longer true. In recent years there has been a wave of expansion of such laws and further expansion is surely to be expected.”
https://blogs.bmj.com/medical-ethics/2023/10/27/twenty-five-years-of-the-oregon-model-of-assisted-suicide-the-data-are-not-reassuring/

Australia- There hasn’t been enough time for the slope to start, although in Victoria euthanasia activists criticised the government for refusing to consider legislation to expand it during the 5 year review. Activists here also intent to lobby to expand the bill in our Parliament as soon as it is passed.

https://cathnews.com/2023/03/14/victorian-doctors-push-to-scrap-euthanasia-safeguards/

Australia:
Voluntary assisted dying schemes have been in effect in the following states; Victoriasince 19 June 2019,[1] Western Australia since 1 July 2021,[2] Tasmania since 23 October 2022,[3] Queensland since 1 January 2023,[4] South Australia since 31 January 2023[5]and New South Wales since 28 November 2023.[6] A voluntary assisted dying scheme will go into effect in the Australian Capital Territory on 3 November 2025.[7]

I think we need a discussion about being able refuse life-extending care when people are very unwell.

My DM has dementia but she didn't need to be in this position if we had only thought about it. She had bacterial pneumonia a few years ago and could easily have avoided this dementia if she could just have gone to paliative care then.

I wondered if people could just have the choice to go to palliative care rather than having euthenasia?

But also I think sometime euthenisia is kindest, and I certainly wanted it for all my pets.

I do worry about depressed teens though. The teenage years can be so hard, and giving them the option of euthenasia seems like an enormous burden.

I’m in ROI and from the outside looking in I would like to see similar legislation in Ireland. I agree with other who have expressed concerns in the same way that I recognised the concerns of people in the abortion debate in Ireland. People have good reasons to be concerned and to object however for me on balance the benefits of having a mechanism to allow people with terminal illness to die at a time of their own choosing makes sense. We were recently at a funeral where a man lived with Alzheimer’s in a home for 9 years. He had lost every function and had lost so much weight, he was about 6 stone when he died. He would never be covered by a bill like this but honestly it was harrowing what he and his family went through in those years. There are no easy answers here just trying to do something a bit more compassionate than what currently is offered.

Even Oregon has the slippery slope too, they amended it in 2020 and 2022 expanding it.
https://blogs.bmj.com/medical-ethics/2023/10/27/twenty-five-years-of-the-oregon-model-of-assisted-suicide-the-data-are-not-reassuring/

“First and most obviously there has been a dramatic increase in numbers from 16 in 1998 to 278 in 2022. At the same time, the proportion referred for psychiatric evaluation prior to assisted suicide has dropped from 31.3% to 1.1%.
The 25-year review also highlights changes in the drugs used and in the rate of complications. Between 2010 and 2022 complications were reported on average in 11% of cases. In 2022, reported complications fell to 6%. Unfortunately this is not so reassuring as it seems, as an increasing percentage of data on complications is missing. In 2022 there was no data on complications for 74% of cases.
The reports also show shifts in the reasons given for seeking assisted death, with more citing the fear of being a burden and more citing financial concerns. The figures vary from year to year but in both cases the trend is clear. The increasing number of people seeking death because they feel they are a burden to others does not speak well of changes in social attitudes in Oregon since the DWD Act came into force.…”

“If political debates outside Oregon influenced its shift in use of language, they may also account for the recent expansion of the DWD Act. Before 2016 there were only three States with such legislation (Oregon, Washington, Vermont) and one where assisted suicide was legal through case law (Montana). However, by 2021 there were ten jurisdictions with statute laws plus Montana where assisted suicide remained legal by case law. It is remarkable that, before 2019 neither Oregon nor any other jurisdiction in the United States had amended their law on physician assisted suicide. However, in the four years since 2020, there have been seven amendments to such laws across five states: in Oregon in 2020 and 2023; in Vermont 2022, and 2023; in California in 2022; in Washington in 2023; and in Hawaii in 2023 and an amendment has been introduced in New Jersey. This amounts to six out of the ten jurisdictions with such legislation. All these changes expand access, for example, waive waiting times, allow nurses to prescribe the lethal medication, or drop residency requirements. Until 2019 it had been possible to argue that there was ‘no evidence of a “slippery slope”’ because ‘The Oregon law has remained unchanged since 1997’. This is no longer true. In recent years there has been a wave of expansion of such laws and further expansion is surely to be expected.”

https://blogs.bmj.com/medical-ethics/2023/10/27/twenty-five-years-of-the-oregon-model-of-assisted-suicide-the-data-are-not-reassuring/

@ThePure
All the people comparing it to pets there's the issue that a cat or dog lacks capacity to make its own decisions and you decide for it so this is not really analogous to someone with capacity who has cancer choosing to die and much more akin to ending the life of someone with eg Alzheimer's who lacks capacity to decide for themselves which is not covered by this bill.

I agree with your point, you entire post was great, but I wanted to inform you that this bill does in fact cover euthanising those who lack capacity. There is an entire section that will legalise consent by a proxy. If a person cannot communicate their consent, a proxy can sign the consent on their behalf and the bill states that the signature of the proxy is to be legally the same as if the person to be euthanised had signed it themself.

I'm truly sorry for your loss.

I don't support this law though and I'm not sure that your mother would have done so. You mention assisted suicide could have helped your mother avoid "multiple life threatening infections", with implied treatment of these. Consenting to treatment for these doesn't indicate that she was someone who would have considered assisted suicide.

I watched my best mate die from cancer in her thirties. That was a long, drawn out, hideous death and I wouldn't wish it on my worst enemy. Sure, it's possible to have a pain free death, but it doesn't happen for everyone.

I set up a Dignitas savings account straight away and I have my 10k ring fenced for that should the same fate ever await me. It would be nice not to have to travel abroad to do it, though, so I support this change 100%.

let’s be honest, if the law goes through as it is strictly being proposed, there are very few people who will actually be eligible vs those who feel they should be. And so it’s only a matter of time until there is a further amendment, with cries of “you wouldn’t let a cancer sufferer go through this, so why someone with <insert illness>”

Exactly, @NotOneOfTheInCrowd, and even that wouldn't be so bad if it was the sufferer themselves who believed they "should be eligible"

But again, what if it was relatives or medics, faced with the uniquitous targets and all too well aware of the cost of continuing treatment and support?

I absolutely think that it is a human right to choose death over suffering, why should I have to rely on a friend or relative to help? A medical professional that views life at all costs as their aim isn't one who puts a dying patients interests at heart in my opinion.

IThe dying process has already begun, the physician is simply supplying the meds that speed up the inevitable, administered by the patient themselves.

OK, but you said in your OP:

If the assisted dying bill was around whilst my mum was alive I know she would have never entertained an early death whilst she was still in control and able to fight, but I do know that her love for the family would have also meant she would never have wanted us to endure that final two weeks of watching and waiting for her body to shut down if it could have been avoided and she was able to specify what was to happen at the end.

Do you mean she would have signed an advance directive? Lots of people seem to like that idea because they don't want to die slowly of dementia but PP have highlighted the problems.

Lets also not forget the avoidance or trauma for the loved ones who stay until the end and then have to live with the recurring nightmares and visions of what happens in those situations.

Sorry to sound harsh but when it comes to changing the law we absolutely do need to 'forget' the loved ones' desire to avoid trauma. Any new law must be 100% patient focused.