AIBU to see the government vote against assisted Dying, as preventing personal choice in how we might want to die?

Sure, it prevents personal choice, but for me that then follows along with what issues do we have in society that affect that personal choice. None of this is happening in a vacuum.

I've no issue with AD becoming legal in theory, even expanding it beyond the 6 month limit that was in the previous bill. I find limiting based on things like that is to put in weak safeguards and ignore the major concerns around people being pressured by others and being clear on what consent to death actually means.

Alongside discussions to ensure the person isn't being pressured, that they full understand what the process involves, and ideally a evaluation into both psychiatric wellbeing and to cover any potential alternatives, the safeguards I would like to see in place would be the ones which prevent medical professionals, government officials, or anyone in a position of authority over the individual to be the ones to start the conversation. At the very least with medical professionals as there needs to be information shared across, we need the capability to have it in our records as opt-in only and discussion to only be brought up the patient without that. For someone who opts-in, these conversations can be a relief; for others like me (born disabled, grew up hearing how much better it would be for everyone if I died), it would result in an immediate lack of trust. Most of the most horrifying cases I've heard involve some HCP or government official making that suggestion first to someone who was asking for help with something else - that needs to prevented.

I also think if the person at the time refuses, the processed should be delayed - the discussion cannot be around choice in death and then have people be held down to administer it because they consented earlier just because they have dementia. That's not how consent works, that is not the peaceful death many who discuss AD are hoping for.

To me, this framework could be applied whether it's AD done by the NHS or, if as a pp poster suggested, as part of the framework with other protective guidelines to protect if someone who wants their family member or other loved one to assist at particular time. I can see the issues previously mentioned of having the state involved, just as there are issues to having it privately. It's clearly something much of the public wants and I think the frameworks we build need to be less around how quickly/what are people dying of (basically picking which conditions make life not worthwhile which to me is more an individual choice) and more about how those with power over us act from the start of the process to the end.

Let her just top herself too? Its her choice right?

That is an area of concern. There have been recommendations to include a full psychiatric evaluation regardless of reason for wanting to go the AD route, as well as discussions around the evidence that most suicides from mental health reasons are impulsive - many are less than ten minutes from idea to action - so the idea is that any framework would have enough steps to catch those who can be support those where an alternative can be given; however, nothing we can make it likely to do that perfectly.

Many of the studies are cited here:
https://publications.parliament.uk/pa/cm5901/cmpublic/TerminallyIllAdults/memo/TIAB255
https://publications.parliament.uk/pa/cm5901/cmpublic/TerminallyIllAdults/memo/TIAB255.htm?utm_

Pertinent extracts:

The public may understandably assume that drugs for Assisted Suicide (AS) work reliably and that nothing can go wrong. They may not realize that when used for AS their safety and efficacy haven’t been studied, they are being used experimentally, and they are unlicensed.

4.1. In Oregon between 2001 and 2023, data on complications is only reported for 1093 of 2847 deaths. Of the 1093 deaths, complications were experienced in 7.7% of patients and included oral mucosal burning, nausea, vomiting, regurgitation and regained consciousness following coma induction Oregon DWDA Data Summary 2023.
4.2. In the Netherlands between 2013 and 2015, of 165 cases, 17 patients (10.3%) reported complications including retching, falling asleep before finishing the full lethal dose, muscular contractions, bad taste, throat pain and stomach pain ( Horikx 2016).

5.1. The time from ingestion of the lethal drugs to death appears to be highly unpredictable. In Oregon (2001 to 2023), of 2847 deaths, 1618 (56.8%) had a recorded duration. 103 (6.6 %) occurred more than six hours after ingestion of the drugs. The median time from ingestion to death was 35 minutes (range 1 minute to to 137 hours (5.8 days)).

another link showing the complications and problems mentioned in the Netherlands:
https://www.nejm.org/doi/full/10.1056/NEJM200002243420805?utm_

You are over simplifying this. Many people support assisted dying in principle but did not think the legislation being proposed was sufficient. It is desperately sad for those that want it to be available now, but it is more important that we get it right.

I don’t think that’s what @charliehungerford Is saying. Facing a painful death when you have terminal cancer that is in your bones, or you have motor neurone disease is very different than suffering with mental health issues, a mother with post natal depression can be treated and make a full recovery, the condition is not terminal. If someone is given a terminal diagnosis they should be able to discuss the possibility of an assisted death when it all becomes too much. We’re not talking about someone who is just old, that’s completely different. Most people desperately want their loved ones to live as long as possible, but equally they don’t want them to be in terrible pain. Everyone should have the right to ask for an assisted death when they are already dying, there is no cure and they are in distress from the pain that often cannot be adequately controlled.

Please could you cite your sources for this? I've seen and read many accounts of peaceful and calm deaths with relatives who have nothing but praise. I've seen people interviewed who have serious doubts about safeguarding but I havent seen accounts of botched endings.

Not sure how you.got that from my post. Of course in the run of things we should strive to help people overcome that feeling but I also believe that people do have a right to decide, after a decent interval (not the 24 hour pathway available in Canada) that that is their preference. We can also look at methods. In some jurisdictions, death comes from self administered oral medicine, in others it requires an MD to inject. If we as a nation felt more comfortable with the former, that may help.

It was a free vote so MPs voted with their consciences it wasn't a Government decision.
Amso I think the Bill doesn't have enough safeguards in it to ensure vulnerable, disabled and elderly people are not coerced into doing something they don't really want to do.

I agree with you

I was so glad it was voted down.

I started from a position of supporting assisted dying. After watching with growing horror as the supporters used emotional blackmail to try to push it through and flatly ignored the glaringly obvious safeguarding flaws, I started looking up how it was working in other countries.

That was a horrifying shock.

I am now firmly against any form of state sanctioned killing.

And at what point do you say you want somebody else to kill you? It could be many years in the future.

What sort of physical capacity do you mean? If you lose continence or mobility? You think thats the end of your life?

And someone who doesnt have mental capacity cannot make a decision, thats the point of them being deemed to lack capacity

And certainly I dont agree that anyone who lacks capacity should have a decision made by others to end their life, its just too risky.

I can assure you that I am not misunderstanding DNR at all, or the context of which it was assumed by staff that one would be in place due to my Dad's disability. I was there during the the conversations, I was a part of them, and I questioned Doctors at the time. The question general boils down to, if something happens that is nothing to do with the presenting issue, or even the disability- Would you like us to save your life or not. Why you then decide to assume what taxes I would or wouldn't pay, is completely irrelevant as my original post, stated just that! We do not have the infrastructure for AD.

I could also quote the dictionary definition, but I chose to share my lived experience and that is what I base MY decision on.

No but if you’ve been diagnosed with dementia or something you can make the choice before you completely lose your capacity or leave your wishes with your solicitor to enjoy one last roast and a pill .

I did wonder but when you listen to some of those who supported this bill its clear that they truly didn't care how many people would be harmed by it, in particular if you listen to the testimony from the Australian assisted suicide practioner and the callous way they spoke about the amount of coercion and the lack of proper recording of such things its truly scary.
As I said im for assisted suicide and think that it should have a clause that allows people to prerequest it in the case of dementia and stroke, brain damage, permanent vegitive state etc or illnesses like mnd, but that bill was just a licence to basically murder the old, sick and disabled imho

I think as soon as someone loses mental or physical capacity

Somebody without mental capacity would not have the ability to make that choice.

I think as soon as someone loses mental or physical capacity they should be able to say I’ve had a wonderful life , love to you all and pop a pill . I don’t see any dignity at all in seeing a living corpse dying in front of us . We need to change the mindset from longevity at any price to quality . I also don’t buy that there are millions of ‘ vulnerable ‘ at risk from family .

It’s nothing to do with bumping off disabled people. Or killing off poor people. It’s ending people’s life who will soon die anyway before it becomes unbearable.

That is the goal, but how do you establish who will soon die anyway and how do you prevent disabled people and poor people being pressured to end lives that other people don't think are worth living? How do you distinguish between somebody choosing to end their life because they feel that they are a burden and feeling that they should end their life because other people have made it clear that they are a burden?

If concerns about the legislation were genuinely just 'straw men', the bill would have passed.

You are misunderstanding what DNR means. It doesn’t mean letting someone die by withdrawing treatment. It means if someone actually has a cardiac arrest who is frail anyway not artificially resuscitating them. Medical people know the odds of someone who is already frail being able to recover from resuscitation even ina hospital setting. They know it means probably having their ribs broken, and being physically pummelled only to live for a short period of time with no quality of life.

It doesn’t mean his life was lesser. I’m sure he was treated as well as anyone else. As for the elder lady that’s nothing to do with this law. Although social care does need improvement but are you and everyone else willing to pay more taxes to facilitate it?

The thing is though thst palliative care has been presented as the answer to this issue. Except it isn’t. When you’ve seen people in agony despite the best palliative care and clinical people saying there’s nothing more they can do for someone’s pain then it seems dishonest to claim this as the solution. Those involved in palliative care will surely know that it’s not the answer for many people.

Of course palliative care should be improved. And people should also be able to die when they want when they’re terminally ill.

It’s nothing to do with bumping off disabled people. Or killing off poor people. It’s ending people’s life who will soon die anyway before it becomes unbearable. I’m not actually afraid of dying. But I am afraid of dying in agony and with no dignity. And people shouldn’t force that on others because they are making straw men cases.

I agree with the premise of AD, but only in a medical system that we don't currently have, so on that basis I wholeheartedly agree with the decision. The NHS is not equipped for this, and I spent years of looking after my disabled Dad, every single hospital admission came with a question around DNR, that was an assumption that his life was lesser, and that he would prefer to die. I was in hospital 2 weeks ago, an elderly lady referred to herself as a bed blocker, she felt she was a problem. She was not, the absolute failure of social care is the problem.
This Bill has been watered down throughout the reading, any safeguards have been removed and the opportunities for coercion have increased. So sadly, even if it is passed, its the disadvantaged, and low income that will be worse off as a result and once the door is open, there is no way of closing it again.

Doctors already have the ability to administer higher and higher doses of opioids as long as the intention is to relieve pain, even if the side effect is to shorten life. This is the doctrine of double effect.

Kathryn Mannix, a palliative care doctor has written a wonderful book called With the End in Mind that can help to ease anxiety about and demystify the natural process of dying.

Great.

Now can we talk about all the money we waste on suicide prevention.

Why do we even have it?

I think that the reality is that the assisted dying campaign has been badly thought through in terms of the safeguarding issues, although I am sympathetic to the arguments; I’ve seen elderly relatives die in circumstances in which the system has kept them alive and suffering in a a state no one would choose. This is not because doctors are monstrous - quite the opposite, it’s the reality of a system that does not have clarity of objective, so the only objective is keeping people alive. Not necessarily comfortable, but alive.

People who oppose assisted dying often talk about palliative care needing improvement, but it’s not clear what they actually think palliative care should do or be. Personally, I’d prefer to be given a massive opioid dose to see me on my way if I was seriously incapacitated and unambiguously dying, even if the alternative was being sponge bathed by fairies for a month until I finally croaked. More seriously, a lot of the hospice sector is in the service of dying comfortably and is not going to kick in at the inevitable long decline stage at which many might want it to.

The assisted dying bill also doesn’t really deal with everyone’s worst nightmare, which is getting dementia, because it won’t be available to those who can’t consent and dementia won’t necessarily kill you within a year (my gran lasted more than a decade from the point at which she wasn’t safe to live alone).

I would like to see reforms to the current system of decline and dying first, with an expansion of autonomy over treatment. As well as DNR and Respect forms (which are not always consistently respected), I think that it’s totally fine for people (or their relatives with POA, but ideally people themselves electing a long time in advance - note that this is only workable with a properly joined up system with proper medical records being viewable by professionals, of the type available in basically any decent European system), I would like to see people being able to refuse flu jabs, antibiotics etc in advance if they get to a predetermined state at which THEY decide that quality of life is low by reference to specific benchmarks that they determine in advance. And to request that, past a certain point, they must be given pain relief even if that has the effect of shortening life. And to request that doctors do not administer any treatment that would extend life if it does not come with immediate quality of life or pain reduction benefits. Not mandatory, just available.

Nobody is stopping you from taking your own life if you decide that you are a burden to your children and the state.

The question is about the circumstances in which you should be allowed assist in the death of somebody else.

It was badly drafted legislation submitted at a time when we have too few resources to care for the vulnerarble, when there is active and persistant narratives that frame a life of disability as worthless. I'm glad it didnt pass. If you cannot see Canada as a cautionary tale then you are trying very hard not to look.