Matthew Paris - assisted dying

[Noicant]

https://www.thetimes.co.uk/article/we-cant-afford-a-taboo-on-assisted-dying-n6p8bfg9k

This made me feel deeply uncomfortable, he has a point about aging societies and the fact that we haven’t come anywhere near squaring the circle. It does feel very much like “it’s a good think if people feel pressured to just cut their life short if they are a burden”.

I’m a bit conflicted about this, on one hand I have an only child and I’m keenly aware that I never ever want to be a burden on her personally. I’m also very much in favour of assisted dying. But the idea that social pressure is exerted to almost make someone feel shame if they choose not to euthanise themselves is really quite horrific.

I get the black and white cost analysis and I do think many people would resist it (I have had elderly members of my family being absolutely clear that they expected everything possible would be done to keep them alive, they weren’t ready, one of them was furious at the idea that treatment would be withdrawn even though it was doing more damage than good by that point). But there would be people who are very vulnerable who would struggle to say “I don’t want this”.

It puts me in mind of MAID, I think a journal actually looked at the cost saving of implementing euthansia policies. On one hand theres a clinical honesty about that (which I think is lacking in our current political debate) but it also feels immensely inhumane and brutal.

That article is behind a paywall, but the title makes it clear it is about the terminally ill.
Terminally ill refers to those who have fewer than six months to live. It virtually always means those with cancer or another life-limiting illness, where the person is going to die anyway.

We can’t afford a taboo on assisted dying

https://www.thetimes.co.uk/article/7ac1f4c5-63b2-4df7-b504-74b1e30f0fc2?shareToken=55ddc3b303459bb78763330c3290b27b

Here is a share token.

I suppose the balance for me would be if it was like a power of attorney nomination and needed doing formally, witnessed etc while the person has capacity. I get that there might then be issues with eg changing your mind (like it's easy to say 85 is old, plenty of time, wouldn't want to be older than that etc ... until you're 84)

It's so tricky to put the appropriate safeguards in place though as people,can be so vulnerable to coercion, both intentional from a particular heir / person and societal.

Can’t read the article as paywalled but on the face of it I’d add that it is somewhat problematic that this discussion is being had against a backdrop of multiple councils being bankrupted by social care and unprecedented pressure on the NHS which is largely due to an aging population. Those things should be a separate debate but it’s impossible for those considerations not to be in the background and muddy the waters.

Basically discussions around assisted dying should be completely separate to “ should we restrict publically funded expensive treatment options that only extend life for a few months?” but unfortunately it’s likely that they become mixed up.

“In short, a taboo will be lifted — and taboo is potent. What today is criminal could tomorrow become (as its proponents tend to insist) a sad but permitted option in a relatively small number of special and agonising circumstances; but within a decade or more be seen as a normal road for many to take, and considered socially responsible — and even, finally, urged upon people. Such (say objectors) is the wedge of which the Scottish proposal is just the thin end.”

I agree with the bulk of it, it’s the bit about being seen as the socially responsible thing to do when infirm. For me euthansia is a personal choice, made because the person who is deciding has had enough. I’m not sure I would be entirely convinced if a loved one said to me “it’s the socially responsible thing to do so I’m euthanising myself”.

Just to reiterate I’m very much for assisted suicide I guess though perhaps I’m uncomfortable with the idea that we start making judgments on whether someone is being socially responsible or not.

I think it’s also the MAID thing and some disability campaigners pointing to people applying for MAID because they can’t afford to live rather than wanting to because they are done here.

It shifts the conversation away from personal ethics to public good. I actually admire Paris for his honesty here and he’s right that an increasingly dependent population is unaffordable. Maybe I’m just being a bit squeamish.

Assisted dying shouldn't be legalised because the risk of pressure, on the elderly, infirm and disabled, to end their lives for the benefit of others is too great. It's all well and good thinking it's about individual choice, but it's not really as humane as people in favour seem to believe. There was a young lady who ended her life in her early thirties a week or two ago, in Switzerland, 18 months after an accident that caused her spinal damage. She couldn't live with it but did not have a terminal disease. If she'd committed suicide by any other method, the story would have recognised that it was a mental health tragedy. But because it was an assisted dying, it's been repackaged as a legitimate personal choice. My point is as follows, where do you draw the line. How do you rule out undue influence or mental health crisis as he driver. You can't, it reliably and that's why the law shouldn't permit assisted dying.

Matthew Parris saying the quiet part out loud.

I'm cautiously supportive of legalising assisted dying. My own experience of a family member's death was that the last month was simply painful and borderline degrading and, if he had had the option of euthanasia, that would have been preferable (in fact he had talked about Dignitas when he was less ill but, as so often happens, by the time he was ready to end his life he was too ill to travel). I understand the arguments about self-determination.

I think Parris's point is a more practical one and he's not wrong- our ability to keep people alive has grown faster than our ability to give them quality of life, so we're now spending resources maintaining the lives of people who are getting very little benefit from them. This would be fine if we had unlimited resources but we don't, and while mismanagement may account for some of this it does not account for it all.

I think people shy away from these arguments because they are so uncomfortable and because we feel that decisions like this shouldn't be influenced by practicalities, so we pretend those practicalities don't exist. But we already make medical decisions by reference to cost, and some of them are much starker and harsher than decisions around euthanasia for the terminally ill. According to the Times this morning, 250 people a week are dying because they wait too long in A&E. We can't avoid thinking about practicalities when we talk about life and death.

I also think people tend to assume that decisions made with money in mind are necessarily bad and the outcome of social pressure, and I don't think that's true. If I develop dementia, say, I'd far rather choose to die than to have all my savings spent on my care (which is of no benefit to me as I have no quality of life or knowledge of it) when they could go to my children instead. That's a decision I should be entitled to make- the fact that I'm considering cost as a factor doesn't mean I'm being unfairly influenced by it.

All of that said, some of the stories from places like Canada are extremely concerning. I don't think that any of this is easy. So I'm pleased to see people setting out all the arguments, even when some of them make us feel very uncomfortable.

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He's been writing about this since 2015.

It's eugenics. Become too ill/too expensive and the possibility of being put down by your doctors creeps to an expectation

A mark of the character of a society is how it treats its vulnerable. A life is no less valuable because it is expected to be short, or because it is inconvenient/expensive.

Totally separate question from "what do we do when there isn't enough of treatment XYZ to meet demand"

Assisted dying absolutely requires a public debate.

We don't put pets through things we force humans to live through even though the outcome is still death.

I'm childless and there will be no one to advocate for me, so I hope that if my time comes and I'm in pain and suffering and had enough, that I'm allowed to die with dignity when I choose and not be forced through months of hell and neglect.

Mental health is also absolutely a valid reason for someone to choose whether they live or die. Suicide can be a choice for anyone.

Health conditions are not always curable. Treatable, maybe, but not necessarily stable, healthy, happy or thriving. Mental or physical health should not be differentiated.

Aside from actively ending life, there is the fact of ‘striving to keep alive’ people with a very poor quality of life.

What we can all do is to make sure we have a Health and Welfare Power of Attorney with our own wishes added.

Having far too much family experience of it, we feel the same as @MugLove re dementia, so dh and I have both added a paragraph that goes roughly:

‘If I should develop dementia, or any other condition where I am unable both to care for myself and speak (with full mental capacity) for myself, then I emphatically do not want any life-saving or life-prolonging treatment. I ask for palliative care only.’

To me, its utterly barbaric the way medicine can now keep people alive with little quality of life, well beyond what nature would allow.

I don’t see it’s anyone’s business but my own, what my pain and indignity threshold is, what I consider a quality of life worth living. Euthanasia should be available to everyone that wants it, even if they’re not terminally ill.

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What a vile article.

The article is about the terminally ill but it makes age, costs and being a burden the centre point of the discussion. Not the persons wellbeing. It almost sounds like a decent hospice costs a lot so you shouldnt expect pallative care.

There are lots of situations I'd want to access assisted dying for myself but I think it needs to be about dignity /pain and me not lack of hospices.

I think dementia is one of the worst possible scenarios. I would like to sign a statement saying that when I no longer recognise those I loved, when I cannot eat by myself and am doubly incontinent and permanently distressed, someone would calmly and kindly put an end to my existence on this earth.

I very, very much want there to be the option of assisted dying for myself if and when I am ever in the unfortunate position of unbearable and incurable suffering. But I'm very concerned about the potential for a slippery slope to individual or societal pressure on others to make that choice. And even the most careful and thoughtful legislation may not be able to stop all abuses, which may stop a responsible parliament ever passing it. So I don't know the answer, really.

I’ve never heard of a six month limit, and would guess that is because when somebody is terminally ill doctors don’t like to make predictions about their life expectancy.

However, the article isn’t particularly about people who are terminally ill, it’s about the cost to society of people living longer lives in bad health.

This is why I have also been against AD. It will end up being abused. How horrible must it be when you get to a certain age, knowing that in a few short years you will start being pressured to be euthanised like a pet dog so as not to put too much of a financial burden on the state, or so as not to eat in to too much of your kid’s inheritance pot before you shuffle off this mortal coil?

I read that in one country it’s even being offered to homeless people. Anyone can end up homeless if they fall on hard times. I honestly despair at the way this world is heading. Ageism seems to be getting a lot worse and I see disparaging remarks against old people all the time such as “Ok Boomer” and “Karen”. It’s disgusting. Perhaps the people who are pushing for this should remember that one day their children will be old. How would they feel about them being pressured to having an assisted death when they don’t actually want one or are not yet ready to die? It’s sick.

Hard conversations and debate are always supposed to make you think. It's an opinion piece, not an article of fact. It's been written to encourage discussion and so is deliberately provoking you to respond to the detail.

Reductionist responses don't exactly get into the thick of what you find so distasteful.

Six months is the standard definition of terminally ill in the UK. It’s the point at which you are allowed to claim PIP too.

The article begins by talking about the voluntary euthanasia of the terminally ill, but by the end is more focused on our ageing, heavily dependent population and the many social and economic consequences of non-working people regularly living well into their 80s and 90s.

It’s the latter issue that is of interest to me, because I find myself now, age 51, with my parents in their late 70s and PIL well into their 80s, all still alive. That is new: even a generation previously it would have been the norm for at least one of them to be carried off by heart attack / cancer / pneumonia /stroke. At the bottom end of our family, there are only three grandchildren. My sister has none, SIL only one, DH and I have 2. Replicate that across society and you see what a massive problem we are facing. The demographic pyramid is flipping end on end.

MIL has been in a nursing home for nearly 5 years now. She has Parkinson’s, osteoporosis, dementia. She is immobile, bed bound, doubly incontinent, doesn’t speak. Yet she is kept alive at huge cost to the taxpayer, and continues to receive medical treatment for any and all conditions that might potentially end her life. If she gets a chest infection she is put on antibiotics. She can’t eat solid food, so she’s fed purées in a sippy cup. The excellent care she receives ensures that she will ‘live’ on in this condition for years to come.

Do I want her to die? I know that I’d rather be dead than in her situation. i think that for people in her situation there should be a cut off point where medical treatment of further illnesses is no longer offered, only palliative care. And next time she gets a chest infection, maybe she will die of it. But atm that would require my FIL to accept that his beloved wife really is going to die (and would have died long ago but for the care she has received) and he’s not there yet.

People like you want it to be discussed more and more until it’s put on the table as an option and ultimately made legal in the UK.

This is exactly where I am too. In principle I absolutely support assisted dying but I worry about the practical reality of how a safe system could be implemented, even for those diagnosed with a terminal illness and who have capacity to make a decision themselves.

And what about those that don’t want it? Would they get a choice?