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would be done to keep them alive, they weren’t ready, one of them was furious at the idea that treatment would be withdrawn even though it was doing more damage than good by that point).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.

Sadly they can't see it, because they are looking at only from their own perspective of being healthy adults, or previously healthy adults in the foothills of illness, and frightened by the decline and pain that often precedes death in old age (which is a part of life). They are not contemplating anything other than a personal opt out from a terminal illness that they think would be unpleasant. Assisted dying is not a humane position, because it will always become a cost/benefit calculation on whose life has value, and who is disposable - with all the systemic bias on ability, wealth, class and race that exists in society. Not to mention sly drives at inheritance protection from care costs. I do not believe that people support this at all. If you ask them if they would like the choice to die on their own terms with dignity, of course they say yes - it's a loaded question / bad polling. If you ask them how they might feel about their mother being pressured into suicide to save the state (or their siblings) from having to pay for care costs, you will get a different answer every time.

No please don’t leave me out of the argument- that is not your call! We are shortly likely to be looking at clinical trials to keep me alive. I’ve lived with this shit for 5 years now, this is NOT a life.

No, it was a way of preventing people who had already been deemed to be dying from undergoing painful and futile treatments, such as ABGs, cannulas etc in their last day or two of life.

The issue was a minority of staff putting non-terminally ill patients on it, completely inappropriately, and without discussion with the patient or their family (which is not following the pathway - there were whole sections on family discussions, spiritual needs, etc which these staff clearly weren’t bothering with).

The pathway itself was fine, and basically still exists (rebranded as “Amber bundle” or “End of Life pathway” or whatever the hospital has renamed it as).

I understand the issue with ‘pressure’ on the elderly etc but my absolute honest opinion is that whether someone bows down to pressure or not does not trump other ill people having to endure long periods of suffering. The thought of having to live through something like dementia until it kills me is terrifying.

Well, of course you get different answers - they’re different questions altogether.

@MariaVT65 completely get it. But how many people are you willing to be inappropriately enthused so that choice is open to you when your time comes. How much living suffering in others (under pressure to agree to suicide) are you ready to tolerate, to relieve your own suffering? My point here is that the relief from suffering you seek comes at a direct cost in suffering to others. Is that acceptable?

Couldn't agree more with you.

@Dewdilly different questions yes, but only when it comes to perspective. There is no safe way legally to permit assisted dying without an unacceptable risk of abuse or error. So, and as much as advocates for assisted suicide dislike this, the answer must always be a hard no in law because it isn't really an issue of negative personal liberty (ie a right to choose).

Look at the post above this.

What’s the problem with creating a process for people to sign a declaration that if they have xyz illness/situation/accident in the future, the consent to assisted death. I was thinking exactly the same these posters above.

And me. My advance directive states that following a diagnosis of dementia no further medical treatment is to be administered for any condition. I won’t accept the pneumonia vaccination because it confers lifelong immunity. I may be very grateful to have pneumonia - aka the old man’s friend - one day.

I am pro assisted suicide in general. I would want control over the end of my life at whatever point that I choose. These difficult topics should be talked about. I am uncomfortable with the social pressure that could be asserted on groups (old, disabled, those lacking capacity). I also think it is unavoidable to discuss the costs of maintaining care for people - there comes a point where there are limited resources and difficult decisions need to be made. Palliative care is important but it cannot guarantee a good death. I don’t think all doctors should be the ones to do this but that a combination of specialist doctors, psychologists and advocates should be needed.
I am glad that I find the issue difficult and that some parts I find uncomfortable - that is how it should be.

I am looking at this from the perspective of my own grandmother who had Parkinson's disease and who was in need of care for months before she finally died.
I am looking at this from the perspective of my other grandmother, who suffered and kept calling out "Please God, come and take me, I've had enough" and with no one being able to help her.
I'm looking at this from the perspective of my Grandfather who had end stage lung cancer and for whom a heart attacks came as a blessing.
I'm looking at this from the perspective of the value of my own life to me, if I were in a situation like this.
You are the one attaching costs calculations. But if I have the choice of a clean death and leaving my money to my children, or ending up in a care home, with no dignity or privacy while paying for the existence with everything I have, then I know that I will choose.

That’s not true. The only thing being talked about us for those who are terminally ill who actively choose to have an assisted death. There can be no abuse or error.

But then Pratchett didn't ever put it into action personally did he? He didn't choose Dignitas. People talk in hypotheticals but when they get there few choose it. Many of those with a terminal diagnosis have the ability to take their own lives but they don't. They want to delegate the act. Dementia is a different case where the individual doesn't have capacity but again there is research that shows the spouse will back down from consenting when it comes to it.

Having read about Canada and indeed the Netherlands the slippery slope argument is real.

The discussion we need to have is around better quality of life, giving more people information about DNR to discuss in their 70's and better pain management.

People don’t “choose” Dignitas, because many people are too ill to organise it - it requires a lot of paperwork- and get there, and pay for it, bearing in mind that you have to do it all yourself, including travel, and be able to euthanise yourself. The doctors don’t euthanise you themselves.

I’m currently watching both my parents deteriorating with dementia. It’s horrible for them and traumatic for me. I personally would be happy to opt out of that long protracted death if possible, I don’t wish to steadily deteriorate for possibly 20+ years to the point where I can’t do anything but lay in bed being kept alive with a liquid diet, that is very much a fate worse than death for those of us who have witnessed and are witnessing first hand. I would much rather bow out early. It has nothing to do with money or pressure from relatives. If you have lived through having a parent with dementia you will know how utterly powerless you are, and yet everyone is suddenly painting relatives as evil money grabbing monsters, the same relatives who at the moment are currently giving up work/time/money/mental wellbeing to care and try and advocate for their loved ones and are generally ignored by society. Frankly when I get ill I am more worried that my children will feel pressured to keep me alive by all means and beyond any point of quality of life. I’m annoyed at this article because it is so reductive, it’s made euthanasia a purely financial choice rather than a personal one. For most people in a hospital bed in unending and unendurable pain money is the last thing on their minds.

The longevity of people, advances in medical science and the eventual complex health problems created by this will eventually overwhelm all resources dedicated to health in this country.
Then it won't be eat or heat it'll be old vs young. Councils are already seeing their budgets eaten up by care.

Such rubbish. They are looking at the potential for their own pain and suffering against that of someone else and thinking 'why should my needs come second'? Because we cannot come up with a decent set of safeguards? I don't see why not - we've landed on the moon and split the atom.

And even if for some reason we can't then just because someone might be incapable of resisting a bit of pressure from their relatives? Too bad - they don't count for more than me.

As a long time Times reader, I seldom take anything he says seriously.

I agree. I really object to people looking at someone in pain, who wants to end their life, and saying "no, live with it. I insist you live with it". Just who the hell do they think they are to say that people shouldn't be allowed to say when their life should end.

I really object to people looking at someone in pain, who wants to end their life, and saying "no, live with it. I insist you live with it". Just who the hell do they think they are to say that people shouldn't be allowed to say when their life should end.

exactly. There is something rather puritanical about people who insist others must endure a long and horrible death. It’s almost as if you have to earn your death through suffering. I bet they would feel differently if it was them.

This is an extremely thorny and difficult problem.

It's obviously an overstated argument and where it goes wrong is to encourage people using utility or finances as the "test" not just for themselves but as a society, which is wrong.

What would be better is to usher in a more nuanced era where we have conversations about what our own personal view of our own quality of life is and where we would be allowed to end life if we took a decision to do so in sound mind.

We do live in an era where medics feel a duty to save people and where death is feared to the extent that perverse decisions are made - just look at the decisions taken 3 years ago, to lock up elderly people in care homes and cruelly disallow visitors rather than simply accept that some might get covid and die (flu used to be regarded as an acceptable death for the very frail, the old person's friend) - and to lock down young people at huge economic and opportunity cost stretching into their futures.

This would save a lot of money and might actually prevent unnecessary death. By way of example, my own grandma had a heart bypass at 85, at which point she was still driving herself to bridge and would have said she had an acceptable quality of life - socially useful too, as she was visiting younger disabled relatives. She was tiring and couldn't do much walking, but she was ok and had a good life. By 89 she was definitely feeling it, though. At 90, she died of a big stroke, just a couple of months into Covid - to be honest, I was glad for her because the bits of the world she could access had disappeared. Maybe in a stretched system, she wouldn't have got the heart op and wouldn't have had the last 4 years, which were precious to her and to us. She made it clear that if she couldn't get to the toilet herself one day we should decline everything on her behalf other than pain relief - that shouldn't be everyone's threshold, obviously, but I think these types of personal wishes should be respected far better otherwise we will end up with more extreme arguments for euthanasia taking hold.

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

@user1567879667589 define ‘quality of life’ please?

@lemonstolemonade thats what the RESPECT forms are about (they include a DNR etc too….).

But how many people even want to think about it? let alone going into implementing it (no docs will take the risk of not treating unless they have a legally binding document telling them they shouldn’t. With good reasons too!).

Even when it comes to let’s say cancer, there is a clear avoidance about talking about treatment in those words. (Even though I appreciate it will vary a lot from one consultant to the next).