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would be done to keep them alive, they weren’t ready, one of them was furious at the idea that treatment would be withdrawn even though it was doing more damage than good by that point).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

And please leave those with cancer out of the argument - they are not the target population, very very few people with cancer and available good quality palliative care will seek assisted dying.

No, they are the core of the argument. And many, many people with cancer would like the choice of assisted dying. It may be that when the time comes, they feel they don’t need it because palliative care is working, but the relief of having that option relieves a huge burden. I know lots of people with cancer, and virtually everyone wants the choice.

Cancer patients are absolutely used as a Trojan horse. They have no place at the core of the argument. Their brief spell at the end of their disease is an irrelevance to the overarching plan to save money by dispatching the longer term sick and disabled as the article made clear.

I see cancer patients every single day at work. Not one has mentioned to me the desire for assisted dying.

There is a very real risk that hospice funding will evaporate if this comes in. People don't seem to understand that you don't just go to a hospice to die. Our local hospice is very active in managing and advising on palliative care in the community. They involve family and help with, for instance, breaking bad news to children. Creating happy memories eg family pottery days, one patient described a lovely pot the whole family had contributed to.

I don't know if they still do it post covid but another patient wrote a beautiful blog about a weekend a small group had spent, with hospice staff, at a local holiday resort and the activities, spiritual discussions and therapies they had all enjoyed.

As I said I am massively concerned about and sympathetic to arguments about both cost and quality of life for those with dementia or other debilitating incurable illnesses. I am conflicted about these cases.
But cancer patients need good quality palliative care and support.

I leave you with a post from someone I used to know. A person who managed their cancer and death to the end, dying with love and dignity. (A few days after returning home from the hospice).

I was in hospital recently. In the next bed:
Nervous junior doctor: 'If the worst was to happen and you had a cardiac arrest, would you want us to attempt resuscitation?'
Feisty 92 year old lady: 'Hell, yes!'

84% of people approve of assisted dying in some form.

84% of people approve of assisted dying in some form.

A statistic from where?

Is that meant to shut down all further discussion?

I discuss it with colleagues - none of them agree with it even though they see the same patients I see and have the same understanding of quality of life and cost issues.

This is a very good point, which needs to be properly thought about.

I support the idea of assisted dying. I think that proper legal systems could be put in place to ensure people were not being “killed off” to save money.

I personally am most concerned about getting dementia and having to live till the bitter end. It is a dreadful illness and I would much rather have the option of passing away at the point of double incontinence, if not before. However this would not be an option if only the terminally ill were to be allowed the choice of euthanasia.

Yes @MarionMarion, but I guess that's my point. You have to be really, really clear even for them not to resuscitate you, despite the fact that breaking your ribs in your 90s is pretty painful and it often won't even work and might even if it worked leave you as a demented incapacitated person in dreadful pain. Which I understand to a degree. And the RESPECT form is totally reliant on someone both finding it and following it at the critical moment. And on you doing it before you become infirm enough to make a decision. And, even then the RESPECT form often is saying "withdraw treatment, let me get pneumonia and die" - it'd be more humane to let people have a massive dose of morphine in that scenario, but doctors will only accept the idea of failure to treat rather than hastening death.

A lot of people would love to be able to say "if I become severely cognitively impaired and incontinent with little prospect of recovery, please find a way to hasten my death", but would find it hard to make that decision for someone else. Or to articulate it for fear of judgement. And that is why we are where we are.

My own granny was lucky to have a massive stroke, but she often asked my mum to put a pillow over her face if it came to it. Lots of people know what they don't want for themselves, but it isn't currently possible to get it.

Yep... my MIL has alzheimers/vascular/frontal lobe dementia. She's happy as Larry. She lives in bed, is doubly incontinent and has an occasional inclination to spread crap up the walls. But she chats and laughs and is happy in herself. To us she has no life, just 4 walls, and a slow decline to nothingness, to her she is happy.

I hate the way everyone assumes that dementia is awful to someone. She was chatting about how she'd be a danger to all on her bike yesterday... she's never getting out of bed again, she can no longer walk, but her mind thinks differently... if her quality of life is perceived differently by herself and others, whose view counts... even if her mind is not all there any more?

When my mum was dying of cancer she spent the last six weeks of her life in a hospice after having been moved to a palliative care pathway in hospital. I can't fault the nurses or doctors there. However, she frequently said that had she had the option of assisted dying she would have taken it. She had already written an advance directive to refuse further treatment, one of the points being that she had always valued quality over quantity of life and had always been physically and mentally active.

She was in such pain and discomfort for those last weeks, even with the painkillers, racked by horrible chest infections and secondary infections. She was unable to eat after a bowel blockage and became very emaciated. It was cruel for her to have to go through that.

https://lordslibrary.parliament.uk/assisted-dying-bill-hl/#:~:text=A%20separate%202019%20poll%20of,members%20on%20doctor%2Dassisted%20dying.

I am very much in the fence on this one.

on the one hand if it were happening to me i would love to have the option, as long as there were plenty of checks and balance.

On the other hand I witnessed a family member come out of a very deep long term coma, having been told they only had minimal brain stem activity left, to wake up and have cogent conversations, even crack jokes and be considerate to the feelings of those around them. Sadly, they did still die eventually, but for me it proved that medical science is not 100 per cent accurate on prognosis, and I would hate to see individuals or their families being encourage or spatially pressured to make a judgement, when all hope may not be lost.

A friend of mine's mother actually did use voluntary euthanasia in Canada in her nineties. She went blind, and then felt totally deprived of the things in her life and decided that living on was not for her.

It's not only death we are bad at dealing with but the realities of age; losing faculty and ability. I think it's part of getting a grip on it that you do try and plan or decide, because these decisions are otherwise taken from you.

I expect a total shit show on care of the elderly in the next decade where it becomes very clear governments cannot fund it. That is pretty much where we are now anyway. These moral choices of care will return to families where they used to be before the welfare state.

So Paris thinks that pressurising terminally ill people to hasten their deaths would be a good thing because it would ‘open up discussion’ and eventually we’ll all recognise that it’s the right thing to do when you’re worn out and you cost too much money. What a revolting article.

The problem with assisted dying is that the premise sounds reasonable – who wouldn’t want to avoid needless suffering? – but we don’t know what safeguards would be in best place to protect vulnerable people from others deciding that their lives aren’t ‘worthwhile’ anymore. ”Well, the doctors would handle all that” and other vague deflections aren’t good enough. We’ve had endless attempts to pass legislation on assisted dying but it has never gotten to a stage where we could really pore over the nitty-gritty of how it would work, how are they going to prevent that ‘slippery slope’ etc. That’s why the debate is so polarised, because most people are giving their gut reaction based on half the information.

Wendy Mitchell died recently. She lived with young onset dementia for many years. In the end she starved herself to death.

www.theguardian.com/society/2024/feb/23/assisted-dying-advocate-and-author-wendy-mitchell-dies-aged-68

Her book on dying is worth reading. It considers a variety of viewpoints. Although she herself advocates for people to be given the choice between good palliative care and good palliative care including assisted dying.

Probably what she advocates for most is people actually talking about their wishes and these being respected.

When people say the 90 year old lady doesn't want a DNACPR I think that is a valid choice for her but I hope the junior doctor was honest with her about the likelihood of a successful outcome and complications so she could make an informed choice. Same as if it was offered to a 20 or 30 year old.

For a person living with advance dementia I hope their family consider what would have been most important to that person, living as long a life as possible no matter what (sometimes this is absolutely the case) or maybe they would have hated the loss of dignity and independence if they were aware of it and would prefer life prolonging treatments were not offered, only those that kept them free of discomfort (this is an equally valid choice). But if it's never been discussed that can feel a huge pressure to put on others, are you "letting them die" if you choose that for them?

There are risks with legalisation of assisted dying. We could mitigate these, although likely never eliminate them all. But equally, there are risks in not doing. The risk in not doing is forcing people to suffer who do not want to and who don't deserve to, not giving people a good death. We will all die and a good death is something we should aim to give to everyone as much as good healthcare in life.

I have LPA for an elderly relative, 90 with advanced dementia, GP phoned me nearly 9 months ago to say it was 50/50 that she would survive the weekend and she only had weeks to live. She is enjoying life, loves music and her carers. I don't have much faith in fewer than six months to live.

But Pratchett at the point when he was being vocal about assisted dying was capable of all that, and he didn't choose/organise. He was competent enough to give this clear speech. https://www.theguardian.com/society/2010/feb/02/terry-pratchett-assisted-suicide-tribunal
As I said easy to talk in hypotheticals but facing the reality is another.

@BeyondMyWits

I guess the question is whether your MIL would, back when she had capacity, have wanted what she has now. And if she wouldn't, is it better for her that she is still alive and happy (because she is now in a child like state and can't see things in the way that she previously did)? I don't think there is a right answer to this, but I suspect it is a common issue

That is a good question... but she is a committed Christian, and when she had her wits about her would say that God would take her when he was ready. To her (as she was before) suicide is a sin.

@EwwSprouts

Isn't the point that TP was totally fine when he wrote that speech but knew that he wouldn't be at some point, and at that point his capacity to decide wouldn't be accepted. He wanted to know there was no hope left of living his current meaningful life when he died

@BeyondMyWits

And I very much respect that view. Just as I respect those on this thread who really fear this for themselves. It's a very hard issue.

There is no need for a person with cancer to use assisted dying provided there is good palliative care (which there is in my area)

I think it’s more complicated than that. There is a point where the only way pain (psychological and physical) can be managed is by drugging the patient to the point that they are no longer conscious.

I don’t know what the answer is and like others am very much on the fence, but palliative care does not provide a straightforward answer.

It’s possible to argue that there is no way to legislate for assisted dying that sufficiently mitigates the risk of abuse, and also understand why some people with cancer and other conditions want to control the way they will die.

The fact that he didn’t want to go to Switzerland, pay the money, organise all the paperwork and travel by himself to die doesn’t mean he couldn’t face the reality of assisted death! The problem with U.K. people travelling abroad to die is that you have to do it much earlier than you might want or be ready for.

In the 80's my father was terminally ill. He had a marvellous GP who paid him lots of home visits. She told him that if the pain got too much she would help him.
One evening it did. She came round, gave him enough morphine to alleviate the pain, and said she would come back in an hour and give him enough so he wouldn't wake up again.
We had an hour to say our goodbyes and then he was put into a deep sleep and died within 24 hours. She kept a stack of morphine in the top of his wardrobe.
It was a kindness for him and what he wanted. She probably saved him a couple of weeks of intense pain and a slow death.
I don't think that would happen now.

That is the crux of the point I'm not communicating very clearly. Most people are never ready until it's too late. It becomes a de facto act of delegation. At which point it is euthanasia not assisted suicide. That is why I am so concerned about the slippery slope.

No, paying people to help relieve suffering, which is surely a good thing. And usually with assisted dying, the patient themselves has to do the actual killing of themselves - they have to press a button or drink a liquid.