Euthanasie, dont legalise in UK.

[MrsMarkieParkie]

I just read that 8% of deaths in Canada last year happened via euthanasia. This doesnt sit right with me. Also, as described in the article, the protocol seems mostly the same as the US death by lethal injection.
Do we want this in the UK?

Ethics committee in NL felt this was the right decision. The woman concerned had been very clear in her wishes that she didn’t want to live with dementia past a certain stage.

I have dementia in my family and I would also be very clear about my wishes not to live beyond a certain stage. I’m sorry it was distressing at the end. Her family obviously thought she’d made the right decision for her. It is unspeakably awful to watch an intelligent, proud, vivacious person slowly become a shell as dementia robs everything from them. I can completely understand someone making a decision that they don’t want to suffer that indignity.

The dementia part of it is very difficult to deal with. The story below is very distressing.

At the same time I can see why any of us might say now we want the choice.

The other thing to note about the Dignity in Dying survey is that there is not a huge difference between the attitudes of religious people and those with no religion.

82% Christians (44% strongly, 38% somewhat) supported the proposal compared with 84% of the overall sample (49% strongly, 35% somewhat). 90% with no religion supported the proposal (57% strongly, 32% somewhat).

The results for other religions were interesting - Hindus, Sikhs, Buddhists and 'Other' more in favour than the overall sample, Muslims significantly less so. But the numbers were tiny, e.g. 13 Sikhs surveyed compared with 2636 Christians and 2606 people with no religion.

So the idea that concerns are only being raised by religious people with 'sanctity of life' arguments is false.

Screw it, if I get dementia or end-stage cancer just knock me off! Don't let me wither away and die (esp with dementia where my whole personality is stripped away and I am pissing myself). We would see keeping a dog alive disgusting if it was suffering. Why should we torture people just cos we can spea?

“At the time of death she did not want to die” But had dementia at the point she no longer wanted to die. She had no capacity. Her original wish stood (which had she been sound of mind she would probably have stood by). Imagine the ability to see what dementia had reduced you to. Dementia isn’t just not recognising family or remembering.

You forget how to chew, you forget how to swallow.

Yes I know that's what the ethics committee in NL decided and I don't blame the individual medic who was acting within NL law.

Nevertheless, a woman was held down and killed when she did not want to die.

Did you miss this bit? - It doesn't matter what anyone else would or would not want for themselves in that situation, or what they now think they would want, or what this woman thought she would want when she signed.

'Sorry it was distressing at the end' is a wholely inadequate response to state sanctioned murder, even if her family approved (as if that would make things better). Sorry for the strong words but you can't even call it manslaughter because the intention was for her to die.

84% of the UK may be in favour (strongly or somewhat) of some form of assisted dying but I don't believe anywhere near that % would be in favour of a law that allowed this to happen. I hope I'm not wrong about that.

I agree LangClegsInSpace

I've spent about 10 years caring for people with various kinds of dementia including attending deaths. I know what it's like.

50% of mentally sound terminally ill patients said they wanted assisted dying and then change their minds. Why do you think this would be different for dementia patients?

How do you know that 'had she been sound of mind she would probably have stood by' her original decision when 50% of people change their minds?

And when the human right to life is engaged, why do you think 'probably' is good enough?

I think that when it comes to dementia we need to be extremely cautious, and I think that means in the event that consent is withdrawn in the moment, that withdrawal must be taken at face value and must then not be reversed. Where there is a clear lack of capacity, we need to err on the side of not allowing the death to take place, end of story.

And that probably means people will end up dying at an earlier stage of their illness, when they have capacity, but erring on the side of caution is the ethical thing to do.

My late father had dementia and was offered an advance directive in the Netherlands at an early stage when he absolutely did have capacity. He turned it down. Later on he changed his mind, but at that stage he had deteriorated so badly that he was deemed no longer able to consent. It was heartbreaking because in his lucid moments he knew very well what he had missed out on. It was a relief for all of us when the dementia progressed to the point that he no longer remembered at all. His care team followed the path of caution and rightly so.

But someone else deciding to kill someone is murder
Or do you think someone else should kill them for you

Though I'm no lawyer, if this comes in, is carried out at the patient's request and they'd be expected to take the drugs themselves, I doubt it would class as murder any more

I agree though that it would create one heck of a conflict for some medical staff - though if support is as widespread as surveys suggest I see no reason to assume that many HCPs won't support it too

You make good points

People need to stop wanging on about their pets because animals do not have human rights.

Nobody decent allows their pet to soldier on in pain with no quality of life.

Nobody decent wants people to die in pain and distress.

RSPCA and loads of animal shelters kill animals simply because they are unwanted, most of us eat animals just because they are nutritious and tasty, and it remains legal to kill animals in certain circumstances just for fun.

Humans are animals but we are the only animals that have human rights and they start from the moment we are born until the moment we die.

If you want to legalise assisted dying you need to engage with the human rights implications which have nothing to do with responsible pet ownership.

A good case can be made for a human right to be assisted to die but you need to also show how you propose to respect the rights of those who do not want to die. Article 2 is really strict.

https://www.equalityhumanrights.com/en/human-rights-act/article-2-right-life

Animals do not have a right to life.

Some people have talked about the Liverpool Care Pathway. The inquiry report can be read here:

https://www.gov.uk/government/publications/review-of-liverpool-care-pathway-for-dying-patients

What it said on paper was fine and was well understood by hospice care staff but the implementation was terrible. The purpose of the LCP was to embed hospice-quality EoL care on hospital wards and community settings and it was a terrible failure, especially in hospitals.

The training was so inadequate that there was not even a shared understanding among hospital staff of what 'end of life' meant so patients were placed 'on the pathway' when they had months left to live, when this was only ever meant to be a suitable care plan for people in the very last days of their life. The word 'pathway' proved to be a problem - in hospitals it was interpreted as you do each thing in order until you get to the end, whereas in hospice settings it was meant as 'here are the things to consider at each stage' without any sense of an inexorable progression.

Decisions were left to unsupported junior clinicians working alone, often in the middle of the night or on BH weekends when there was no real urgency and decisions could have waited for a full team meeting.

LCP absolutely hastened a lot of people's deaths. It absolutely was a scandal.

But everything that went wrong was with the implementation, lack of training, lack of support, lack of safeguards. LCP on paper was fine.

It's not at all unreasonable to be worried about a similarly terrible implementation of even the best (on paper) assisted dying law.

Thank you for your contributions to this thread, @LangClegsInSpace People seem to think this is a very cut and dried issue. It isn't.

As a Canadian, I think what people should remember is that the law did have all the safeguards against abuse that people would want. It was limited and what was considered an example of best practice.

There was all kinds of emotive lobbying by pro-euthanasia orgs before, saying look, we have safeguards.

In a few short years they are mostly gone and there are bodies recommending it be extended to children. This is a similar pattern to what happened elsewhere.

This was done by very clever work by the lobby groups. A two pronged approach, one finding the most emotive stories possible of people who were excluded by the safeguarding protocols. The other was through the courts. Once the principle that people have the right to end suffering was enshrined in law, it was possible to beat back against any limitations of that right. In some cases this was also done by claiming that it was discriminatory, for example against people with mental illness.

But the underlying issue was this - once you have the law recognize that there are some lives not worth living, that has downstream effects. For example, with children, of people with disabilities. If some lives are so terrible that living is worse, it suddenly looks like the state, and society, is being cruel by letting such people go on living. It begins to look like there is an obligation to act for such people. And then the idea that only an individual can make that choice, which is supposed to be the hard line, is no longer functioning, and you have the makings of a dystopia. This is why disability groups so often are against this kind of legislation.

No I don't want euthanasia but neither do I want very ill people kept alive by medication to prolong life. Let nature take it's course

Well she didn't understand what she was being held down for. To be honest I don't know why they did it so horrifically they could have premedicated her with benzos given in yoghurt which would have made it less upsetting. Unfortunately we hold down people frequently who lack capacity I did it today to inject insulin. I tell them why I'm going to do it but they don't retain the information. In their mind I could be trying to hurt them. Restraint is common for all kinds of procedures we do it for personal care, injections , health checks. It's a last resort but it happens a lot.

Yes there is sometimes justification for administering health care in a patient's best interests, but against their wishes, when they don't understand what's happening and so cannot give informed consent.

Generally the justification goes something like, 'If they were not given this treatment they would die' - e.g. giving an insulin injection.

That's a very different thing from 'If they were not given this treatment they would live'.

There is no justification for restraining a patient in order to administer a treatment against their will with the intention of killing them.

BTW, the patient had been premedicated with sedatives covertly delivered in a drink but it wasn't enough. She still fought hard and had to be held down by her family in order to be killed.

She did sign the euthanasia request when she had capacity. Do you think if someone signs an advanced decision stating they don't wish for life sustaining treatment if their condition/mental state deteriorates then their wishes could be overridden? An advanced decision is for when you lose capacity , so I think that's what happened legally in this case.
To be honest I think advanced decisions should be binding as what's the point In getting one if they can be easily overturned when the person does eventually lose capacity.

I have a neuro-degenerative chronic disease. I'm not old. At one low point, for some months I couldn't talk, chew, or swallow. Where does your statement leave me and others like me?

Happily, I recovered from that particular episode. But at the time - and for months afterward, as I had to relearn how to talk and write - I could not communicate in any way at all. I didn't have the fine motor ability to type. I couldn't advocate for myself. Discussions like these are frightening to me as it seems some people view disability and ill-health in a burdensome way, and would rather people so afflicted disappear rather than deal with them.

@Felixss

She did sign the euthanasia request when she had capacity. Do you think if someone signs an advanced decision stating they don't wish for life sustaining treatment if their condition/mental state deteriorates then their wishes could be overridden? An advanced decision is for when you lose capacity , so I think that's what happened legally in this case.

If the person says no, it's no. Why are you so eager for death?

I sometimes think the family itself wants to be spared the horrors of a drawn-out death.

And what about people like me? I'm old and frail, I have a few diseases, none of which are likely to kill me.

But, in five months I've left my home three times. I haven't been outside, at all, apart from those three occasions, since December. If I have to live another ten years like this, I think I will go out of my mind.

I was quite heartened to read that dignitas cost £10k, I could afford that, I've got fuck all else to do with my money. but if I have to have a terminal illness with six months to live? Well, in one sense I do (we all do), life is terminal, after all. But no hcp can say when my time will be up.

for lack of a suitable alternative, I frequently contemplate suicide, but more often, hope for a terminal diagnosis of some disease.

@GoldenAye There is a contradiction here, are we to say that, once an individual loses capacity, a decision to end their life will not be accepted but a decision to stay alive will? That is assuming there is no AA in place?

They don't change their mind. Their mind changes. Their personality changes.

Would you let a person with advanced dementia sign a legal document? No, because they lack capacity. They are not able to understand what their decisions mean. That's why they have advanced decision which have to be honoured. I don't want a future version of me with no understanding of my personality, basically a stranger to to make a decision about my future.

And neither should the mawkish professionally offended.

Death is irreversible. The decision to keep living is. Even if the mind isn't capable of reversing that decision, the body itself may take over.

I'm uncomfortable with the notion that the medical profession - and families - may override the desire of someone who wishes to live simply because previously, at a weak point, authorised a DNR or similar. The wish of the person is question is paramount - not the family's, nor the doctors.