Assisted dying bill (TW assisted suicide discussion)

[Onand]

I appreciate this is a divisive subject and a sensitive topic for many. Please avoid this thread if you find any discussion of suicide, death, trauma, terminal illness, cancer and faith triggering.

I’m curious to know how others are feeling about this subject, from what I can see there isn’t a lot of discussion, is this a MNHQ decision or an indifference from posters?

My opinion and views on this potential landmark decision are based on my horrifying experience of watching and waiting for my mum to pass from end stage cancer several years ago.

For over four years she fought advanced cancer, she took every treatment and trial offered to her. She endured major abdominal surgery, many blood transfusions, multiple rounds of chemo, lost her hair several times, her bones started to crumble causing excruciating back pain, severe abdominal swelling, double nephrostomy as her kidneys failed, multiple lesions on her brain that caused debilitating headaches and personality changes, her teeth and bones were decaying due to a calcium disorder, various hospital stays for infections, the list goes on.

Truly the most hideous nightmare cancer ‘journey’ anyone could ever imagine, it always felt like one step forward and two backwards and yet she carried on without much fuss or sign of fear to protect the family and herself from the true horrors of suffering.

She never wanted to die and so she never gave up or gave in- that was until the last few weeks of her life when she had no choice. The immense damage and toll cancer had done to her physical body was too much to survive any longer so the last infection she had took her consciousness and so began the final horrifying curveball that cancer has up its evil sleeve, this one is for the loved ones though, because now you have to wait and watch for the end to come. Anyone who has endured this knows exactly what I am talking about, a horror that truly brings home the meaning of hell of earth.

If the assisted dying bill was around whilst my mum was alive I know she would have never entertained an early death whilst she was still in control and able to fight, but I do know that her love for the family would have also meant she would never have wanted us to endure that final two weeks of watching and waiting for her body to shut down if it could have been avoided and she was able to specify what was to happen at the end. There was no possibility of her ever getting better or a miraculous recovery, death was very inevitable and a certainty but we still had to sit and watch, doing oral care and leaving the room as they checked for bed sores and did secretion suction. The only thing I could do to protect and help her was the make sure she was undoubtedly unaware of what was happening as she feared death and leaving us behind- the thought of her being remotely aware meant we were constantly asking the nurses for more and more sedation.

If this bill gives patients the choice to avoid the hideously evil ending of a terminal illness and the following ptsd that impacts the loved ones left behind then it is an opportunity I strongly agree with. Watching a loved one die an agonising death is soul destroying and something I hope no one has to ever endure if said loved one could choose to avoid.

How do others feel?

I don’t overtly disagree with it, but I think it currently has not been open to enough debate in the current parliament and leaves itself far too open to abuse.

I also cared for my father throughout his demise from cancer.

I agree with it - but I think there should be a referendum

Honestly it’s one of those things for me personally where I can absolutely see both sides. I can see where if I was in that position, terminally ill, no hope of recovery, I would want to be able to make that decision for myself and so I totally understand the position that it could be a good thing in those situations.

However my biggest worry with anything like this is the potential for abuse and this becoming a slippery slope, so can also see the argument against it being a strong one.

I love my cats more than anything. If they were in pain I would make sure I did everything in my power to end it, even if I had to do it myself. It would haunt me for the rest of my life, but I would do it.

This seems to be an acceptable opinion throughout most of society, but then we expect humans to die in painful, undignified, terrifying ways.

I believe if someone wants to end their life they should be able to do so with medical help to ensure it is done as safely and painlessly as possible.

I also believe there needs to be serious psychological evaluations and mental health being a huge consideration. We know we can't trust these processes in all areas (parents and patients have been let down on the trans issue)... So huge oversight of the people signing off on this would be needed.

I'm completely against it.

I'm a nurse abs the repercussions if this passes terrify me tbh.

It is possible to have a good death without the need for suicide/assisted dying.

Given how difficult it is to ascertain if a patient has full mental capacity now I have no idea how they can fully safeguard this for society's most vulnerable people.

Coercion, guilt and pressure undoubtedly will be used to make people feel they have to die.

Its come far too late. Ive watched hundreds of people die in a variety of ways over 40 years of being a nurse.
Some ok others just plain awful. I ended up with PTSD. I do not understand why people cant choose when they want to die.
I have euthanised most of my 10 cats at the end of their lives .aking a considered choice. Id be arrested for animal cruelty if Id let them die in agony but apparently we have to risk dying in agony if we are human. Whts with that?

I've never been through what you have with your mum, I'm so sorry you and she had to endure that. I've always had a fear of dying a horrible, slow, painful death and I really feel there should be an option to end that sort of suffering. I hope this time it's properly discussed.

First of all I'm deeply sorry for the circumstances you all suffered when losing your precious mum, Onand

While obviously I can see the benefits, my own position's remained consistent: it's an excellent idea in principle, but comes loaded with too many potential problems for us to be able to trust its implementation

They've all been mentioned on here and elsewhere before, but briefly:
Coercion in order to save money / the NHS
Targer driven healthcare related to the above
A lessening in the improvement of palliative care
Pressure for those understandably exhausted by caring
The same from those eager for their inheritance
And most of all, "mission creep" as eligibility expands ever further

Staunch backers will insist that these either won't happen or could be overcome, but sadly I'm by no means as confident

I'm completely opposed to it until palliative care is easy to access.

I don’t agree with the bill. Sorry.

Assisted dying won’t make death painless and quick- by the time terminally ill people use it they have gone through the worst of the pain and suffering already. There is no such thing as a beautiful, dignified death.

Where it has been legalised it has been expanded either legally or in practice to include people who are not terminally ill, and who would rather live but due to economic duress, emotional blackmail, mental illness or societal pressure end up feeling they have no choice but to die.

I have stage 3 ovarian cancer, it is in remission at the moment but has an 80 percent chance of coming back. I am also a care worker who has cared for people dying of cancer in their own homes. I believe people should have the choice. I want to have the choice of assisted dying whether, in the end, I choose it or not. Anything in life can be abused, we need to look to what has and hasn't worked internationally so we can have the best protections in place. I don't want to suffer at the end of my life and if assisting dying is not legislated for then that could increase the likelihood of people ending their own lives without medical assistance. I would rather have assisted dying with my family present than suicide (which may or may not be successful) alone because I don't want my family implicated in my death.

I have cared for both my parents at EOL and am in favour. I'm fairly sure they would have taken an assisted death had it been available. I have also kept animals for many years and every one of our pets has had painless euthanasia at the right time. I would never let an animal suffer at EOL, but sadly as a society we seem comfortable with letting our loved ones die what can be uncomfortable prolonged deaths.

I am a retired medic and although I completely understand why people wish to have some degree of control over ending their life in particular circumstances, I wouldn’t personally liked to have been involved in knowingly ending someone’s life. I did capacity assessments as part of my work. I would worry about having to do such assessments on people wishing to end their life. And families can be emotive and strongly disagree with both medics and other family members about capacity / medical decisions.
I don’t know if there have been discussions about whether this would become part of NHS services if the bill goes through - or private companies like dignitas. At least with a private arrangement the people working there would gain expertise and presumably be comfortable in doing what they were doing.
If it’s an NHS thing - can they compel existing staff to be involved. Is there enough capacity given that the service is struggling to manage even the bread and butter stuff at the moment .

My sister had a "good death"... for two years.

It was awful. I'm sure a good death is something that does exist, I'm not sure if you have terminal cancer or altheimers it is actually possible

There's no way in the world I would want to go through what she went through and would much rather be able to go at a time and place of my choosing in a manner that actually is swift and painless. Also that leaves my family with the positive memories not the negative.

We do need to recognise assisted dying. I'm not sure that this bill is the one, but hopefully it will at least jump-start the conversation

if assisting dying is not legislated for then that could increase the likelihood of people ending their own lives without medical assistance.

Studies have shown that assisted suicide does not decrease the nonassisted suicide rate, in fact it stays roughly the same. In fact the total suicide rates go up (assisted plus nonassisted). So it isn’t true that some of today’s unassisted suicides would be prevented by legalising assisted suicide. Here is one

”Objectives: Several US states have legalized or decriminalized physician-assisted suicide (PAS) while others are considering permitting PAS. Although it has been suggested that legalization could lead to a reduction in total suicides and to a delay in those suicides that do occur, to date no research has tested whether these effects can be identified in practice. The aim of this study was to fill this gap by examining the association between the legalization of PAS and state-level suicide rates in the United States between 1990 and 2013.
Methods: We used regression analysis to test the change in rates of nonassisted suicides and total suicides (including assisted suicides) before and after the legalization of PAS.
Results: Controlling for various socioeconomic factors, unobservable state and year effects, and state-specific linear trends, we found that legalizing PAS was associated with a 6.3% (95% confidence interval 2.70%-9.9%) increase in total suicides (including assisted suicides). This effect was larger in the individuals older than 65 years (14.5%, CI 6.4%-22.7%). Introduction of PAS was neither associated with a reduction in nonassisted suicide rates nor with an increase in the mean age of nonassisted suicide.
Conclusions: Legalizing PAS has been associated with an increased rate of total suicides relative to other states and no decrease in nonassisted suicides. This suggests either that PAS does not inhibit (nor acts as an alternative to) nonassisted suicide, or that it acts in this way in some individuals but is associated with an increased inclination to suicide in other individuals.”
https://pubmed.ncbi.nlm.nih.gov/26437189/

It is possible to have a good death without the need for suicide/assisted dying.

If that's the case then why are there still so many people dying in agony, both physical from the illness/disease or mental from things like locked in syndrome? So many people coming forwards begging to be allowed to die, mostly clearly of sound mind. If I could guarantee I would be able to be without pain and still use my brain I might change my mind, but for some people the very thought of being stuck almost paralysed in a bed depending on others to clean up your excrement and feed you, and unable to engage your brain is horrifying.

As a pp posted above, we would be prosecuted for treating an animal the way we treat terminally ill people

Anything in life can be abused, we need to look to what has and hasn't worked internationally so we can have the best protections in place

In principle that could work if we had the fully functioning infrastructure, proper accountability and sufficient money to make sure it did, @ChocolateTurtle, but sadly we haven't

Protection and oversight cost money too, and how much easier to shrug off alleged mistakes because "they were going to die anyway and the benefits outweigh the cost"

I think in principle most people are ok with it but there are so many issues I don’t know how you’d solve them all:

1. my own experience with a terminally ill relative is they spent their last 6 months apologising for being a burden. They were actually very low in terms of support needed until nearly the very end and we had some wonderful times in those last six months. I would have hated if they’d left us early then due to misplaced guilt.
2. the current proposition is that two doctors and a judge sign off on each patient. How long would this take to do properly? The switch from “terminal but ok quality of life” to “really suffering and will die within weeks” is often quite rapid. So you then throw the family into begging doctors for assessment and filling in court forms at a really stressful time to maybe cut someone’s life short by a few days by the time it gets through? Would the passing be more peaceful necessarily?
3. are these nhs doctors? Is it fair to ask them to do this? What if they don’t want to ?
4. protection against coercion etc
5. people choosing to take death because admin errors mean they don’t get the support they should be getting
6. people wanting to expand it to mental illness
7. the “easy death” probably won’t be as serene and relaxed as people think and it might traumatise the families and make them feel that maybe it was to early/wrong choice etc. I saw a documentary about dignitas where they filmed the death and he clutched the air and tried very hard to breath. It was upsetting to watch.

there’s probably more. Some of these are solvable but not all. I suspect it will eventually pass even if it doesn’t this time around.

I agree.

I’m so sorry to hear of your sisters horrendous ordeal.

It could be argued my mums ‘good death’ was probably 6 months long from the brain mets being diagnosed, the terrifying personality change and swirling feeling she felt she was losing her mind all whilst she carried around two nefrostomy drain bags attached to each of her kidneys on little metal stands whilst she hobbled in utter agony as her spine crumbled and she lost inches in height, had zero enjoyment of food with painful digestive problems and multiple life threatening infections.

Having a legal humane choice to potentially avoid a worsening end may have convinced her that she had suffered enough and that she could walk away from the fight on her terms.

We need to do better for those with incurable degenerative life ending terminal diseases that wreak pain and suffering for entire families and circles of friends who do not want to endure the suffering but also do not want to be complicit in murder as things stand in the eyes of the law now.

I know the emotive argument is about the right to die with dignity and in theory I don’t disagree with it.

But while we live in a society with so much needless homelessness, where end of life care is so appalling, where so many people with disabilities or mental health problems do not have the support they need I think this bill puts those people at risk.

When we have the kind of society that supports people to LIVE with dignity then we will be the kind of society that can handle the responsibility of assisted dying.

Unassisted is awful for the people that find the person, and the family that may not have had a clue about why.
This won't stop with an assisted bill, because not every person's circumstances will be considered.
Even then there will be family/friends who disagree for whatever reason (religion maybe?)
Who will responsible for checking the person is of sound mind/in enough pain or meets whatever criteria? Are the government proposing to fund this?
If it's self funded then the less well off won't have access to it.
Too many variables atm for me to agree it's a good idea, that's before the possibility of coerced signing.

Anything in life can be abused, we need to look to what has and hasn't worked internationally so we can have the best protections in place.

While this is true, assisted dying is especially serious as abuse results in death. There is nothing more final than that. We abolished capital punishment because errors meant that on a rare occasion, an innocent person was executed for a crime they did not commit. So even if abuse of assisted dying can be categorised as a rare occurrence, why would we treat it differently from capital punishment? Why is it too dangerous to execute convicts because a handful might be innocent but alright to risk even a handful of deaths of some of the most vulnerable people in our society?

The process outlined to determine true consent and capacity is a mere charcol sketch compared to the rigor of past capital criminal trials. The two physicians signing off on it are not even required to confirm with a specialist that the person is terminally ill or has the capacity to consent. And it is quite clear the court judge is simply there to rubber stamp it as a state indemnification against any wrongful death civil suits that relatives might file against the physicians.

Not a nurse, but I agree wholeheartedly with @Girliefriendlikespuppies I say that as someone who’s lost both parents and has a life limiting condition.

All the people comparing it to pets there's the issue that a cat or dog lacks capacity to make its own decisions and you decide for it so this is not really analogous to someone with capacity who has cancer choosing to die and much more akin to ending the life of someone with eg Alzheimer's who lacks capacity to decide for themselves which is not covered by this bill.

This is why I really don't think it will be very long until people start to push for it to apply to those lacking capacity or for some advance directive mechanism otherwise I don't see how it can assist anyone dying of dementia who will lack capacity way before they have 6 months left.

Most people with terminal cancer are in fact very keen to live for as long as possible. I can't see that many people asking to be euthanised in that circumstance. My mum died young of metastatic cancer. She was desperate to survive and be with her family as long as she could and her death was as OK as I think death can be. She was in a hospice where she did not suffer unduly although obviously seeing my
Mum dying was still horrible. Death is always horrible you cannot take that away entirely.

Also Drs notoriously cannot tell how long someone has left. My mum was given 6 months to 2 years at least 6 years before she died and 5 of those were really good years that she would not have wanted to miss out on.

I am a Dr and I will conscientiously object if I am asked to have any involvement in this. I did not go into medicine to kill people. I am all for letting nature take its course and not 'striving officiously' to keep people alive, which happens all too often, but I do not want to be responsible for ending anyone's life.

When we have the kind of society that supports people to LIVE with dignity then we will be the kind of society that can handle the responsibility of assisted dying

I couldn't have put it better myself, @AnonyMouse80

How easy, though, to argue that we could better afford to support those with a decent life expectancy were it not for the costs of caring for the terminally ill - and if this was adopted it's an argument I'd expect to be made all too soon, though doubtless wrapped up in different words