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 support it. I think people should be given the choice. Just because some people have experiences of family members wanting to live to the very end (which I completely understand) doesn’t mean that everyone will feel that way. It will be a choice not a full blown conclusion. If the patient wants to stay around until the very end, those wishes must be respected. But if they don’t want to suffer any longer, or controversially if they don’t want to be a burden on their families then they should have the right to choose.

A nurse you say? So all these people living in pain and agony for months if not years waiting on the inevitable are invisible to you? So please tell me, a 52 year old given 12 months or so to live after 2 years of chemo/radio/immuno and all the side effects that go with it including double nephrostomys due to kidney problem caused by ‘treatment’, not to mention the hip fracture they aren’t going to do anything with because pretty much it’s a waste of their time and money how good my death is going to be? Not to mention why it is anyone else’s decision rather than mine? The pain I’m in mentally and physically just waiting to die is almost unbearable. It’s so bad I’ve already signed a DNR in the event that a welcomed heart attack might happen. My choice!

@Errors I agree. Cancer runs ragged through my family and I've seen too many relatives have rubbish, drawn out deaths. Older people hate being a burden, and my relatives would cry and tell their caregivers "For heaven sake, end it now", but of course they couldn't. If my relatives said, I want to be let go, and they could do that with repercussions, I think they might have seriously considered it.

Choice is the word here. You should be able to choose to end it early, or choose not to.

The key here is how much room for coercion might there be. That's the thing that worries me. And I don't want to our country to end up like Canada.

But the basic principle of allowing two doctors to agree that assisted dying is a reasonable choice for a terminally ill person, I am in favour of.

Sadly, I don't think there's been enough debate about this Bill in this country, and I think it will not pass, like all other attempts before it.

i am against it because it is the slippery slope to eugenics.

There was another thread about this recently, and posters were saying thing like “baby steps”, and “by the time my time comes the law will have been amended to allow for/or extended.” So it is blatantly obvious that even the public who approve want this to be the start of a slippery slope.

People talk about dementia, about how it will be a way out for those people, when actually it won’t. Because you have to have capacity, which someone with dementia doesn’t have. But people won’t let it drop there. They will want it to be like countries like Belgium and the Netherlands where patients with dementia are physically restrained in order to kill them due to an advance directive. And that, IMO, is murder. If a woman consents to sex one night, then goes out and gets drunk, and the man she is with has sex with her even if she says no, we confirm that he raped her, because she didn’t have the capacity to consent at the time. Therefore someone who consents to be euthanised at a particular point doesn’t have the capacity to consent when the time comes, and as such, holding them down to perform the act is murder. IMO.

Everyone has the right to commit suicide if they want to end their life. At best the law can be changed in order to absolve relatives who travel abroad with someone to end their lives. But that’s as far as it should go.

I am totally against this.

There will be coercion. 100%. Whether that is money grabbing relatives, relatives thinking they are doing the right thing - ie they would want an assisted death so granny must want one too and convince them or people not wanting to be a burden, don't want to waste inheritance. Also drs offering it makes it sound like it is recommended, people trust drs. There will be coercion.

I also think it's a slippery slope. Today it's people with terminal illness who choose this. Tomorrow the nhs has no money so people with terminal illnesses are forced down this path because it's much cheaper than other palliative care options.

Very conflicted.
From here and other sources I hear about the incredible pain and suffering endured in the final stages of life. Also for those knowing that it is the last few months.
If there are doctors and judges who agree who am I to say no. Why should two people suffering experience different end because one is rich and can afford Dignitas?

However I don’t trust any government to invest in palliative care so there is a genuine choice.

The time between the doctors and court and the death seems to be designed to be short which means an advance directive would not work. To avoid the suffering you would have to be assisted in the early stages of the 6 months. There might be a postcode lottery of doctor and court time leading to suffering of the paperwork

If I wanted this for myself it would probably be in the case of dementia and the law would not help. If I write something up now when I have full capacity and hope that then law changes how does someone decide when is the “right” time?

I have also got a physical disability so in the case of cancer when the law should help I might not be able to physically take the drug if only my right side was working (it doesn’t work properly so likely they would have used every part of my good left side to treat.) Yet it would be a slippery slope to help me with the last bit of inserting the syringe or pushing the button.

I have depression - does that mean I will automatically not have capacity in relation to a decision about death due to my cancer? Lots of people develop depression due to cancer or other illnesses that would otherwise qualify- what happens then?

I absolutely oppose it. People will feel guilty and under pressure to end the suffering for their relatives' sakes if not their own.

Good quality end of life care is what is needed. We probably all have experience of losing loved ones which is not pleasant but excellent pain relief and hospice care should be the focus from Government not this.

Also, tbh most people have access to massive amounts of opiates in the final few months anyway.

I feel exactly the same as you, for the reasons you've stated.

I'm so sorry about your mum.

I've felt this way for many years. I have had many cats and dogs euthanised over the years and have always felt it's so wrong that the same dignity isn't afforded to humans.

For people making the comparison between humans and animals, there is no comparison.

Yes, we have the ability to have an animal put to sleep in the case of suffering or long-term illness.

But people also routinely have animals put to sleep if they e.g. can’t afford a treatment for a condition. My cat has recently cost me £4000 for a treatment which is relatively new and therefore expensive. But the vet said most people still choose to put the animal to sleep because they can’t afford it.

If a dog bites we are advised to have it put to sleep.

People take their dogs to have them put to sleep if they no longer want them.

And this one of the reasons why the veterinary profession has one of the highest suicide rates.

This law is being proposed precisely so that in future it will make it easier to kill off the elderly, the disabled, the mentally ill, the homeless, where shall we draw the line at who we can kill?

Because let’s be honest, if the law goes through as it is strictly being proposed, there are very few people who will actually be eligible vs those who feel they should be. And so it’s only a matter of time until there is a further amendment, with cries of “you wouldn’t let a cancer sufferer go through this, so why someone with <insert illness>”

For those saying that you have the right to commit suicide - the difficulty is doing that safely, reliably and painlessly in a way that doesn't cause trauma to your family.

That isn't easy to achieve - it's made deliberately difficult to achieve so that people can't make that decision on a bad day, or a bad week and then not live to regret it.

So how do we make suicide accessible to those who want to commit suicide without making it accessible to those who are suffering from depression but who, as a society, we generally believe will and should have the opportunity to recover, rather than being able to make that decision at a rash moment?

OK, but you said in your OP:

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.

Do you mean she would have signed an advance directive? Lots of people seem to like that idea because they don't want to die slowly of dementia but PP have highlighted the problems.

Lets also not forget the avoidance or trauma for the loved ones who stay until the end and then have to live with the recurring nightmares and visions of what happens in those situations.

Sorry to sound harsh but when it comes to changing the law we absolutely do need to 'forget' the loved ones' desire to avoid trauma. Any new law must be 100% patient focused.

I absolutely think that it is a human right to choose death over suffering, why should I have to rely on a friend or relative to help? A medical professional that views life at all costs as their aim isn't one who puts a dying patients interests at heart in my opinion.

IThe dying process has already begun, the physician is simply supplying the meds that speed up the inevitable, administered by the patient themselves.

let’s be honest, if the law goes through as it is strictly being proposed, there are very few people who will actually be eligible vs those who feel they should be. And so it’s only a matter of time until there is a further amendment, with cries of “you wouldn’t let a cancer sufferer go through this, so why someone with <insert illness>”

Exactly, @NotOneOfTheInCrowd, and even that wouldn't be so bad if it was the sufferer themselves who believed they "should be eligible"

But again, what if it was relatives or medics, faced with the uniquitous targets and all too well aware of the cost of continuing treatment and support?

I watched my best mate die from cancer in her thirties. That was a long, drawn out, hideous death and I wouldn't wish it on my worst enemy. Sure, it's possible to have a pain free death, but it doesn't happen for everyone.

I set up a Dignitas savings account straight away and I have my 10k ring fenced for that should the same fate ever await me. It would be nice not to have to travel abroad to do it, though, so I support this change 100%.

I'm truly sorry for your loss.

I don't support this law though and I'm not sure that your mother would have done so. You mention assisted suicide could have helped your mother avoid "multiple life threatening infections", with implied treatment of these. Consenting to treatment for these doesn't indicate that she was someone who would have considered assisted suicide.

People like yourself are why this is so important, it’s fucking bleak and just horrendous, truly sorry to read your words. Having that choice to walk away on your terms rather than waiting for things to get unbearably worse is crucial.

Those whom oppose the choice of an assisted death- I really hope you do not ever have to go through the horror of either suffering or witnessing the evil of a difficult end of life.

@ThePure
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.

I agree with your point, you entire post was great, but I wanted to inform you that this bill does in fact cover euthanising those who lack capacity. There is an entire section that will legalise consent by a proxy. If a person cannot communicate their consent, a proxy can sign the consent on their behalf and the bill states that the signature of the proxy is to be legally the same as if the person to be euthanised had signed it themself.

Even Oregon has the slippery slope too, they amended it in 2020 and 2022 expanding it.
https://blogs.bmj.com/medical-ethics/2023/10/27/twenty-five-years-of-the-oregon-model-of-assisted-suicide-the-data-are-not-reassuring/

“First and most obviously there has been a dramatic increase in numbers from 16 in 1998 to 278 in 2022. At the same time, the proportion referred for psychiatric evaluation prior to assisted suicide has dropped from 31.3% to 1.1%.
The 25-year review also highlights changes in the drugs used and in the rate of complications. Between 2010 and 2022 complications were reported on average in 11% of cases. In 2022, reported complications fell to 6%. Unfortunately this is not so reassuring as it seems, as an increasing percentage of data on complications is missing. In 2022 there was no data on complications for 74% of cases.
The reports also show shifts in the reasons given for seeking assisted death, with more citing the fear of being a burden and more citing financial concerns. The figures vary from year to year but in both cases the trend is clear. The increasing number of people seeking death because they feel they are a burden to others does not speak well of changes in social attitudes in Oregon since the DWD Act came into force.…”

“If political debates outside Oregon influenced its shift in use of language, they may also account for the recent expansion of the DWD Act. Before 2016 there were only three States with such legislation (Oregon, Washington, Vermont) and one where assisted suicide was legal through case law (Montana). However, by 2021 there were ten jurisdictions with statute laws plus Montana where assisted suicide remained legal by case law. It is remarkable that, before 2019 neither Oregon nor any other jurisdiction in the United States had amended their law on physician assisted suicide. However, in the four years since 2020, there have been seven amendments to such laws across five states: in Oregon in 2020 and 2023; in Vermont 2022, and 2023; in California in 2022; in Washington in 2023; and in Hawaii in 2023 and an amendment has been introduced in New Jersey. This amounts to six out of the ten jurisdictions with such legislation. All these changes expand access, for example, waive waiting times, allow nurses to prescribe the lethal medication, or drop residency requirements. Until 2019 it had been possible to argue that there was ‘no evidence of a “slippery slope”’ because ‘The Oregon law has remained unchanged since 1997’. This is no longer true. In recent years there has been a wave of expansion of such laws and further expansion is surely to be expected.”

https://blogs.bmj.com/medical-ethics/2023/10/27/twenty-five-years-of-the-oregon-model-of-assisted-suicide-the-data-are-not-reassuring/

Those said infections saw her personality change within seconds, a sky high temperature, delirium, nausea and fear with sheer terror of what was happening and her being unable to understand where she was. The medical team had a duty of care and would always bring her back from the brink, a weakened frail body slowly being devoured by cancer and its plethora of heinous side effects.

Lets not forget that being in NHS hospital wards with the mental health patients and under staffing meant the level of care she received was usually terrible, they had neither the specialist knowledge or time to adequately meet her needs, a very poorly lady who was in wards like scenes from One flew over the cuckoos nest, we fought as hard as we could to get her the best care but ultimately the ward staff had their hands tied.

Going to visit your dying mother on a hospital ward and realising her nephrostomy bag has leaked all over her bed and the stench of urine is so strong it makes you wretch as she lies there crying in agony and embarrassment is really something which makes you wonder if a dignified planned death to avoid such hellish existence had been offered once the terminal diagnosis was made she may have opted for it.

We need to get away from this notion that inducing death is a bad thing, if the patient chooses an easy way out they should be able to take it.

I’m in ROI and from the outside looking in I would like to see similar legislation in Ireland. I agree with other who have expressed concerns in the same way that I recognised the concerns of people in the abortion debate in Ireland. People have good reasons to be concerned and to object however for me on balance the benefits of having a mechanism to allow people with terminal illness to die at a time of their own choosing makes sense. We were recently at a funeral where a man lived with Alzheimer’s in a home for 9 years. He had lost every function and had lost so much weight, he was about 6 stone when he died. He would never be covered by a bill like this but honestly it was harrowing what he and his family went through in those years. There are no easy answers here just trying to do something a bit more compassionate than what currently is offered.

I think we need a discussion about being able refuse life-extending care when people are very unwell.

My DM has dementia but she didn't need to be in this position if we had only thought about it. She had bacterial pneumonia a few years ago and could easily have avoided this dementia if she could just have gone to paliative care then.

I wondered if people could just have the choice to go to palliative care rather than having euthenasia?

But also I think sometime euthenisia is kindest, and I certainly wanted it for all my pets.

I do worry about depressed teens though. The teenage years can be so hard, and giving them the option of euthenasia seems like an enormous burden.

US:
“Before 2016 there were only three States with such legislation (Oregon, Washington, Vermont) and one where assisted suicide was legal through case law (Montana). However, by 2021 there were ten jurisdictions with statute laws plus Montana where assisted suicide remained legal by case law. It is remarkable that, before 2019 neither Oregon nor any other jurisdiction in the United States had amended their law on physician assisted suicide. However, in the four years since 2020, there have been seven amendments to such laws across five states: in Oregon in 2020 and 2023; in Vermont 2022, and 2023; in California in 2022; in Washington in 2023; and in Hawaii in 2023 and an amendment has been introduced in New Jersey. This amounts to six out of the ten jurisdictions with such legislation. All these changes expand access, for example, waive waiting times, allow nurses to prescribe the lethal medication, or drop residency requirements. Until 2019 it had been possible to argue that there was ‘no evidence of a “slippery slope”’ because ‘The Oregon law has remained unchanged since 1997’. This is no longer true. In recent years there has been a wave of expansion of such laws and further expansion is surely to be expected.”
https://blogs.bmj.com/medical-ethics/2023/10/27/twenty-five-years-of-the-oregon-model-of-assisted-suicide-the-data-are-not-reassuring/

Australia- There hasn’t been enough time for the slope to start, although in Victoria euthanasia activists criticised the government for refusing to consider legislation to expand it during the 5 year review. Activists here also intent to lobby to expand the bill in our Parliament as soon as it is passed.

https://cathnews.com/2023/03/14/victorian-doctors-push-to-scrap-euthanasia-safeguards/

Australia:
Voluntary assisted dying schemes have been in effect in the following states; Victoriasince 19 June 2019,[1] Western Australia since 1 July 2021,[2] Tasmania since 23 October 2022,[3] Queensland since 1 January 2023,[4] South Australia since 31 January 2023[5]and New South Wales since 28 November 2023.[6] A voluntary assisted dying scheme will go into effect in the Australian Capital Territory on 3 November 2025.[7]

I already live with two chronic pain conditions, an also have dementia on both sides of the family. Currently I manage my pain using strategies it has taken me 20+ years to develop, plus lots of hospital appointments and medication. Should I develop dementia in the next few years those coping mechanisms go out the window. So I’m looking at 10-20 years of dementia plus chronic constant pain that I cannot control or cope with and ultimately even communicate to others. I consider myself incredibly vulnerable to ending up in this position and even more vulnerable to those who would wish me to stay alive as long as humanly possible, at great emotional, physical and financial cost to my love ones. Why is this not considered a fate worse than death? Why do people have to battle on to the absolute bitter end so others can feel their death has be properly “earned”?
I personally would be happy to sign a document every year stating the point at which, should I develop dementia, that I should like to end my life. The slippery slope argument is always pulled out against it, as things are I feel like I’m heading towards a slippery slope no one acknowledges.
I don’t expect assisted dying to be voted in. Government doesn’t really represent public opinion and the minority of people opposed are incredibly vocal.

I agree 100% that in this situation it would be kindest to be able to go at the time of the patient's choosing.

This is what I want for my DM but the discussion was never had and now it is too late.

More on activism in Victoria, Australia by Dying With Dignity Victoria (DWDV)
to expand the legislation down the slippery slope…

”DWDV made seven key recommendations, including that the prognosis requirement and definition of suffering be widened. Suffering is too narrowly construed as people with intolerable physical or mental suffering who do not meet the prognosis requirements are excluded.
The organisation also wants a restrictive “gag clause” lifted. Registered health practitioners are prohibited from initiating a discussion about VAD with patients. No other area of healthcare requires patients to know their treatment options before consulting a doctor.
It said not enough doctors are providing VAD. Out of 35,000 medical practitioners in Victoria, only 208 had actively participated in VAD as of last June. This particularly impacts individuals, their families and carers, in regional and rural areas.
Institutions that object to VAD still have the power to significantly curtail people’s ability to access a medical service. This needs to change, DWDV said.
Victorians who lack the ability to make decisions at the time they become otherwise eligible for VAD, or who lose that capacity during the assessment process, are excluded from accessing VAD, and this also needs to change DWDV said.”