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 am totally in favour of it.

Why would you not want to spare yourself and your family experiencing / witnessing a potentially agonising and traumatic death? Such an experience is a terrible burden, so I think wishing to spare family and yourself that is totally rational.

It's also rational to wish that the cost of a final six months' of suffering be instead added to a family inheritance, or gifted to the dogs' home.

I honestly don't see how coercion would work in practice either. I think that is a red herring and totally overstated.

I worry that the debate is dominated by those with religious beliefs. This is an ethical issue, not a religious one.

We treat our animals with greater respect and dignity.

I agree
(My mum died of cancer ) staff / nurses were great and she passed very peacefully.
I have a dear friend who is quite elderly ( and very comfortable financially)
There is one particular relative who is just waiting ..... it is to open to abuse.

I’m pleased your DM passed so peacefully, both you and her were spared a truly hideous experience and I’m sorry for your loss.

Do you reasonably think that relative of your friend would commit murder for their inheritance? There’s no legal framework for them to abuse now so perhaps you should inform social services if you have a gut feeling that they’re just waiting?

@Onand that's so sad. It's bleak isn't it, the memories that don't leave us.

I really wish this was part of a commission looking across the whole piece, very little that is ever done these days is more than piecemeal or stop gap.

As it is, bill looks likely to pass and nhs and courts aren't sure how they'd cope...

The religious aspect worries me too because too many choose to conflate religious and ethical arguments. I don’t want my personal medical wishes to be impacted because of what someone’s religion says- that’s medieval thinking in a progressive society. I do fear the loud voices against this will be an insidious mix of big pharama and religious purists. I hope the advocates for it are able to overcome them.

‘It’s social murder’ — is Canada’s assisted dying a model or a warning?

www.thetimes.com/article/d9416604-19c4-4d35-b823-0b3272e9dec6?shareToken=f15ea22c7b46f0ccdb839523c9895066

There are plenty of non religious non pharma reasons for thinking that the issue needs more thought. Personally I want to be sure that the courts can cope, the nhs can cope, and that this isn't the hobson's choice option that people take as a default because the nhs is on its knees and they're terrified of a painful death.

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

Indeed, @SugarandSpiceandAllThingsNaice - again a useful reminder for the many who haven't read it but insist tthe safeguards are adequate

As for the link from Oregon about expensive cancer drugs being refused but suicide offered instead, words fail me except to express an utter expectation that the cash strapped NHS would fall upon the idea all too fast

You mentioned those who "make something out of death" @Noras, and if talking about targets I'm also concerned about the organ donation issue.
Clearly many of the terminally ill wouldn't be suitable, but what about the case of an otherwise healthy person who'd suffered a massive injury? How easy to blur the margins and talk about how they wouldn't want to live with the results

Take a look at our own system, that of other countries and at the state of the world in general.. then ask yourself if humans as a collective have proved themselves anything like capable of safeguarding vulnerable people against politico-economic expediency and coercion creep.

Does anyone even know which way's forward anymore?

Like with many things there are opportunities for abuse, I think those who could abuse the system would more than likely already be looking to speed up their inheritance quicker with or without an assisted suicide bill. Also how many people are we assuming would be murderers or consider murder by using assisted suicide for nefarious reasons under coercion? I’d like to think we’re talking of a very tiny minority and not the millions of people this could potentially help. One is one too many. There is 100% going to be coercion on some levels. It’s not possible that there won’t.

One of the reasons why people campaign against capital punishment for instance is because a miscarriage of justice could mean that an innocent person is put to death. Even if it’s just the one, people argue that it is one too many, even if that means thousands of heinous criminals being put to death.

So why is it suddenly different when it comes to assisted dying.

So one miscarriage of justice is one too many but one person being coerced isn’t? The needs of the many and all that and to hell with the few?

And the truth is that the person will be dead. Coercion is going to be very hard to prove.

When we have people talking about instructing HCPs to act at their behest regarding a relative, we’re already teetering even closer to the edge of the slippery slope.

You think "big pharma" is opposed to this bill for financial reasons? Won't "big pharma" be providing (and setting the price of) the suicide drugs?

I wouldn't have brought cost into this debate, however given that you have. I don't expect the bill to have any negative effect on the profits of pharmaceutical companies. They'll do what companies always do find new income streams (I e. Assisted dying medication) and increase the costs for their existing products. They'll probably make money out of it.

Suicide drugs are cheap and out of patent. Much less expensive and profitable than palliative chemo for a dying cancer patient.

However like you I very much doubt that they're genuinely lobbying for this: the upside is pretty minimal and the negative publicity should they be exposed would be severe.

My dad stopped being able to swallow so he inhaled his food and got infection after infection, lastly pneumonia. In the end they withdrew everything (including hydration) except morphine to let him die as he was skin and bone and in a cycle of infections. His quality of life was nil. God knows how he must have suffered. It took him eight days without hydration to die (after three weeks of no nutrition) with phlegm building up in his airways. It was ghastly. I wish he could have been helped to die much sooner but he had dementia so even with this proposal he couldn't have been helped. But for myself I would rather sign something beforehand to ask that my life be ended if I get to that point than endure what he did.

You underestimate the potential ramifications to cost in this. I think the scale of investment and dependence on end of life treatment is significant enough to have those with vested interests concerned that their industry potentially faces a potentially dramatic shift in demand.

Remember how disruptive the iPhone was when it was released?

I’m not so sure Blackberry managed to adapt quickly enough to the change in consumer expectations and they were market leaders. Market dominance is difficult to maintain if the competition rewrites the narrative and takes your customers away.

The truth is that the person will be dead. Coercion is going to be very hard to prove

Indeed, @NotOneOfTheInCrowd, and that could easily explain why some are quite so happy to wave the questions about coercion aside.
All very well insisting "it won't happen" when you know perfectly well it would be very difficult to prove it had, and it's not as if the dead would be around to give a view

Won't "big pharma" be providing (and setting the price of) the suicide drugs?

Edited to add yes they will, @ConfusedBear, but if we're talking a pure numbers game they'll already make more out of palliative drugs than they might out of a few suicides ... until, that is, the concept grew as it has elsewhere

A devastating experience for all. Until you’ve gone though it no one can appreciate just how harrowing end of life can be.

'When we have people talking about instructing HCPs to act at their behest regarding a relative, we’re already teetering even closer to the edge of the slippery slope'

Do try to understand the points that are being made and the importance of context. To instruct a hcp to stop, for example, taking blood samples that have no bearing on treatment, or to not give antibiotics to someone sadly moribund is not close to any 'slippery slope'.

Unfortunately maybe hcps can make a distressing and painful situation worse by constant and unnecessary interventions instead of, as has been said, focusing on a dignified and comfortable end of life.

It absolutely is a slippery slope.

I have already outlined why and how antibiotics and steroids can significantly improve QOL for some people.

You have failed to demonstrate why that is not the case ( and ‘because I say so) isn’t a convincing argument.

Coupled with your assertion that you will be ‘instructing’ HCP’s it is clear that this very much an issue that needs to be considered by others when reading this bill, particularly with regards to the frightening lip service that is paid to the role of a ‘proxy’

But isn’t this a bit like the idea of coercive abortion?

It absolutely shouldn’t happen, there are safeguards to prevent it (two drs signatures etc). But I’m almost certain it does occur, people eg partner or family putting pressure on a woman to abort against her wishes.

However, that doesn’t mean we ban abortions for everyone, the vast majority who are not being coerced and have weighed up the options and are making the best decision for them in the situation they find themselves in?

I've made my wishes on this very clear to my next of kin - and in writing. Why should they NOT be my proxy when I'm not able to express my wishes myself? We have registers for organ donation, we could have a register for end of life wishes. I'm concerned my wishes wont be followed and those opposed to easing the pain of the dying will force me to suffer.

But instead of suggesting, for example, a register for end of life wishes as a way to reduce the risk of coercion those who are opposed to assisted dying have nothing constructive to say. In some minds one possible "coerced " person apparently outweighs any amount of suffering from people who could benefit - they just want to see people suffer.

'I have already outlined why and how antibiotics and steroids can significantly improve QOL for some people.You have failed to demonstrate why that is not the case ( and ‘because I say so) isn’t a convincing argument.'

Yet 'because I said so' seems to be your argument.

I have no issue with steroids being given to control symptoms, if you read my comments I have said it is the unnecessary and intrusive blood sugar monitoring that is unnecessary in someone's final days. It is pointless and causes everyone distress to be faffing on disturbing someone.

Once again, any pain or discomfort caused by an infection can be treated with opiates not antibiotics that can cause distressing GI symptoms. That isn't because i said so it is a fact.

Plenty of evidence on this thread why end of life needs to be vastly improved. Let people die peacefully.

Signing by proxy is not the same as signing due to lack of mental capacity. Unfortunately.

Out of interest, does anyone know why the demarcation line is 6 months of life remaining? Why not 1 year? 3 months? Is there a reason for that time period or is it random? I do think this is one area where there's a 'slippery slope' waiting to happen.

My worry is, imagining myself, that six months from death is unprovable, and also that in practice the mind would be too far destroyed to be able to make the decision.

Assisted dying has bigger incentives to family coercion than abortion though - family stand to get immediate personal gain from the death, reduced caring responsibilities/money/and end to the trauma of watching the suffering.

I have qualms about the state having bad incentives here too because in the end, shortening cancer care is going to cost the state less.