Assisted Dying (Continued)

[Nordione1]

Follow on from the previous thread which is nearly full.

Dementia is such a difficult part of the euthanasia discussion.

The law here (the Netherlands) was changed in 2020 to grant euthanasia to people with advanced dementia as long as they had made a living will, when they still had full capacity, clearly stating that they wanted to be euthanised when they were beyond all quality of life.

As far as I know they must also (like every other euthanasia applicant) have repeated this wish on several occasions, unprompted, and also when they still had all their mental faculties.

I'm quite saddened on this, and the previous, thread to see so much discussion of countries where euthanasia is badly handled. The Netherlands isn't perfect, and it is very strange to put down a coffee up at a neighbour's house and hug them goodbye knowing that in 3 hours and 27 minutes they will die, but there is a grace and pragmatism to it all that I deeply appreciate.

Social and palliative has fallen way short for many decades (coinciding, incidentally, with the beginning of privatisation of the NHS) now and has worsened. It is not getting better; quite the opposite. There simply isn't the billions of pounds that would be needed for it to improve or to offer people a 'package'.

As former GP John Oldham wrote in his reader letter to The Times recently:

"I was a GP for nearly 30 years. Palliative care in the 1990s was much better than it is now. We had a set of dedicated district nurses attached to our practice, access to GP beds in the community hospital for 24/7 hospice-like care, greater availability of home care, and “syringe drivers” for continuous analgesia for patients.

"Yet there were still people whose terminal suffering we could not fully relieve, and who begged us to do more when we couldn’t. I have witnessed such suffering in many patients and my own family. These people should have the choice whether to live or to die, as exists now in many countries, and the roof of moral value hasn’t fallen in in those places."

If you believe in body autonomy how can you object to assisted dying? If we allow/ enable abortion, which does involve ending a life or potential life of another, then surely having choice and autonomy over your own life is a given?

Ive been a nurse for nearly 30 years, I have witnessed some ‘good’ deaths and some terrible deaths. My own Fathers death from lung cancer was nightmareish and not because of any ‘failures’ of medical care. He wanted to die with dignity before that point But didn’t have the option.

Add to that the fact that actually some types of pain are intractable and you have to sedate and medicate so heavily to relieve that pain that the person is no longer aware anyway.

And what about those people whose ilnesses cause them immense psychological suffering, sometimes death really is the lesser of the evils.

A couple years ago I had a mental health crisis. I was already sick (chest cold), left work and went to the energency room. This happened in Colorado in the US. I remember crying for what felt like hours and telling people I wanted to die. Most of the staff was kind except for the doctor who was mocking in tone with me.

They transferred me to a mental health facility. I was still crying and saying I wanted to die. We went over my whole history at intake with a provider who I think was some kind of nurse, not a doctor. I was telling her about my abusive mother, having all my babysitting/after school job stolen and my mom trying to talk me into dropping out of school. Being basically harassed into homelessness by my parents. They would even bother me in the parking lot at work. I talked about all my bad relationships, a bad expertwuth a church I joined, being SA’d in my sleep by a guy I was dating and him laughing when I woke up and asked him to stop. All of this bad stuff that happened when I was a young person and that I still have problems trusting people etc. I kept saying things like, “it never gets better, it only gets worse, why not just euthanize me safely so I don’t do it myself and end up disabled?” She sighed and said, “Look maybe you’re right but that’s not the law in this state.” The pharm tech at the nurse station when I was crying and saying I wanted to die actually advised me of two states where they might accommodate me, but said I should just comply and say the right things to get out and go do it there. She also said they couldn’t give me anything for this chest cold I had or any ibuprofen for my foot/joint pain. Although they did give me a pain relief cream for my feet.

in a facility like this they come around and take your blood pressure and other vitals 5-6 times a day. The first day I was a mess crying a lot. The second day I noticed that I felt worse when my BP readings were low. My BP was skewing low to normal, when it was reading low that coincided with my low mood and crying jags. I mentioned that and they said it might be the machine, it might not actually be low. But it was also low the time they used an old school cuff. I asked if they could treat the low BP but the meds window said they couldn’t I’d have to see a GP when I got out and maybe they would prescribe a vasoconstrictor.

So I just started putting salt on my food at meal times, to raise my BP a little. Because we all know salt raises BP. I started to feel better just from that. I also got my period maybe 24-30 hours after being admitted. About a day after i started to feel better i was telling staff I felt better and didn't want ti hurt myself but they held me longer anyway.

I came out of that experience feeling very critical of right to die movements. Because the decision making, more educated staff were all for it really they didn't discourage me. The lowest level of staff, the techs, would be like "don't be silly you're really bright you have a lot to contribute." and things like that. But the nurses, pharm techs etc were pretty on board with people getting to choose to end their lives.

This facility was also not ethical. They tried to diagnose me with a condition that was ruled out by a psych provider affiliated to NYU medical center in NYC. They couldn’t give me a reason why they were now ruling it in, whereas he’d been really specific with me about why he’d ruled it out. They listed two ‘group therapy’ sessions on the schedule but weren’t providing them. But it seems they billed insurance as if they were doing them. Proper psych treatment is also that you’re supposed to treat physical conditions (like the BP and chest cold) first because a physical condition can affect mental health. They also billed Medicaid (public insurance) even though I was in a union at the time, they wouldn’t let me call the union hall and get benefits information.

No one ever looked at my hormones although they did drug test my urine. I’m still confused about what happened, I don’t usually have PMS symptoms but I always wonder if it was some weird hormone blip that month.

My story also isn’t that unusual. Obamacare forced insurers to cover mental health so a lot of unscrupulous providers moved into that space. I’m part of a lawsuit that is pursuing them under RICO (racketeering) charges. It’s hard to prove medical negligence esp about something emotional like mental health. However their inaccurate billing and holding people after we stabilized is easy to show from their own printed schedules and notes about what I was saying.

So I think this is a bad road to go down. A provider there trained in pharmacy was telling me what states I could go to as even a non resident and get MAiD. And I wasn’t in my right mind, they were taking me seriously about wanting to die without treating my physical issues (giving me something to stabilize my BP) and seeing if my mood improved.

The other thing - in intake my mood was so low I couldn’t see the good things about my life. Going to a great university, achieving responsible positions at work, my friends. They didn’t try to reframe anything or ask me to reframe anything. On like day 3 one traveling nurse helped me do that. But no one at intake, and no one at the meds window, and not the one MD there.

MAiD has always basically happened - they have always given actually dying people morphine and poof they die within a day. That’s assisted dying even though we don’t really acknowledge it as a society. Cancer patients and things, or shooting badly wounded soldiers on a battlefield, no one thinks twice about that. But loosening the ethical restrictions on this is not a good idea.

Not all providers are ethical. This could be a real train wreck that would hurt the most vulnerable people in society. I have a bad relationship with my family due to all the abuse as a kid. They wouldn’t even let me call my union, people who may have offered support. They don’t want anyone to even look at what they’re doing.

Sorry I typed this all on mobile & can see some missed words and autocorrect issues but happy to answer any questions

BeccaS34 so sorry that you had to go through that awful experience
It’s very concerning. I think here in UK people are only just beginning to understand what new kinds of abuses might be opened up with these laws

https://www.bbc.co.uk/news/articles/c0j1z14p57po

The Bill makes no mention of pain and suffering because assisted dying can’t prevent pain or suffering. In fact, the drugs used to end life are not painless and can cause extreme pain and suffering for however long it takes for them to kill you, unless you’re unlucky enough for them to not work and wake up requiring a boost to put you down for good. There is a lot of romanticism in the advertising and rhetoric from those pushing this bill.

@Littlemissgobby

Yes, those estimated to have only 6 months left to live are going to die anyway. Yes, in a perfect world they should be able to choose to die earlier although it won’t be painless, dignified, and all that the marketing literature promises. It’s like watching an execution by lethal injection or a death by drug overdose.

But the problem is that we do not live in a perfect world and some people will be coerced/forced into assisted dying or be euthanised against their will. There isn’t a way to avoid it. The safeguards do not exist. The high court judge- Leadbetter has amended the bill to quietly take out the primary safeguard she has sold this bill with.

And so the problem is that why should the convenience of people who are going to die soon anyway to die a few months earlier justify the murder of other people who do want every last hour that nature allows them?

Except that we can’t pretend that the benefit to some is of equal weight to the harm to others?

Is convenience really as or more important than another persons right to life?

The goalposts of this Bill keep changing for what are perfectly reasonable and practical economic reasons- that we don’t have enough judges, anyone can agree with that- but please note with great caution that this new model is very much not being made for the benefit of the people who want assisted dying.

Kim Ledbeater is now trying to say that a panel of whoever professionals is going to be better than the original idea in the Bill of using a judge. But actually no, that’s not true, otherwise everyone who is pro assisted dying in Parliament wouldn’t have tried to reassure MPs and the public, that we had the best level of scrutiny on the basis that a judge would be involved.

Actually I think the best level of scrutiny is the minimum to expect on this because the stakes are so high and so is people’s vulnerability. To me the change to a panel of people is a perfect illustration that the person who is requesting assisted dying is not really at the centre of this.

Far too easily the goalposts could get changed again for public finance and logistical reasons. We’re not resourced or ready to protect the vulnerable from the consequences of this ‘choice’.

It’s worth noting that although Euthanasia has been possible in the Netherlands for over 20 years and there have been expansions it still makes up less than 5% of all deaths. The vast majority of which are people with terminal cancer or other terminal illnesses. I don’t think that demonstrates a slippery slope.

Well to see a line (a slope) you need more than one data point.
In 2002, assisted dying accounted for just under 2% of deaths, but as of 2023 had increased to 5.4% of deaths (see chart). To put this into perspective, if 5.4% of deaths in England and Wales in 2023 had been from assisted dying then that would correspond to 31,393 deaths, or 86 people per day.

As for evidence of slippery slope insofar as coercion, once it was expanded for psychological suffering, we saw a 20% increase in deaths from 2022 to 2023 alone 115 to 148. Several cases included perfectly health young people choosing to die due to autism making life in society difficult or being told their depression is incurable. How is this not concerning?

GPs doing euthanasia for patients with a dementia diagnosis have reported a steady increase in requests as well, up 13.8% from 2022 to 2023 from 288 to 328 with 43% reporting they “felt pressure from the patient’s relatives” to euthanise the patient. How is this not concerning?

You can see coercion is going on in the Netherlands. And personally, I think 5.4% of deaths is a hell of a lot of people when you consider that’s 86 people per day. And it shows no sign of levelling off in the Netherlands or anywhere else it’s been legalised. The slope is more and more are being euthanised.

If you believe in body autonomy how can you object to assisted dying? If we allow/ enable abortion, which does involve ending a life or potential life of another, then surely having choice and autonomy over your own life is a given?

The abortion analogy is insulting. A fetus isn’t even an organ. It is a scrap of tissue. You aren’t ending a life through abortion in the same way that assisted dying will result in the coerced premature deaths of living adults, full persons with thoughts, hopes, feelings and human rights.

I have been through similar and you highlight a huge concern I have with this Pandora’s box, as activists have openly and publicly stated this bill for those with 6 months left to live is just the start. They want to expand it to include the psychologically “unbearable suffering” with a wish to die. What you describe is exactly what is happening in states and Canada and Netherlands- it is easier and cheaper to let a suicidal person be herded on to euthanasia than it is to treat their body or MH. All you need to do is pretend that a person in the middle of a mental health crisis has the mental capacity to agree to their own death. It’s really terrifying tbh.

There is no mandatory test for capacity in the bill. In addition, HCPs that assess capacity on a daily basis say it is not very reliable and they often get it wrong for matters like agreeing to medication and are not comfortable when the stakes are life and death with being asked to do capacity assessments. The bill only requires a doctor (GP type) to refer the patient for an assessment if in their opinion, the patient may lack capacity. In practice, where this check was copied from, GPs end up almost never referring anyone for a capacity assessment because it delays the wait to die, ruins their performance targets and drives up costs.

People are scared of dying a horrific death and want the choice.

An individuals right to chose what they want shouldn’t be less important than those scared they will feel pressure.

Pets are treated with more dignity and suffer less and that’s not right.

Where are you getting this idea about coercion from. I find it pretty insulting - I live in a country where assisted dying is legal and we aren't all going about coercing terminal ill people into dying.
In fact a sizeable percentage of people approved for assisted dying don't take that route but have peace of mind knowing that it is available in their final months. I really don't understand why you want to take that away.

Coercion isn’t an unfounded fear or a might not happen. It’s been documented as happening in countries/states where assisted dying is legalised. Disturbingly, there have been cases of chemical restraint used to prevent a patient resisting “assisted suicide” from proceeding which flies in the face of it being fully safeguarded by autonomy and free choice.

https://bmcprimcare.biomedcentral.com/articles/10.1186/1471-2296-7-39

https://pmc.ncbi.nlm.nih.gov/articles/PMC10808165/#Sec9.

https://www.australiancarealliance.org.au/bullying_or_coercion

https://www.bma.org.uk/media/4394/bma-arguments-for-and-against-pad-aug-2021.pdf

And some of us live in a country where we were told to "protect the NHS"

https://www.theguardian.com/society/2025/feb/22/domestic-violence-victims-assisted-dying-debate-coercive-control
The Observer highlights this important campaign by women’s groups including The Centre for women’s justice, that there are unacceptable high risks of coercive control around assisted dying if it is legalised.

The groups said discussion of the proposals had so far failed to consider domestic abuse or the risk that perpetrators could coerce or pressure victims into assisted dying.
Kim Leadbeater MP, who introduced the bill, which covers England and Wales, said she welcomed the contributions of these groups and was “absolutely committed to ensuring the right protections are in the bill”.
Nogah Ofer, solicitor at the CWJ, said: “The evidence shows that coercive control frequently results in victims losing their own sense of self and self-worth, and is closely linked with both domestic homicide and suicide related to domestic abuse.
“We know some perpetrators of coercive and controlling behaviour drive their victims to suicide, either because the victim cannot see a way out of the abuse, or because the perpetrator deliberately tells the victim she is worthless and should kill herself.
“There will be some cases where perpetrators of domestic abuse, especially coercive and controlling behaviour, pressure victims to seek to end their lives. There’s a significant risk that, through this dynamic, coercion will play a part in some cases of assisted dying.”

One of my closest friends is dying, advanced cancer only diagnosed early Jan, already spread to the brain. She wouldn’t qualify anyway for assisted dying as she does not have capacity due to the brain tumour. She is only 57, now in a care home receiving end of life care. All dignity has gone, the vibrant fun person she is, has long gone. Everyone who loves her is praying she goes soon as it’s horrific to witness. I don’t know how anyone can think this is preferable to an earlier death, before the terrible symptoms of the brain tumour set in. She has zero quality of life now and it’s absolutely horrible that this is the end of her life. I pray peace comes soon for my wonderful friend, as she does not deserve this.

The other patients in the care home, well I feel for them all. Maybe some have some quality of life, but many do not, that is evident and it’s harrowing to see.

That is terrifying.

I think you’d expect to see the numbers increase as it becomes more societally acceptable. Honestly if anything I’m genuinely surprised it’s as low as it is. I’d expect to see numbers of dementia patients increasing too. It’s difficult because it’s a decision that has to be made and implemented when you have full capacity. I can well imagine a dementia patients family asking for them to be euthanised. It is hard it’s like you’ve already lost that person that you love. Losing speech, mobility, continence, being scared all the time. It’s no wonder families plead for euthanasia, it’s horrible to witness a loved ones suffering.