AIBU to question why assisted dying laws require self-administration?

[Holdinguphalfthesky]

I have always been broadly in favour of assisted dying, based on the argument that we put our pets to sleep when they lose their joy and dignity, that people should have absolute authority and autonomy over their lives and bodies, and that many illnesses make dying an awful, painful experience.

However, with recent wider political debate about the concept, I have started to wonder why there is such emphasis on the person being able to administer the fatal medication themselves? Surely that leaves the patient more likely to suffer manipulation and guilt tripping, because they’re doing it themselves and still have consciousness and rationality; whereas if the decision were to be made by NoK alongside a couple of doctors once the person is in so much pain or has lost consciousness it would be more safeguarded. And potentially easier for all concerned.

The question is informed by my experience caring for a parent and for a friend, both of whom died from cancer. I have also held a pet while they passed from a pts injection. Interested to hear others’ thoughts on why the legislation debated insists on making it possible only for people to self-administer, potentially doing it before they are ready to stop living.

I am sorry, I don’t follow your logic as to how to someone who has lost consciousness can consent? This is a basic principle of medical ethics.
Secondly, someone administering it would mean that someone’s job is basically ending people’s lives.
Not that I really want to have a debate about this, my view is that money and resources need to be put into palliative care and health care (we basically have a system where people can be waiting hours to even get seen in A+E, and weeks to see a GP, so there are many cases where better early treatment would save lives).

Well I'd have thought because another person giving the injection could be accused of murder, whereas suicide is not a criminal offence.

I am firmly in favour of assisted dying, and furious at the House of Lords (again). I’m also married to someone with a life-limiting illness who has every intention of choosing when to die.

I can think of several reasons for self-administration: relying on others to decide what’s best for a terminally ill person opens the door to all sorts of potential abuse and coercion, regardless of whether the final arbiter is medically qualified or not;,it’s an unfair burden to put onto medical staff; it removes autonomy from the dying person.

Thats an unfair burden to put on doctors - imagine being the person whose job was to essentially kill people. Regardless of whether they want it or not, you are still ending a human life and psychologically thats a huge, huge thing to put on someone.

I could never do it. Also, I agree with PP- if someone else were to do it the chances of it being abused would go up, not down

But you could say in advance that that’s your wish. Like, my parent was able to enjoy life until about a week before passing, but that final week was hell. Pain, loss of dignity, loss of any enjoyment of anything at all. If I could have shortened that period for him, I would have. And the change from living to dying- which took away his ability to do anything for himself- came overnight. So had he self-administered, he would have had to lose precious moments of joyful life, and nobody could know when his last moments of living would be, when he would lose his ability and start dying.

I have started to wonder why there is such emphasis on the person being able to administer the fatal medication themselves? Surely that leaves the patient more likely to suffer manipulation and guilt tripping, because they’re doing it themselves and still have consciousness and rationality; whereas if the decision were to be made by NoK alongside a couple of doctors once the person is in so much pain or has lost consciousness it would be more safeguarded. And potentially easier for all concerned.

Self administration means it is assisted suicide which always has risk of coercion. Administration by another person to someone who has consented is euthanasia which also has risk of coercion.

The focus is on self administration because the politicians backing it don’t want to admit that the assisted dying law would be quickly expanded to include euthanasia for disabled patients unable to self-administer an oral dose of lethal drugs. This isn’t a hypothetical fear, this is an almost certain outcome as every other country or state that has introduced assisted dying has either included euthanasia from the outset so disabled patients can access it or have quickly expanded the law to include after a legal challenge by a disabled patient demanding access to assisted dying by allowing putting the drugs in a feeding tube or going with a lethal injection either by syringe or IV.

Euthanasia has been banned for so long that the politicians are trying to distance assisted dying from it.

Killing someone when they are unconscious or otherwise do not have the capacity to consent is murder. I don’t understand how you think having family decide to put to sleep an unconscious relative is less likely to be murder than if a person self administers a fatal dose!

This is not like someone in a coma or medically dead but on life support and the decision is made by the doctors and family to withdraw life support and let the person die naturally.

@Holdinguphalfthesky no, the idea of assisted dying is that you end your life before you get to that point. At the point of being unconscious or losing your mental capacity then you arent able to make that decision.

But a person commits an offence under section 2 of the Suicide Act 1961 if they do an act capable of encouraging or assisting the suicide or attempted suicide of another person, and that act was intended to encourage or assist suicide or an attempt at suicide.

If this wasn’t the case, there wouldn’t be a need for a specific law permitting it.

It’s such a blurred line because when other people get involved there can then be legal consequences.

I agree the person shouldn’t have to be physically able to self administer to qualify. If I was in the state I saw my grandmother deteriorate into, I would want someone to “put me to sleep”. At that point she wouldn’t be able to self administer. She died a painful death and the hospital just kept her body alive with lots of drugs. It was sad to see. My dad in the other hand is suffering from cancer, he’s lost half his face, eye included and is suffering so much he wants to die. It’s sad to watch.

the reality is though, with any option there will always be people who abuse the system which is sad. It’s a very sensitive topic for many

I am sorry for your loss. Dying can take time and is usually traumatic to relatives supporting the dying person. Was his pain not managed well? How did he lose dignity was he not cared for appropriately? He should have been pleasantly numb for the last week and not suffering so much.

It would be less 'safeguarded' if a NOK could make this decision for an unconscious person. Opens the entire system up to abuse.

When they are in pain, unconscious etc then this is end of life.

Someone who has had let say depression all their life and feels it unbearable to carry can choose to go thru the assisted dying route

@Peachmarmalade i know, but my point is, how can you know the best moment to do it? If you’re still capable, for many people they still want to live. Once you start dying- by which I mean the process my loved ones went through- it’s too late to self administer but it’s the time that you would want to shorten. Well, I would.

@FiatLuxAdAstra i see it as being very similar to withdrawing life support. A person starts a process of dying, you can see it, but that last few days can be prolonged and painful. It won’t end until it ends but why prolong the suffering?

I am completely against assisted dying, I think it’s completely open to abuse and rapid expansion to include lots of other people. Start small with lots of safeguards and then slowly remove them.
as a pp said I’d rather see better early intervention and /or palliative care being resources and researched.
however currently self administration gives a pretence of autonomy.

@Holdinguphalfthesky
Life support is fundamentally the opposite of hastening or causing immediate death.

@Holdinguphalfthesky this is the whole point of it its free will. If they want to back out at the very last minute they can.. it is their choice.

I think you're conflicting AD and end of life

I can see both sides OP. I agree with you that at the time you can do it yourself you probably still feel good enough not to want to, and by the time you don’t feel well enough to do it then you can’t, but equally I can see that opening it up to others to do it for you could create huge risks for lots of people. Someone in a care home for example who has expressed in advance a wish to have their life ended, costing £££ a week, if a family member felt they wanted to cut the cost and maximise inheritance they could take that step before it was really time…

Thank you. Yes it was very difficult for me and other people around, in both cases I have seen. It gets to the point that there is pain, breathing is a struggle, it might be that there are unexpected problems around toileting and then obviously the shame for them, the discomfort and disruption involved in cleaning the person, the bed… even when done with love and care there were problems we could not avoid and things happened that we would not have wished our loved ones to go through. In both cases we’re talking almost a week, and it felt endless for me- I can only imagine how it felt to the ones going through it.

i am talking about a gentle assist, once someone is at the very end stage of life. Extra morphine to the point of fatality via sleep, something like that.

Another example is if someone has the start of dementia and still has the capacity to start AD vs someone who is in the throes of having lost all capacity..then AD cannot apply because they have lost capacity

I think the gentle assist when near to death (hours away) to ease over the threshold is already commonly done?

Even with assisted dying, patients also experience struggles to breathe, incontinence/vomiting and discomfort. It’s literally an overdose of drugs you take to end your life.

Your mind might be set, you might be mentally at peace and not feeling pain, but your biological body is going to fight to live. In countries where relatives can attend at bedside for assisted dying or euthanasia, they have trauma counselling for the relatives because the advertised ‘peaceful, painless death with dignity’ is often not the reality experienced.

Yes I know, but it can be withdrawn if the person cannot survive (like Ian Huntley recently). So death then follows. If death is inevitable what is the problem with gently speeding it up? As I said elsewhere, I’m talking about a gentle assist into a pain free death, offered at the very end stage of life just to shorten the process of actually dying.

It's an important distinction. Someone else administrating the fatal dosage would create a whole new category of law: the state would pre authorise one citizen to kill another. Currently we have only retrospective justifications for killing (self defense, defense of another) under ordinary peacetime conditions. It's a much more fundamental proposed change in law than assisted suicide and alters the relationship between citizen and government as well as the relationship between doctor and patient. Assisted suicide, self administered, arguably only builds on and enhances rights already enshrined (autonomy, bodily integrity, etc). Pre authorising the act by someone else is a whole other category of law and IMHO one that should

I think that is already done. It’s end of life care, which isn’t assisted dying where you choose to die months or years before your anticipated death.

Remain closed
Sorry, posting on phone and it wouldn't let me finish my sentence!

I think the gentle assist when near to death (hours away) to ease over the threshold is already commonly done?

Is it? It wasn’t part of my experiences.