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.

The language has been softened to the extent that it obscures meaning. It's physician/state assisted suicide.

Earlier attempts to legislate on this were very clear that it was about helping someone to take their own life. For them to have assistance, particularly from someone medically qualified, meant that they would have more time than if they had to take their own life at an earlier stage of the illness (while still able to do so unassisted) and also reduce the risk of failure and so ending up still alive, but distressed and possibly even more physically disabled.

Ah I see what you mean. Yes, but the maximum doses of painkillers did not alleviate the pain felt by those dying.

@Seeingadistance exactly, that’s what I mean.

The continuous morphine is usually how they do it.

I don’t think that is correct.

But there was still pain and suffering for many days and nights 😢

That is awful and I would think they did not receive adequate palliative care in this situation.

Over 100,000 people die every year without any pallative care. The number dying every year with inadequate palliative care is much higher.

This is suffering and pain that is best addressed imho by improving palliative care.

OP, please think about what you are actually saying here. You are talking about somebody who “wants to live” when they have capacity.

And then you are saying when they lose capacity, you want the next of kin or doctors to be able to kill them, knowing that wasn’t what they wanted. That is not assisted suicide, it is murder.

There isn’t a “maximum dose” of painkillers in palliative care

I don’t know where I really sit on this. However I don’t agree with the argument about us doing it for pets. Yes many pet owners do it from a place of love and kindness. But there are undoubtedly some that do it because their pet is or has become inconvenient, costing too much or shelters that have to choose euthanasia as they have no room or funds. Which mirrors the concerns that there are with allowing this for humans.

People change their minds.

My mum died recently, massive stroke. Knew within an hour of arriving at the hospital that it was hopeless. She was put on 'comfort care' almost immediately. Everything withdrawn except pain relief and sedation.
Well there was nothing comfortable about seeing someone dehydrate to death over several days and not knowing when that last breath would be. I was delirious with sleep deprivation as was my poor dad.
I worked in veterinary for 30 years and have assisted/performed thousands of peaceful dignified euthansias. People always think it's the sad part of the job, it's not. It's a privilege to end suffering quickly and painlessly .
I said to the nurse at one point, in my world we would administer an injection at this point and this hell would be over in seconds and she looked at me saying 'I know', as if she wished she could. If it was legal I would have administered it myself, my mum believed in euthanasia.
Leaving an animal in a kennel to slowly die would result in prosecution!

I read online a while ago that (from memory) in France, someone has the right to be permanently sedated during the last days of life. I presume this means not conscious, so they just slip away after a few days of zero awareness of pain? Sitting with DF during the last weeks of his life, it became unbearable for him, in the last week. He was on a morphine syringe driver, but was still experiencing a lot of pain and discomfort; the dose was continuously having to be staircased up by the hospice at home staff and rapid response team. Despite this, it was still unbearable for him. I thought at the time that it had reached a point where he should just be sleeping (unconscious) through the last days of pain - but I am not sure if this happens in the UK, or maybe if it does then is it highly dependant where you are in the country as to what provision you get? Or is it only possible if you are in hospital for your final days?

Because the NHS has previously set a ceiling of care for my son - he’s 23 but severely disabled. They’d love nothing more than administering an end of life treatment.

He has a good quality of life so shouldn’t be put to sleep because someone doesn’t know him and has their own opinion/judgement.

It’s open to abuse.

I say this having watched my mum die of cancer and my dad ultimately of sepsis.

I respect that others want the right of choice but having that choice means they accept the responsibility.

The trouble is that in principle this sounds like a good thing, in practice it would be open to all kinds of abuse.

I am absolutely glad that what seemed to be the foregone conclusion that it would go through appears to being halted by The House of Lords.
Of course, it will come again. And continuous vigilance is required.

I really, really wish I possessed the naivety of some people that assisted dying legislation would not be abused, come on now, I say this nicely but really?

In any case, even if the drugs were used, it would not be a pleasant process. It's not as if people just go gently into death when they take them.

Yeah presumably somebody has to hand over the medication.

Would you be happy to give an injection to euthanase another person OP?

There was a case on tv the other day (BBC1 programme) where the journalist went to Australia to interview a terminally ill man with a heart condition. He had chosen the day he wanted to die. He was in hospital and had to drink something to put himself to sleep, and I think he died about half an hour later. You obviously didn't see that part. When interviewed, he seemed very relaxed and confident about his decision, and was able to change his mind at any point. It was all very dignified.

That isn’t quite what I am saying. I’m saying that at the point a person can physically swallow something they put in their own mouth, they may not be ready to start dying and not want to lose moments of ability. Once they can no longer do that, they may be ready to pass, but assisted dying proposals would mean that they were no longer able to choose to do so because losing the physical ability also means losing the right to have that choice, even if you are mentally lucid.

if the process were to ease the passing and shorten the time of pain, once the person is on that road, how can it be abused? I suspect those advocating for better palliative care are actually agreeing with what I am suggesting, you can’t mistake the start of the dying process, it’s quite different to the illness process.

During covid a DNR was put on my sons notes without anyone asking. He has autism and they just blanket put dnr without reference to the patient or nok. My gp was very diligent and when we contacted them about shingles during covid she said did we know? And removed it after talking through whether he was a good candidate ti attempt resus on. If we had a different less good gp or not got shingles it might still be there.

I have zero faith in anything decided by the state and relying on a 'good doctor' or non abusive nok

@Lifewontbethesame i am sorry for your loss

Yes, I would have done that for my parent.

They won’t show the undignified bits where his body will have fought against the drugs. He won’t have been aware of it and he likely didn’t feel pain and was mentally at peace. It would have been anyone doing the death watch with him that was not prepared for the body’s instinctual noises, movements, possible incontinence/vomiting, gasping for breath that might be traumatised. Too often we wrongly superimpose our experience of watching someone die with how that person felt dying.

I suspect those advocating for better palliative care are actually agreeing with what I am suggesting, you can’t mistake the start of the dying process, it’s quite different to the illness process.

Yes, I am agreeing with this as part of proper end of life palliative care, however what you are suggesting has nothing to do with assisted dying. Assisted dying applies to someone who is not currently dying, but has a terminal diagnosis and has an estimated 6 months of life to go.

It has to be a current conscious, well-considered and immediate wish on the part of the person whose life is ending. Consent in advance for someone else to administer is no good - you can never know if that's their wish right now and no one can know exactly how they are going to feel in a week or a month.

Part of that decision is whether to give up the last 5 minutes or few hours or few days of bearable life to avoid an unknown duration of unbearable existence. If you want to remain conscious capable and alive until the very last second before becoming too overwhelmed by the process of dying to be able to participate in this strictly regulated process then that is a valid choice to make but in that case assisted dying is not for you.

It makes no sense to say that self-administration is more open to coercion - the point is that with a self-administration requirement it is made very clear at every step that if it isn't the person's own real wholehearted and conscious wish then the process cannot happen. Encouraging or coercing someone to undergo it when it is not their wholehearted personal choice should be classified as at least manslaughter if not murder. I would be in favour of technological advancements that make it easier for people with limited muscle control to self-administer with automated systems that can be triggered by a button press or an electronic signal from specific eye movements but it has to be under their personal control and with no barriers to choosing not to.

I do support the right to assisted dying but I think it is criminally unethical to make it available in a context where palliative care that could make life bearable for some is underfunded and not always available to the extent that would actually grant the person an acceptable life without assisted dying. It should only be necessary to consider when there is nothing more that palliative care could possibly do and nevertheless life is still intolerable.

Because assisted dying is a form of suicide - suicide is not illegal but assisting it is

whereas euthanasia is a form of homicide which is of course not legal under any circumstances. In law you can’t consent to being murdered

the conversation is around assisted dying although there are groups who support voluntary euthanasia as well.