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.

Just awful but utterly believable.

I think it was Dr Jordan Peterson who said when talking about assisted suicide that, "they can't even make the trains run on time".
So even if no actual calculated malice intended, who the heck in would entrust the state to get these things right?

'Assisted dying' is the epitome of the phrase the road to hell being filled with good intentions.

Killing someone when they are unconscious or otherwise do not have the capacity to consent is murde

it is also murder even where they do have the capacity to consent.

There is no painkiller on the planet that can take away cancer pain at the end of life. Knocking you out is the only option and even then, they awake to pain.
"Paliative" care is fuckin shit

Yes,

and pet euthanasia is still a big area of complaint from clients in the veterinary industry - they couldn’t get a house visit at short notice in the middle of the night, the vet couldn’t get a vein easily, the owner wasn’t happy with the words the vet used, it was a busy day at the clinic and there was noise going on outside, the owner wanted to wait until another family member could get there after work but the animal was suffering, owners not being in agreement about when was the right time etc

We sometimes spend a really long time trying to counsel and prepare clients for what is going to happen, and we can do multiple euthanasias in a day.

I’m not sure the nhs could deliver this in the way people imagine it would be, and it would unfair to burden medical staff with this moral and emotional burden day in and day out. It can be tough on veterinary teams.

It's all very complex. Personally, I am in favour of assisted dying, but I do agree it can be open to abuse. I am physically disabled and need some support. I wouldn't want to get to the point where I am a huge burden on my children and/or the state, however, I am sure there are some people who have family members that would be keen for them to die. Greed being one of the reasons. You see it all the time where estranged family members challenge Wills to get their hands on the money.

Because once you give the State the power to kill you without your consent bad things are sure to happen?
In Nazi Germany one of the first groups that they targeted were mentally disabled German citizens.
It could turn into a modern eugenics movement.

Yes, in principle I am in favour of assisted dying and euthanasia but in the world we have today with unavailable or substandard palliative care, with the disabled actively being discriminated against for work, with politicians regularly using what I see as ableist hate speech and depraved cuts to disability benefits when the disabled are already the #1 demographic in poverty, with elder abuse rampart and more ageist hate speech as well, plus the bad economic times encouraging greed amongst the young for the money of their older relatives. I could go on. We as a society could not put in place or enforce any safeguards against abuse at the individual, family, NHS or state level.

In the world we have today, I know this would be so abused that innocent people who do not want to die will be coerced or murdered and I’m not willing to vote for it as a result.

Are you sure they would've wanted you to end their life? I don't think I'd want someone to end mine. I definitely wouldn't want to put that decision on the shoulders of my loved ones.

When my df was dying (cancer), with morphine via syringe driver, administered by hospice at home team and rapid response team, there was a very strict (and slow) progression of dose of morphine, and it very much felt like we had to negotiate hard for each increase in dose. My df was in constant and increasing pain, despite syringe driver. Sedation was not routinely offered, it happened only once, again after I had made a case of how much he was suffering. In terms of someone being responsible for a person dying, it really struck me (during that final few days), that when the hospice at home team said that my df was now too weak to eat / drink anything, so he was nil by mouth and we had to not give him liquids, that it would be this that actually ended his life. He was still desperately thirsty and was asking for water, which we had been told not to give him. It was really clear that his actual death would come about (at the time that it would) because we had been depriving him of water (under medical instruction). This is essentially ‘assisted dying’ by the back door. So why not formalise it and make it more humane (and much quicker), at that very end of life stage? It resulted in three to four days of intense pain and suffering of my df, which was not alleviated by the morphine he was receiving - and was really harrowing to experience as a close family member..

But when the loved ones are told not to give their dying relative water, then that is essentially ending their life..

No, they are already dying. The denial of water is to prevent suffering. It doesn’t hasten death.

I have no interest in, or intent to, change people’s views on assisted dying, but must point something out.

There are illnesses for which no amount of palliative care, no matter how excellent, can prevent a dreadful dying and death. My husband worked for much of his career with those who had the life-limiting disease he is now living with, and his decision to end his own life (even more prematurely now that assisted dying has been ruled out across this country) is based on solid clinical experience about the practical limitations of other medical interventions.

I was giving my nan water at the end of life. There was no advice not to.

@Sofado When my df was making the decision to come home from hospital, to spend his last days at home, the consultant very clearly said that he would not survive as long if he came home, as he would not be able to have a drip (IV fluids) - which is only available in a hospital setting. So I understood from that, that the lack of fluids at home, would hasten his death - as did my father, but he wanted to come home to die.

I suppose these things all vary; certainly all the leaflets from MacMillan i read about the dying process mentioned no water being given at the end when someone is unable to swallow, but it highlighted that the person isn’t thirsty at this stage and that there are things you can do to moisten the mouth etc etc. So I think (certainly in cancer) that nil by mouth is fairly common toward the end of life.

It was cancer but my nan had a rapid decline and died on an assessment ward so maybe the advice would have been different in another setting. It's useful to hear other stories, it can be such a taboo topic that leaves people not knowing what to expect.

@JLou08 I agree.

I suspect end of life interventions by HCP have changed over the last 25 years. I remember very elderly relatives in the late 1990s dying in hospital, heavily sedated - and (I don’t know this for a fact, this is just my impression) I got the feeling that there was perhaps a more informal way that hospital doctors used of easing someone over the threshold when it was at very end of days - through heavy pain relief / sedation. My recent experience with my father (very tight controls on pain relief, leaving him in constant pain despite stepped increases in doses) make me feel that things have changed a lot - perhaps since Harold Shipman?.. things are much more controlled / monitored / restricted. So my memories of grandparents dying peacefully in hospital with end stage cancer in late 1990s (sleeping through the last days) perhaps couldn’t happen now.

I am so sorry to hear about your mum, this sounds dreadful. I'm shocked that fluids are withdrawn and the patient suffers from dehydration, I thought they stopped doing this? What is the rationale? This cannot be considered good palliative care surely. It sounds very traumatic for everyone.

I’ve just visited a relative in a hospice, it was awful to see them like that. If they had any choice they’d have taken an opportunity to go days ago. They can’t self administer anything today, but I think if you asked once they had seen everyone they wanted to they really, really want to fall asleep and not wake up. Rooms and rooms of people waiting for the end, in pain, struggling to breathe, wasting away and just waiting.

Even without taking the cost of living crisis etc into consideration, there are some people who are greedy for greed's sake.

A few years ago, an elderly neighbour of mine died from cancer. He had three adult sons. One son lived many miles away, but would visit his DF fairly regularly. The other two sons lived locally, but were estranged from their father. They all fell out many years previously. All three sons were left a substantial amount of money, but the house was left to the son who was still in contact with his father. The two other sons proceeded to contest the Will, but the father had put in an explicit clause to say he didn't want them to have anything else and explained why. The judge stood by the wishes of the father. I found out later that both of those sons were extremely wealthy in their own right; one even had a large property portfolio.

Well, if loved ones are required to administer, they're at risk of suffering 'manipulation and guilt tripping' themselves, and (I would have thought) are likely to be haunted by it afterwards even if the patient had wanted it. That's just one reason.

No one ever seems to think about the emotional impact on loved ones when this debate comes up.

Thank you. Worst few days of my life.
I suppose the rationale is fluids would just prolong the dying process.
End of life palliative care is basically people starving/dehydrating to death which is why I am in favour of helping things along with a little Injection of pentobarbital. And yes I know this is a different scenario to planned euthanasia, but once you're brain dead with no chance of recovery these prolonged deaths are just torture of the families, and I didn't get to be with my mum at the end as I'd gone home for a couple of hours sleep.

Nobody should die in agony because people are worried about people are being pushed into this. The safeguards are already there as you have to be within six months of death so you can't push a disabled or elderly person into it, because they might have 10 years left.

Also, it's not just about pain, it's about being bed bound and unable to do anything for yourself or have any quality of life. If someone has had enough, they've had enough. People should be able to decide what they want for their own bodies.

As somebody that actually has cancer, I completely disagree with you. Why should I not have the right to make my own choices? It's not a pretence at autonomy, it's my right to decide when I've had enough. What gives you the right to think you know better than me about my own life and death?

I agree with this, having seen loved ones die and speaking to the palliative care team. For example PP mentioned dehydration, it's easy for us watching someone pass to think that's immensely torturous because we aren't near death where our body has stopped wanting to take in food or water so we can't imagine going without water. I remember getting so upset about how thirsty they must have been because I was imagining myself as a no dying person going so long without water. Death isn't pleasant but some things are natural and can be well supported with the best palliative care (which I know not everyone gets). I do feel that some of the support of assisted suicide is more in the families interests than the patient.