The prospect of Mum and Dad dying is bad enough without being asked to finish them off?

[sweetnsour]

Terry Pratchett and co are calling for assisted suicide to be legalised. I entirely support his right to die in the face of an appalling illness (dementia). But I object to the apparently seamless assumpation the campaigners make that it's the sick person's relations/family who get to 'perform the act' - ie the killing itself, with/without the family GP.

Acquiring the right to die is one thing. But having the right to ask someone else to kill you?

Doing it would be ghastly for the people left behind and, on top of the burden of grief, could damage them very badly.

Well my brother was cared for by me, my parents, his wife and our other brother and died at home. His last days were 'peaceful' and he 'died well'. But he was still in agonising pain, 34 years old and completely dependent on us for everything in the last days. He had no dignity, and all the palliative care in the world would not have given him any.

I agree that palliative care should be improved. But if a person decides that their life is no longer a life with an incurable disease then they should be allowed to end it, with the assistance they need, be that family assistance or from a Dr.

Goth - you certainly haven't offended me and I'd be suprised if you've offended anyone else.

Sorry, I meant to say that my brother did have dignity in himself, but that the cancer had taken away his dignity. If that makes sense - i don't think I'm getting across what I'm trying to say.

'Family members should not be involved' - well actually, if my brother had chosen to do this then we would absolutely have been involved, directly or indirectly.

Did you read Terry Pratchett's article Sassy about there being no evidence of abuse of the system in Oregon? And how he outlines the criteria for a panel to make a decision on each case?

I'm quite sure that Switzerland also has safeguards put in place.

I do agree that more money should be spent on palliative care and on training but that isn't always the best solution for everyone.

There are conditions that I wouldn't care to live with no matter how good the standard of palliative care,and conditions and circumstances that may not be life threatening but that I'd still find utterly intolerable.

I would not want to be involved in someone I loved's death.

If they could kill themselves I would support them but would not help. I think it's horrible when dying people pressure other people to 'help them', the guilt they feel afterwards is just not fair.

I think the location of death is absolutely critical actually. Everything we apply to birth at home can also be applied to death - it's warmer, more comfortable, more familiar, more 'right' than any other environment. Only a tiny number of those who would like to die at home are actually able to do so. Good palliative care should include options for care at home. Pain and distressing symptoms should not be forcing people in to hospital.

There is a big difference imo between not resuicitating or continuing to treat actively and actively taking steps to hasten death. The former is compassionate and the second runs the risk of being anything but. We should be putting all our resources in to ensuring nobody dies alone, nobody dies afraid, nobody dies in pain. In nearly every case it is possible to achieve that - if we put a higher value on life and living and on the end of life. It's the bits leading up to death we need to fix - not the event of dying itself.

I hope sassybeast is going to come back and explain about stopping "repeated life saving procedures fior smokers"

I missed that part. I'd like to hear more on that too.

Re. end-of-life care at home - I agree that it would be marvellous if this could be achieved for the people who want it. But IME there's one big stumbling block: lifting. Unless you have a relative or team of relatives who are physically able to life the dying person in and out of bed, on and off the commode, in and out of the bath, etc, dying at home can become horribly undignified compared with good care at a hospice. As I understand it, HCPs no longer lift patients because of health and safety regulations (understandably - they run this risk of buggering their backs), so eveb live-in nurses (if you can afford the enormous expense) don't solve this problem. I don't know what the answer is to this.

Portable hoists and other moving aids PW. It's not universally applicable but if we had the resource I think we could get something in to nearly every home. Even if we could just get people home for the last 24 hours of life it would make such a difference to them and their loved ones.

No matter how much you spend on improving care at home and treatments to improve life towards the end you will still end up with suffering for some. The mere fact of keeping people alive longer ensures that.

Of course we should do all that anyway. No one should be considering dying because they are lacking in some treatment/comfort that we can supply.

Policywonk - the NHS does not have infinite resources. And one of the reasons why people at the end of their lives die in agony and in distress is because the NHS does not have the resources available to care for them. End of life care has traditionanly been way down the pecking order in terms of funding, specialist education and provision. We as a society are becoming much more aware of our rights and our entitlements. And yes, without question a 'good' and peaceful death should be one of the main things that we can expect the NHS to provide for us.

But in the current climate of wanting it all and refusing to take personal responsibility for our health, then yes, funding, IMO. SHOULD be redirected. I'm talking about younger smokers who have 1 heart attack due to smoking, requiring emergency treatment, perhaps bypass surgery, who are theym offered comprehensive help to stop smoking and who chose not to take that help. Who then present a few months later with another heart attack, requiring more surgery and another significany amount of money spent on drugs to maintain them. And again a few months later. It's not a popular view among smokers but it's the harsh reality that harsh decisions have to be made. And yes, it cvould be argued that I've made smokers an 'easy' target, but a lot of my feelings regarding the use of resources are based on my own experiences within the NHS.

At no point have I suggested that smokers should receieve anything other then the best possible end of life care. But I think in order to achieve that in the future and to have the resources to do it we need to change the way we as a society view the NHS - that it can and will fix anything that we chose to do to our bodies.

Thanks NL. My dad wasn't offered any of those things when Mam was dying, and I don't think it was for lack of resources because she had a million other mobility aids - just not hoists. Maybe most health authorities just don't purchase them? I do agree that anyone who wants to die at home should be facilitated in that wish.

Sassy, that's such an awful, inhumane viewpoint. I barely know where to start, and given that this is an emotional topic for me I probably ought not to get into it. I do advise you to be mindful, though, when you're expressing these views, that you're likely to be causing anger and distress to people who have lost loved ones to smoking-related causes. Suggesting that the people they loved are less deserving of healthcare than other people might lead to you getting punched in the mouth. I'm just saying.

Anyone who thinks Dignitas is a decent option should read this I read it last year and was shocked to the core.

Sassybeast, you might want to take that to the current anti smoker bashing thread where they will explain that smoking taxes pay for more than smoking related illnesses cost.

I will refrain in this instance from sharing my opinion of your 'views' as it would distract from this thread.

Policywonk - that is NOT what I've said AT ALL and it is best to leave it if that's how you interpret my post. I hope you read my post again and understand the point that I am trying to make (however badly) I know, as well as anyone else, the devastation that a long, lingering death causes. It shouldn't happen, but it does and I have tried to illustrate how we can maybe stop it happening in the future. But please don't call my views inhumane, becaue I may be many things, but inhumane is not one of them. I'm sorry for the loss.

My dad died of cancer when I was 14. We watched a huge strapping outback "bloke" who could wrestle cows and win turn into an old man overnight, he was so very angry.

He died relatively quickly (his body was riddled with it in the end - must have had it for years but continued on) but I think if he had asked then my Mum at least would have done what he wanted.

I don't know. If I thought the person I loved really wanted it to end and I was sure of that then I think I would take it on. DH knows I would rather die than lose my mind, but he also knows that he isn't to break any laws and put himself at risk if it came down to it.

My mother (who is in sound health both of mind and body - may she long continue to be so) and I are already discussing this. She watched and nursed both her parents through to the end of their lives - both of them in great suffering. For the best part of four years she was closely involved with their steady and undignified decline.

She is adamant that she does not want to either experience that long drawn-out agony herself not ask it of me to care for her during it (my siblings live abroad). However the current legal "grey" area causes her deep concern because, without clarity of what may or may not happen to me should I end up helping her to Switzerland or any other option, she thinks it IS too much to ask of me. If she could rest easy that I will not be prosecuted or held accountable for her death, then it becomes a decision that we reach together considering the emotional aspects and the family legacy of our actions - not overshadowed by legal repurcussions.

My view - we'd be happy to come before a board of review to make our case. I would want to have objective observers certify that I am not putting her under pressure nor she me. We'd certainly prefer medical support rather than being thrown on our own resources - and we'd both need the option to back out.

But I don't see that it is wrong of her to ask it of me. She's my Mum, she's done so much for me and asked very little in return. If she is staring at a terminal phase of pain and disintergration that fills her with horror, then I hope I can have the courage to help her do what she sees fit for herself.

I also completely endorse the requirement for better palliative care - but this is about what happens when what care is available is no longer enough.

Fantastic post Duchesseofavon.

My MIL has discussed the same thing at great length with my exH. Her own mother had early onset Alzheimers, and was in a practically vegetative state for 13 years. My exH says he greaved for her 15 years before she died, when he went to visit her and saw 'she' was no longer there, it was the same for all of the family.

It was an enormous stress, physically ,financially and most importantly mentally for her family to care for her for so long.

Well exactly Duchess which is what I said earlier - this isn't about 'forcing' or even 'asking' family members to assist in someone's death, it's about ensuring that if they do that family member will not be liable for murder or manslaughter. It's also about allowing a dying person so element of control over their final days.

I think people are being a little harsh on Sassy. She might not have expressed her views very well, but she's absolutely not saying that some people are more 'deserving' of the NHS than others. Her point about taking responsibility for one's health is a valid one.

Another view to add.....my dear Dad has two types of dementia - vascular and alzheimer's - sadly he is a long way away from the 'Dad' we grew up with. My mum is still looking after him at home and he has good and bad days.

The good - he sits quietly and doesn't really say much

The bad - screaming out the windows that he's locked in and needs help, crying, asking to go home, asking when his mum is going to collect him (he's 73 by the way, his mum died over 25 years ago)

The worst was last year - he had a period of lucidty (2 days) - he knew who I was and he grabbed my hands and held them so tighly and stared into my eyes (his eyes were the most alert they had been and he looked just like he used to) and he asked why he had to go through this and if I would help him - he said if he could get a knife he would slash his wrists (but knew my mum would stop him) - he just kept saying 'I just want to die - this is no life - I want to go, just help me'

Sorry a bit of a ramble there - I just wanted to back up the thoughts on why palliative care is not always enough.

Dad is still with us - and I only told DH what he had asked. Its not something I could actually do.

As others have said - until you've walked the same path.....

Onagar -I've acknowledged that my view is not a popular one. FWIW, I think that the argument about smokers taxes paying for smokers care doesn't hold water - it's not a 'like for like' scenario. But I'm interested in how YOU would pay for improvements in palliative and end of life care ? And I do happen to think that the issue IS relevant to the thread. If we could afford to care for dying people properly in this country, then there wouldn't be a need for families to be placed in the position of having to assist their loved one to die, or vulnerable people being placed at risk of being killed (the point I made earlier on) It's a utopian ideal yes - but one that we SHOULD be aspiring to. But we can't afford to do it at the minute. We can't afford to look after people in their own homes because we can't afford the equipment. And people who are in hospital against their wishes suffer more severe pain than those who are setttled and calm in their environment. We can't give people particular drugs in their last days because they are too expensive. We can't provide specialist doctors and nurses because we don't have the money to train them. We don't have enough hospice beds becasue health trusts can't fund them. So how can it all be funded ? Because the stark reality is that in the UK, dying people often have painful, horrible deaths which leave a lasting effect on their loved ones because we can't afford to do it properly. You can't stop people from having congenital heart problems or developing type 1 diabetes as examples. We can't stop people needing ICU beds after being beaten up in the street. So you can't address compliance and treatment issues in those areas. But you CAN do it with smoking related diseases. You CAN reduce the amount of money spent on health problems manifested in the early life of a smoker. So WHY is it so unnaccepatable to consider it as a sound way to free up some of the desperately needed funds for the care of the dying ?

I read somewhere that euthanasia was this generation's equivalent of abortion, and I agree.

We've been conditioned to gasp in horror at death, discussion of death, insensitivity etc when the bald fact is that many people of sound mind would love nothing more then to be allowed to die.

My own view is that we need to grow up as a society and face this reality head on, as it is only going to get worse if we don't.

Doctors administer drugs, not family members. If we could get away from the silliness of 'doctors shouldn't kill people' (in fact they've been doing it compassionately for as long as there's been a medical profession) and look at the realities then maybe we could have a meaningful discussion of how and where best to administer lethal drugs to those that need them.

AFAIK there is no abuse of the system in countries that legalise euthanasia.

My own view is that just as a nation cannot call itself civilised if it administers the death penalty or denies its citizens abortion rights, it is uncivilised to criminalise the distraught relatives of those who wish to die.