Assisted dying - so angry

[specialsubject]

No-one is saying it will be compulsory. But it looks like it is going nowhere. And this kind of comment is why:

Archbishop of York says: "Dying well is a positive achievement of a task which belongs to our humanity"

tell that to Tony Nicklinson's family, and many others.

I am no more terminally ill than any other healthy person. But if I become so, I would like the choice. I have seen the suffering of someone who didn't have it.

It was ok for George V. It is ok for suffering animals. Why isn't it ok for terminally ill humans who want to make that choice? Why is this choice not allowed?

[JugglingFromHereToThere]

I think Stephen Hawking's opinion in favour of this bill is interesting not only because of his experiences but also because of his great intelligence - if he's thought it through well, and I'm sure he has given his life situation and awareness of the importance of his contribution to the debate, then I'll listen to his POV especially as it seems to agree with mine

[DikTrom]

Even the assisted suicide scheme in the Netherlands can still cause anguish, in the sense, that my friend had a very anxious six months before the panel of doctors finally approved his request. He was petrified that he would choke to death one night. If anything got blocked or dislodged or if he picked up an infection he could do nothing, absolutely nothing, he couldn't cry for help (was no longer able to speak), was large parts of the time even unable to push a simple button as he could no longer control his fingers very well, he was so so scared and only found peace right at the end.

[ClashCityRocker]

Ladylemongrab, that's the thing that worries me about it too.

I'd hope to see the time before the choice was made and the 'cooling off' period as a time when the patient got full and proper counselling and support to come to the decision that they have. I worry that it might end up like abortion, when you're pretty much left on your own unless you know how and where to seek the right help.

[TinklyLittleLaugh]

To me it comes down to fact that we treat dying dogs with more compassion than dying people. How can that be right?

[JugglingFromHereToThere]

Yes, I think that's probably true Tinkly, and wonder if it's the effect of too much religion?
Even in Shakespeare's great speech "To be or not to be" it seems the possibility of an unquiet rest is the main deterrent to putting an end to the slings and arrows of outrageous fortune.
Hopefully most of us will choose to stay as long as we can as fellow companions with our loved ones on life's road, weary or otherwise.
But IMHO the end of life, following the knowledge and experiences of terminal illness, is a different one from that in which we find ourselves for most of our life.

[larrygrylls]

I don't think religion is to blame at all. There are plenty of religious leaders who are pro assisted dying and argue the case eloquently.

The fact is that death and dying are the taboo of the modern age. People expect to live forever and distance themselves from the old and sick. This leaves the 'professionals', the doctors, nurses, carers etc to be the real experts. A lot tell a very different story in private than public, where they are obliged to trot out the party line.

Finally, people use the word 'palliative care' as if it is a magical formula for ensuring an easy death. Firstly there are very very few specialists in this area . Secondly, it is mainly opioid analgesia plus antacids plus laxatives, all with their own issues. If you choose to die in your own home, you are dependent on district nurses and GPS, some brilliant, some extraordinarily ignorant about end of life care. Regardless of assisted dying, we need to invest hugely in proper palliative care and acknowledge its limitations.

[TheHoneyBadger]

i don't think we treat dogs with more compassion. the reality of the decision with animals is about their relative 'worth' realistically. yes we couch it in, it's for his own good, he's only suffering now etc but the reality is that we are unlikely to be willing to pay for the level of pain relief and care and put in the hours required to let the animal have a comfortable end.

for me i cannot get past the fact that we need to invest properly in palliative care and end of life care options FIRST. after that, when that is in place, we can talk about assisted dying. but doing the latter before the former is.... it's not about creating choice. there's no meaningful choice available until we have improved for everyone the way we care for the sick and dying.

[larrygrylls]

The honey,

No, that is the wrong way around. It could take decades to bring palliative care to an acceptable level. In the interim there has to be an acceptable alternative to dying in fear and pain. In addition, there remains the basic premise of an adult with capacity having the right to control their own destiny.

It would be like saying we need to invest more in counselling and adoption before allowing abortion.

[Deverethemuzzler]

I disagree thehoney

Why would I put my dog through what my DD went through?

I couldn't explain to a dog that the terrible suffering was to help them, I couldn't explain why their normal life had come to an end. No socialising, no walks, no fun.

They wouldn't know that is was in the tiny hope trying to save them.

A dog cannot read or watch tv or take part in the small pleasures that a human can even if they can't do the other things they have previously loved.

Their needs and wants boil down to being able to walk around, run, eat and sleep, an absence of pain.

I wouldn't keep a dog alive with cancer that had a minimal chance of cure. It wouldn't matter how rich I was.

[TheHoneyBadger]

larry but you are not asking for a person to do it themselves, you're asking for others to be allowed to assist them in doing it and sanction it as a nation.

no one has been prosecuted for attempted suicide in a very long time and as far as i'm aware, the last time this debate came round it was clear that the cps in general are very reluctant to prosecute in cases of assisted suicide by a family member.

i will happily support not prosecuting on a case by case basis where their is clear consent but i do believe formally legalising is a very different kettle of fish.

improving palliative care will never happen if we reach a point of 'well if you don't like it you know what you can do'. that worries me.

as i say i'm essentially for people's right to do this IF they can do it for themselves or if someone is willing to take the risk of helping them outside the law and would be happy for a very lenient approach (as we have) from cps on those cases. legalising it and making it a service is something i can't condone a society doing if it hasn't even invested in making palliative care and options of a standard that means it would be a meaningful choice.

[DikTrom]

TheHoney - yes, palliative care needs to be improved and made more consistent across the country.

However, this does not remove the need for assisted dying, as there are cases where palliative care simply is not enough, not even the best palliative care. This is either because the physical pain cannot be controlled apart from inducing a medical coma (and really this is also then a way to speed up the dying process) or because the psychological pain/fear of what the patient is going through or the patient will be going through is so great that the patient's only wish is to control his or her own death.

Let's be honest, when somebody is put in a deep medically induced coma we simply do not know if they still suffer or not (eg hallucinations, nightmares, etc.), we just don't know. My FIL was in a deep medically induced coma but it did not at least look that he was sleeping peacefully. I think we have to be realistic that there is a lot we do not know and that there are limitations to what doctors can do to relieve suffering.

[larrygrylls]

The medical coma is the ultimate cop out. The person is essentially already dead but no one can grieve....horrible. DIY death is difficult and scary. Most people would not attempt it unless they knew it would be successful. Most fear being a vegetable or waking up even sicker. No one would suggest DIY abortion, so why death?

[TheHoneyBadger]

death is difficult and scary.

please don't compare killing a full grown human being with a fetus - that is offensive to both people who have had abortions and to the lives of sick people.

[3littlefrogs]

Palliative care is a post code lottery, just like everything else.

If you are unlucky enough to get admitted on a Bank holiday weekend, or encounter a doctor who cares more about their ego and their power trip than providing good care, or you end up on a ward that is totally unsuitable because there are no beds, where there are no qualified or experienced nurses, you will probably end up enduring a slow, painful death over a period of days or weeks.

Or - you could be lucky - get admitted on a week day, when the consultant is not on holiday, where there are knowledgeable, compassionate staff and a local hospice that has beds.

Either is equally likely.

This will never be solved because it involves the need for sensible management of money.

[TalkToFrank]

larry it's not true that a doctor cannot relieve suffering of an actively dying person just in case they 'hasten' death. In fact, doctors are protected by law against prosecution if the dosage of opioid needed to relieve suffering also results in the death of the patient. It's the doctrine of double effect here

[TheHoneyBadger]

as far as i've seen with elderly relatives doctors have no problem upping and upping morphine use and that 'indirectly' (as in wasn't the reason it was given) hastening death.

even the catholic church has no problem with the double effect.

[GnomeDePlume]

TheHoneyBadger - I disagree. I think that there are parallels with how we approach terminations and how we approach assisted dying. They arent the same but I think there are parallels.

In a debate like this I dont think that it is helpful to constrain the discussion because people are going to be offended. All that does is stifle what should be a free and open discussion.

[GnomeDePlume]

TheHoneyBadger (honestly, I'm not picking on you!) isnt there a problem with a doctor 'indirectly' (but knowingly) hastening death? It is ungoverned. It is open to abuse and it is possible to botch it up.

[TalkToFrank]

Gnome yes it certainly was a problem - it was how Harold Shipman killed his patients after all - however since that case it has become much more regulated and scrutinised. The premise remains though, the doctrine of double effect is recognised and acknowledged in law. What else is there to do? Unless we are willing (as medical professionals) to leave someone suffering as they are dying?

[DikTrom]

The problem is that nobody knows how humane a morphine induced coma is as some patients are likely to suffer horrendous hallucinations. Doctors know this, but there is not much they can do.

[ICanHearYou]

Palliative care will naturally improve if it focuses on people who want it though.

There are so many people dying, waiting to die, living in shit conditions, lonely and sad, if we just gave the people who wanted it the option to die in their own time and in relative comfort then there would be a lot more time/money/resources for people who felt uncomfortable with it and wanted palliative care.

People talk about 'worth' well yes a man who has fought for his country and raised his children and loved his wife is 'worth' a lot to our society and to his family, but to suggest that taking that proud, strong man and watching him disintegrate into someone who cannot urinate and needs a cathetre and frequently defecates in his pants, left alone to die in a house by himself for the last 4 years of his life before finally meeting his end in a narrow hospital bed surrounded by bright lights is 'proving his worth' is totally backward.

Actually giving him a choice as a younger man is respecting him enough to make the right decision for himself.

That people are saying 'oh but he might change his mind' as an excuse not to allow someone to make a choice for themselves is beyond me. My children might change their minds about what colour school bag they want but I still give them that choice because it is up to them.

If people really think there is more 'harm' in allowing assisted suicide than in dying a slow, painful death over many years then I would say those people don't have much/any first hand experience of this situation.

We need to be focussing on making the lives of the LIVING better, not paying for people to stay alive at every cost even when they don't want to.

[larrygrylls]

TheHoneyBadger,

'please don't compare killing a full grown human being with a fetus - that is offensive to both people who have had abortions and to the lives of sick people.'

It is equally offensive to those who want to shorten their lives by a few miserable weeks, days or hours to deny them bodily autonomy. In fifty years time, I suspect our attitude to assisted dying will be compared to Ireland's attitude to abortion, both equally morally reprehensible.

TalktoFrank,

I had a look at the journal you quoted. Is it a UK or U.S one? The reality, based on recent personal experience is that, if you choose to die at home under the auspices of a hospice, your care is determined by your GP and district nurses, ideally liaising with the hospice. This means that, at weekends, you are dependent on locum doctors. They do not know the full history, or how terminal you are. The guidelines that the one I met seemed to follow is not introducing any new opioids if someone is already on one or more, and not giving what he termed a 'bolus shot' if someone is already on a syringe driver. This meant a search for the correct 'injectable' medications for a new syringe driver. No, they were not in the house, though maybe they ought to have been. If the guidelines are as you suggest (which I am not sure), clearly many GPs do not know them or are not following them. When I asked him for a bolus shot, he said he would have liked to give it but it was 'more than his career was worth'. He was very pro assisted dying.

[larrygrylls]

Palliative care and assisted dying are not either/or. They are part of a spectrum. We should have excellent palliative care and assisted dying.