Euthanasia: those who "assist"

Well, England is providing much food for thought at the present time, isn't it?

Since the 1960s, Ray Gosling has been presenting various programmes and documentaries on British TV and radio, and, in fact, he has continued to do so right into his 70s. He was also an influential gay rights activist and was prominent in the the movement to highlight discimination against homosexuals.

Just a day or two ago, he admitted in another television programme that he had once smothered his lover, who was suffering from AIDS, to relieve his suffering. At one point after this confession, he said he made the admission because he was making a programme about death, and he was aware that many other people in the country had been involved in similar "acts of mercy".

Gosling is now under arrest and is being questioned by Nottinghamshire Police.

Last year, three people were arrested in connection with the death of a woman suffering from multiple sclerosis. One of the three is a former "right-to-die" campaigner and a retired GP.

Earlier that year, another MS sufferer - who has openly declared that she is considering ending her life at some time in the future, using the services of an organisation like Dignitas in Switzerland, and has said that she wants her husband to be with her during her last moments - managed to persuade the House of Lords to order the Director of Public Prosecutions to clarify under what circumstances he would prosecute a person who had assissted someone to commit suicide.

Under UK law, it is an offence to assist a suicide, even if committed abroad. There are severe penalties attached to the crime, but the DPP has discretion whether to prosecute. To date, it is unclear how and when he will decide to prosecute. The Lords' ruling has so far resulted in the DPP indicating that prosecutions are likely to be made where there is a financial motive and/or depending upon how the decision to die was taken. Further clarification is still awaited.

After all that preamble, I want to start this debate by asking, are these people all killers, who deserve to be punished, or do acts of mercy such as these deserve recognition for the simple kindness they have done, at such an enormous risk to themsleves?

Ray Gosling claims that his lover was suffering, and Ms Purdy, the MS sufferer, wants to die while she still has a degree of self-control and dignity, and that these reasons (a) justify their death and (b) exonerate the "facilitator". On the other hand, a senior nurse at a hospice here has said, she has seen many of her patients die of terminal and debilitating conditions, and only a tiny handful have ever died in pain or distress, because the medicines they administer enable almost any amount of pain to be controlled, either by blocking the pain sensors, or by knocking the patient out. In fact, she suggested that, far from bringing the patient to an early death, it was often possible to prolong their lives a little.

Tough topic. I think people should have the right to make that decision for themselves.

I think it's okay to "assist" if that assistance is to help bring the person and means together... but...

The person committing the suicide has to be the one, and the only one, with the "finger on the trigger". S/he has to swallow the pills, or close the circuit, or inject the drug, or tie off the plastic bag... or whatever the means of suicide, themself.

Smothering someone with a pillow, for example, takes away the possibility that the person committing suicide could change their mind at the last moment.

It's only characterized as an act of mercy (at this time) because we don't allow suicides. Give people the right to end their own lives and an act of mercy is no longer necessary.

So yes, they're murderers imo, but whether or not they require punishment, goes to the question of gain (as you pointed out.) But I would much prefer to simplify the question by making such acts unnecessary, in which case, such acts would clearly be wrong.

First, if someone is going to kill themselves, its pretty much a moot point, they eaither will or will not.

I think if the person wants to die if they are incapacitated beyound a certian point, then let them, its there choice to go.

If they cannot do it for themselves for whatever reason, then there should be some kind of legal protection for those who would carry out their wishes when the time came.

Similar to how a DNR (do not rescesitate) order is executed.

It sure would save the the loved ones the metal anguish of having to do it illegally on their own, not to metion allieviate the undue burden placed on medical staff in such situations.

As for the hospice nurse...sounds to me like she is allowing her own beliefs on suicide to cloud her objectivity when it comes to how pain relief medications work, there are in fact patients who no ammount of pain medication seems to help and no one knows what those in some kinds pf commas are really experiencing.

In any event it sounds a lot better to me than removing life support and or nutrition and allowing a paitent to litterally slowly sufficate, dehydrate and or starve to death.

A practice thats allready allowed by law under certian conditions.

I've already stated elsewhere that I consider suicide to be a personal decision, not one which the state has any business trying to prevent. In that same line, if a person wants to die, due to some incurable illness which prevents him from actually performing the suicide himself, then there should be legal provisions for his loved ones, or some neutral party, to assist.

But all decisions must come from the dying person. And they must be at least rational. An insane person cannot, by definition, make a rational decision. A person in a coma cannot make such a decision. They could, of course, set out conditions for their termination ahead of time, a living will kind of thing, but one which includes termination, not just forbidding resuscitation.

As denuseri said, that hospice nurse may be injecting her own beliefs into her observations. There have been many instances of people waking up during surgeries, paralyzed but aware and in pain. There have been reports of people waking from comas and reporting on things that went on around them, or of experiencing pain during their comas. In truth, we do not know how much someone might be suffering while unconscious, only that we cannot see that they are suffering. While this may help us cope, it doesn't help the patient.

So yes, I think assisted suicide should be permitted. And in some cases, termination of unconscious patients. We insist on allowing people their dignity in life. Why can't they retain that dignity while facing death?

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Originally Posted by MMI

Under UK law, it is an offence to assist a suicide, even if committed abroad. There are severe penalties attached to the crime, but the DPP has discretion whether to prosecute. To date, it is unclear how and when he will decide to prosecute. The Lords' ruling has so far resulted in the DPP indicating that prosecutions are likely to be made where there is a financial motive and/or depending upon how the decision to die was taken. Further clarification is still awaited.

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A remark aside: I think the UK has too many unclear laws.

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After all that preamble, I want to start this debate by asking, are these people all killers, who deserve to be punished, or do acts of mercy such as these deserve recognition for the simple kindness they have done, at such an enormous risk to themsleves?

Ray Gosling claims that his lover was suffering, and Ms Purdy, the MS sufferer, wants to die while she still has a degree of self-control and dignity, and that these reasons (a) justify their death and (b) exonerate the "facilitator".

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An old problem, but always relevant. I think one mark of freedom is the right to die, if you want. Only you yourself know if that is the right decision.
Therefore I think helpers should go free, but of course there must be strict control first to ensure that this really is the decision of the person to die. If a doctor's help is required, it must be a volunteer.

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On the other hand, a senior nurse at a hospice here has said, she has seen many of her patients die of terminal and debilitating conditions, and only a tiny handful have ever died in pain or distress, because the medicines they administer enable almost any amount of pain to be controlled, either by blocking the pain sensors, or by knocking the patient out. In fact, she suggested that, far from bringing the patient to an early death, it was often possible to prolong their lives a little.

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That is IMO besides the point. The decision must still be that of the person him or herself.

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Originally Posted by thir

A remark aside: I think the UK has too many unclear laws.

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"It is the tragedy of law-abiding men in England that they must respect the law without ever being sure what the law is." - Chesterton

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Originally Posted by Ozme52

Tough topic. I think people should have the right to make that decision for themselves.

I think it's okay to "assist" if that assistance is to help bring the person and means together... but...

The person committing the suicide has to be the one, and the only one, with the "finger on the trigger". S/he has to swallow the pills, or close the circuit, or inject the drug, or tie off the plastic bag... or whatever the means of suicide, themself.

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But it's the helpless who often want this most of all. I have seen my mother and my wife die slowly from starvation, helpless and in constant pain, because withdrawing tube feeding was the only way the doctors were allowed to help them to die. And in case you didn't know, that takes a horribly long time for someone who is bedridden and not using much energy.

If I had been allowed to help my wife on her way and spare her those last horrible weeks, I would have done it gladly, and with her happy thanks.

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Originally Posted by MMI

On the other hand, a senior nurse at a hospice here has said, she has seen many of her patients die of terminal and debilitating conditions, and only a tiny handful have ever died in pain or distress, because the medicines they administer enable almost any amount of pain to be controlled, either by blocking the pain sensors, or by knocking the patient out. In fact, she suggested that, far from bringing the patient to an early death, it was often possible to prolong their lives a little.

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Either the pain relief I've seen given was inferior to that available to her, or she was fooling herself. Beyond a certain point, you either leave people in pain or give them a fatal dose, there's no margin between. This is not theory, I've been there watching.

While I've no reason to doubt you, I also have no reason to doubt the nurse - a health-care professional, after all.

I can only reconcile the two positions by assuming that your wife and your mother fell into the "tiny handful" of patients that pain-killers could not help, a remarkable coincidence. This makes me wonder if those in favour of assisted deaths are focusing exclusively on that handful, while those who are against are looking at all people in the late stages of a terminal illness, whether in pain or not.


On another tack, I also wonder, is there ever a justifiable financial motive?

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Originally Posted by MMI

On another tack, I also wonder, is there ever a justifiable financial motive?

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I'm sure you won't agree, but yes, I believe there is. Why should a spouse or other loved one be forced to maintain a terminally ill patient, incurring all of the tremendous costs involved, if there is absolutely nothing that can be done to save the patient? (Assuming, of course, that the patient is ready and willing to die.)

And I also wonder how long hospitals and doctors would keep those patients alive if they could no longer receive any funds, either from the family or the insurance, but had to pay to keep those patients alive themselves? I would guess they would quickly lose about 95% of their "moral" objections to termination.

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Originally Posted by leo9

But it's the helpless who often want this most of all. I have seen my mother and my wife die slowly from starvation, helpless and in constant pain, because withdrawing tube feeding was the only way the doctors were allowed to help them to die. And in case you didn't know, that takes a horribly long time for someone who is bedridden and not using much energy.

If I had been allowed to help my wife on her way and spare her those last horrible weeks, I would have done it gladly, and with her happy thanks.

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As I said, I don't have a problem with bringing the means and person together. So long as the "helpless" person can at least lift a finger to press the lightest of buttons.... or to actuate a switch with tooth or tongue...

It's just the line I feel comfortable drawing.

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Originally Posted by Thorne

I'm sure you won't agree, but yes, I believe there is. Why should a spouse or other loved one be forced to maintain a terminally ill patient, incurring all of the tremendous costs involved, if there is absolutely nothing that can be done to save the patient? (Assuming, of course, that the patient is ready and willing to die.)

And I also wonder how long hospitals and doctors would keep those patients alive if they could no longer receive any funds, either from the family or the insurance, but had to pay to keep those patients alive themselves? I would guess they would quickly lose about 95% of their "moral" objections to termination.

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I'm not sure if I agree or not, which is why I asked the question: I hadn't een thought of the situation where the hospital might want to accelerate death because of the cost (or the need to free up a bed). And again, many people choose to die at home.

I don't have a position on this question - or maybe I have several mutually incompatible ones - but this is a problem that is exercising many legal brains over here.

Sir Terry Pratchett, who suffers from Alzheimer's Disease, argued for the creation of tribunals that could "authorise" the voluntary death of an individual by "gentle medical means," in his Dimbleby Lecture earlier this month, (see http://www.guardian.co.uk/society/20...icide-tribunal to read an extract).

"... I have vowed that rather than let Alzheimer's take me, I would take it. I would live my life as ever to the full and die, before the disease mounted its last attack, in my own home, in a chair on the lawn, with a brandy in my hand to wash down whatever modern version of the Brompton Cocktail some helpful medic could supply. And with Thomas Tallis on my iPod, I would shake hands with Death."

(I can almost hear Spem in Alium myself, the music filling my head and the taste of brandy on my lips, and while warming rays of sunlight fall onto this halcyon picture my own still body waits while the shadow of the Grim Reaper slowly approaches ... Enough of that!!)

" ... That is why I and others have suggested some kind of strictly non-aggressive tribunal that would establish the facts of the case well before the assisted death takes place. This might make some people, including me, a little uneasy as it suggests the government has the power to tell you whether you can live or die. But, that said, the government cannot sidestep the responsibility to ensure the protection of the vulnerable and we must respect that. It grieves me that those against assisted death seem to assume, as a matter of course, that those of us who support it have not thought long and hard about this very issue. It is, in fact, at the soul and centre of my argument."


Sir Terry points out that, in his view, such a tribunal would be working both in the public interest, and as protector or guardian of the "applicant". A terrible responsibility that could be fulfilled only by the wise heads of professional people who had built up long experience of dealing with the terminally ill.

A reasonable preacaution. Who could measure up to it?

He then goes on to deal with the point made by the hospice nurse I referred to earlier (although not entirely satisfactorily, from my point of view): "The Care not Killing Alliance assures us that no one need consider a voluntary death of any sort since care is always available. This is questionable. Medicine is keeping more and more people alive, all requiring more and more care. Alzheimer's and other dementias place a huge care burden on the country. A burden that falls initially on the next of kin who may even be elderly and, indeed, be in need of some sort of care themselves."

Care Not Killing is an association that lobbies against "right-to-die" movements. It points out that, no-one can prevent you killing yourself, but equally, no-one should be allowed to kill you. Not even a doctor. The association is supported by some eminent health practitioners who worry that Britain could introduce "on demand" euthanasia unwittingly, and ride roughsod over a 2,000 year old medical tradition of preserving life, not taking it. They question the publicity given to Ray Gosling's confession by the BBC, which, they suggest, should have informed the police before screening the programme, and they quote the Archbishop of Canterbury's assertion that granting a right-to-die would be a moral mistake that would upset the "balance of freedoms": "... the current law served the public better than an 'opening of the door' into provision for the legal ending of lives."

I have to admit, this patchwork of quotations has set my head spinning, and probably does no justice to either side of the argument. Yet we are all entitled to form a view, if we can, on whatever information we are aware of. As yet, I cannot. I worry about terminating life, when, as an atheist, all I can see is, life is all we have, and life is sweet. Yet I sympathise with Sir Terry Pratchett when he says: "... if I knew that I could die at any time I wanted, then suddenly every day would be as precious as a million pounds. If I knew that I could die, I would live. My life, my death, my choice."

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Originally Posted by Ozme52

As I said, I don't have a problem with bringing the means and person together. So long as the "helpless" person can at least lift a finger to press the lightest of buttons.... or to actuate a switch with tooth or tongue...

It's just the line I feel comfortable drawing.

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Here's a question for you, then: Would you draw that line just for yourself, or for everybody?

I can understand someone not wanting to throw the switch, certainly. While you may know intellectually that you are helping your loved one, emotionally it might seem like you're killing them. I can imagine many people feeling like that. That's why they want the doctors to do it for them. Or give the patient the means to do it himself.

But legal issues aside, you run smack up against the religious prohibitions against suicide. How many patients would be unwilling to push that button because it would condemn them in the eyes of their Church? Isn't suicide the unforgivable sin?

And you still have the problem of patients who are non-responsive, virtually brain-dead, yet still breathing. They cannot push the button themselves. Could you do it for them?

I've experienced this situation myself. My mother-in-law had a massive stroke, leaving her comatose and all-but dead. The doctors said she would not awaken, and that even if she could there was too much damage. She would be a vegetable. But they could keep her alive indefinitely with a feeding tube.

I didn't have to make the decision, my wife and her father did, but I was asked for my opinion and they made what I believe to be the right decision: they refused the feeding tube. The hospital would provide no food or water, except for the little amount of fluid she would receive with the medication she was given to block stomach acids. We were also told that we could ask for morphine injections if we felt she was in any pain. This was, I believe, the doctor's way of letting us "push the button."

I don't know if my father-in-law realized that, but it doesn't matter because he wouldn't have done it anyway. Neither would my wife. I think I would have, but I can't be sure. It was hell watching her die slowly, even though there was absolutely no indication that she was in pain or aware of her situation. She lasted less than a week.

Ultimately, I think this week was good for my father-in-law as it let him acclimate himself to the idea of her death. By the time she was gone the worst of the mourning was over and we were able to make funeral arrangements in a less emotional state. But I still think she would have been better off if we'd taken the morphine option and ended it quicker. Sitting in her hospital room listening to the Cheyne-Stokes breathing as she got closer to death was about the worst thing I've ever had to experience.

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Originally Posted by MMI

While I've no reason to doubt you, I also have no reason to doubt the nurse - a health-care professional, after all.

I can only reconcile the two positions by assuming that your wife and your mother fell into the "tiny handful" of patients that pain-killers could not help, a remarkable coincidence. This makes me wonder if those in favour of assisted deaths are focusing exclusively on that handful, while those who are against are looking at all people in the late stages of a terminal illness, whether in pain or not.


On another tack, I also wonder, is there ever a justifiable financial motive?

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Your tiny handful isnt so tiny MMI, trust me I worked medsurge including floating to oncology and was a travel nurse for several years. There are points where pain medication no longer works, just like leo said, and if you give them anymore you will kill them or in the case of the non-overdosing drugs just maintain the same level of relief if any.

Medically induced commas are the only viable alternative, but we dont know for certian that they provide any relief so much as reduced phisological response to outward stimuli though the consensus is that they are not all trapped inside themselves and screaming, we still dont know for certian.

What kills me, is you go back to before our healthcare systems got mired in legal red tape by the greed induced insurance companies and other corperations and you dont hear mention of this being such an issue. The Medical staff just took care of buisness using common sence between themseves and the next of kin, everything was handled.

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Originally Posted by Thorne

Here's a question for you, then: Would you draw that line just for yourself, or for everybody?

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I initially draw it in the context of the initial post, and the smothering of someone with a pillow.

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Originally Posted by Thorne

I can understand someone not wanting to throw the switch, certainly. While you may know intellectually that you are helping your loved one, emotionally it might seem like you're killing them. I can imagine many people feeling like that. That's why they want the doctors to do it for them. Or give the patient the means to do it himself.

But legal issues aside, you run smack up against the religious prohibitions against suicide. How many patients would be unwilling to push that button because it would condemn them in the eyes of their Church? Isn't suicide the unforgivable sin?

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Bringing religion into the conversation makes it about religion and not ethics. But in that context.. it's an easy answer. "Thou Shalt Not Kill"
If you believe one religious precept, then you might as well believe them all.
Not to mention...Unforgivable sin? It's a rule of the church, not one of God's rules. Like eating fish on Fridays. (A rule that was created for economic reasons.) Even the commandment has unspoken text. It's full of loopholes. "Thou Shalt Not Kill (people of our faith.)"

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Originally Posted by Thorne

And you still have the problem of patients who are non-responsive, virtually brain-dead, yet still breathing. They cannot push the button themselves. Could you do it for them?

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I probably couldn't. Should you, without having discussed it first? If the patient is terminal and knows it, and didn't discuss it? Nope. You shouldn't. If they did, then there is clearly a point in the progression of the disease where s/he can make that decision of when and still push the button themself.

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Originally Posted by Thorne

I've experienced this situation myself. My mother-in-law had a massive stroke, leaving her comatose and all-but dead. The doctors said she would not awaken, and that even if she could there was too much damage. She would be a vegetable. But they could keep her alive indefinitely with a feeding tube.

I didn't have to make the decision, my wife and her father did, but I was asked for my opinion and they made what I believe to be the right decision: they refused the feeding tube. The hospital would provide no food or water, except for the little amount of fluid she would receive with the medication she was given to block stomach acids. We were also told that we could ask for morphine injections if we felt she was in any pain. This was, I believe, the doctor's way of letting us "push the button."

I don't know if my father-in-law realized that, but it doesn't matter because he wouldn't have done it anyway. Neither would my wife. I think I would have, but I can't be sure. It was hell watching her die slowly, even though there was absolutely no indication that she was in pain or aware of her situation. She lasted less than a week.

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A very difficult question. An unexpected and sudden debilitating event. I don't have a good answer for you. I just don't know.

What I do know, (with no intent to point fingers... just noting the situation...) euthanasia is against the law but we allow morphine overdoses and/or starvation to side step it. It's a hell of a loophole.

I'd be much happier with a change to the law first, and then identifying the circumstances under which direct assistance is allowed.

Tiny handful was not my phrase, but the nurse's

Please for give me for directling the post as a responce to your own then good Sir.

I failed to note and or recall in the heat of the moment where the words in and of themselves first came from and do not mean to imply that you personally agree with the nurse in the op persay....: though I still stand by the rest of my responce in both its veracity and pertianence to the topic.

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Originally Posted by Ozme52

Bringing religion into the conversation makes it about religion and not ethics.

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It's about religion for the patient, perhaps, but not for the doctors or family. For them it's ethics.

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But in that context.. it's an easy answer. "Thou Shalt Not Kill"

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Except that the accepted translation is, "Thou Shalt Not Commit Murder". Killing is quite acceptable, given the proper justification.

So, is euthanasia just another name for murder, or is it justified?

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A very difficult question. An unexpected and sudden debilitating event. I don't have a good answer for you. I just don't know.

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That's the best answer anyone could give. I don't know either. Unless one is actually in the position where he has to make such a decision, I don't think anyone can know.

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I'd be much happier with a change to the law first, and then identifying the circumstances under which direct assistance is allowed.

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I could agree with that. As long as lawmakers alone are not the one's setting the guidelines. Doctors, nurses, patient advocates, should all be involved. Perhaps lawyers in an advisory capacity, but that's about it.

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Originally Posted by Thorne

It's about religion for the patient, perhaps, but not for the doctors or family. For them it's ethics.

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Fine. In which case, for that patient, in what way is asking someone to terminate you any different than pulling the trigger yourself?

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Except that the accepted translation is, "Thou Shalt Not Commit Murder". Killing is quite acceptable, given the proper justification.

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Semantics. Especially considering that in the Roman Catholic version... the religion that says suicide is an unforgivable sin, they use the word "kill". So my argument against that instance is still fine.

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So, is euthanasia just another name for murder, or is it justified?

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That's really another conversation. This one however... regarding assisting suicide, is clearer in my mind for me.

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That's the best answer anyone could give.

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Thanx

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I don't know either. Unless one is actually in the position where he has to make such a decision, I don't think anyone can know.

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I agree.

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I could agree with that. As long as lawmakers alone are not the one's setting the guidelines. Doctors, nurses, patient advocates, should all be involved. Perhaps lawyers in an advisory capacity, but that's about it.

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That won't happen. If it could, euthanasia laws would be enacted by now. In the meantime, we're stuck with suicide, and as I have said, aside from not knowing about the debilitation question, I think such assistance must stop short of "pulling the trigger" for them.

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Originally Posted by Ozme52

Fine. In which case, for that patient, in what way is asking someone to terminate you any different than pulling the trigger yourself?

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Maybe it's just a question of giving permission, more than actually asking. But then, I've never had a problem with someone wanting to commit suicide.

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Semantics. Especially considering that in the Roman Catholic version... the religion that says suicide is an unforgivable sin, they use the word "kill". So my argument against that instance is still fine.

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Except when it's witches or heretics? Those are okay? Or enemies, of course. The RCC never had any problem with killing enemies.

No, even the RCC has exceptions for killing.

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In the meantime, we're stuck with suicide, and as I have said, aside from not knowing about the debilitation question, I think such assistance must stop short of "pulling the trigger" for them.

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Given the way the laws are written in this country, I'd have to agree with you. Legally it's wrong. Morally? Like many other moralistic arguments, that one has to lie with the individual.

Thorne, My comments about the RCC had to do with some level of consistancy with the so-called unforgivable sin and asking someone to do it for you. I see that as hypocritical.

I'm not RC, nor even religious, in a "member of some organized church or theological entity" way. I don't defend (and try not to attack) them. But as you asked the specific question regarding suicide and euthanasia, I was answering it on the basis of what I see as a theological breakdown, and therefore having no substantive value to add to the ethical question posed.

The fact that they and other religious entities have numerous exceptions for breaking the rules when it's convenient is yet another matter for an interesting conversation (although I would be unlikely to participate.) LOL

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Originally Posted by Ozme52

Thorne, My comments about the RCC had to do with some level of consistancy with the so-called unforgivable sin and asking someone to do it for you. I see that as hypocritical.

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One thing I've learned about the RCC is to never expect them to be consistent. Except, perhaps, consistently wrong.

Lol.

sigh...i had a family member who was a heroin addict commit suicide and the church told us God understood he was suffering (my families born again church).
my father was suffering from cancer and did not commit suicide and it was only due to believing if there was an autopsy of any sort insurance wouldn't pay.
my mother died about 2 months ago on all the best pain meds hospice can offer and she suffered tremendously the entire time.
i am aware of someone whose doctor assisted his suicide by helping family members get the right prescriptions filled so if he chose to it was there. he was suffering from parkinsons disease.

suffering is only quantified by the person suffering i think and to have an outside religious or legal agency dictate that is not right as far as i am concerned. although there is a slippery slope argued well that mental suffering or emotional suffering is suffering as well and suicide is wrong for that too. i just know that if i was faced with the same decision i would face it without incriminating others if possible. i would not wish to risk my family suffering either through my illness or legal or ethical issues