Right to die

The cabinet in the UK was recently reshuffled. A new minister for Health Anna Soubry promptly came out to say, 'I think it's ridiculous and appalling that people have to go abroad to end their life instead of being able to end their life at home.' Using the words 'ridiculous' and 'appalling' on a subject where the moral arguments are finely balanced and when getting things wrong can result in horrific out comes in both directions probably wasn't a good idea but the fact that there are ministers on that side of the debate is interesting.

For the record I think we should keep the law against assisted suicide, while realising that some people are living a horrendous nightmarish existences, because, making assisted suicide legal (i.e. the person who helps the person concerned to die won't be prosecuted for murder) could cause older or infirmed people to feel a pressure to stop being a 'burden on society' and to suicides that aren't actually suicides.

There is also a problem, if people can ask to die in hospital, that you are expecting doctors and nurses to kill people on a regular basis.

Daily mail article. More papers should show full length images of ministers. It's always good to know what ministers are wearing as they make the important decisions.

BBC item. Film will play automatically.

Edit: Edited for clarity

For me this has ways been pretty cut and dry. If someone wants to end their life with more dignity and (presumably) less pain than a gunshot or starvation then I think they should have the legal ability to do so. If there's any freedom in the world, I'd like to think we'd have the freedom over our own right to live or die.

In the case of the elderly... Christopher Buckly actually wrote a pretty amusing book about that with regards to social security reform: "Boomsday!"

As for the right to die... I get the argument for the sanctity of life.... and the waters are certainly muddied by those instances where the person is no longer capable of making that decision but their living will or loved ones suggest a perferred outcome.

But I just don't get the hooplah on this one. Kind of strikes me as similar to the abortion debate in that a whole bunch of legislators who have never experienced this issue first hand are making rules on what other people can't do.

I don't know what I would do if I was in a situation that would precipitate thinking about this... but i would prefer the option be available should i be ready for reincarnation.

garion333 wrote:

For me this has ways been pretty cut and dry. If someone wants to end their life with more dignity and (presumably) less pain than a gunshot or starvation then I think they should have the legal ability to do so. If there's any freedom in the world, I'd like to think we'd have the freedom over our own right to live or die.

I suppose the tricky thing when it comes to the law is if the person can't take their own life and needed help. Wives, husbands or doctors can help and then find themselves locked up for murder.

I've edited my original post to be clearer.

Oregon's Death with Dignity Act is one of the things that makes me respect my state's government and citizens over much of the rest of the country. The story of the act, the various challenges to it, and the consistent support by voters is worth looking at for this discussion.

For me, the question isn't as much about being a burden on society as it is about quality of life. If I get to a point where my physical or mental health is so far gone that I can no longer be myself, I want to be able to go out in a peaceful and controlled manner. My wife and I have discussed this, but I really do need a legal directive to this effect.

For me, if there's a right to a dignified life then there's also a right to a dignified death.

This has been a big fight in Canada recently. It was knocked down some years ago but there are some more court cases that are challenging the prohibition.

My school actually had one of the lawyers who advocated for the right to die at the Supreme Court of Canada. It was very interesting and I found my self convinced of the rights necessity.

Higgledy wrote:
garion333 wrote:

For me this has ways been pretty cut and dry. If someone wants to end their life with more dignity and (presumably) less pain than a gunshot or starvation then I think they should have the legal ability to do so. If there's any freedom in the world, I'd like to think we'd have the freedom over our own right to live or die.

I suppose the tricky thing when it comes to the law is if the person can't take their own life and needed help. Wives, husbands or doctors can help and then find themselves locked up for murder.

I've edited my original post to be clearer.

Well, let me be clearer too.

I meant what I said to include assisted suicide. Here's a few videos I found this morning on Youtube to help clarify my position.

Manifesto

This is not the documentary itself (which I haven't seen), but it does contain clips from the documentary, including the portion where the man drinks the cocktail that kills him and you will see him after he has passed. So, be forewarned, there is images that can be disturbing to some, but I assure you there is nothing gruesome about any of this video.

And finally, Terry Pratchett. I haven't watched any of this video and I'm excited to give it a watch.

It's certainly a debate worth having. Out of the mouth of a member of this Tory cabinet, though, all I can hear is "Keeping gomers alive is expensive and assisted suicide is another service we can farm out to the private sector."

Especially the way she said "go abroad to end their life". No mention of the moral/ethical angle here at all. Pure bottom line.

Maq wrote:

It's certainly a debate worth having. Out of the mouth of a member of this Tory cabinet, though, all I can hear is "Keeping gomers alive is expensive and assisted suicide is another service we can farm tax from the private sector when the public pays for it."

Especially the way she said "go abroad to end their life". No mention of the moral/ethical angle here at all. Pure bottom line.

FTFY!

garion333 wrote:

For me this has ways been pretty cut and dry. If someone wants to end their life with more dignity and (presumably) less pain than a gunshot or starvation then I think they should have the legal ability to do so. If there's any freedom in the world, I'd like to think we'd have the freedom over our own right to live or die.

Yep.

Higgledy wrote:

There is also a problem, if people can ask to die in hospital, that you are expecting doctors and nurses to kill people on a regular basis.

What if the ability to commit suicide was provided by the medical staff but not administered by the medical staff?

As Kraint mentions, Oregon's Death with Dignity act has made this possible here for a few years. I've seen a few articles following up on it over the years (sorry I can't cite them as the specifics have drifted out of memory) but an interesting element of it has been the fairly low number of people who have taken advantage of it. Despite some of the concerns of those before it passed, I think this reality reflects that it truly is only being used by those who have made the personal journey to decide this is their best option.

My point being that your concern about doctors and nurses being asked to 'kill people on a regular basis' may still be a very rare occurrence. I'm not a medical professional but personally I would have a very hard time watching suffer on a regular basis when there is legitimately no hope that their suffering will end before death.

Phoenix Rev wrote:
Higgledy wrote:

There is also a problem, if people can ask to die in hospital, that you are expecting doctors and nurses to kill people on a regular basis.

What if the ability to commit suicide was provided by the medical staff but not administered by the medical staff?

Set the patient up with a button a bit like they do in Dignitas?

That might be ok.

I don't personally have a problem with there being a system for people to end their lives in a medical setting as long as the medical staff don't object. In a sense they do deal with death on a regular basis. I have heard doctors saying that they could end up taking lives more than saving them. Not actually administering the lethal dose themselves could well remove any trauma to the medical staff involved.

garion333 wrote:

I meant what I said to include assisted suicide. Here's a few videos I found this morning on Youtube to help clarify my position.

Very interesting thanks. I thought I had this dilemma worked out. Now I'm not so sure.

Sometimes I think making policy and law is like balancing walnuts on a plank. If a group of walnuts are rolling off you have to tilt the plank to save them but doing that may roll just as many walnuts off the far side.

Maq wrote:

Especially the way she said "go abroad to end their life". No mention of the moral/ethical angle here at all. Pure bottom line.

I would consider having to leave your country and not being able to die at home as part of the moral/ethical angle.

They don't have bridges or tall buildings in England?

LeapingGnome wrote:

They don't have bridges or tall buildings in England?

They and their surrounding areas were all padded following the introduction of the nanny state....

Having never been terminally ill, with the reaper over my shoulder I find it tough to make much of a value call on this. I have had loved ones pass in a Morphine fueled fugue, that seemed to be an OK way to go.

Whether I am drawing an arbitrary line or not, I have a problem with doctors administering an overdose themselves. I have less of an issue with doctors allowing patients to take home a prescription capable of overdosing them at home or in the hospital-a month's worth of Opiates in one trip say. I believe the former is an area ripe for murderous opportunities. Look up Richard angelo AKA The Angel of Death for example.

I am also not in favor of assisted suicide as an "Ice Flow" solution. IE when the sick or elderly are seen as a burden, even by themselves. They still have their faculties, or can still lead a meaningful life but because of being wheelchair bound, or the prospect of expensive treatment makes them look to death. I have seen people genuinely say that regardless of the options, they would choose death over undergoing chemotherapy, even for cancers and early detection with 90+ percent remission rates.

I just wonder at what point do we go from ending suffering to Suicide booths like in Futurama.

Interestingly I came into this, as you may have detected, thinking that the general consensus was that assisted suicide was something that should remain illegal. Now I'm beginning to see that that might not be the case and that I might even be on the wrong side of the argument on this but there are some very tricky dilemmas that come up when you start to consider legalising suicide.

There is the problem of pressure from families. Elderly relatives in care can often feel that they are a burden on the family. What if someone like that was insisting on dying for that reason? Also, there are cases where grown up children kill parents for their money. What if someone presented themselves for assisted suicide but the doctor felt that the person was being or had been coerced into the decision?

There are also temporary states, such as depression, where someone may be adamant about dying but who, if prevented from killing themselves may go on to live a happy life. There are illnesses that seem terminal where people can make a full recovery.

It's also worth considering that you couldn't realistically limit suicide to older people. Terry Pratchett, in one BBC interview, suggested the age limit should be set at the age of consent (18 in the US, 16 in the UK.) What if any number of teenagers started presenting themselves I hospitals looking for assisted suicide?

In theory the problem can seem clear cut. In practise I think it would create horrendous moral and ethical dilemmas for doctors and medical staff. Imagine if you had helped someone to die when you felt, for any of the reasons above, that it wasn't right to do so and if you had to face problems like that every day.

It is a hard issue, but I think there are clearly ways to handle it that are fair to everybody involved. Things like having a psychological evaluation to establish that the person is in their right mind and has firm reasons for making the choice. It's a bit of a balance, between our desire to be sure that people don't harm themselves for other reasons, but still making sure that they're allowed to act when they decide perfectly rationally that it's time. Likewise, documents written ahead of time detailing the situations in which you do not wish people to continue to preserve your life, etc.

As another example of tricky things: I believe the Oregon state law requires self-medication, and I recall reading a news story which mentioned someone with a degenerative nerve condition that caused him to lose control over the muscles of his body. Under the law, he could be prescribed poison, but he had to give it to himself--which involved some sort of setup where he could tip a cup over into his own mouth, using his mouth (since that's basically all he had left that he could move). That's a very awkward situation, but I think it does a good job of illustrating both the kind of situation where almost everyone would agree that someone ought to be able to choose to die, and the weird kinds of difficulties that legal requirements can create.

(And now that I think about it, I think that same article talked about the very small number of people who have actually ended their lives under the Oregon law.)

So--I think there's clearly a place the law can sit that doesn't create a serious moral hazard for health care workers, but which allows people the ability to choose to end their lives in extraordinary conditions. No such law will be perfect, but a reasonable law goes a long way towards allowing people to avoid tremendous suffering in especially clear situations.

Higgledy money is a huge concern:

The Estate Tax Exemption and Death

Life or death determined on whether your inheritance or your surviving family's inheritance will be smaller or larger. Do you continue respiration for a wealthy family member in a vegetative state because in 2012 your estate tax will be lower?

I saw this article earlier this year, and I think it is quite relevant to the discussion.

I'm also in favor of doctors being able to administer, or at least set up a self-dose to the point of triviality, the lethal medication. Not forced to, but able to. This is for the sake of those who are not physically able to self-administer, and for those who are mentally unable/incapable of doing so(the caveat is that some sort of advance directive may be required). For those who think that physician administration is problematic for medical staff, could you outline that a bit? I can understand physicians not wanting to do it for personal reasons, and am against forcing it. But I can't imagine that there are not some who are willing to perform the procedure, especially after an appropriate and well-defined medical review is conducted(no coercion, no possible cure/relief, etc.).

Higgledy wrote:

There are also temporary states, such as depression, where someone may be adamant about dying but who, if prevented from killing themselves may go on to live a happy life. There are illnesses that seem terminal where people can make a full recovery.

It's also worth considering that you couldn't realistically limit suicide to older people. Terry Pratchett, in one BBC interview, suggested the age limit should be set at the age of consent (18 in the US, 16 in the UK.) What if any number of teenagers started presenting themselves I hospitals looking for assisted suicide?

Anything like you describe disqualifies the person from any of the legal methods I've seen. An actual terminal/permanent disease or injury must exist, as verified by real doctors, a psychological evaluation, and the process requires some sort of third party involvement. None of this is about clearing out the elderly, or having the process be no more complicated than going to your doctor and paying the co-pay. This is a graceful way out for people who are looking at months of pain, loss of self, extreme pressure on friends and family, and six-figure hospital bills, followed by death.

I want to second Kraint's post.

One thing that bothers me in the US is the pains we will go to in order to make a death sentence somewhat "humane" (i.e. painless -- IIRC -- lethal injection versus the electric chair or hanging; which I support, by the way: if we're going to kill people let's at least do it as humanely as we can), but we won't afford the same consideration to individuals who wish to enact their right to death.

If I'm ever in a position where I have a legitimate reason to end my life, and can make the decision lucidly, then I should have a better option than "go buy a gun and shooter yourself" or the like. Physician-assisted lethal injection should be a medical right.

Kraint, I suspect any doctor even if the law changes who is known to administer a lethal dose of anything to a patient is about to lose his insurance.

I also have a deep concern that it will provide a safe haven for doctors and nursing staff who kill patients intentionally or negligently. If the instrumentality of that negligent or intentional death is the same as an assisted suicide, you have created a serious legal defense.

Looking at my angel of death serial killer example, you are also looking at a population that has always been ripe for exploitation-weak, sick, elderly. The longer a person is in that infirmed state, the more time they spend alone.

In my living will I was able to specify circumstances in which my family could 'pull the plug' so to speak, part of the standard legal practice for this is that two physicians have to independently agree that I'm not likely to recover to a functional state. I do not understand why we can't allow similar things for the right to die via assisted suicide and I would think requiring physicians to sign off would counteract at least some of the issues with kids trying to inherit money or the like. If the patient is able then yeah, put a button in their hand after fully explaining what it will do. There needs to be some means of policing the Angel of Mercy type stuff but here too I think requiring physician sign off would help police things a bit.

Another factor to consider is that for us organ donors letting things run their natural course may render organs which would have been fine sooner unviable. Sure you want to avoid being signed off simply because they know you're a donor but personally I'd probably be willing to cut things a bit shorter if it was the difference between helping others vs not.

Higgledy wrote:

There is the problem of pressure from families.

Here in the States pressure from the family means doing everything humanly possible to keep the older/sick person alive, whether or not they want it.

Just a few years ago we had a highly politicized case involving Terry Schiavo, a woman who had a heart attack, which lead to massive brain damage, in 1990. She never regained consciousness and her doctors listed her as being in a persistently vegetative state.

In 1998, her husband petitioned the court to remove her feeding tube. That's when her parents got involved and this case turned into an even greater tragedy.

Her parents were convinced that she was still conscious and so filed the first of some five law suits to keep their daughter "alive". All of this culminated with an 11th hour law being passed by our Congress in 2005 to transfer her parents law suit to federal court because they had lost all their appeals in state court (completely voiding all those state rulings). This extraordinary effort proved pointless because the federal courts agreed with the state courts and threw out the parents' case.

Terry finally died in March of 2005 after her feeding tube had been removed. When they autopsied her body they found that her brain was half the weight it should be and that the remaining tissue had extensive damage caused by the loss of oxygen that happened when she had a heart attack some 15 years prior.

In this case, family members moved heaven and earth to keep a vegetable alive. There was absolutely no way Terry would have ever regained consciousness or been able to interact with her family. And yet her parents fought to keep her body alive for a decade and a half.

This is what happens in a great deal of cases here in the States. It's part of the reason so much money and resources are spent on people in the last six months of their lives. Children who either weren't around, weren't able to help, or just didn't care suddenly get all guilt-ridden when their parents are old and sick. To overcome that guilt they push for extraordinary medical treatment, not even thinking that perhaps their parent doesn't want to die in a hospital with tubes sticking out of them.

I'm with Pratchett on the age of consent being 18. How else would you set up an arbitrary year, say 40, that determines if a person has lived "long enough"? 18 is when we are considered an adult by society in a legal sense, excluding a few things, so that's the point where we fully take responsibility over our choices.

As far as there being some sort of mass suicide epidemic, I think that's a fear that's probably blown out of proportion. Assisted suicide is not something someone can simply show up for and have it done. I don't foresee a McDonald's for suicide or the aforementioned suicide booths from Futurama. Younger people are more likely to look for the quick way out, like a gun or a bridge, than a process which involves a process over a period of time (and presumably includes some form of counseling).

The question of physician assisted or self administered has already been determined in most places, as has been mentioned. Above, in the second video I posted, the man who was overseeing the procedure made it clear that he needed to videotape the patient saying he was doing it of his own volition and that the patient had to administer it to himself. His situation was similar to the one Hypatian mentions in the man had ALS, so the physician held the cup of barbituates for the man while he drank from a straw. As the physician said, he was allowed to hold the lethal dose, but the patient still had to ingest it on his own. Since we're talking about assisted suicide, it's pretty clear that doctors and staff will not be doing the final button push, as it were. That would be considered murder in the places that allow for assisted death.

Assisted death is something that needs to be legislated very clearly so those who operate in the field are able to keep their heads above legal water. Places like Germany and Oregon have these rules already in place.

KingGorilla wrote:

Kraint, I suspect any doctor even if the law changes who is known to administer a lethal dose of anything to a patient is about to lose his insurance.

I also have a deep concern that it will provide a safe haven for doctors and nursing staff who kill patients intentionally or negligently. If the instrumentality of that negligent or intentional death is the same as an assisted suicide, you have created a serious legal defense.

Looking at my angel of death serial killer example, you are also looking at a population that has always been ripe for exploitation-weak, sick, elderly. The longer a person is in that infirmed state, the more time they spend alone.

The example law I listed at the beginning of the thread already accounts for all of that. This isn't a unilateral decision by the doctor, it isn't a quick decision, and it isn't completely private between doctor and patient. This isn't the doctor deciding the procedure is necessary and walking in with a syringe, as you seem to have construed it.

Death with Dignity Act wrote:

Under the law, a capable adult Oregon resident who has been diagnosed, by a physician, with a terminal illness that will kill the patient within six months may request in writing, from his or her physician, a prescription for a lethal dose of medication for the purpose of ending the patient's life. Exercise of the option under this law is voluntary and the patient must initiate the request. Any physician, pharmacist or healthcare provider who has moral objections may refuse to participate.
The request must be confirmed by two witnesses, at least one of whom is not related to the patient, is not entitled to any portion of the patient's estate, is not the patient's physician, and is not employed by a health care facility caring for the patient. After the request is made, another physician must examine the patient's medical records and confirm the diagnosis. The patient must be determined to be free of a mental condition impairing judgment. If the request is authorized, the patient must wait at least fifteen days and make a second oral request before the prescription may be written. The patient has a right to rescind the request at any time. Should either physician have concerns about the patient's ability to make an informed decision, or feel the patient's request may be motivated by depression or coercion, the patient must be referred for a psychological evaluation.
The law protects doctors from liability for providing a lethal prescription for a terminally ill, competent adult in compliance with the statute's restrictions. Participation by physicians, pharmacists, and health care providers is voluntary. The law also specifies a patient's decision to end his or her life shall not "have an effect upon a life, health, or accident insurance or annuity policy."

I also have a deep concern that it will provide a safe haven for doctors and nursing staff who kill patients intentionally or negligently. If the instrumentality of that negligent or intentional death is the same as an assisted suicide, you have created a serious legal defense.

Looking at my angel of death serial killer example, you are also looking at a population that has always been ripe for exploitation-weak, sick, elderly. The longer a person is in that infirmed state, the more time they spend alone.

I think the Dutch have it right. Assisted suicide is outlawed there; however, if the following conditions are met, prosecution will be avoided:

The law allows medical review board to suspend prosecution of doctors who performed euthanasia when each of the following conditions is fulfilled:

the patient's suffering is unbearable with no prospect of improvement
the patient's request for euthanasia must be voluntary and persist over time (the request cannot be granted when under the influence of others, psychological illness or drugs)
the patient must be fully aware of his/her condition, prospects and options
there must be consultation with at least one other independent doctor who needs to confirm the conditions mentioned above
the death must be carried out in a medically appropriate fashion by the doctor or patient, in which case the doctor must be present
the patient is at least 12 years old (patients between 12 and 16 years of age require the consent of their parents)

The doctor must also report the cause of death to the municipal coroner in accordance with the relevant provisions of the Burial and Cremation Act. A regional review committee assesses whether a case of termination of life on request or assisted suicide complies with the due care criteria. Depending on its findings, the case will either be closed or, if the conditions are not met brought to the attention of the Public Prosecutor. Finally, the legislation offers an explicit recognition of the validity of a written declaration of will of the patient regarding euthanasia (a "euthanasia directive"). Such declarations can be used when a patient is in a coma or otherwise unable to state if they wish to be euthanized.

Euthanasia remains a criminal offense in cases not meeting the law's specific conditions, with the exception of several situations that are not subject to the restrictions of the law at all, because they are considered normal medical practice:

stopping or not starting a medically useless (futile) treatment
stopping or not starting a treatment at the patient's request
speeding up death as a side-effect of treatment necessary for alleviating serious suffering

Euthanasia of children under the age of 12 remains technically illegal; however, Dr. Eduard Verhagen has documented several cases and, together with colleagues and prosecutors, has developed a protocol to be followed in those cases. Prosecutors will refrain from pressing charges if this Groningen Protocol is followed.

This effectively removes the "safe haven" for greedy relatives, unscrupulous doctors and serial killers. It also prevents killing someone because they are depressed. Note that each assisted death is investigated as a killing, and if any questions arise, the doctor will be suspended and undergo prosecution.

KingGorilla wrote:

I also have a deep concern that it will provide a safe haven for doctors and nursing staff who kill patients intentionally or negligently. If the instrumentality of that negligent or intentional death is the same as an assisted suicide, you have created a serious legal defense.

Looking at my angel of death serial killer example, you are also looking at a population that has always been ripe for exploitation-weak, sick, elderly. The longer a person is in that infirmed state, the more time they spend alone.

Richard Angelo was poisoning people so he could save them, though. I understand what you're trying to get at, that people who want to watch people die or whatever might go into this line of work and then force people to do something they may not want to. That's why you can't just flip a switch to kill someone 5 minutes after a person states that they might want to not live any longer. There needs to be a process in place and it can't allow for quick turnaround, as it were. There needs to be evaluation and oversight.

I think our right to ending our lives the way we want to outweighs the potential for abuse.

I have a very absolute view on this. Suicide is not illegal. I can, at any point, decide to kill myself, and go ahead and do it through any means I deem fit. I can jump off an overpass. I can shoot myself. I can drink bleach.

None of these things are illegal. Some may be of dubious morality, for sure (jumping off a overpass is a douchebag move for instance, it would likely traumatize a lot of folks who are nothing to do with me), but they are all A-OK by the law of the land.

So, it's established and settled law that I have a self-determining power to end my own life, right? To my mind, it's moot whether it's my finger on the trigger of the shotgun in my mouth, or a doctor pushing IV morphine because I'm physically incapable of performing the deed myself.

Of course there needs to be legal and procedural infrastructure to prevent abuse as numerous posters upthread have noted. Establishing consent/intent of the patient is paramount.