Today’s New York Times has a piece on physician-assisted suicide: two states, Washington and Orgon, have laws that allow doctors to prescribe fatal doses of barbiturates for terminally ill patients. As far as I can see (and have witnessed on one video from Dignitas, the Swiss organization that helps organize doctor-assisted suicides), one just goes to sleep.
The piece highlights Dr. Richard Wesley, a physician who was diagnosed with ALS four years ago, is now wheelchair bound, and seems to find immense relief in knowing when he can choose his end.
As the Times piece notes, Massachusetts residents will vote on a similar law in November, but initiatives like this one have failed in California, Maine, and Hawaii. I don’t understand why this form of euthanasia isn’t legal everywhere. First, and most important, it saves patients (and their families) immense suffering.
Second, there are strict rules for undergoing the procedure:
In both Oregon and Washington, the law is rigorous in determining who is eligible to receive the drugs. Two physicians must confirm that a patient has six months or less to live. And the request for the drugs must be made twice, 15 days apart, before they are handed out. They must be self-administered, which creates a special challenge for people with A.L.S.
Finally, fears that such laws would lead to mass suicides have proven groundless:
Oregon put its Death With Dignity Act in place in 1997, and Washington’s law went into effect in 2009. Some officials worried that thousands of people would migrate to both states for the drugs.
“There was a lot of fear that the elderly would be lined up in their R.V.’s at the Oregon border,” said Barbara Glidewell, an assistant professor at Oregon Health and Science University.
That has not happened, although the number of people who have taken advantage of the law has risen over time. In the first years, Oregon residents who died using drugs they received under the law accounted for one in 1,000 deaths. The number is now roughly one in 500 deaths. At least 596 Oregonians have died that way since 1997. In Washington, 157 such deaths have been reported, roughly one in 1,000.
. . . There were fears of a “slippery slope” — that the law would gradually expand to include those with nonterminal illnesses or that it would permit physicians to take a more active role in the dying process itself. But those worries have not been borne out, experts say.
Well, there are at least two reasons why these laws aren’t universal, at least in America:
Such laws have influential opponents, including the Roman Catholic Church, which considers suicide a sin but was an early leader in encouraging terminal patients to consider hospice care. Dr. Christine K. Cassel, a bioethicist who is president of the American Board of Internal Medicine, credits the church with that effort. “But you can see why they can go right up to that line and not cross over it,” she said.
The American Medical Association also opposes physician-assisted dying. Writing prescriptions for the drugs is antithetical to doctors’ role as healers, the group says. Many individual physicians share that concern.
The Catholic Church’s stand is immoral, for its activities prevent even non-Catholics, who don’t see suicide as a sin, from ending their suffering. And surely one can see the immorality of forcing terminal patients to continue suffering when they could end it all (and presumably meet the same post-mortem fate that they would have had they not taken barbiturates). Would God really send such patients to hell? What kind of God would that be?
The American Medical Association also needs to reconsider its stance. True, I agree that doctors shouldn’t assist with lethal injections of prison inmates, but this is a different situation. Why would doctors prolong suffering by withholding medication when they know the patient is doomed to a terrible end without it? Besides, as all doctors know, they already engage in a similar practice. That involves giving overdoses of painkillers like morphine to terminal patients: overdoses that they know will kill them by stopping breathing. The euphemism it goes by is “reducing pain,” since doctors are bound to do that if they can. They ask a patient if he/she is in pain, and if the answer is “yes,” they give more morphine—often enough to cause death.
But if they do that, why not reduce the pain by ending the suffering deliberately and permanently? It amounts to exactly the same thing.
I see no rationale, neither medical nor religious, for forcing terminal patients to meet a “natural” death, enduring mental and physical suffering right up to the end.
Reblogged this on Mark Solock Blog.
It is outrageous that religion, the catholic church, has so much control over secular lives. And there is no discussion about,objection to it, except among the secular choir. And to think that there are 6 catholics on the supreme court! Religion is like a vast, dark, propaganda shroud over the world.
No kidding! “A vast, dark, propaganda shroud over the world.” No wonder people are “Driven mad by religion.” Like liquor stores, there’s a church on every corner, just waiting to mess with our hippocampus’ delicate wiring.
I think the hesitation on some people’s part to assisted suicide is because they come from a dysfunctional family and they wouldn’t want to trust any of them to give the word to pull the plug. Also, bad experiences with doctors and the medical profession could sour people’s attitudes, especially those people who have had “medical mistakes” made when they were dealing with a health issue.
You wouldn’t treat a dog like that; where is the humanity in insisting that humans must be treated worse than dogs?
That almost begs the question of whether, in Xtian eschatology (“The department of theological science concerned with ‘the four last things: death, judgement, heaven, and hell’.”), dogs go to hell, heave. or limbo.
To paraphrase the occasional incursion of dog-o-philes, “you can’t look into the eyes of a $DOG_BREED$ and not believe that it has a soul” ; personally, I was thinking exactly the same the last time I came eyeball-to-eyeball with a Sepia cuttlefish. So, the question of where their souls go is clearly important.
I note a recently-reported specimen of a very early “dog” (for certain values of “dog”) buried with a piece of mammoth bone jammed between it’s jaws (figures 6 & 7 in the abstract). Clearly, for 10s of thousands of years, pre-Xtian humans, condemned to burn for eternity in hell, have had the opinion that their dogs are going to go somewhere after death.
So, why are modern humans treated worse by modern Xtian religions than dogs have been treated by (Xtian and non-Xtian) humans for tens of millennia?
I apologise for not being accomodationist to such scumbags. Honestly.
To your point, I have euthanized a couple of pets and had a cat pass last Xmas day when I was only going to wait a day or two more to put her down. And I’ve also had to kill half-dead wild animals found on my property, most of whom were put in that state by one of our cats!
I have never regretted ending an animal’s suffering, but I do feel ashamed and guilty for the selfishness and wishful thinking that led me to prolong their suffering for even a day. It makes me sick that people don’t have the Bsolute right to end their own lives at a time of their choosing.
Whenever the church is involved, you are expected to stop thinking and to forget humanity.
I don’t think that that is neccessarily true. I think an awful lot of the time the church gets bad press, bcause every time it goes wrong, admittedly quite a lot, it generally gets in the media. But there is so much that churches do in general, and many Christians, who act accordingly with their faith, are normal and happy human beings.
Saying that, I do get annoyed at the church when very influential people do not act what they preach – a fundamental part of Christianity, in my opinion – and cause many outside of the church to think its a bad, irrational thing.
I think Christians like to forget the reason they belive – they are imperfect so God had to die for them.
Well, there you have it, folks: God died. So, God is dead. Now, let’s the rest of us get on with our lives, and with science, technology, reality, reason, logic… You know: The good stuff!
Doctors take an oath to heal their patients. Well, in the case of a terminally ill patient who is not going to recover, doesn’t the doctor’s inability to heal cause a problem?
Why not add a short statement at the end of the Hippocratic Oath….something to the effect of “in the case of incurable illness, the patient’s right to dignity and a painless death supercedes all.”
The modern versions of the Hippocratic oath (see for example this and this) already allow a doctor to assist a patient to die.
That is why it is so important to have a living will and a person to handle only your affairs noted on your power of attorney to handle such things in that living will. It will pull the plug, and not leave the Doctor or anyone else making any heroic measures to keeping you alive when there is no longer any hope.
There is no one “Hippocratic Oath” ; different medical schools, and possibly different teaching authorities, use their own variants, little constrained by scholarship.
However one of the few bits that is almost universally used is the precept : “First cause no harm.”
I don’t disagree with a doctor who takes that as a guide. But on the other hand, I’d have no compunction about terminating a life myself if I thought it was the appropriate thing to do.
(Pouring fuel onto a different fire : killing people for past crimes I do not consider “an appropriate thing to do”.)
One could argue that assisting a patient to die when that patient sincerely wishes to die is not “harm”.
One could argue that ; one could argue the opposite.
By the time one gets to having an evidence-based argument about the facts of the matter, then the religious have lost their “God said ‘Do This’, so that’s the argument over” argument.
Socrates’ last words – “Crito, we owe a rooster to Asclepius. Please, don’t forget to pay the debt” – have been interpreted as meaning that death was a healing from the sickness of life, and that therefore Crito should sacrifice on his behalf to the God of Healing.
Is it not extraordinary that, if I have (e.g.) a pet dog that has a terminal illness, I can be prosecuted for not ending the dog’s suffering, but if I have a relative with the same terminal illness, I can be prosecuted for not perpetuating that person’s suffering?
The Catholic Church, it seems, will go to any lengths to ensure that it’s membership is as large as possible, no matter how much any individual member may suffer. The Catholic Church will, therefore, always oppose suicide, assisted or otherwise. The Catholic Church will, therefore, always oppose birth control, even though such measures may prevent the spread of terminal diseases and even though a ban on birth control will ensure that so many children are born into third-world, poverty-stricken families and thus, born into a life of suffering, which is all too often very short.
The Catholic Church has even expressed their opposition to the advertising of abortion and contraceptives on broadcast media, thus trying to impose its doctrine on those who do not even adhere to its beliefs.
The Catholic Church, in their all-male club focus, considers everybody on earth to be their child, a child that is easily misled, thereby requiring them to feel completely justified in their efforts to control everybody’s life as they know God the father’s will, and if they do not do God’s will, well, the old bugger might smite even them. Immense fear and insecurity underlies the supposedly ‘inclusive love and mercy’ allowing passive-aggressive meddling of the most invasive sort.
There would be no Catholic church without people who are attracted to this hideous institution. Certainly there are some who have no choice, they would be disowned, etc, in certain families and cultures, but there are many who actively, willingly, and deliberately embrace Catholicism. This says something way more about these individuals than it does about the actual rotten Catholic edifice in Rome.
In fairness to those trapped in the Catholic Church, they start the process of indoctrination at a very early age, especially if one is unlucky enough to go to a Catholic school, as I did. They tell kids from the age of 5 that they, the nuns and priests, are the ones qualified to tell them what to believe. They even tell kids, infants, that, if they don’t think they have sinned, then they haven’t thought hard enough.
Luckily, I asked too many questions about the myths and magic and was, thus, exposed to the cruel and spiteful side of Catholic indoctrination, sorry, ‘education’. I say “luckily” because this just served to accelerate my loss of faith. A second stroke of luck was that we moved to an area with no Catholic school, which further facilitated my loss of faith. A third stroke of luck came when my mother, who always maintained her own faith, raised no objection to my loss of faith (but then, she was never fond of the more excessive mores of Catholicism). My siblings, too, expressed no more than intrigue and my father never had any faith.
So, I got thrice lucky, but many, many more do not and are so thoroughly indoctrinated, no, brainwashed that they find it difficult, if not impossible, to escape, no matter how much they might question the myths and magic. It is simply how it has always been for them. Indeed, the usual reaction of a questioning Catholic is to consider it a sin (see above) and rush off to the confessional for a fresh dose of brainwashing.
The Catholic Church is a self-perpetuating male hegemony that maintains its iron grip through the continual systematic brainwashing of its membership almost from birth.
What is taught in the Catholic Bible is the same in any other Bible, whether it be Baptist, Methodist, or what have you. I’m Catholic and left the church for a bit to study other religions and found they all follow the Ten Commandments. Most are the same with very little difference. You still marry, shouldn’t sleep around, don’t steal, don’t lie, don’t murder, and so forth. I don’t know why so many become enraged because I finally went back to the Catholic because they are much the same as other beliefs as all the others are just a take-off from them in the first place. (Notice I said Much)
“that it would permit physicians to take a more active role in the dying process itself.”
Doctors are already doing this by using machines to keep people alive artificially or to prolong the inevitable. That’s why some people want living wills/advanced directives and “Death with dignity” laws, so they don’t spend their last days (or longer) needlessly suffering or in limbo on life support while their families go bankrupt.
As Leslie proposes above, the Hippocratic Oath could be amended to allow for euthanasia or simply a “natural” death. Another solution might be specialized training for interested doctors, and allowing patients to choose a doctor who is willing to consider (and able to implement) several end-of-life options.
The Hippocratic Oath isn’t legally-binding — it’s just a traditional statement of physician ethics, without any real power. Besides, the typical “modern” version (and there are several, and they differ from the classical version) do not outright prohibit euthanasia:
“Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.”
That statement seems to me to leave the door open to carefully-considered end-of-life treatments, including euthanasia.
Dear Abby put it well, some twenty or so years ago. To paraphrase, she said that while prolonging life is a blessed act in the Jewish tradition, a mitzvah, prolonging death is not.
And that is the crux of the problem. All doctors with terminally ill patients should keep that distinction in mind and ask themselves, am I prolonging life? Or am I prolonging death?
“Thou shalt not kill, but need not strive
officiously to keep alive.” – W H Auden
But the Catholic Church, if not the medical profession, adhere to this, not endorsing heroic measures of life-support – just allowing slow and painful – but “natural” – deaths?
Once upon a time, doctors and their training were less scrutinized and controlled by government. With the scrutiny came governmental control (i.e., nonmedical personnel, politicians included, restricting what doctors can and cannot do). In the past couple decades, groups like the AMA have jumped on teh bandwagon, suggesting they protect doctors by providing guidelines to care. Each patient is unique, but if a physician recognizes that and appropriately goes outside such guidelines and legal restrictions, the potential ending of his or her career has been so traumatic and cruel in its style of actions as to lead to a high suicide rate amongst physicians so targeted.
I worked in a hospital the first 10 yrs after I graduated from college. I’ve seen two friends die of ALS and am currently watching my wife deal with end of life issues with her father. My opinion remains firm. Taken together, I’ve decided that death is not the worst thing that happens to humans.
Terry Pratchett (facing his own personal hell, and in the process casting a very unwelcomely bright and humourous light into the debate in Britain) would probably use that as a basis for an “anti-Hippocratic Oath” for the Guild of Torturers, Inquisitors and Vengancers.
The “slippery slope” argument that so many people make is precisely backwards. As you point out, lives are frequently terminated early anyway – but the rules are unclear and each doctor’s judgement is different. Abuse would be pretty easy – who knows how often it happens? Well-defined rules for euthanasia means we get off the slippery slope, not on to it.
“… fears that such laws would lead to mass suicides have proven groundless …”
And even if they hadn’t, whose business is it anywhere? Why is suicide such a big issue? Why such a fuss when a person decides to end their life? It’s my life, if I want to end it I will, and it’s nobody’s business but mine.
Indeed, the ideal situation would be one in which something approaching 100% of people are able to consciously and rationally choose the time and manner of their own death, instead of leaving it up to blind chance and/or mindless pathogens.
donotwash,
I think your attitude is far too cavalier. The fear is in part that if suicide becomes easier and more socially acceptable then more people might make a rash decision to kill themselves during a temporary period of depression or treatable illness. You make it sound as if suicide is always a calm, rational decision made after due consideration. That may be true for many cases of suicide by people who are suffering from a debilitating terminal or untreatable illness, but many suicides are not like that.
It may be, it may be not. But who is person A to say when person B may or may not end his/her life?
But come on, if someone (in full control of their physical faculties) wants to kill themselves they will. Whether or not it is a spur of the moment thing or not, whether it is a calmly rationally thought through thing, there’s not a bean you can do to stop it. What are you going to do, make it illegal for anyone to be in charge of the means of self-termination? No belts, no knives, no poisons, no more than a fixed quantity of water (2 gallons can kill), etc.
Anyway, there are 7 billion people on this planet, the loss of a few who don’t want to bother should be neither here nor there.
But who is person A to say when person B may or may not end his/her life?
I just told you why this may be appropriate. Person B may be making a rash or impulsive decision to end his life, a decision he would regret if he were not suffering from some treatable medical condition like depression or if he were better informed about other options.
But come on, if someone (in full control of their physical faculties) wants to kill themselves they will. Whether or not it is a spur of the moment thing or not, whether it is a calmly rationally thought through thing, there’s not a bean you can do to stop it.
We’re not necessarily talking about people in full control of their physical faculties. Many of these cases involve people who are bedridden or in some other way disabled. And even among people who are fully able-bodied, the ease with which they are able to obtain painless, reliable lethal medication may make a significant difference to the actual number of suicide attempts.
Anyway, there are 7 billion people on this planet, the loss of a few who don’t want to bother should be neither here nor there.
Another statement I find incredibly callous.
You will appreciate that the fact that you find it “incredibly callous” is just a point of view? I may be able to respond that I find your point of view tediously sentimental.
If suicide becomes easier? Two words for you; Exit bag. Painless, peaceful suicide is already trivially easy. There are instructional videos available on youtube for cryin’ out loud! (Unfortunately what is trivial for you or me is physically very difficult for, as in this case, someone suffering from ALS.)
I agree, since one out of every six people have a mental diagnosis of some kind and those are the ones that are diagnosed, how do we know they actually know suicide is what they really want and it’s not just some temporary form of Depression that might pass? Many are not diagnosed and it takes time for that to happen. There is an awful lot to consider, that is why a living will should be done while the person is healthy knowing what their wishes are way before that time comes.
Why is suicide such a big issue?
Because a great many suicides are by people who are not in their right mind, particularly people having a depressive episode.
Or look at that guy who shot up the mosque recently, then killed himself. Was he in his right mind? Or had he been driven mad by propaganda from racists and Faux News?
We’re talking about people committing suicide, not murder. And besides, what are you, personally, going to do to stop someone if they want to take the early boat home? And who are you to tell a person what his / her “right” mind is? One that agrees with *you*?
If he deliberately killed himself, he committed suicide by definition. What he did before that is irrelevant – except that some hare-brained violent crimes ending in police shooting have been descibed as “suicide by cop”.
Someone may be said to be not in their right mind if at other times when circumstances were not substantially different they were not of a mind to kill themself. I’ve known several people who suffered from depression and/or committed suicide, and in no case was it a rational act, given the circumstances. Depression is a chemical imbalance in the brain, not a good reason for killing oneself.
(This is not to say that suicide can never be rational, but apart from auto-euthanasia, it very rarely is.)
Don’t you mean the guy who shot up the Sikh temple?
The media speculated he did so thinking them to be muslim, and not knowing a Sikh temple from a mosque. Baseless speculation as far as I’ve gathered.
Yes, you are right. I meant the guy who shot up the Sikh gurdwara in Wisconsin – and then shot himself.
This mistake was a very stupid one on my part, as I am well aware of the distinction between Muslims and Sikhs, and between mosques and gurdwaras.
At any rate, to reply to Donotwash, my question really was “when he shot himself, was he in his right mind?”
(Cripey, I hate it when I mess up a posting like that.)
As a physician, I consider the alleviation of suffering my primary focus. Logically, this would sometimes mean I would assist terminal patients in terrible pain with no hope of relief to die–if it were legal for me to do so. To make this legal, however, safeguards would clearly be needed. Though I applaud the spirit of the rules put in place in Washington and Oregon, they remain for me slightly problematic: studies show doctors are notoriously bad at predicting life expectancy even in terminal patients. Also, people want to die for a variety of reasons (six, actually, as I wrote about here: http://www.happinessinthisworld.com/2011/10/16/the-right-to-die/#.UCgBOkRTs6U). The reason matters. If, for example, a patient with ALS becomes depressed and wants to commit suicide not because she’s yet in a near-terminal state but because she’s depressed, wouldn’t our obligation be first to identify and treat that depression as best we could? There might be many months—perhaps even years—of satisfying quality of life left that would be tragically curtailed if such a depression wasn’t identified and treated (I’ve come up against this very scenario). Thus, I would think some kind of psychiatric evaluation for patients requesting assisted suicide might be a good safeguard. For anyone interested in my take on this subject further: http://www.happinessinthisworld.com/2011/10/16/the-right-to-die/#.UCgBOkRTs6U.
Abdel Basset Al Megrahi for one? Given 3 months to live by two different doctors for the Scottish Government ; returned to Libya to spend his last few weeks with his family (an option which he allegedly didn’t give to the people who died on the Lockerbie flight ; but it seems incredible that he was the only person involved) ; and 2 years later he’s still alive.
I believe, though I’m not sure, that that is the case in some of the Australian and Dutch regional regulations. For exactly the reasons you give.
FWIW, Al Megrahi ceased to be in May.
And, although he would have received good medical attention in a Scottish jail, his will to live and make the most of the medication available would have been greatly enhanced by being in his home country surrounded and supported by his family. I suspect that if he had remained in jail, his demise would have come sooner.
Well, with regard to Al Megrahi’s life expectancy, it’s not unusual for terminal patients to undergo remission (at which point, notoriously, the faithful are wont to claim ‘miracles’).
I have another friend who became very depressed as Doctors gave him six months to live. That was back in 1988. He beat cancer, is alive and well today and remarried. At that time, he sold his house, everything he had, blew his bank account and went on a drinking binge, but when he didn’t die, I asked him what are you going to do if you don’t die? Well, he didn’t but what if his choice was suicide? He’s a happy man today.
“The reason matters. If, for example, a patient with ALS becomes depressed and wants to commit suicide not because she’s yet in a near-terminal state but because she’s depressed, wouldn’t our obligation be first to identify and treat that depression as best we could? ”
ALS is probably one of the most horrible ways to die. And the patient is powerless do do anything about it (unlike other patients who are capable of acting on their own). Let me be honest, that kind of existence absolutely terrifies me. I’ve had nightmares like that. Please, please, please end it before it comes to that (I am in good health don’t take this as some bizarre call for help).
You have no idea how much I appreciate your comment. I work in an E.R trauma/cardiac center that of course also receives emergency mental health issues (i.e sucide, suicide ideation).That, as you staed is a whole different ball game.
While I most certainly agree with the ‘end of life, right to die’ agenda, as do many of the doctors I work wih, there are legal restraints as well as patient misconception and demands. The biggest problem/issue I consistantly run into, like many medical professionals, is that the wishes of the family prolong life beyond a reasonable time, and we are often bound to that legally, as you well know.
*stated*
It might help if we, physicians and the rest of the western world, quit conflating depression with disillusionment, discouragement, a few other “dis’s”, and grief. A person newly diagnosed with something like ALS or even CFS, for that matter, should be expected to grieve over his or her loss. All the dreams, plans, and expectancies of life lost with such an illness and its diagnosis deserve the respect of grief, to say the least. Expect it, encourage it, and it will be a stepping stone for further growth and development to compensate for the losses.
Add to that the permission to suicide, and the very helplessness caused by disease is ameliorated to some degree by the empowerment over when and how to die. Neeful grieving and end of life empowerment decrease the desperation which can lead to untimely suicide. Then, there is patience to wait for timely suicide.
+1
That is very psychologically insightful. If you can do it any time then, as you say, it means you’re controlling death rather than it controlling you; and, since you can do it any time you want, you don’t *have* to do it now.
It’s a bit like being claustrophobic in a small room – if you’re locked in you’ll go crazy, but if the door’s open and you could walk out any time you like, why, then, you don’t need to.
Thank you. It is rare for anyone to understand instead of slamming closed their minds, and you’ve just provided me with an excellent comparative illustration.
Thank you for the compliment.
And thank you for mentioning that morphine may reduce choking feelings. It’s possible that my mother’s last days may not have been quite as dreadful for her as it seemed to us. It’s something I can hope, anyway. (Still doesn’t let the pro-lifers off the hook though).
No, it doesn’t let pro-lifers off the hook one little bit. They keep making me wish they’d each fall victim to the very worst possible outcomes they themselves can imagine, so that they find themselves wishing for an abortion or the right to suicide, as there is no other way they will ever hope to understand.
Sorry, the first link in my comment above should have been: http://www.happinessinthisworld.com/2010/04/25/the-six-reasons-people-attempt-suicide/#.UCgCsERTs6U
Your sixth isn’t an example of committing suicide, it’s an example of accidental death. Impulsive suicide should be prevented. Anyone who is in so much pain that they don’t want to live should be allowed to commit suicide if they reasonably believe they will not change their mind. Obviously, stated thus simply,that criterion is too vague: there need to be safeguards. (And I believe people who want to commit suicide have a moral obligation to the people who love them to provide a chance to say goodbye. Ironically, where suicide is illegal, people are forced to be content with at best a “note.”) Anyone who has severe chronic pain, of which severe depression is a subcategory, understands that suicide can be a rational and morally appropriate choice. Most people fail to adequately understand what it is like to live with severe chronic pain. There is nothing in their experience they can relate it to, and they can’t objectively verify its existence. Unfortunately, because everyone has experienced “pain,” people incorrectly assume that they basically understand what it’s like to live with severe chronic pain. It will help when fMRI scanning becomes available to provide an objective demonstration that the brains of people with severe chronic pain, including depression, look very different. This will increase empathy and reduce uncertainty.
You left out an important pair of reasons: severe, intractable pain, and serious disability that precludes living any kind of decent life.
Perhaps the argument is that these conditions lead to depression, hence a decision to suicide is invalid, but it certainly seems to me that if you are hurting seriously with no prospect of relief, you are fully justified in being depressed. Not all depression is pathological!
Likewise, when disability makes it impossible to lead anything like the life you are used to, the desire to stop living is not pathological. A year or two ago, the English condutor Edward Downes and his wife went to the Swiss euthanasia clinic and there died. He was blind, deaf, and had motor problems that made any semblance of a musical life utterly impossible. For someone whose entire career had been tied up in active musicianship, it was intolerable: he couldn’t even read a score or listen to a CD.
Agreed. Even non terminal constant pain without reasonable option of recovery (crippling arthritis) is a potential valid reason.
I would bring up another one that people avoid: the mentally ill. Not just any mentally ill person, but some go through hell every day of their lives, haunted by voices and feelings they cannot control. So we force them to stay alive, after all, we don’t hear those voices, we don’t feel those terrors…
In terms of mental illnes, I think that you are mistaken between depression and those that hear voices (or any type of delusion), in terms of wanting to die. While those that are ‘depressed’ often most certainly feel suicidal, after 14 years of working emergency and psych. I have never met one patient that heard voices, who wanted to willinly die, EXCEPT for a ’cause’. The chance that meds can treat that to resume somewhat of a normal life is a risk worth taking.
Been there. A friend of mine did herself in by hanging herself from a tree in the garden for precisely this reason. Poor lassie had been ill for many many years and in fact in all the time I’d known her had never been very “strong” (so to speak).
The trouble here is that nobody was taking her seriously because of her history of being known as being “a bit simple”.
In the absence of clinical depression, I’d consider the choice of someone in severe, intractable pain or with a serious disability that precludes living any kind of decent life to kill themselves to be, as I suggested in the link, a “philosophical desire” to die, and choice serious consideration should be given to supporting. I agree with you that sometimes becoming depressed is a normal response to an awful situation.
Bear in mind that the so-called “natural” death we’re talking about amounts in many cases to suicide by starvation, as terminal patients simply lose interest in eating.
If only there were a cheap, reasonably safe, painkiller, mild soporific and appetite enhancer drug available from any Tom Lehrer compilation album you can find?
Oh, hang on ; someone has just passed me a spliff. Ahh, munchies!
But it’s illegal, not patentable, and you can make paper from it too. Boo!
The difficulty with that particular analgesic is that it leaves you stoned – and not everyone likes being stoned. Furthermore, individual responses to the magic herb are highly idiosyncratic, a problem aggravated because different strains contain different mixtures of various cannabinoids, and cannot be expected to give the same results.
It’s good stuff, but it’s not a panacea.
You can’t make paper from it; Randolph Hearst made sure of that.
Anyway, it would be a dreadful waste.
Unless you made paper from the dope, for making spliffs also from the dope. Or was WRHearst into the cigarette paper business too?
(Otherwise ; yes, I know it’s highly variable. But that’s largely because people aren’t allowed to experiment significantly on the plant. When Dutch amateurs worked on the plant in the relatively liberal 1980s and 1990s, they managed a 5-10 fold increase in potency in only a few years. Which gets more impressive when you realise that their only testing equipment was their own lungs. And then they had to stop smoking the good stuff and write up their lab notes. True dedication!)
The mother of a close friend was diagnosed with a terminal illness and chose to starve herself to death. Unfortunately, she kept thirst at bay with Gatorade, thereby slowing the process down. Had she known to also stop fluid intake she would have been gone in days, not weeks.
Dying of thirst is (from what I understand) more unpleasant. Being thirsty is a far more unbearable sensation than being hungry, which (again from what I have learned from various sources, maybe more or less believable) after a number of days dies away.
This agrees with what the hospice nurse told me during my mom’s final illness. Don’t force her to eat if she doesn’t want to, but do try to keep her hydrated, since dehydration can cause dementia.
Someday, forcing people to suffer a natural death will be seen as the barbaric practice of a benighted and superstitious people, just as human sacrifice is viewed today. I see very little difference between the two practices. The justification given for them is essentially the same.
I think the argument from doctors that it is antithetical to the profession to “cause harm” is nothing more than a convenient cop-out to avoid dealing with complex moral questions that were unprecedented into recent years. If the “no harm” rule is followed blindly, it amounts to ideology and so will cause suffering with bitter irony. They ought to reposition themselves to caring about quality of life, and that may reasonably entail aiding the end of undignified, painful lives.
It’s not so much the “complex moral questions” that are the issue, as it is the exaggerated reaction of the law enforcement people, the disproportionate penalties imposed, including the loss of one’s career.
What irritates me about this topic is that it is apparently perfectly acceptable to starve someone to death but not to give them a pill or an injection that would end their life quickly and painlessly.
Just why is it okay to torture someone by refusing them food, thereby prolonging their death, but it is considered wrong to quickly end their life? If this person were not suffering a terminal illness, then starving them would be considered torture, why does the presence of a disease suddenly remove the torture aspect?
Is it okay to force someone with a terminal illness to die of starvation by refusing them food? I’ve never heard of this. I’ve heard of terminally ill people refusing food themselves, but that’s not the same thing.
Many terminally ill people are incapable of eating.
You can’t seriously be in favor of prolonging agony, can you? Insanely expensive agony, at that.
Yes it is, there is a program called “The Liverpool Care Pathway” where they advocate just this. I personally think it’s a disgusting way to end someone’s life, if you did this to a P.O.W. you would be up in court, but it’s apparently quite acceptable to do it to a terminally ill person.
Keep in mind that the cancer, itself, is starving the patient. That is why cancer kills. At some point, feeding the patient no longer does anything substantial for the patient. It only feeds the cancer.
And what is to stop the doctor from giving an injection that ends all the suffering? Oh yeah, that’s right, religion.
Another point, what if the patient is dying from something other than cancer?
Starving someone to death and calling it humane is an oxymoron.
You are welcome to your opinion, but that doesn’t convince me to agree. You speak as though from a preconceived and — dare I say it? — religion-based position, blinding you to the realities of others. Food must be very important to you, but to someone slowly dying, it costs to much energy even to chew and swallow, and the risks of IV nutrition are not small.
At some point when a person has cancer they don’t want to eat, the body isn’t hungry, doesn’t “feel” hungry. Since it isn’t exercising or moving anymore it doesn’t take that much to keep them comfortable. Their body slowly shuts down until they finally just leave us. They are given pain medication but with organs shutting down even in some of those pain subsides.
Ah, the christian “everyone will kill themselves if we allow this” – a statement as true as their god. Of course it’s convenient to ignore the fact that the Swiss are still around.
Who said “everyone will kill themselves if we allow this?”
I think MadScientist was using hyperbole to point out the concern of officials who were afraid that if assisted suicide laws were put into place, there would be a migration of people to Washington and Oregon who wanted assisted suicide. A concern that never really came to fruition.
It’s generally a better idea to address the arguments your opponents actually make, rather than an absurdly exaggerated caricature of them.
Rhetorical devices like sarcasm have their place.
I got MadScientist’s point. It wasn’t even that greatly exaggerated.
I have seen (in the past) a bit of blowback, surprisingly, from advocates for the disabled. The rationale seems to go like this: If we legally accept patient A’s contention that life is not worth living under his condition, it suggests that life is not worth living for patients B, C and D. That is a situation that we cannot accept, therefor patient A is not in his right mind.
Essentially this is a psychic argument, it is unacceptable because some people find it horrifiying… not unlike the abortion arguments.
I don’t think their argument is that disabled people who would choose suicide are “not in their right mind,” but rather that there is a risk that if people with a particular disability are allowed to commit suicide and some choose to do so, it will create a social expectation for other people with the same disability to also choose suicide, especially if the ones who choose suicide justify their decision in terms of “not wanting to be a burden on others.” Perhaps that fear is misguided, but I don’t think it can simply be dismissed.
One simple principle: if we are to live an autonomous life, we are to die an autonomous death. If we decide at some point to terminate our life, no meddling should be allowed. In that sense, I am radically opposed to the idea and practice of “suicide prevention”. If a person is in danger of killing herself because of mental illness, all help should be extended to cure or alleviate that illness, to the effect that the person becomes again capable of autonomous decisions.
So the question of medically assisted death — be that suicide by proxy, active or passive euthanasia — is really the question of the degree of autonomy we are ready to concede to severely incapacitated, terminally ill human beings. I cannot see any other categorical imperative than “Do unto others as you would have them do unto you”.
Like most people, I have been a caretaker for close relatives, both chronically and terminally ill: hepatocarcinoma, Lewy body dementia, Parkinson, glioblastoma. From the mid-1990’s on, I spent a whole decade giving home-care, with an average of three days per week spent in hospitals or medical institutions. I was called upon to make life-or-death decisions. Example: Due to a medication error while on trial antidepressant treatment, one of these relatives fell into a coma, developing pneumonia. I was advised not to ask for antibiotics, as the case seemed desperate. Knowing my patient and his mind, which the doctor did not, I made sure antibiotics were forthcoming. The patient made a slow but spectacular recovery. However, due to Parkinson, deglutition became durably impaired, leading to aspiration of food and drink into the lungs and subsequent pneumonia. Enteral nutrition by tube was advised. As a statistician, I went through all available records and found no significant extension of life expectancy for patients of similar age with this type of disease. The benefit of tube feeding was almost entirely on the side of the caregiving institution: less work, less hassle. As I observed from daily experience and subsequently confirmed from available data, patients feeding themselves or being fed orally benefitted enormously from the interaction with the caretaker. Pure life quality! I decided to take a calculated risk and forgo tube feeding for the sake of human interaction. My patient survived for another eighteen months, longer than the average prediction for the enteral nutrition cohort, without any serious episodes of pneumonia. He recovered speech, said farewell to his wife, spent one last summer in his garden, and succumbed to sudden cardiac arrest.
So much for the “slippery slope”. The advocates of autonomy in death as in life, like myself, are not the harbingers of an euthanasia and suicide epidemic. The present situation is far more dangerous: patients being “eased into death” because medical personnel cannot be certain that they will be properly attended to by familiars or institutions once their condition degrades further. Scared and exhausted familiars having to learn the ropes and the “codes” for obtaining that extra, lethal, dose of morphine. Etc. There should be a clear base for life-or-death decisions, and ultimately they should belong to each autonomous individual.
Footnote concerning Dignitas: one of the doctors working for that organisation is a schoolfriend of mine. When I asked him about his motivation, he told me: “After years of work in a mobile emergency team, I had to face up to the fact that I was often called in cases where people had jumped from a high window, had thrown themselves in front of a train, or just shot themselves. A terrible mess, and we were basically called to mop up the mess. Then I thought, why not help prevent the mess altogether?”
Yes, one hell of a mess. Time to let humanity do the right thing about it.
Thank you.
Historically, this has been a hot-button issue far longer than abortion. Pre-Christian pagans like Seneca and Marcus Aurelius thought suicide was justified in certain circumstances, while the churches declared it mortal sin.
One strong argument for holding that Shakespeare was a non-believer is how he treats the suicides of Romeo, Juliet, and (in a different play) Othello. No one holding a Christian horror of suicide could have written these stories that way.
My mother, who (on the few occasions the subject came up) had always been in strongly in favour of voluntary euthanasia, died of cancer. It took far too long and she repeatedly requested the doctors – demanded in fact – that she be put out of her misery. But of course that was illegal. I’ve always felt guilty that I didn’t know how to kill her painlessly and was too cowardly to find out. I’d like to think that a doctor relented and gave her a massive OD of morphine, but I never dared ask, not that I would have got a straight answer.
If this life is all we’ve got, that makes it even more vital that the ending of it shouldn’t be horrendously bad. As several people have said, if you treated a dog like that you’d be in court and reviled as a sadistic monster.
So, to anyone from the ‘pro-life’ lobby who opposes voluntary euthanasia, anywhere, I curse you personally for your vicious evil meddling in other people’s deaths. And I pray to your God (since I don’t have one) that you die slowly, over weeks, screaming in agony and begging for relief which would be so easy to provide and which you don’t get. This is, after all, only what you want to inflict on others. I mean this. Damn you to hell.
(I don’t believe in curses or gods but it’s worth a shot, just in case).
There’s something very seriously wrong with the medics who looked after your mother. They could have given her enough morphine to eliminate her pain – but didn’t. I wouldn’t be surprised that if challenged they’d offer the excuse “oh, she might become addicted.”
If that’s the case, then one phrase applies: how incredibly stupid! It simply doesn’t matter if a person with a terminal illness gets addicted to anything: they aren’t going to be around long enough for it to make any difference. Wouldn’t surprise me if the DEA had its meddling fingers in this pie.
Ca. 10 years ago, a friend of mine lost her husband to kidney cancer. When he was diagnosed they told him he had six months and he’d better get his affairs in order. At one point I asked Susanne (pseudonym) how Franklin (psn) was doing. The answer? “He’s at home and he’s not feeling any pain. I have the bottle of morphine and the syringe and he gets a shot whenever he needs it.”
That’s the way to do it.
No that wasn’t the case. The hospital staff gave her enough morphine to kill pain, but the cancer was in her throat and choking her. Morphine can’t hide that feeling, and it was making her ‘high’ and paranoid.
While I agree about the total stupidity of the War on Some Drugs, we weren’t in the US and that wasn’t a factor anyway. The staff in the public hospital terminal ward were marvellous (as my mother said too, up till the point where the cancer overcame her), but of course they were constrained by the stupid law. (By the way, here in NZ, all this was covered by public healthcare and cost us – directly – nothing. We pay in our taxes. But that’s a different debate).
Odd thing about morphine: In doses as high as some cancer patients require, it can cause painful muscle spasms, thereby defeating its own purpose. I learned this when someone very close to me was in hospice care. FYI, for those cases, ask the doctor about decadron and other options to supplement the effect of morphine, so less can be used. I assume you know about Fentanyl, by the way.
Personally, I know almost nothing about the drugs (and this was many years ago in any case, I couldn’t talk about it otherwise). I assume the hospital doctors were conversant with all the considerations and prescribed the optimum in the circumstances. I don’t think my mother was in intense pain as such, but I believe the cancer was literally choking her – I don’t think any painkiller could hide that. Whether massive doses of valium or similar would help I don’t know.
Had she been helped to die about a week earlier , I would have said that was about the right timing, when her life became so distressing as to not be justified prolonging it. From her point of view, which is IMO what really counts.
The other thing about morphine is its easing of the sense of suffocation from high CO2 levels (i.e., as breathing and oxygen levels decrease, on the way to a slow death). Morphine was named for Morpheus, the Greek god of dreams, and so connected with sleep.
As infiniteimprobability has pointed out, it is not always that straightforward. Some people cannot tolerate high doses of morphine because of distressing side effects.
The WHO’s Pain Ladder admits that 10-20% of patients suffering from cancer pain fail to get relief from opioids. If I were in that 10-20%, I would certainly want help for an elective death.
I do agree that the addiction argument is ludicrous.
HTML fail; try http://www.who.int/cancer/palliative/painladder/en/
When it comes to treating cancer patients with narcotics, especially terminal cancer patients, addition is not really considered, based on my training and practice experiences. Physicians do try, however, to be alert to signs that such drugs are being diverted by someone else, a caretaker, perhaps, rather than being given to the patient.
Depression can make staying alive torture. A person should be allowed to legally end their life to end emotional devastation as well as physical.
I happen to agree with you. Pain is pain, whether physical or psychological/psychiatric. If it can’t be well controlled and managed, if life itself has become an unbearable torture, a person should have the legal right to a dignified end, with all the proper support that requires.
It’s just one of the many serious reasons I quit the AMA. As a medical student, joining the AMA seemed almost obligatory, part of joining the club, as it were. Later, I realized quite a few colleagues had and were giving that club up. The media doesn’t seem to realize how weak the AMA has become. It’s almost like a dirty little secret inside the medical profession.
Couple of thoughts in relation to this issue:
1) On the con side of the argment I am not sure anyone has mentioned the potential issue of the sick and elderly feeling pressured into seeking V.E. in order not to be a burden to relatives. This is perhaps an aspect that needs to be carefully considered.
2) I note that the US states that allow it require a physician’s opinion that the person is expected to die within six months anyway. I believe that, for many people wanting to use assisted suicide, the problem they are seeking to escape from is that their current life is intolerable due to pain, incapacity etc but that they do NOT expect to die naturally within a short period of time – they are condemmed to a continuing (and potentially relatively long) life of sufffering so there is good reason to remove that six month life expectancy condition.
On balance I am in favour of assisted suicide with appropriate controls which I believe can adequately address the issue mentioned in my point 1.
I have no problem with any of this, except with the “dignity” part. I absolutely, positively do not want to die with dignity. The very thought makes me shudder. I want to die in relative comfort, without pain, like falling asleep. Dignity is simply not part of the equation.
I’m not sure I understand your point. For me, dying without dignity would imply, for example, needing others constantly to be cleaning me up because of incontinence or vomiting. The death you describe would be dignified.
Perhaps the problem is how to define dignity. “Dignity, for the Roman Catholic Church, is to live life solely in terms of its moral principles, principles which have no foundation other than dogmatic assertion.” Quoted from Eric MacDonald. Certainly not how I would define it.
My definition of a dignified death would be close to your definition of your preferred death.
Colin.
Precisely. For me, dignity is what the dictionaries say it is. Also for me, that is adding to the suffering while trying to make it look as though it is easy, stiff-upper-lip Mother-Teresa style.
That is why I prefer to spell out what type of death I wish for myself and for others, unless those others make it clear they prefer the suffering type.
I was present when my paternal grandmother died, in a Catholic home for the elderly. They called that a beautiful and dignified death. It was so beautiful and dignified I had nightmares about it for years, and I still cringe when I think of it. Nope, no dignified death for me, thank you very much.
I far prefer the undignified-but-comfortable-and-painless type.
Another attempt along with abortion to play God
Bad Idea satan also wants to be god.
When does a doctor start to play god? When he (or she) inserts the tube in order to keep the patient alive, or when the tube is removed to allow the patient a dignified death?
Are antibiotics “playing God”? Are fertility treatments “playing God”? Are eyeglasses and appendectomies and chemotherapy and fillings also “playing God”?
Unfortunately, there are some people out there who would unequivocally answer “yes” to your questions. These are the kind of people who “pray the disease away”, with the results you’d expect to see. 🙁
If it is up to god to chose the moment of our death, then any medical intervention into prolonging our lives is against god’s will. Or as suggested, any medical procedure whatsoever is against his will. Where do you draw the line, paulthehumble? Aspirin?
PS paul – your linked blog needs some work.
Colin.
Ok line is.. causing extermination…. Hitlers choice.
blog is under construction thanks for the visit
Be gone, troll. You are not welcome here.
And now he has Godwinned this thread!
You lose, paulth.
The Catholic Church’s stand is immoral, for its activities prevent even non-Catholics, who don’t see suicide as a sin, from ending their suffering.
Brilliant. In one fell swoop you have just legalized sado-masochism, dueling, gladiatorial combat, removing healthy limbs from patients who request it – basically, any form of physical harm to which consent can be procured before a person becomes mentally incapacitated.
Maybe you would be happy with that, but I doubt you would not take action to prevent something you believed to be wrong from happening regardless of others’ beliefs. The teaching of intelligent design theory as science, for instance.
Hardly. While I myself am still of two minds about euthanasia, there is a clear difference between the right to die for terminally ill patients, and the forms of self-injury you describe.
At the same time rejecting the Catholic Church’s opinion of morality is not the same thing as rejecting morality.
Provide legitimate, peer-reviewed scientific data to back your statement of exaggerated claims. If you cannot or will not, then you are a troll, and as such, you are not welcome, here.
The Catholic Church does not number toleration as one of its guiding principles. If they view something as wrong, they oppose it for everyone, not just their communicants. This is particularly so where there are questions of life and death. The Chruch is unreservedly for ‘life’, as they define it, except in those cases when they are not, which seems to be, historically, when the Church wishes to send someone to hell itself.
We can all be thankful that the Church’s monopoly on morality has been broken, at least so far as the civil power is concerned. We must be vigilant to see that it stays that way.
The Oregon Death With Dignity law has had an unintended and beneficial consequence. My recollection is that, once doctors realized that their terminal patients now had an alternative to the slow, painful death that the doctors insisted was inevitable, the doctors began to treat pain symptoms more aggressively. The result was that terminal patients lived their last days much more comfortably. Many patients who were prescribed the Death With Dignity drugs ended up never actually taking them because the pain did not reach unendurable levels before death occurred naturally.
That is very good to know. I wouldn’t be surprised if just having the “out” available reduced patients’ stress. Not only does stress exacerbate pain, but having the freedom to “leave the party” (as Hitch put it) means one can just as well choose not to or, at least, not just yet. I discussed that in an earlier comment, around here somewhere. If we could just get this data absorbed into the religion-wracked brains of everyone else, it would (pardon the pun) be a no-brainer!
Gosh I just came from the nursing home where my friend is at. I wonder how many of those people would be more than happyn to end their lives this way. I see so many suffering people there it just breaks my heart. Not to mention the large amount of money it takes to care for these people. Just makes me so very sad to see it all!