Assisted dying

Many of you will have realised that I have opinions about almost everything of substance, and many insubstantial things too. Here, though, is something about which I cannot settle on an opinion. I've never been in unendurable pain, never received a terminal diagnosis, never accompanied a loved one down that road to the point of separation. Consequently I'm wary of judging those who are dealing with those situations, or setting out what I would do with any certainty. I'd like to be able to say "none of my business", but I'm a citizen of a state that makes it illegal to help someone end their life, so in some small way it is my business.

I don't find the "sanctity of life" arguments convincing as regards to the law, but the issue of coercion and avoiding "being a burden" is one that concerns me. Even without the possibility of money-grubbing relatives some folk will, I think, take this path to preserve inheritance from care home fees or simply from a place of unrecognised but treatable depression.

Is it possible to allow those in terminal pain the release of a fatal dose of morphine while avoiding harm to others who could be enabled to have fulfilling, if shortened, lives?

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Comments

  • I think that, in such a discussion, we should include some consideration about what it does to others both to be asked to end someone’s life, or to actually facilitate or enact such an ending.
  • Yes, I had rather bypassed that aspect.
  • I don't find the "sanctity of life" arguments convincing as regards to the law, but the issue of coercion and avoiding "being a burden" is one that concerns me.

    I think this - especially given the crisis in social care - is what concerns me the most currently about this issue.
  • I don't find the "sanctity of life" arguments convincing as regards to the law, but the issue of coercion and avoiding "being a burden" is one that concerns me.

    I think this - especially given the crisis in social care - is what concerns me the most currently about this issue.

    Definitely - and I'm more convinced by 'sanctity of life' but recognise that it's a viewpoint, not an ordinance I should expect to hold over everyone else. What really worries me is the potential for people to think it's 'doing the right thing for my family'
  • I don't find the "sanctity of life" arguments convincing as regards to the law, but the issue of coercion and avoiding "being a burden" is one that concerns me.

    I think this - especially given the crisis in social care - is what concerns me the most currently about this issue.

    Definitely - and I'm more convinced by 'sanctity of life'

    To be clear I'm also concerned somewhat about the sanctity of life argument, but suspect that in reality the way it'll be driven is through the lens of social care (or lack of it).
  • I don't find the "sanctity of life" arguments convincing as regards to the law, but the issue of coercion and avoiding "being a burden" is one that concerns me.

    I think this - especially given the crisis in social care - is what concerns me the most currently about this issue.

    Definitely - and I'm more convinced by 'sanctity of life' but recognise that it's a viewpoint, not an ordinance I should expect to hold over everyone else.

    This was what I was trying to say. I may, from the privileged position of never having faced this situation, think it wrong to take my own life or help take someone else's. It doesn't automatically follow that it should be illegal.
  • RuthRuth Shipmate
    I think that, in such a discussion, we should include some consideration about what it does to others both to be asked to end someone’s life, or to actually facilitate or enact such an ending.

    In California no one is required to assist someone in ending their life - doctors can refuse to sign off on it, pharmacists don't have to provide the drugs, and the person ending their life has to self-administer the drugs.

    The out-of-pocket cost for the drugs runs to several thousand dollars - it's not covered by Medicare or private health insurance.
  • I have a vivid memory of my grandmother asking my mother to kill her, because of the pain she was in and how distressed they both were at that time. Fortunately, we were shortly thereafter able to get her the pain control she needed (morphine) and subsequently the last few days of her life were much more comfortable for her - and afforded her the opportunity to say goodbye to her friends. I realise that doesn't - and probably can not - happen for everybody.
  • Not sure how things work in other countries but I’m worried that in the US a whole social stratum that used to be able to leave a modest inheritance to its children now is forced to spend down all of its assets in order to become eligible for Medicaid coverage of long term elder care.

    The very wealthy can afford to pay out of pocket for the nicer nursing homes and the somewhat wealthy has the resources and connections to work with lawyers to pass on assets to children early enough to avoid scrutiny from Medicaid or to create family trusts (legally) to place assets in where Medicaid can’t claim them. And a great deal of people never had wealth to pass on to children. But in the past, when people’s lives were not as long as today and most people died at home or after a brief hospital stay (and also when more people took care of elders at home or at least lived near their elderly parents), a part of the non-upper middle class could expect to pass on the family home and some savings on to children after they died. That isn’t the case anymore - at least, unless you know how to work the system and have lots of time to plan, which, honestly, most people don’t.

    So I do worry about financial considerations playing a role - along with many other factors of course- for some people with painful terminal illnesses to decide to end their lives earlier than they otherwise would, and in places where the legal right to die applies to more people than just those with painful terminal illnesses, even more so.
  • I think that if there were good, caring palliative care available and administered, the current demand for assisted dying would drastically reduce. It’s disgraceful that hospices are charities and not provided for within the NHS in Britain.

    Nightmare stories of people dying on hospital wards with distressed loved ones feeling helpless add fuel to the fire.

    And whenever we give money a higher priority than people, we get it wrong.
  • RuthRuth Shipmate
    Raptor Eye wrote: »
    I think that if there were good, caring palliative care available and administered, the current demand for assisted dying would drastically reduce.

    I wouldn't be so sure. Many of the stories I've seen about people ending their lives have to do with the losses piling up in their lives - particular the loss of enjoyable things they used to do and the loss of control. There's more to a good life than avoiding pain.
  • Ruth wrote: »
    There's more to a good life than avoiding pain.

    At some level, the thought "my life isn't worth living" is a completely rational consideration. Life has good things and bad things. If all the good things, and any prospect of future good things, goes away, is it worth continuing to experience the bad things?

    I think this sort of consideration is quite different from the fairly typical end-of-life dual-effect morphine push.
  • Bishops FingerBishops Finger Shipmate
    edited October 2021
    Yes. The *end of life morphine push* is quite common practice now, I believe. This happened to my mother, dying of severe burns, back in 2004.

    OTOH, and some 14 years previous to that (before I knew or married into the family), Mrs BF's sister - a high-ranking NHS nurse - was asked by their Father to help end his life, as his terminal cancer was simply too much for him to cope with any more. This, despite the fact that he had a loving wife, two sons, and two daughters, who cared for him very much AFAIK.

    Whether she did so assist him, I cannot say, but I would not be surprised to learn that she did.
  • CaissaCaissa Shipmate
    Do any Shipmates live in countries that have MAID (Medical Assistance in Dying) legislation comparable to Canada's?
  • HeavenlyannieHeavenlyannie Shipmate
    edited October 2021
    UK medical staff are only allowed to administer morphine to relieve pain, not to remove life. The dual effect is apparent with the consequent suppression of respiration but that is not allowed to be the aim; such a thing would be illegal.
    Nothing in my 20 year nursing career, and in my subsequent teaching of palliative care, suggests that such an action is common practice and I would be very concerned if it is.
    Short article I just found on how double effect doesn’t work anyway https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1808133/
  • So I start from the conviction that everyone should have the right to end their own life. I agree that there is a problem with forcing physicians to co-operate, but it is likely that there will be sufficient who have no moral objection, so long as it was not breaking the law.

    And I've never seen a good argument that shows that suicide per se is always wrong. I can accept it sometimes is, but not that it always is or even that it mostly is. But I am aware that to most people "it is just obvious" that suicide should not be allowed, and people who don't get it are just weird.

    If we are to discuss this from a Christian standpoint, I would really like to know how the conviction developed in the church not simply that suicide was a sin but practically the worst imaginable. SFAIK it has never been viewed this way in the Jewish faith, and still isn't.

    What I find even odder, is that opposition to cutting short our life in this world is most, rather than least, opposed by those who believe the next world to be far better. And I suspect it has something to do with the value of suffering, as something never to be avoided.

    What am I missing?
  • DoublethinkDoublethink Admin
    edited October 2021
    Well, for starters, suicide and euthanasia are usually distinguished from one another. There is a lot of research on suicide, we know it tends to happen when people feel trapped and is often impulsive. (Which is why limiting how much paracetamol you can by at one shop had an such an impact on the U.K.s rate of completed suicide.)

    So there is a sense in which many people feel that some one who is a victim of suicide may not have been fully able to come to a reasoned decision, they may not have been fully capacitous.

    I urge you to consider that people reading this board may be friends or family of those lost to suicide, or may have lived with suicidal ideation or survived attempts themselves. It is a subject that needs to be approached with care. Many churches now recognise that traditional discussion and appraisal of suicide was unhelpful.
  • GwaiGwai Epiphanies Host
    edited October 2021
    Let's keep suicide and assisted dying separate--start a new thread for suicide if you want--and please do be sensitive. These are very difficult matters.

    Gwai
    Epiphanies host
  • NenyaNenya Ecclesiantics & MW Host
    edited October 2021
    UK medical staff are only allowed to administer morphine to relieve pain, not to remove life. The dual effect is apparent with the consequent suppression of respiration but that is not allowed to be the aim; such a thing would be illegal.
    Nothing in my 20 year nursing career, and in my subsequent teaching of palliative care, suggests that such an action is common practice and I would be very concerned if it is.
    Short article I just found on how double effect doesn’t work anyway https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1808133/
    Thank you; that's helpful. I've left verbal instructions to Mr Nen that I want to be given as much medication as needed to keep me comfortable and if it shortens my life that's absolutely fine. I thought that got me, and my loved ones, out of making any difficult decisions about the end of life but I see now it's not really a meaningful instruction. I am not sure where to go from here about it, but it's useful to know.

    On a possibly related subject, I wonder how decisions are made about treating conditions that will shorten a life that's near its end anyway, seeing them as possibly a merciful way out.
  • When my father was told his cancer was terminal, in September 2020, he explicitly stated that he did not want my mother to see him in any distress and he wanted to be "bunged full of morphine" at the end.

    That isn't what happened. The cancer progressed more slowly than anticipated; he was told in September 2020 that he "might see Christmas, but probably not" but he was still well, though increasingly tired by April 2021. He then had a minor stroke, followed by blood clots in his lungs. The NHS care was superb - he made an almost full recovery although he was more or less confined to bed after that, with carers coming in four times a day. The NHS supplied us with a hospital bed / commode etc. He then developed pneumonia, which was successfully treated with anti-biotics but developed pneumonia again and did not recover. He did get morphine at the end, but I don't think it was enough to hasten the end.

    Mum and the rest of us did see him suffer, but from the stroke and pneumonia, not the cancer. So long as his suffering was from something treatable, he was treated.

    The level of care provided by the NHS to a terminally ill man in his eighties; the combination of professionalism and compassion was astounding.

  • Gwai:
    Let's keep suicide and assisted dying separate--start a new thread for suicide if you want--and please do be sensitive.
    Sorry. I am genuinely of the view that euphemisms generally are not helpful, including assisted dying. I admit that "assisted dying" starts out with a pretty strong presumption of the validity of the reasons for the act, because of the pre-conditions it presupposes. For me that doesn't affect the basic ethical issue.

    However.

    I am beginning to think I'm not quite up with the culture on Epiphanies, and I have to be honest that I find it irritating to have always to be looking out for other people's feeling on a discussion board. Not in life in general but specifically in a board created to debate issues.

    But since Epiphanies was set up for this, I totally accept that if I don't want that type of discussion, I know what to do.
  • Ethne AlbaEthne Alba Shipmate
    edited October 2021
    Interesting comment to be honest.

    And I think this is where the general population is as well.

    I think that In Real Life ( and I include governments in this) maybe lots of people feel that there is no clear definition of what is being talked about.

    And in talking about one thing, another thing might need to be clarified as well.

    In real life, as in Epiphanies, real people and their feelings are involved.

    It is tricky for sure.
    Both Out There in real life and here in Epiphanies.



    Think it s going well so far and I m following this thread closely
  • I think it's fairly self-evident that it's virtually impossible to be absolutely certain as to what is happening in any given case of *assisted dying*, however it may be accomplished (if that's the right word...).

    Each case is going to be individual and unique, both as regards the mental, spiritual, and physical condition of the person affected, and also their family situation.

  • HeavenlyannieHeavenlyannie Shipmate
    edited October 2021
    Nenya wrote: »
    Thank you; that's helpful. I've left verbal instructions to Mr Nen that I want to be given as much medication as needed to keep me comfortable and if it shortens my life that's absolutely fine. I thought that got me, and my loved ones, out of making any difficult decisions about the end of life but I see now it's not really a meaningful instruction. I am not sure where to go from here about it, but it's useful to know.

    On a possibly related subject, I wonder how decisions are made about treating conditions that will shorten a life that's near its end anyway, seeing them as possibly a merciful way out.
    Compassion in Dying https://compassionindying.org.uk/ have information on Advance Decisions including forms, which you may find helpful. For information though, they are the sister organisation to Dignity in Dying, which campaigns for assisted dying, though the two organisations are run separately.

    The main issue with decision making is capacity; the ability to understand the information needed to make a decision, to weigh it up and retain it. In the UK, a person is presumed to have the capacity to make a decision regardless of their diagnosis and should have the options explained in an informed and unbiased way. If you have capacity you have the legal right to make an unwise decision and should be supported in your decision making.
    Obviously it is more complex when the person does not have the capacity to make decisions. Then the decision needs to be made in the person's 'best interests' which can be a complex concept. People often assume that their next of kin will then having authority to make decisions but there is no legal requirement for this in the UK and the responsibility actually lies with the medical professionals unless a surrogate is named (and in some cases ends up a court decision). But obviously in practice decision making is usually a joint exercise between a multi-disciplinary team and family, looking at a person's best interests and values and weighing them up in a person-centred way. Well, ideally anyway.
  • CaissaCaissa Shipmate
    Here is an academic article that looks at the issue of suicide vs. medically assisted dying. I have read the abstract and it looks interesting and germane to the discussion. https://www.tandfonline.com/doi/full/10.1080/07481187.2019.1614110

    Googling reveals that there seems to be a healthy academic debate around the terms and any similarities and differences.
  • Caissa wrote: »
    Here is an academic article that looks at the issue of suicide vs. medically assisted dying. I have read the abstract and it looks interesting and germane to the discussion. https://www.tandfonline.com/doi/full/10.1080/07481187.2019.1614110

    That article seems to deal with people's perceptions of the words "suicide" and "medically-assistance in dying", rather than anything about the actual issues at stake.

    The Canadian Centre for Suicide Prevention offers this graphic, but I confess that I don't actually see the substantive difference. Most of the differences in that graphic centre on the practicalities of the process: MAiD is calm and peaceful, whereas suicides tend not to be. Those things are consequences of the different legal framework, rather than fundamental differences.

    The only point that actually addresses a real difference is the first, where the distinction is drawn between people who are suicidal, who, it asserts, "do not actually want to die; they want the pain of living to end" and people who want MAiD, which "hastens death for people in irremediable circumstances".

    The well-known Dignitas clinic in Switzerland uses the phrase "assisted suicide" to describe its services. Many of its clients are not terminally ill in the Canadian MAiD sense, but have seen their quality of life reduced by some progressive illness to the point that they no longer wish to live.
  • CaissaCaissa Shipmate
    edited October 2021
    Try this one then Learning Cniht https://onlinelibrary.wiley.com/doi/full/10.1002/hast.1083

    My point in sharing the first was merely to establish that the issue is being studied by academics.
  • PomonaPomona Shipmate
    I am disturbed by the attitude of some who are very pro legalising assisted dying who view concerned disabled people and disability advocates as somehow wanting people to suffer needlessly. We know from people in Welsh nursing homes having DNR orders applied without their consent that end of life care can and will be abused, and one person being killed without their consent is one too many. I don't oppose the principle of assisted dying but it's extremely naïve to act like nobody would ever eg get power of attorney over someone for untoward purposes. It seems very difficult to legalise assisted dying and guarantee safety for people who don't want it.
  • PomonaPomona Shipmate
    Nenya wrote: »
    Thank you; that's helpful. I've left verbal instructions to Mr Nen that I want to be given as much medication as needed to keep me comfortable and if it shortens my life that's absolutely fine. I thought that got me, and my loved ones, out of making any difficult decisions about the end of life but I see now it's not really a meaningful instruction. I am not sure where to go from here about it, but it's useful to know.

    On a possibly related subject, I wonder how decisions are made about treating conditions that will shorten a life that's near its end anyway, seeing them as possibly a merciful way out.
    Compassion in Dying https://compassionindying.org.uk/ have information on Advance Decisions including forms, which you may find helpful. For information though, they are the sister organisation to Dignity in Dying, which campaigns for assisted dying, though the two organisations are run separately.

    The main issue with decision making is capacity; the ability to understand the information needed to make a decision, to weigh it up and retain it. In the UK, a person is presumed to have the capacity to make a decision regardless of their diagnosis and should have the options explained in an informed and unbiased way. If you have capacity you have the legal right to make an unwise decision and should be supported in your decision making.
    Obviously it is more complex when the person does not have the capacity to make decisions. Then the decision needs to be made in the person's 'best interests' which can be a complex concept. People often assume that their next of kin will then having authority to make decisions but there is no legal requirement for this in the UK and the responsibility actually lies with the medical professionals unless a surrogate is named (and in some cases ends up a court decision). But obviously in practice decision making is usually a joint exercise between a multi-disciplinary team and family, looking at a person's best interests and values and weighing them up in a person-centred way. Well, ideally anyway.

    This presumably is different if someone is sectioned, because I know then that the next of kin DOES automatically get decision making authority unless the patient goes to court and has another named person established in that role.
  • Pomona wrote: »
    I am disturbed by the attitude of some who are very pro legalising assisted dying who view concerned disabled people and disability advocates as somehow wanting people to suffer needlessly. We know from people in Welsh nursing homes having DNR orders applied without their consent that end of life care can and will be abused, and one person being killed without their consent is one too many. I don't oppose the principle of assisted dying but it's extremely naïve to act like nobody would ever eg get power of attorney over someone for untoward purposes. It seems very difficult to legalise assisted dying and guarantee safety for people who don't want it.

    This, especially your final sentence.
  • HeavenlyannieHeavenlyannie Shipmate
    edited October 2021
    Do you have a link for that info about sectioning Pomona? My teaching deals mainly with capacity in dementia and unconscious patients.

    I agree with some of your points about disabled people above, which applies to other vulnerable people too, though DNR is not the same as killing people.
  • HeavenlyannieHeavenlyannie Shipmate
    edited October 2021
    Just looked up the info on sectioning and it would appear to depend on which section you are detained under and you can opt not to have a relative contacted, here’s a link to to Mind charity https://www.mind.org.uk/information-support/legal-rights/sectioning/family-members/
  • CaissaCaissa Shipmate
    Pomona wrote: I don't oppose the principle of assisted dying but it's extremely naïve to act like nobody would ever eg get power of attorney over someone for untoward purposes.

    to which Caissa responds: This would be impossible in the Canadian context. An alternativre decision maker could not initiate or agree to MAID.
  • DoublethinkDoublethink Admin
    edited October 2021
    Just looked up the info on sectioning and it would appear to depend on which section you are detained under and you can opt not to have a relative contacted, here’s a link to to Mind charity https://www.mind.org.uk/information-support/legal-rights/sectioning/family-members/

    In the U.K. even if you are detained under the mental health act, decisions about your physical health - if you are not deemed to be capacitous - would still be governed by the mental capacity act. But if you have previously given someone power of attorney, or they have health and welfare deputyship, they could make a decision on your behalf. That said, if the U.K. ever legalises assisted dying - I suspect there would be specific legislative provision about best interest decision making. Currently, best interest decisions must be compatible with life.
  • HeavenlyannieHeavenlyannie Shipmate
    edited October 2021
    Yes, the current GMC guidance is that in the case of lack of capacity if there is no legal advance refusal of treatment or no-one has the legal authority to make decisions, the decision making lies with the doctor, though relatives and multidisciplinary team should be consulted and further legal advice sought if necessary. If someone is legally appointed they can make decisions on your behalf.
    If assisted dying was legalised in the UK I suspect that these would no longer apply and it will be only those with capacity being allowed to make the decision, though there may be some argument for legally drawn up advance directives being included.
    My main objections to assisted dying are that my years of nursing taught me that some relatives are coercive, controlling and unscrupulous, and some vulnerable people feel guilty about being a ‘burden’ on others.
  • There's a Radio 4 series called Inside the Ethics Committee that discusses how some of these decisions are made. Link to an episode entitled Terminally Ill and Suicidal which
    discusses the real-life case of Mary, a terminally-ill woman in her 80s. She has considered her condition and has decided that she wants to die.

    She is admitted to a hospice for respite care. On the first night she attempts suicide. The psychiatric team, who assess Mary, conclude that she is not clinically depressed.
  • some vulnerable people feel guilty about being a ‘burden’ on others.

    It doesn't have to be vulnerable people that feel guilty about being a burden. And to the extent that we're talking about a free, rather than coerced, choice (and I'll agree with your concerns there), it's not clear to me that "I don't want to be a burden" is a worse reason for seeking assisted death than "I don't like the quality of life I have now". If a person, of their own free will, elects to not be a burden, should we gainsay their wishes?
  • Martin54Martin54 Deckhand, Styx
    edited October 2021
    Speaking for myself. 5 years ago I had a cancer 'scare', which was an understatement when I thought I was looking down the urethra of a gun. I survived the registrar's 'Ouch!' level blood (despite the haematuria) pressure sleepless night by talking myself through it. Worst case, after all the optimal (what would you do Doc?) chemo & surgery, make me as comfortable as possible and if that was going to end, but before death, I'd head it off at the pass by refusing food and all medication apart from morphine, ketamine, fentanyl. Would consider coma.

    (Slept some that morning and started walking even more, hours and hours a day, and came up with a bucket list. After having a BBC inside broadcast unit driven up my willy and THIRTEEN FUCKING HARPOONS FIRED UP MY ARSE!!! (on top of the initial indignity which nearly prompted Billy Connolly to summon a constable) and being told off by the consultant for hyperventilating as the local anaesthetic was superficial to the colon, I at least manned up when the Bulgarian nurse said, with Bob De Niro turned down mouth and turned open hands, 'There will be pain.'. That was AFTER the harpoons. Until the anaesthetic wore off. While I was driving. FUCK ME!!!!!! With a proper harpoon. Apart from constantly elevated PSA, nothing. Probably all because I was caught short and peed in an alley on a lovely September Sunday just a few hours walk and heard a near voice and STOPPED. The voice was through a hedge and not connected. So I've had a dummy run. And the foregoing para will apply. I'd never ask or expect anyone to kill me unless I was raving.)
  • RuthRuth Shipmate
    Pomona wrote: »
    I am disturbed by the attitude of some who are very pro legalising assisted dying who view concerned disabled people and disability advocates as somehow wanting people to suffer needlessly.
    Who says this?

    It makes sense to me that a disabled person who has been told in subtle and not-so-subtle ways that their life isn't valuable is going to see a potential threat in assisted dying laws and practices. It also makes sense to me that someone facing a slow, disabling lead-up to death would feel like they are being sentenced to needless suffering because others have successfully opposed the legalization of assisted dying.
    I don't oppose the principle of assisted dying but it's extremely naïve to act like nobody would ever eg get power of attorney over someone for untoward purposes. It seems very difficult to legalise assisted dying and guarantee safety for people who don't want it.
    Oregon's Death with Dignity Act went into effect in 1997. The Dutch have had Termination of Life on Request since 2002. It seems to me that we shouldn't have to theorize about whether assisted dying laws will be abused when there are jurisdictions with a couple of decades of experience with these laws. Have they been? I haven't found a good source that says they have.

    Looking for information about that, I found a transcript of an interview with a journalist who has written a book about how the assisted dying laws are working out in the US. One thing that struck me is that people talked most about "losing autonomy and dignity" as the reasons they were considering ending their lives. When they couldn't define dignity, she asked them what indignity they feared, and a lot of them cited incontinence. She went on to talk about how these laws are being pushed in the US by the baby boom generation, which has been a strong driver in the patient autonomy movement.

    Having helped my mother in the bathroom, I can't see ending my life over incontinence. But I think it would behoove us to look at the things that make people think that what they're facing in the last months or even years of life will be so bad that they'd prefer to die, and do what we can to ameliorate those things. And I think we should accept that some things just can't be fixed or even helped, and let people end their lives quickly and comfortably when they so choose.
  • Gee DGee D Shipmate
    Ruth wrote: »
    It makes sense to me that a disabled person who has been told in subtle and not-so-subtle ways that their life isn't valuable is going to see a potential threat in assisted dying laws and practices. It also makes sense to me that someone facing a slow, disabling lead-up to death would feel like they are being sentenced to needless suffering because others have successfully opposed the legalization of assisted dying.

    I have written before on these boards about mate of mine, who was a judge (now retired). He says that the hardest case with which he's ever had to deal concerned a man in his late 20's, who'd been seriously injured in a car accident, paralysed from the neck down. Somehow, he'd basically retained full mental capacity. For 8 or 9 years, he had lived on a support system with no hope of any improvement. He decided that that was enough and that he wanted the support system turned off. The hospital sought the court's advice that the system could be turned off legally. My mate found that that could be done. A day or so later, on the eve of his birthday, he asked for the support to cease. In accordance with the man's wishes, his family was there and his 2 brothers together turned the switch off, each holding a hand. Very quickly and without a struggle, he lost consciousness and died peacefully.

    That was a good case, and I can well imagine that there could be a case where the body struggled to remain alive. The horror for any family present would be terrible.
  • HeavenlyannieHeavenlyannie Shipmate
    edited October 2021
    That is withdrawal of treatment rather than assisted dying, though. Doctors have not actively done something that will end his life, they have instead stopped doing something to prolong it. He has asserted his autonomy as someone with capacity to make the decision that he does not want treating.
    I agree it would be traumatic if his body fought it but I assume appropriate tests were done and contingency plans made to ease the distress.
  • Gee DGee D Shipmate
    That is withdrawal of treatment rather than assisted dying, though. Doctors have not actively done something that will end his life, they have instead stopped doing something to prolong it. He has asserted his autonomy as someone with capacity to make the decision that he does not want treating.
    I agree it would be traumatic if his body fought it but I assume appropriate tests were done and contingency plans made to ease the distress.

    The man did not have the ability to remove the life support system and so, at his request, his brothers did. There were no doctors around.
  • My apologies, I had not noted that the brothers did it. It must have been unbelievably emotional for them.
    But my point still stands. Removing life support (in this case with consent via the man’s capacity and supported by legal means) is considered withdrawal of treatment not assisted dying. Life support is a form of treatment and it has been removed at the man’s request. Under UK law people with capacity can refuse treatment. One assumes the reason it went to court is because the hospital wanted to confirm his capacity to make the decision.
  • Gee DGee D Shipmate
    edited October 2021
    In one sense, you're sort of right. In practical terms, there's not a great difference between the 2.

    UK law is not relevant to this.
  • CaissaCaissa Shipmate
    Medical ethics clearly notes the difference between withdrawal of treatment and MAID. The former recognizes every competent patient's right to determine and consent to medical treatment.
  • GwaiGwai Epiphanies Host
    Issues like the trolley problem imply that many of us do think that there is a difference between causing something to happen and allowing it to happen by doing nothing. MAID and withdrawal of care may have the same effect, but there is a lot of history to support that it makes an ethical difference to many people whether it is done actively or not.
  • Martin54Martin54 Deckhand, Styx
    edited October 2021
    Part of the inspiration for starving to death on morphine if MAID is not available and even if it is (and I have no concerns about it if it is available, it will be done in an open, civilized, fully accountable manner, and yes we all know the untreatably suicidal Belgian teenager horror story) was a then 50 year chronically depressed featherless bird frail MIL, paralysed and incontinent with arthritis, who whispered brokenly sobbing to me that she didn't want to live with the shame of it all. "It's all right Vi. It's all right", meaning that's, was all I could say. She stopped eating then and still took weeks to die on a drip. The young doctor in charge asked me what should be done, I told him there was nothing that could be done and was angrily surprised that he should ask in helplessness. We visited every week for several weeks from a hundred miles and she'd laugh at my jokes, eyes and mouth otherwise closed. She was a tough, dignified old bird from that decision on. And yes, it's haunted me ever since and affected relationships in that barely spoken British way.
  • So sorry, Martin. 😥
  • Martin54Martin54 Deckhand, Styx
    Raptor Eye wrote: »
    So sorry, Martin. 😥

    Thanks mate. Life eh :smile:
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