Sarco Pod used for first time as American woman takes her own life
The_Riv
Shipmate
in Epiphanies
*Fair Warning* -- descriptions of the device's function as well as the passing of its user are contained in the linked article: The Guardian.
There was a time when I'd have been wholeheartedly against such a device. The older I've grown, however, the more I find myself opening, albeit slowly, to the idea of determining and carrying out one's ultimate end. What are your thoughts?
There was a time when I'd have been wholeheartedly against such a device. The older I've grown, however, the more I find myself opening, albeit slowly, to the idea of determining and carrying out one's ultimate end. What are your thoughts?
Comments
I agree. Given the awfulness of the pain in which some people die, even in palliative care, having the opportunity to end one's own life in a dignified and painless manner seems like a good option.
Doublethink, Admin
Conversely, given the amount of safeguarding enquiries that happen every year - I have no confidence that at a societal level we can stop people being emotionally or physically coerced into such a course of action.
I also see far too much of the devastation suicide causes to the survivors to be comfortable with promoting it.
And there's a tendency to fix this in the absence of a functioning system for social care.
There is, I think, in principle no difference between what is desirable for an execution and what is desirable for an assisted death: in both cases, you want death to be painless, and you don't want the possibility of botching the job and not actually killing the person.
The moral arguments around executions and assisted suicide are mostly independent of the method.
I have experienced such devastation. I had a friend who committed suicide when he and I were both in our 40s, and my college roommate made three serious attempts within five or six weeks in spring of our senior year. My roommate's attempts had effects on my life that played out for over a decade. My friend's early death left a giant hole in his family, and they still feel pain over his not conveying to them how serious his health and financial problems were. But medical assistance in dying, which where I live is only accessible to people with a prognosis of less than six months to live, is not at all the same thing as the suicides of desperately depressed people who might still be alive if they'd received mental health care.
I am very glad that the aunt and uncle of a friend were in January and earlier this month respectively able to end their lives as they saw fit rather than be sentenced to enduring pain and dementia. My friend and her family are of course sad that these much loved family members are gone, but everyone got to say goodbye and none of them are sorry that these two people made their own decisions for the ends of their lives. This friend describes the whole experience as "bittersweet." If the natural end of my life looks like it's going to be miserable, I fully intend to do something similar, depending on the options available to me at the time. It would be a hell of a lot more preferable to either being miserable for the last months of my life or having to contrive my own messy death without being able to let loved ones know my plans for fear of implicating them in something illegal.
I have to say, I am not sure why this is supposed to be somehow better than a massive morphine overdose.
I too have lost people to both suicide and terminal illness. I have also repeatedly seen the exploitation and abuse of vulnerable people as a result of the nature of my work - and I would encourage us all to be aware that those vulnerable people are not a special subset.
Anyone can be vulnerable in the wrong circumstances, and almost by definition anyone who is the end stages of terminal disease is likely to be disabled by their condition to some extent and vulnerable.
No needle required would be an advantage, I suppose. And, as you note, no trained medical support needed: you don't need someone to insert an IV for you.
You largely bypass the medical establishment, and you can do it out in the forest. Here's a free link to a NY Times piece from a few years ago that discusses what the inventor is trying to do. It notes the objections, which aren't hard to imagine: loss of human connection in the death process, mis-use, malfunction of the machine. It goes on to point out there are other implications:
Do you know of any cases where vulnerable people have been coerced into asking for medical assistance in dying?
It's precisely because I am like just about everyone else likely to become vulnerable to one extent or another toward the end of my life that I want to have the option of peacefully ending my life open to me.
No I haven’t seen people coerced into assisted death - because that’s illegal in this country. “Mercy” killings do happen and attract more or less publicity.
During the pandemic blanket do not resuscitate orders (DNAR) were issued for the elderly and disabled people and institutions had to step in and get them rescinded. When my mother was hospitalised with Covid, a DNAR was put on her notes - she was not mentally capacitous at the time, we as a family were not told or consulted. My father who holds an active power of attorney for her was not told or consulted. We only found out because it was on the discharge paperwork when she came out of hospital.
I have also seen this happen for intellectual disabled patients, and have had to actively challenge professionals who were proposing not to treat lung cancer because of the patient’s intellectual disability and their uninformed understanding about what the patient would understand and be able to tolerate.
These people would tell you they had good intentions - but what was happening is that they were making decisions about other people’s quality of life without consulting those people or their families - and also the relative value of people’s lives when, in the pandemic, there was a fear we’d run out of ventilators.
Likewise there had to be a very active campaign by young disabled people, about how they planned to gatekeep access to intensive care early in the pandemic. They intended to use an inappropriate scoring tool, that would have systematically discriminated against people with physical disabilities.
Re safeguarding, we regularly see the sexual, physical and financial exploitation of vulnerable people - whether by strangers, “friends” or family. If they happen for some reason to have money, it’s like a moth to a flame. So in terms of this scenario - think inheritance.
Sometimes, I am sure, as with the dnars - there would people would be able to convince themselves they were doing the right thing.,
Periodically we see this sort of thing - it’s very difficult to know how often it happens in fact.
Learnings from serious case reviews are published, if you want to get a feel for the severe end of what we see in practice.
My grandmother (who I've not included in the count above because I never met her) commited suicide by sticking her head into the oven in the 1960s, it had a long-term and lasting impact on my father. In particular during his slide into memory loss and dementia in the last few years.
Somehow one has to balance that pain against the personal choice to end ones life, particularly if it has become unbearable by illness and disease.
Maybe it sounds wrong, but for me I think I'm more comfortable knowing that the person had to make a journey, do planning and make an effort to die in this way than the deaths by overdose and depression that I've experienced.
So although I'm not particularly against physician assisted euthanasia I'm not worried that it's not available here in the UK.
I think suicide while at the low end of the bipolar cycle should not be regarded as a sin or even as folly but as a symptom.
My personal feelings on assisted dying are similar to those expressed by Doublethink. My 20 years as a nurse opened my eyes to how coercive and mean people can be to their vulnerable relatives, and also how vulnerable people can feel like a burden to others. I don’t support assisted dying, though I do understand why others would support it. I think it would be hard to find evidence of people who have been coerced into assisted dying as the victims would be dead, their closest relatives the likely perpetrators and the doctors would have approved the method. Who would challenge it? The vulnerable often have no voice when they are alive and can live isolated lives. Who else would know or care after their death?
Bizarrely, this is not a subject I find easy to discuss despite the fact that I teach ethics on a module about death, dying and bereavement. I think I find the subject too personal due to my own mental health disability and having studied the history of its stigma and abuse, and experienced the stigma myself in my daily life.
So do I. What a thorny thicket this subject is...I support the idea in principle, but those doubts are still very valid.
It's a question of balancing the potential harm of any such abuse against the suffering that may be relieved by having provisions in place.
This shouldn't be settled by the old "is that what you want? Because that's what'll happen!"
That's certainly true, at least with regard to some politicians. *Let the bodies pile up!*...
After looking at evidence, some bioethicists previously opposed to MAID have changed their minds:
Source: Voices in Bioethics. The piece goes through all the arguments against MAID and ably refutes them.
There is no evidence of existing laws having been abused. MAID laws have not led to people not getting palliative care; instead, "states with MAiD laws tend to have better access to palliative care than states without."
MAID laws are consistent with valuing life, and there is a more compelling moral argument in favor of them than against them. The fears about abuse and coercion are unsubstantiated by decades of experience with the implementation of MAID laws, and terminally ill people should have the right to determine how their lives will end rather than have others decide that they must suffer to the end. Their alternatives are active suicide, which is messy, both literally and figuratively, and unnecessarily painful for their loved ones, or passive suicide through ceasing to eat and drink, which can drag on unpredictably and have nasty side effects.
https://www.teenvogue.com/story/canada-maid-law-disabled
(by freelance disabled journalist John Loeppky)
So either Oregon is doing something right that they aren't, or we aren't getting the full picture from one place or the other.
In the light of the horrific attitudes to benefits and disability we've been seeing from successive Labour and Conservative governments in the UK, it has made me worry that people will feel death is the only way out of these hells because our social safety net has been withdrawn so far.
https://labourhub.org.uk/2024/08/31/how-state-violence-has-devastated-the-lives-of-disabled-people/
I've seen a lot of disabled people genuinely worried about it and these days I count as one of them.
I think its correct that views differ among disabled people but I think the balance of that has been changing a bit recently in the UK. It used to be here that a lot of disability advocates (especially those with terminal conditions) supported assisted dying but now I see more of the other opinion - disabled campaigners being queasy about it and sounding the alarm. The people I know who are worried are not conservative Christians who oppose on religious grounds but people who've been on the front line of fighting our awful and murderous not-fit-for purpose disability 'benefits' system, so it gives me pause.
I'd be much happier seeing moves towards medical assistance in dying in a country with universal basic income, a properly funded health system and better attitudes towards disability.
I also agree with Doublethink that the way disabled people were treated in the pandemic makes me wonder what would happen here.
It's something I agree with in principle but really worry that safe conditions for it won't exist in practice.
The most expensive treatments and care tend to happen toward the end of life.
Or in the case of the UK, at what point does access to palliative care get much more difficult: hospice places even now are like hens teeth. The Shipman case has complicated the provision of adequate pain control in your own home.
Some things I noticed in a recent report back to Parliament on assisted death was that people who chose assisted dying tended to have a higher level of education than those who didn't and I wondered if some people just weren't aware of the option, and were more likely to be Pakeha (white New Zealanders) than Maori.
The head of the Hospice movement here pointed out that being euthanized was totally funded by the State whereas Hospices were funded only half their costs by the state and had to raise the rest of their running costs with Ops shops (charity shops), donations and whatever fundraising ideas they could come up with.
Opinions aren't experiences, though. And your question to Caissa would make a nearly impossible case to prove. How could Caissa possibly demonstrate that the MAID system in Canada is not open to abuse in such a way that would reassure disabled people in a global forum? ISTM all systems are open to abuse. And as we know, abusus non tollit usum (misuse of something does not delegitimize proper usage)
MAID has a place in Canadian health care.
Disabled people are right to be aware of any slippery slopes, since they are often the first ones pushed down them. But right now in Canada, all the ableism seems to be directed at systems that would withhold MAID from people who would otherwise qualify to receive it.
For example: a woman with autism sought and received permission for MAID. Autism was not the qualifying condition for MAID - she has chosen not to disclose what health condition qualified her. Her father fought for and received an injunction against it. https://cbc.ca/news/canada/calgary/calgary-maid-father-daughter-court-injunction-appeal-interveners-1.7224430
Private insurance varies. What private insurance in the US covers depends on government regulation and cultural expectations as well as the companies' profit motive. There has been a big push for palliative care in California over the last 10-20 years, so the large insurance providers do cover it. They've learned that since palliative care frequently keeps people out of the hospital, whether or not they have a terminal prognosis, it's well worth their while to cover. If insurance companies were so ghoulish as you've imagined, they would already offer plans with lower premiums if you agree to less expensive hospice care instead of fighting your cancer or whatever to the bitter end. What private insurance is required to cover is government regulated, so it's not hard to imagine a regulatory response to the extreme situation you've imagined.
I was braced for at least one account of someone talking about how their sister, friend, grandfather, someone had been coerced into assisted suicide or had opted for it because the benefits available to them were entirely inadequate or something along those lines. But again we hear about concerns and fears, which all available evidence shows have been adequately addressed in the MAID legislation.
That there should be safeguards on MAID to prevent abuse is obvious. That the safeguards in place in Canada and the US states with MAID are inadequate has not been demonstrated.
The article's conclusion: "Restricting an autonomous choice to pursue MAiD due to the injustice of current non-ideal circumstances causes more harm than allowing the choice to pursue MAiD, even though that choice is deeply tragic."
The first response, from a research fellow in the Department of Environment & Geography at the U of York in the UK, likens the authors to Dr. Kevorkian and claims that "in Canada, MAiD is 99% euthanasia" - at which point I stopped reading carefully. The second response is from a bioethicist who cites the example of a suddenly disabled person who requested MAID because he was denied the mobility supports he needed. His care team instead advocated for him and got him the supports, "valued his higher desire and intrinsic value, over a desperate request driven by unjust circumstances," which suggests that the care team were only motivated to advocate for him because MAID was an option he could invoke, and also suggests that the law worked as intended -- the doctors said no. The third response suggests that the article's authors don't "take ethics seriously" because they take a different approach than his, so I find it hard to take him seriously.
https://www.independent.co.uk/news/world/americas/diabled-woman-canada-assisted-suicide-b2363156.html
This is the kind of thing that worries me. I can see it happening here - how precisely do you stop it in underfunded social systems?
There was also a report detailing 13 cases of concern prepared by advisers to the vulnerable persons standard who were doctors and physicians working in the Canadian health care system in this brief
'Failing People with Disabilities who Experience Systemic Suffering: Gaps in the Monitoring System for Medical Assistance in Dying
A Brief to the Standing Senate Committee on Legal and Constitutional Affairs’ Pre-Study of Bill C-7'
November 2020
Warning - PDF
https://sencanada.ca/content/sen/committee/432/LCJC/Briefs/VulnerablePersonsStandard_e.pdf
The cases they cite are summarised and have links
But as this is from 2020 - perhaps this has been addressed? I'm not an expert in Canadian legislation but I see disability groups are bringing another challenge in Canada which suggests that they're not entirely happy with how it's working.
We're about to get assisted dying legislation here in Scotland - a bill is at stage 1 but we can't defend ourselves very much from Westminster's attacks on disabled people and the benefits system and the likelihood is that we're going to have a Labour government soon too who won't tackle the current hostile UK government attitudes to disabled people.
There is a problem with people who seek to strip autonomy from others in systems which allow assistance in dying but I think there is also a problem with having welfare systems which immiserate very many disabled people and then seem happy to fund dying when they don't properly fund living.
A CBC news article indicates that the woman in question, Rose Finlay, applied for MAID but did not indicate that she had been approved. Since this article was from June 2023, I cannot find any further updates on this case. https://cbc.ca/news/canada/toronto/rose-finlay-medically-assisted-dying-odsp-1.6868917
I would seriously question whether Ms Finlay actually intended to follow through with MAID, or if it was part of her media campaign for her Go Fund Me fundraiser. I hope you will pardon my cynicism. I believe that she would rather not have to live on ODSP (Ontario Disability Support Program) but I am not convinced by the articles I've read that she seriously intended to receive MAID.
Thank you for the link.
Housing in Canada is in crisis. It is particularly terrible for people seeking access to government-funded housing. This is exceptionally stressful for people with disabilities, who may have to accept nursing home (personal care home) institutional care to address their needs. It has been this way for decades, and AIUI worse since the pandemic. Housing preferences matter - I do not think these people's wishes were necessarily unrealistic - but currently, there are limited housing and support service options for disabled people.
Family members may complain to the media that their loved one ought not to have received approval for MAID. I think we can all agree that families' reasons for complaining may be complex, including grief and guilt. That does not make their complaints baseless, but none of the articles linked explored their emotional, psychological, financial, or religious reasons for complaining of MAID (except in the case of Jack Sorenson, where religious objection was given in the article.)
I read through the 13 cases listed in the report and where possible (without a subscriber access) the articles supporting their inclusion in the report. Of the 13, I would describe them as follows:
A Rolland - lack of access to preferred housing
S Tagert - lack of access to preferred housing
A Nichols - family complaint
Mom of J. Turton-Molgat - family complaint, and possibly lack of access to preferred housing. (The substance of this inclusion is based on a Facebook post made by the daughter, which is an interesting methodology.)
Mr. X (Jack Sorenson) - family complaint. Mr Sorenson was an atheist, his wife a Christian whose beliefs did not support MAID https://www.cbc.ca/news/canada/nova-scotia/nova-scotia-medical-assistance-in-dying-jack-sorenson-bridgewater-couple-court-1.5751454
Y Tremblay - lack of access to preferred housing
G Bouchard - lack of access to preferred housing
T Sec - lack of access to preferred housing and social isolation (did not use MAID? unclear)
J Marchand - lack of access to preferred housing
"Kim" - "considered applying" based on lack of access to preferred housing
R Bourbonnais - lack of access to preferred housing
R Foley - lack of access to preferred housing
C Lewis - would not have been eligible for MAID, as the request must come from the individual, and Lewis lacked capacity to make the request.
Ten of the thirteen cases in the report include some form of "lack of access to preferred housing" as a/the factor in MAID. Three were based on family complaint.
What is described here is the sort of thing that bothers me
Countries which don't provide decent housing or dignity to disabled people shouldn't, as I see it, be in the business of offering euthanasia to those they won't pay to appropriately house and care for.
Act, the party who introduced the original Bill into Parliament is now part of the Coalition Government and have said they want to change this limitation.
Morally, in various times and places (ancient Rome and Japan, for instance), it's been considered even required behavior, depending on circumstances.
Other than a few very early saints (I'm thinking of Pelagia the Virgin, for instance), I believe the Christian Church has been against suicide (and by extension, helping others commit suicide).
I was also trying to vaguely make this point, but then considering my own experience, clearly it isn't as simple as this. My father who is now over 80 is still clearly grieving his mother who left him more than 60 years ago.
There's obviously a tremendous amount of pain experienced by the survivors of suicide that can't be waved away with consent.
My inclination is that it should be an option but remain difficult and unusual. But then the trouble with that position is that those who most need it (those experiencing crushing pain, for example) are also those who have least ability to make a difficult journey.
I don't know what the answer is, but then also recognise the privilege we have as individuals and societies where this is even a discussion. In most/many parts of the world, death quickly finds those who lack the will or finances to keep fighting for life.
It's about any and all of those. I asked an open-ended question in the OP: There was a time when I'd have been wholeheartedly against such a device. The older I've grown, however, the more I find myself opening, albeit slowly, to the idea of determining and carrying out one's ultimate end. What are your thoughts?
Well, it couldn't be done without the assistance of the machine and someone teaching how to use it.
I have no answer to the question. I find myself agreeing with everyone.
I've known 'lovely' deaths and awful deaths. I know which one I'd want, but it wouldn't only be about me, would it?
From one perspective, whether it is only about me is up to me to decide. But from another perspective, whether it is also about the people who love and care for me ought to be a significant determining factor.
If I find life too much to bear, then one of the ways in which I might find life too much to bear is the unwanted responsibility for the feelings of those who care for me. If I want to divest myself of that responsibility, what are my options?
Why do you think these are different?
We're talking about someone who wishes to terminate their life early, to avoid experiencing some significant amount of pain (where the pain might be physical, or might be mental / emotional). There is a tacit assumption that there are circumstances in which it is rational for an individual to make this choice, and that wishing to die is not always an indication of mental illness.
I don't think there's a significant difference between telling someone "here is a cocktail of drugs that will kill you (or here is another method that will kill you), and here's how you administer it", and letting them push the button, vs being the person who pushes the button / injects the drugs at their request.
Amen.