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'Do not reanimate, I am 91+' Michel Porro/Getty Images
There is a popular image of assisted suicide: a swift, straightforward procedure, backed by the awesome authority of modern science, sure to send you off in a comfortable doze. Dignity in Dying, for instance, claim that assisted suicide can āguaranteeā a calm and peaceful death. Terry Pratchett expressed his wish to die āsitting in a chair in my own garden with a glass of brandy in my hand and Thomas Tallis on the iPodā.
Now compare the experience of Linda van Zandt. In 2016, on the day of her auntās assisted suicide in California, an Uber arrived bearing thousands of dollars worth of lethal medication. That included 100 capsules which had to be crushed, dissolved and swallowed within the hour. Wearing latex gloves and wielding toothpicks, the family frantically scraped the white powder from the capsules, combining it with a sugar syrup to make a bitter sludge so āvileā that van Zandt broke down in tears. Afterwards, she sat at her kitchen table wondering: āWho wrote this law?ā
That, to be clear, isnāt everyoneās experience ā but then nor is the romanticised picture presented by assisted-suicide advocates. The vision of people like Pratchett āis not the clinical realityā, says Mark Taubert, palliative care consultant and professor of medicine at Cardiff University. Claud Regnard, a retired consultant, points out that only two studies have compared āquality of deathā by assisted suicide and by nature taking its course. Both studies, one in Oregon, one in the Netherlands, concluded that they were as good, or bad, as each other.
Assisted suicide relies on lethal drugs. But how reliable are the medications themselves? An article in a leading medical law journal remarks: āThe pervasive belief that these, or any, noxious drugs are guaranteed to provide for a peaceful and painless death must be dispelled; modern medicine cannot yet achieve this.ā On every point ā the supply chain, the means of administration, the risk of complications ā the reality is far from straightforward. But that reality is about to hit Britain as the Leadbeater Bill on assisted tying is being debated by MPs on 29 November.
Take Mehdi Alavi’s Dream Pharma ā which operated out of the Elgone Driving Academy in Acton. In 2011, this one-man firm was suddenly placed under the spotlight of an international human rights story, as it emerged that it was supplying Arizonaās death penalty system withĀ deadly chemicals.
Why did Arizona have to rely on a man at a driving school in Acton? Welcome to the strange world of lethal drugs, a shadow world largely unmonitored by health authorities, where supply chains can suddenly disappear, where new experimental mixtures come and go, and where best practice remains decidedly unclear.
When it comes to the physical stuff doctors depend on, assisted suicide and the death penalty are entwined. In the early 2010s, European companies launched tough new restrictions on the export of certain drugs to the US because the drugs were being used for capital punishment. That explains the emergence of individual suppliers such as Mehdi Alavi. But these small-scale alternatives were soon banned by American courts too. US pharma companies also stopped making the drugs used in assisted suicide ā possibly because there are few other medical uses for them.
The shortage caused problems for penitentiaries and assisted-suicide clinics alike. One chemical, until then a popular choice in assisted-suicide states, practically disappeared from the market. Assisted-suicide doctorsā groups scoured America looking for the drug, but to no avail. Next they turned to another chemical which was supplied by a company called Valeant. The company was plagued by scandal and investigated for price gouging; the price of the drug rose from around $400 to almost $3,000 per lethal dose between 2010 and 2016.
Without commenting at all on the pros and cons of Assisted Suicide, it does seem like nonsense to me to claim that there are no drugs available that can deliver a painless death.
Even before fentanyl, there was heroin. And there are drugs to knock you out for operations.
There are serious discussions to be had about Assisted Suicide, but a pharmaceutical or technological inability to achieve it is absolutely not an issue.
Personally, I could probably be persuaded to support the idea of assisted suicide for the terminally ill who are in pain and want to go with some dignity at a time of their own choosing. But when looking at the unforseen consequences in countries where it has been legalised, we should be very wary indeed. The process should never become easy, and certainly should not ever be considered commonplace
Canada legalised assisted dying in 2016 – initially only for the terminally ill. In 2021 that was extended to those with a chronic physical condition. Canada now has some of the worldās most permissive euthanasia laws, allowing all adults to seek medically-assisted suicide if they choose.
In 2022, more than 14 THOUSAND people availed themselves of this new legislation ā thatās over 4% of all deaths in Canada that year. It is one thing for the law to permit the withdrawal of life support in the face of agonizing pain. But Canada instituted a system that allows people to choose doctor-assisted death for depression and other mental health issues, simple old age and even, most controversially, financial worries.
More sinister still was an advert on Canadian TV extolling not merely the morality but “the beauty” of assisted suicide, as though the policy is virtuous enough to be in line with the “brand values” the company wishes to promote.
(It won’t let me link to the ad – but it’s on YouTube. Search for Assisted Suicide Promoted by Canadian Retailer Simons – if it doesn’t terrify you, I’d be shocked)
Imagine, say, a John Lewis advertisement that reassured you that they are on your side, that they understand how difficult the cost of living crisis is for their customers, and that if only Granny would forego her expensive medical care and agree to being pushed off her perch then the rest of the family could get that lovely new sofa in the January sales, not to mention freeing up a house for the kids to sell.
We’re not quite there, yet – but this is where it starts. Normalising assisted suicide is the first step to pressuring people that it’s the responsible choice to take. If anyone had suggested just a few years ago corporations advertising their support for euthanasia, it would have seemed the stuff of dystopian sci-fi. Perhaps the scariest thing is just how readily believable such a practice is now.
Which celebrity would be shameless enough to front such a campaign, I wonder? Now that the BBC has finally tired of that grinning Toby-jug of woke, St Gary might do it. ……
“Dignitas. Because …. why be a burden?”
I was in favour of assisted suicide until I saw a documentary by a disabled British actress. In Canada, poverty and homelessness are now legitimate qualifications for state suicide.
Then there is the uncomfortably honest words of Wes Streeting that with three current state of palliative care in this country, it could not be a fair choice. He should know.
You say that 4% of deaths in Canada are now assisted suicide, yet you you donāt say how many of those people were terminally ill and would have been dead within a year anyway.
Without that info the statistic is rather meaningless
Every day in the UK there are tens of thousands of operations performed that require the client to be placed under a general anaesthetic. The process after inserting a canula into the back of the hand takes less than 10 seconds. If a professional clinician is incapable of then facilitating the delivery of KCl to stop the heart, for example, then they should be struck off for incompetence.
Gareth, the problem is that the patient would only *probably* die.
If that is the case why are there so many ābotchedā lethal injections in the US when the condemned man does not die easily?
Because doctors refuse to carry out lethal injections for execution, meaning theyāre having to be done by people not trained to do so.
Many pharmaceutical companies also refuse to sell prisons the drugs needed to carry out the execution, so they often improvise with random cocktails of the drugs that theyāre able to get theyāre hands on
The Bill currently before Parliament requires the patient to SELF-ADMINISTER the lethal dose. Difficult to see how they can manage that after being fully sedated.
In that case is it not badly named to be debated as “Assisted dying”?
This is about choice. Mind your own business.
It might be simply about choice to you, but to others itās much more.
One can neither ‘choose’ to die or ‘choose’ to live.
One can only damage the physical body, with bare bodkin or poison, up to and only up to the farthermost rung of this mortal coil. Death is not an event in life, as the philosopher once said.
As it stands, self harm in almost every other context is rightly legislated against.
The question is a substantive one, it cannot be conjured away.
So its not quite as simple as an appeal to ‘choice’.
My body, My choice.
We are capable of putting people under anesthesia for surgery. We are capable of putting down animals with no apparent discomfort to them. But it’s somehow impossible to have a formula that works to stop the human heart? I’m a bit skeptical.
Try a Brompton Cocktail, tried & tested on royalty I believe
In the eighties I had several friends who managed to die quite easily, by mistake, with heroin or morphine. Surely this is the drug of choice for a painless death.
The huge victory obtained by those opposed to assisted suicide is banning of direct, instantaneously effective means of assisted suicide as “cruel.” If a person wants to die instantly, and doesn’t have the physical ability, or emotional resolve, to do the job themselves, they should be able to ask another person to shoot them in the head, and the law should permit that option.
No doubt this comment will attract many downvotes. But I say if a person is truly committed to dying, a bullet (or two) to the brain is quick and as close to foolproof as you can get.
Of course, opponents will brand my suggestion “barbaric” etc. But is it really preferable to subject people to injection with noxious chemicals that might not work?
And you can make the grisly argument that some people, determined to kill themselves, are willing to involve or kill others, without their permission, by jumping off motorway bridges or train platforms.
Itās not a very ādignifiedā way to go though, is it?
A guillotine would be better.
If someone else is pulling the trigger, that is not suicide any more (even āassistedā); thatās murder.
There is always the choice to stop eating, of course.
It seems strange that vets put down animals with no problems every day, but the author would have us believe that the same cannot be done for humans.
Interesting point, but do we actually know about the perceived thoroughness of putting down animals.
Quite. And no doubt many of the opponents of assisted dying are quite happy to have their pets put to sleep.
This is classic “problem selling” behaviour. Just throwing out FUD with no attempt to actually find solutions. Which, as you say, are known to exist.
Strange you see no difference?
The article suggests there’s a problem with ‘methodology’.
The point about having pets humanely put down is it demonstrates there is no problem with methodology. Strange that you’ve chosen to use a different idea – i.e. human v animal, to try to distort the very point the article is based upon.
One look at who he writes for in the footnotes tells us all we need to.know.
No, it doesn’t. The fact that he has written for a Catholic paper doesn’t invalidate the points he’s making. Deal with those, rather than making a superficial ad hominem comment.
The superficiality exists entirely within the article itself, which is disingenuous, and for reasons i’ve suggested elsewhere.
In terms of “ad hominem” the author is very much culpable of that in respect of seeking to undermine the dignity of those suffering from terminal illness and their loved ones.
I had the same thought.
Interesting thought.
Perhaps in future the idea of a natural death will be as remote and terrifying for the well conditioned model citizen as a ‘natural birth’ is now.
Still better it will be presented as ‘reckless’ and ‘selfish’ when the State is willing o manage it all for us.
It sounds as if the first example in the article bought the assisted suicide kit from Temu
Given that Health Authorities have merrily carried out gruesome experiments with drugs and surgeries on ātransā youth with frequent disastrous outcomes – the complete lack of evidence supporting these procedures isnāt really shocking at all.
Mmm, looks as if, once again, the authorities have not given us the whole truth. What a surprise. But why? Why has the information been so vague or misleading?
There is a fundamental difference between the US law and Canadian law. US law requires self-administration by the patient, at the patient’s expense. Canadian law permits the physician to administer first an anaesthetic medication to put the patient to sleep and then the lethal injection to stop the heart. The cost to the patient is zero because it is covered by Medicare. The procedure is usually performed with family and friends present.
Two words: slippery slope. The Canadian law didn’t start out that way, once the principle is established it the qualifying criteria are easily expanded.
Surely the quickest way to kill someone would be a bullet into the brain. Messy but quick!
Guillotine!
One of the proponents of this Bill has described assisted dying as ‘shortening death’.
Wasn’t that where Jesus of Nazareth rose from the dead on the third day. Even Jacob Marley was only dead to begin with.
To the State taking a life is easy and unremarkable. Deny people adequate heating or food and they will die. It may take some time but, miraculously, the State’s hands remain clean.
Palliative Care is pretty good these days. Most people with terminal illnesses have a relatively pain free death in surroundings of their choosing. More of a problem is dementia. No one with dementia is going to ask for an assisted death because they don’t understand what’s happening to them, almost by definition. Denial, delusions and paranoia are pathognomonic. The higher cognitive functions are the first to degenerate. So insight, judgement, decision making etc are impaired. Exactly the functions needed to consent to an assisted death. Just visit a “secure” psycho-geriatric unit, watch perplexed, agitated patients wandering around and around a sterile hospital ward smelling of urine, not recognising staff or family anymore. Experiences differ of course, but it often looks like a living hell. There appears to be no enjoyment of life at all. The idea of ending life like that is unbearable. But an increasing percentage of us will succumb to dementia because we’re not dying from heart disease, strokes and cancers like we used to. Not only that, but demented patients are living longer due to improved care. They are shielded from harm, fed and cleaned well, and not “chemically restrained” ie not sedated, so they get to experience the full force of their persecutory delusions. I wish I could leave a living will asking for an assisted death in the event of a dementia diagnosis. But no one will agree to it because the very mechanism of the disease will preclude informed consent at the time. In fact it’s likely to be aggressively opposed by the person who may have actively wished for it just a few months earlier. It’s a conundrum that no assisted dying authorities have addressed. Interested to hear other people’s views.
This is the interesting ‘other side’ of the conversation and you put your points well.
Choice, consent, life, death. Shakespeare made a sonnet cycle out of these themes which still baffles the intelligent reader.
“To this I witness call the fools of time,
Which die for goodness, who have livād for crime”
The artificial extension of life beyond the seeming natural point of human continence and into that vale of “labour and sorrow” which attends advanced senesence must also be borne in mind.
Consent as well, as you mention, is another vexed question. It appears to be the last shared juridicial standard in our society and yet it is so very frail.
Can the present ‘Will’ bind the future? Trammel up the consequence and leap the world to come? “Regret, like an April Violet” is just as real as the will to consent, just as true – and how can we possibly know if a suicide regrets?
Most of the comments here confuse ‘assisted dying’ with ‘euthanasia’. The former is actually assisted suicide: the patient administers it himself. The latter is permitted killing by a second party, generally a doctor. The difference is important. Almost all commenters here are talking about euthanasia, comparing it to anaesthesia or ‘putting to sleep’ pet dogs and cats, and focusing on the probably lack of pain. But Kim Leadbetter is trying to introduce assisted suicide, and specifically excludes euthanasia in her bill.
The difference is important but I donāt see how it impacts the choice of drugs used.
Not true re vets. In the last three years I have had to have two dogs put down. In each case it was an horrific procedure. In one the vet tried to get the canule into all 4 legs. Before he managed the dog was screaming in pain. In the other, similarly, the vetās assistant insisted on stretching out the paw of a dog which was in severe arthritic pain causing it even more pain.
Any anesthesiologist can tell you how patients should be put into deep sleep, with the inability to breathe, and on top of that, what substances should be injected to stop the heart. That it is handled so frenetically in the USA is a shortcoming, from which many people will suffer. It is purely a lack of legal options.
oh really? And the whole Covid fiasco wasnāt?
I remember when pharmaceutical companies had to pay to experiment on people, now the NHS pays them!
What an evil country this country has become since she gave up Christianity.
Did you ever hear about the 17th & 18th century witch trials, torture and murder, all.in the name of Christianity?