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October 21, 2021 - 1:00pm
The calls of the ‘assisted dying’ lobby for legalisation often make it sound like a well-established, evidence-based healthcare intervention. It is not.
Baroness Meacher’s current Assisted Dying Bill, heading to the Lords tomorrow for a second reading, proposes broad ‘safeguards’ for assisted suicide. But there is a worrying lack of evidence that they are effective or verifiable. For one, increasing evidence in jurisdictions where physician-assisted suicide is legal shows that palliative care services are being detrimentally impacted. Physicians have reported that patients are hesitant to enrol in palliative care and hospice services for fear that they promote euthanasia. Based on the concerns of patients and practitioners, some hospice facilities in Canada have refused to incorporate the practice within the scope of their services.
These hospices have had their statutory funding threatened or withdrawn. Reports have suggested that ‘medical assistance in dying’ may reduce Canada’s annual health care bill by up to $138.8 million. This sends a worrying message that assisted suicide is an economic practice and is preferable to investing in palliative care; inevitably this would increase pressure on those in our society who already feel they are a burden.
Patients who request assisted suicide often experience significant mental health difficulties and may be at a higher risk of coercion and abuse. Of the patients who received assistance in dying in Oregon in 2020, 53% reported “feeling like a burden on their families, friends or caregivers” as an end-of-life concern. While another study found that one in six patients who received a prescription for lethal medication met the criteria for a diagnosis of depression. Yet fewer and fewer patients in Oregon are being referred for psychiatric assessment, demonstrating the weakness of safeguards in legislation to protect the most vulnerable.
Of concern is that the proposed eligibility criteria for assisted suicide are elusive and vague. They also provide no reliable safeguards against abuse. First, ‘mental capacity’ is a deceptively simple concept; clinical assessment of capacity is complex and influenced by the individual experiences of assessing doctors. Indeed, several legislatures have expanded eligibility criteria to include people without decision-making capacity.
Secondly, prognostication is notoriously inaccurate; we get it wrong over hours and days, let alone months. The proposition of a six-month prognosis is no better than a guess, potentially inaccurate by years. Finally, the combinations of drugs in high doses used to achieve assisted suicide have not been submitted to scientific scrutiny. The scant available evidence on how people die after ingesting these lethal drugs suggests that they can cause unpleasant symptoms and that death is not necessarily immediate or certain, reportedly taking up to four days.
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SubscribeAs a consultant in palliative medicine you have a vested interest in the status quo. Assisted dying, as specified in the bill, is targeted at those with a diagnosis of a terminal illness who are in the last months of their lives and want the option to die without excessive suffering when the time comes. Some say that just knowing they can ask for release is comforting enough, even if they never request the prescription drugs that will kill them. The bill does not seek to establish a right to ‘assisted suicide’ aimed at physically fit people who happen to have mental health issues. Depression however can accompany a painful terminal illness.
It’s strange that Dignitas manages to dispense effective drugs without the drama of a lingering death that you describe. Maybe you should look at how they do it. I read a very long article describing the process in detail (can’t remember where) and it seemed full of safeguards. The patient takes the drugs without assistance after being recorded on video giving express consent. The ‘assistance’ requested is the agreement of doctors that there is no hope of recovery, and the writing of the prescription. Thereafter the patient is cared for by a nurse.
Nobody is asking you to break the Hippocratic oath and if you don’t wish to be involved nobody can force you. However please don’t use your professional status to deny those patients who want it the choice of having assistance at the end of their own life to end their suffering sooner than you would choose in their place.
“Nobody is asking you to break the Hippocratic oath and if you don’t wish to be involved nobody can force you.”
They can and they will. Lets look at the Hippocratic oath, one Wokeists have long since gutted:
“Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion.”
A great many places require doctors to break these rules. Now abortion is labeled a human right the insane run the asylum. No one can predict where society goes. (I assume a AI/Virtual Reality Metaverse implants, with elective recreational drugs, a life alone in one’s bedsit with your sex/Partner doll – till even that is not enough, and so the call to Digitalis, and finally the machines unplugged and your room made ready for the next one.)
Galeti perchance do you hail from texas and have reincarnated on Unherd ?? If so welcome back !
Julia, I think you should weigh in on Mary Harrington’s article on assisted dying too….
Well said. The medical profession has a vested interested in keeping à person alive to maximize their income without regard of the suffering of the individual. Of course they will deny that.
Or they may be perfectly rational, and making a reasoned judgement about the pain and futility of extending their life any further. Is it for you or for me to deny them?
Absolutely …
”53% feeling like a burden on their families, friends or caregivers”
This is a perfectly rational conclusion to reach for many, and an entirely acceptable additional reason to (unselfishly) decide to call time on your own life when your existence is painful and only going in one direction.
I don’t understand why so many people fail to acknowledge how reasonable this viewpoint is … maybe they lack the empathetic capabilities to understand how anyone can (happily and rationally) put consideration/love for their families at the top of their priorities.
it is annoying, these old Grannies keeping the housing tied up and stopping the young from getting on the property ladder…..finally a law which will help reconcile this injustice…..
The whole “life at all costs’ is such a juvenile attitude to death – as if people just cannot accept that ALL HUMANS WILL DIE !
“a reasoned judgement about the pain and futility of extending their life any further. Is it for you or for me to deny them?”
Before the Utilitarian Post Modernists took over intellectualism there was reason to deny them, or not assist anyway.
Once it was agreed that humans had a soul, that there was some ultimate – past the merely mechanical living chemical processes.
Now life is as death, Nihil, nothing….Karma, soul, Are Gone from modern consciousness, but that does not mean they are gone from reality or existence.
But if there is an ultimate (that which supersedes the Mundane) then we need to recon our life before the end. We all do harm to others in life, we all fail in duty, obligation, and charity, and at the end of life we have the chance to be reconciled, to make amends, or merely to acknowledge ones failings, and so to Karmically move forward. Once dead this is finished. If we died to escape pain maybe it was our lot to have endured it, maybe it is our atonement, or our chance to get through things and accept our life’s choices – and to FORGIVE others for their harms to us.
I do not know we have the right to euthanize any but the most egregious physical tormented, because humans have Karma they may need to work through – Just as I know we should not be aborting healthy babies for lifestyle reasons – because there is some sanctity in human life. The philosophical basis of Western thinking, pre Christianity, agrees – the Hippocratic oath states:
“Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion.”
for good reason, philosophical reason…
If you were sitting at the bedside of someone dying in pain, would you say ‘maybe it is your lot to endure it, or maybe it’s your atonement’?
So why keep the most monstrous prisoners alive instead of the reasonable execution? Why is their life so important to you?
Will you have free euthanasia in the Prison system too????????????????????????
I kept my very old father in my home till he died – although we actually killed him, legally. They leave morphine with the carers for when breathing becomes to painful for the dieing – and when you think it is time you give it to them which stops the pain of the need to keep breathing, and they stop, and die.
I have no worries of euthanasia for the mortally dieing – but this law, and this drive, is all about slippery slopes, about quality of life euthanasia. It will be abused – supposedly for compassion – but life/death is more complex – and exceedingly individual, no one size fits all.
Personally I have the means to kill myself, and likely will when I find it time, but would not allow myself that luxury when I find that I am just sick of it – I was set down here on earth, no one knows why, but I was, and I assume life is something I must live, for that same reason; no one knows why.
Life is not much pleasure to me anymore – I have seen too much suffering, too much….. in all manner of things and people, that I just do not really care for it. I do understand beauty – I have seen more of it than 99%, that is my great appreciation – and I have seen Amazing decency, love compassion, creativity, nobility, intellectualism – and those justify all the natural suffering… but I still am too bothered by the suffering I have seen to be really happy….
I live in one of nature’s beauty spots, on the water, in the woods, with vast room, no neighbors, yet on the edge of a town, with dogs, gardens, chickens, family scattered in corteges around me. I have money, lots of work if I care, a beach cottage, I can be in London all I want, but life has kind of just worn me down, I have just seen to much of it, been to too many places and too many situations, and seen too much misery…
But I will carry on to the end…. spoiled I guess. Now I am going fishing – the thing I like best, being in nature so absolutely as that (I lived many years in the remote bush). I semi commercial fish almost daily ( I have held a commercial fishing license in several states, and for many years). My family does not eat red meat, and we eat fish most days – and I give it to other people who like some fresh, ecologically soundly caught, fish. My 96 year old mother who lives with me is in hospital for 2 days with mild pneumonia and her amazingly great carers my mother asked if they would like some fresh caught fish (I fillet them) and they said yes – so I am off to catch fish for 4 people. (Fresh, caught that day, and filleted right away – is so much better than bought – very much better)
I have seen a very great amount of life, I have spent most of my life traveling about and seeing life and people in weird places and cultures – and thus my ideas on life are more complex, as I have seen so very much outside the normal way people live, …..
There is a subtle conflict in philosophy (and perhaps some perceived professional competition) between some some palliative care physicians and some physicians who participate in providing medical assistance in dying (MAiD). Up to a point, these medical interventions are mutually exclusive. But again, a patient can choose which medical treatment they want, at what stage of the deterioration of their health.
I don’t know whether the UK Bill will become law, either as drafted or as amended, but there seems to be a growing international recognition that it is not the role of government to compel a person who has the mental capacity to consent to MAiD to continue living with what is to that person intolerable suffering. The slogan in Canada has been “My death, my choice.”
One important philosophical question, therefore, is setting the appropriate balance between state control and private personal agency in circumstances of intolerable suffering near, or in anticipation of your death.
I find Simon Jenkins’ arguments more convincing https://www.theguardian.com/commentisfree/2021/oct/21/britons-assisted-dying-legalised-mps-lords-commons-choice?CMP=Share_AndroidApp_Other
Why is assisted dying restricted to the terminally ill? A person with a chronic and painful condition that is not life-threatening might also want to exit a life of pain.
Canada’s law was recently amended so that death need not be reasonably foreseeable through a terminal illness. Canada has a parliamentary committee studying advance requests from people suffering from Alzheimer’s who fear loss of the ability to provide informed consent at later stages. There has not been a flood of applications for medical assistance in dying, it remains a rarity.
They’re eliminating Down’s children in the womb because of the potential suffering and expense they create. Yet the parents of Down’s children who have been born are against this.
People abuse rules, and these assisted dying rules will be abused against the vulnerable. If you ain’t vulnerable, then sort it out for yourself – it’s not difficult.
Life/death/suffering these are the things I always spent much of my time thinking of. At a very early age I set off alone for many years on solitary travel, broke and just living rough, and that way I saw life in the harder side – life where society is not buffering misery by wealth.
I have ssn a lot of good and evil – and I do not mind people being killed much – I would have the violent criminals executed. I would have the wars fought along Powells lines – use every method, tolerate large collateral losses, tolerate your own losses, kill and destroy the enemy as best and as hard as you can. Because winning fast means quicker rebuild, and thus MUCH less aggregate suffering.
I am a student of Military History – death is not something I am fastidious about. Suffering is my problem – I want that to be minimized, but not to the expense of causing greater suffering down the line.
Covid response! I would let the Herd Immunity happen naturally. THEN the recovery will be short and less destructive in the end. People take their chances, that is tolerable when compaied to breaking society to save a small percent.
But then there is Karma and soul. I have seen too much to disregard their truth. That is the problem with this euthanasia. I do not mind their death, but the karma they need to resolve – and the karma of those who help the process of deciding and influencing, and doing….