The right to die?

Euthanasia and doctor assisted suicide are huge topics for one little blog post so this will not be in depth.  What I hope to do instead is share a few facts, figures, anecdotes, opinions and my own personal feelings on the matter.

This can be a very sensitive subject and whilst I invite comments on my blog, I would ask that you bear in mind that I, and other commenters, are people and we are entitled to our views on this and I’d ask that you use your words kindly.  Disagree but don’t fight.

For me, the key issue is the paradox of being physically disabled and mentally ill.  I have been suicidal many times in my life due to mental illness and obviously it is complicated but for me, suicide is a safety net, a way out if things get really bad.  If it wasn’t for my limitations due to my physical disability, I would still have the choice to kill myself.  Being physically unable to kill myself takes away an option I have always had.

Euthanasia does not exist in isolation, it is part of a spectrum around end of life issues:

  • Do Not Resucitate orders
  • Advanced Directives – documents written by the individual to make their wishes for care clear in the case that they are no longer able to speak for themselves
  • Withdrawing treatment
  • Refusing food and drink
  • Assisted suicide – self adminstration of doctor prescribed medication
  • Voluntary euthanasia – most usually an injection but the key is that it is directly carried out by a doctor
  • Non-voluntary euthanasia – where the patient’s consent is unavailable, illegal in all countries
  • Involuntary euthanasia – without asking consent or against the patient’s will, in most cases this is considered murder

For the purpose of ease of writing and reading I am using assisted dying to encompass assisted suicide and voluntary euthanasia.

Let’s start by looking at a few of the concerns around assisted dying.  Like abortion, the choice to die debate appears to threaten the existence of disabled people, seems to suggest a life with a disability is not worth living and ignores the social context around disability and illness.  There is also a concern that focus and money spent on assisted dying will be taken away from improving end of life care and those things which increase quality of life.

However, it is important that disability itself is not considered enough to qualify for assisted dying.  And this is clear in the legislation which currently exists.  Most of this focuses on unbearable suffering, terminal illness and incurable illness.  The concept of unbearable suffering is one in which the patient has to determine when that level is reached.  So whilst disabled people may chose assisted dying because of their disability, it is not enough to be disabled.  This is essential as part of any safeguarding criteria, as is patient consent.

Associated with this is the concern that if assisted dying is allowed then it will make it easier for legislation which allows for killing disabled babies or people with severe disabilities, that is to say non-voluntary or involuntary euthanasia.  Evidence from Oregon, who’ve had access to assisted dying for over 20 years, shows that fears around slippery slopes and other risks are unfounded.

Another worry is pressure to “choose” assisted dying.  This does feel like a very relevant discussion point at this time when Trump is destroying medical care for many disabled people in America.  Without medical and social care and support, disabled people will suffer reduced quality of life and are also strongly receiving the message from the government that they are not valued citizens.  Internalised oppression and ideas about disability can also pressure people.  These might include feeling like a burden, feeling like you are financially draining your family and feeling like you can’t contribute to society.

I don’t really have a counter argument for that but I do think it must be part of any safeguarding procedures and it feels really important to gather evidence about the reasons why people choose assisted dying.  This is already the case in many parts of the world which allow this choice and it is imperative that this data is collated and reviewed and action taken if key social factors are identified as pressuring decisions.

Where assisted dying is legal, there are tight criteria around who is able to access these options and this is a crucial aspect of safeguarding when it comes to assisting a person to die.  These include a cooling off period, multiple medical practitioners, being able to stop at any point and there being a waiting period for those people who have just become ill or impaired.

As we saw with abortion, it is possible to advocate for assisted dying for those who wish to seek it whilst also valuing disabled people’s lives.

A key issue for me is around the option of assisted dying playing a role in prolonging people’s lives.  It’s not as contrary as it sounds!

Annie Lindsell, who challenged the law on voluntary euthanasia, explained that unless she had the reassurance of being given help to die, she would have to do so whilst she was still able without help.  Thus her life would be shortened.

By 2014, over 200 British people had made the journey to Switzerland to end their life.  This takes them away from family and friends, means they have to end their life earlier whilst they are still able to travel and there is a financial cost as well – the cost of the service as well as travel and accommodation.  For many people, this will not be an option they can afford.  This leaves them with three options; continuing to suffer, attempting suicide alone, attempting suicide with someone’s help.  The last two of these come with risks of unsuccessful suicide attempts and the health issues that can come with that.  The last comes with the additional risk of the assisting person being prosecuted.  This also adds a layer of discrimination – only those who have enough money can choose a dignified death.

The evidence from places like Oregon shows that although a majority of people want access to assisted dying, most will not use it.  The comfort of having the option is itself enough to ease anxiety and some of the suffering.  Indeed, I think it’s only about half of the people who get the medication or the go ahead for assisted dying do not follow through.  They live with the knowledge that they have a way out and this can be incredibly freeing.  Indeed, one study reports that pain, depression, anxiety and fear of dying were higher in those who had not requested assisted dying.

Finally I would like to pose an area of assisted dying that a lot of people would agree is ethically sound.

“As he lay comatose on his deathbed in 1936 George V was injected with fatal doses of morphine and cocaine to assure him a painless death” – Jo Cartwright

There is a great chapter in the book Assisted Dying by Reverend John Cartwright about his view on faith and assisted dying.  In this he says “My conclusion is that God approves of helping people to die when the person being helped is near to death, is in great distress and their death is the unavoidable consequence of trying to alleviate pain.”

This introduces us nicely to the Doctrine of Double Effect, the practice that aided George V’s death.  The idea that if a dying person is in pain, it is ethical to provide pain relief at levels which are known to increase the risk of death.  The assumption in these situations is that relief is preferable to a longer, painful life.  It’s obviously a lot more complicated and nuanced but that’s the basics.  From the perspective of God, he suggests that a benevolent God would not wish to prolong the suffering of someone who is inevitably going to die very soon anyway.  This then asks, if the doctrine of double effect is considered ok, what implications does that have on the ethics of assisted death?  Are we to punish people in severe levels of pain, who wish to die, because they are not yet close enough to death?

We expect autonomy in every other part of our life so why can’t we expect it in our death?

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