Raymond Tallis in the next issue of The New Humanist makes the case for assisted dying.
The case for a law to legalise the choice of physician-assisted dying for mentally competent people with terminal illness, who have expressed a settled wish to die, is very easily stated. Unbearable suffering, prolonged by medical care, and inflicted on a dying patient against their will, is an unequivocal evil. What’s more, the right to have your choices supported by others, to determine your own best interest, when you are of sound mind, is sovereign. And this is accepted by a steady 80-plus per cent of the UK population in successive surveys.
But the UK population still can’t have it, because god. But the goddists try to hide the god part, so that they can win.
Only four of the known 30 member organisations of Care Not Killing are non-religious. So much for “a broad coalition”. Dr Peter Saunders, CEO of the Christian Medical Fellowship and Campaign Director of Care Not Killing, made the strategy clear:
“As Christian doctors we oppose euthanasia and assisted suicide because we believe in the sanctity of human life made in the image of God … But to win the debate on assisted dying we need to be using arguments that will make sense to those who do not share our Christian beliefs … Christian doctors need to play a key role in this debate; and they will do so most effectively by learning to put what are essentially Christian arguments in secular language.”
In other words, we christians want to bully everyone, so we’ll hide our christianness to fool people into thinking we have secular reasons so that they will let us bully them into doing what we want-because-god.
Most faith-based opponents of assisted dying, therefore, conceal their real reasons behind arguments intended to instil fear of the consequences of legalisation – mobilising factoids that do not withstand scrutiny as part of the “strictly evidence-based approach” referred to by Living and Dying Well.
He ends with the horrible death of Ann McPherson – a doctor and the wife and mother of doctors – who had wanted and campaigned for choice in dying but didn’t get it.
The end came at last, after three endless, unbearable weeks of unremitting suffering:
“Even as she died, her body seemed furious with its final fight, gasping to the end, and in a desperate haunting shudder I found myself sitting in pools of expelled fluid. That was not what she wanted. Mum had seen this happen before and wanted to avoid it, for future patients and their families.”
Thus the testimony (much abbreviated) of a loving daughter.
Because of the fancy footwork of those who have beliefs I do not share, this is a fate that could await me or those I love. A small but vocal group, prepared to bear other people’s suffering heroically for the sake of God, must not be allowed to impose their views on the rest of the medical profession, and through them on society as a whole. Opponents of change make a lot of noise – it’s time that the relatively silent majority made more.
Christians, if you don’t like assisted suicide, then don’t use it. But keep your grubby paws away from the rest of us who don’t share your love of pain and suffering.
For the most part the only secular argument against assisted dying is the slippery slope, i.e., before long we’ll be killing people against their will, or assisting the death of those with minor illnesses or minor disabilities.
This is a bad argument, of course (Oregon’s example shows why), but unfortunately it can inspire fear in those who are uninformed.
So, Charles Sullivan, we inform them.
I have been for assisted suicide since I listened to my father die in 1952. It is only in the last 20 years or so that I realise how traumatised I was by that and how many later problems tie into it.
If y’all haven’t made it over to Eric MacDonald’s blog — Choice in Dying — you should remedy that situation.
http://choiceindying.com/
I have the horrible feeling that some of the “religious” are hoping that the terrors of a painful and prolonged death will convert the dying at the last moment, on the “no atheists in foxholes” principle. Someone should ask them, not that they’d give an honest answer.
If these religious people believe in immortality of the soul, then who cares about squeezing a few more weeks or months of machine-assisted life?
If the person is dying and they know there is no chance for recovery, why not make their last days pain-free or just speed up the inevitable. The only reason is the belief that only god decides the exact moment when someone dies. It’s inhumane to let people suffer, but who cares. God decides when you die, no matter what.
maureen.brian, I’m so sorry about your father. My dad was given morphine to be administered at home when the doctors knew it was just a matter of time, but it a very small amount for pain.
Thanks, callistacat. When my dad died suicide itself was illegal. The morphine had to be administered by the doctor and was never enough to completely kill the pain.
When my partner died 30-odd years later he was put on a morphine pump. We had a chat, he knew it was terminal and said he had struggled enough. I didn’t argue, he pressed the blue button a few times and slipped away in peace.
All we are asking, in truth, is that people who cannot press blue buttons should have the same human rights as those who can.
No-one I know is planning to force this upon the religidots.
Nearly 60 years ago I was born and raised in a large family that lost faith generations ago (way back into the 19th century). I think I had only one aunt (out of 20 or so uncles and aunts) who was religious for some time. Religion never was an issue at all in my upbringing. I am not afraid to die, never was and never will be. Although you never know when it will happen, for as long as I can remember I have always wanted to choose the time of my own death. I have always wanted to do it myself and I want to be fully conscious. I am curious and dying only happens once in your lifetime and I want to fully experience it. Do not make the mistake of thinking that I am suicidal. I love life and I will live as long as I can.
Way back in 1978 my dad was terminally ill (cancer). He was taken care off by my mom, my grandmother, my sister, her husband, my wife to be and me. He was at home and he wanted to die there. The last few days he was so ill that the doctor wanted to take him to hospital. When the doctor said that I looked at him in agony, for it was certain my dad would die within a few days. I told the doctor I was not going to allow it. So I asked the doctor if he could help my dad dying at home. The doctor said no. So I asked the doctor if my dad was in pain. The doctor said he didn’t know (my dad was unconscious most of the time and couldn’t speak anymore). So I asked the doctor to provide me with very strong painkillers to make sure my dad didn’t feel pain. The doctor looked at me (he knew what I was going to do) and he nodded and provided me with very strong painkillers, way more then was needed. After the doctor left I started to give my dad 6 times the maximum dose and a couple of hours later another 6 times. My dad died peacefully and with dignity at his home in his own bed at age 53, surrounded by the people he loved most. We all held him tight the moment he died.
Luckily there are doctors now who can and will help people in the situation my dad was in and when following protocol (there must always be a 2d opinion from another doctor) they are also legally protected. This also means it no longer depends on relatives or friends to give the lethal dose. Doctors provide the means and if necessary do it. Since euthanasia is allowed in the Netherlands less and less people use it. The euthanasia numbers in the Netherlands are among the lowest in the western world.
I wonder what a religious person would have done in my situation. Disrespect his/her father’s wish and let him die in hospital? Maybe without dignity and maybe not in the presence of his loved ones?
So, what is it that the 80% find so convincing in the secularized versions of the otherwise unconvincing religious arguments that they somehow go against their own wishes when electing legislators and lobbying/social movements/campaigning?
I appreciate people sharing their personal stories on this topic; however, I think the main premise of this blog post is inaccurate:
“Unbearable suffering, prolonged by medical care, and inflicted on a dying patient against their will, is an unequivocal evil”.
This seems to imply that euthanasia laws are required for physicians to discontinue life-prolonging measures when this is not the case. Furthermore, physicians can legally and ethically administer analgesics (e.g. morphine) for pain control at the end of life even if this exceeds “safe” limits and may hasten the patient’s death, provided that the actual goal is pain control. This is known, I think, as the principle of double effect. All of this is already common practice in countries where physician-assisted suicide is illegal. The quote above from Raymond Tallis is much too black-and-white and seems to confuse the difference between suicide and withdrawal of care. I think the taking of a human life, in any situation, deserves more reflection than he has provided.
A second point is that palliative care has improved dramatically in the last 2 or 3 decades and continues to improve. With good palliative care, symptoms at the end of life can be well-controlled. Society may be better served at increasing and improving these services further. These issues are extremely relevant as the majority of people in industrialized countries will die of a disease that has been diagnosed by a physician long before it actually kills them. Meaning, most of us and our loved ones will be “terminally ill” one day. Regardless of whether or not assisted-suicide is legalized, it isn’t sufficient care for the dying. It’s worth remembering that, at most, a very small proportion of people with terminal illness would choose to ask for assisted-suicide. I worry that the legalization of assisted-suicide could lead to a devaluing of other solutions to the problem of end-of-life suffering. Not a sufficient reason to keep it illegal, I realize, but still a point worth making.
It may be that in Britain most of the political opposition to assisted-suicide is religious in nature. I agree that religious principles shouldn’t guide legal/political decisions. Physician-assisted suicide, however, is a much more nuanced issue than just religious people imposing their views on everyone else.
You can’t swing from asserting that a plain statement is “inaccurate” to discussing what you think it “seems to imply” and expect thoughtful people to take you seriously. When you then go on to assert what people “would choose to ask for” without any evidence except your own version of the slippery-slope argument already stated above, you reveal that you haven’t really paid attention to anything except your own prejudices.
There are obvious and necessary distinctions between being in “unbearable suffering” and just being nearly dead, and nobody here is saying different. Some might say that anyone who is nearly dead has the right to decide when and how to check out. They might also say that, suffering or no, it was one of the jobs of a humane medical system to support those choices. Those are things one can discuss. What you said isn’t.
It’s this Raymond Tallis you are talking about, isn’t it, MDSkeptic?
“Raymond C. Tallis F.Med.Sci., F.R.C.P., F.R.S.A. (born 1946 in Liverpool) is a British philosopher, secular humanist, poet, novelist, cultural critic and retired medical doctor. Specializing in geriatrics, Tallis served on several UK commissions on medical care of the aged and was an editor or major contributor to two key textbooks in the field, The Clinical Neurology of Old Age and Textbook of Geriatric Medicine and Gerontology.” (from his Wikipedia page)
When, in the middle of the last century, medical technology and pharmaceuticals took an exponential leap forward the training of doctors lagged and lagged badly. Hospitals had many of the gadgets we take for granted but the physicians of the generation which trained Tallis were still thinking mid-nineteenth-century – that they only test of whether they were any use was whether the patient was still alive.
They passed those ideas on to trainee doctors, to the extent that patients were sometimes at the mercy of people who regarded a technical “win” – with accompanying distress – as over-riding the injunction to “do no harm.”
Some, like Tallis, worked to get to grips with this mis-match. Others rely upon cliches like the slippery slope or the ridiculous notion that palliative care will always have the answer – even when that answer is not what the patient chooses.
Just to maybe clarify my point. Withdrawal of care & euthanasia are vastly different concepts and are issues that need to be discussed separately. Withdrawing care is both already legal and not controversial I maybe worded that poorly, but Maureen you seem to have missed that point. The quote from Dr. Tallis also blurs that line, in my opinion. That is what I meant by inaccurate. With regards to the rest of your post, Maureen, what do you think I meant by improved palliative care? There was and still are times in medicine when our technology is overused, it’s just not the same thing as whether or not doctors should kill their patients. Also, there was never a time when “the only test of whether they were any use was whether the patient was still alive”.
The number of patients who choose physician-assisted-suicide is very small. This comes from examples of Oregon and Holland. Official statistics are available if anyone is interested. The point being that legalized euthanasia would comprise at most a very small component of the total end-of-life care which should be provided. If euthanasia is legalized, people should at the same time focus on other ways to reduce suffering.
I wasn’t even arguing against euthanasia, just for a more accurate distinction between discontinuing treatments and actively killing patients. I know physicians and bioethicists who oppose euthanasia and these people are neither religious or “unquestionably evil”, nor do they unnecessarily prolong suffering. I think in this case, Dr. Tallis and some of the comments should have been more nuanced.
The number of patients who choose physician-assisted-suicide is very small.
Which is a good sign that it’s not abused, right?
It has been said many many times by many many people that just knowing it’s an option is an enormous relief, and help.
If Eric MacDonald’s wife Elisabeth had had it as an option she would have been able to wait longer. She didn’t, and she was unwilling to risk being unable to make the trip to Switzerland.
Ophelia,
Yes, basically I agree that abuse is not a major problem in practice (with appropriate safeguards & careful application, like Oregon, for example). In my opinion, the potential for abuse is an argument for very careful implementation and periodic re-examination of euthanasia laws, not an outright ban on the practice. I suspect that most people here would agree with that. It’s worth noting that amongst the countries that have legalized euthanasia or PAS, there are different legal and ethical interpretations about what is allowed.
Also, good point that some people living in places where euthanasia is illegal will travel to have this option. Paradoxically, they may end their lives quicker than they would have if it was legal locally. I’m not very familiar with the two people you mentioned, but do know of others who have made similar decisions. The sense of loss-of-control is a common reason for patients to request euthanasia. It’s actually a much more common reason than pain in surveys on the topic.
One reason patients sometimes choose euthanasia that I find troubling is caregiver burden. The literature is unclear regarding how significant a factor this really is. However, I think it warrants further research. Hospice and home-care services are probably better solutions to this specific concern. Especially in the era of cost control in medicine, legalizing euthanasia without also providing alternatives raises some ethical concerns.
End-of-life care is something I consider important. Really, I wanted to point out that there is room for reasonable people to disagree and euthanasia, if legalized, is still not a sufficient answer to alleviating the suffering of the dying. I was actually trying to phrase my arguments in a way that wasn’t intended to change anyone’s mind, just to encourage a bit more nuance in the discussion (admittedly, maybe I wasn’t successful).
MDSkeptic #16
So what’s the point of prolonging a life “not worth living”? Heroic efforts will keep a patient still able to feel pain and be incontinent but what’s the point in that?
MDSkeptic,
Could you clear this up for me?
The thing you are afraid of is that palliative care for the elderly would weaken as a result of legalizing euthanasia (because it would be cheaper to just “encourage” people to die instead of properly taking care of them)?
At least that’s what I’m getting from you. In theory, that sounds like a valid concern, but my impression of countries where euthanasia is already legal was that it’s a part of an excellent system of palliative care. It’s just another option for the patient.
MDSkeptic,
I am not entirely clear exactly what you, personally, mean by withdrawal of care. The phrase is open to too broad an interpretation.
For one person it might mean – a touch of hyperbole coming up but live with it – the arrogant surgeon who says, “If you will not allow me to operate for the 27th time with a 15% chance it will give you an extra week, then I wash my hands of you and will discharge you without a care plan or even contacting your family to ensure that they can cope.”
It might mean the nightmare home for the elderly which, knowing that Ms G will be dead within a week, decides not to waste its limited nursing resources on her but takes bets in the tea room on whether her dementia, her cancer or her pressure sores will actually take her. As I said, hyperbole but neither scenario is beyond imagination or beyond experience.
I hope that what you mean is what I would mean, that the patient and the oncologist – in that order – agree that there should be no more surgery, no more chemo and no attempt to resuscitate if the heart fails. After which the discussion turns to where the patient would prefer to die, how much nursing care the family can manage and exactly what outside help will be needed. All perfectly civilised and as it should be.
It has been my experience that the burden on the caregiver argument is raised in this context by the opponents of PAS. I have never hear it raised when the caregiver is exhausted, ill, at her wits’ end but the patient is not expected to die any time soon. Besides we both know exactly what the answer is – more and better nursing care and carer support delivered in good time and according to need.
I have nothing against palliative care but I do wish it could be available to everyone who needs it. I do not like to see the possibility of it held over the head of someone who is of sound mind, has decided he would prefer to die and asks for a little help with the process. Such a person should not be subject to moral blackmail and no-one on this planet owes any doubter even an hour of pain or distress.
This has all been going on too long. We need to set our worry that the wrong decision might be made in a few cases against the number of people who, in the meantime, have died of neglect or for lack of resources. Perhaps someone should do a study.
“This seems to imply that euthanasia laws are required for physicians to discontinue life-prolonging measures when this is not the case. Furthermore, physicians can legally and ethically administer analgesics (e.g. morphine) for pain control at the end of life even if this exceeds “safe” limits and may hasten the patient’s death, provided that the actual goal is pain control. This is known, I think, as the principle of double effect. All of this is already common practice in countries where physician-assisted suicide is illegal.”
This may be the case in the UK, I don’t know, but in the most of the drug-phobic USA patients, whether terminal or not, are frequently under-medicated because physicians are reluctant to administer enough painkiller for fear of prosecution. As for putting a patient on a self-administering morphine pump – dream on! Over here we’re deathly afraid those terminal patients could wind up addicted, even if dead.
Beatrice,
Not exactly. My problem here was the characterization of those who oppose euthanasia as unequivocally evil. I just meant to provide an example of one of the types of concerns raised by those who opposed the legalization of euthanasia to show that these aren’t all religious zealots who don’t care about the suffering of others. You could conclude that the arguments in favour of euthanasia outweigh those against it and I wouldn’t have a problem with that. There isn’t a consensus amongst physicians, lawyers, or ethicists. Even amongst those who support euthanasia or PAS there are significant differences of opinion. For example, compare the laws in Oregon and Holland.
Maureen,
Yes I think you understood what I meant by withdrawal. An example of withdrawing care in a way that is ethical would be someone on dialysis discussing her care with her doctors and choosing to stop treatment. Aterwards, a physician would still have a duty to care for this person by, for example, treating symptoms of pain even though prolonging her life is no longer the goal. This type of decision is considered ethical (and legal) even by those opposed to euthanasia. Most ethicists and physicians distinguish between withholding or stopping treatment thereby allowing death to occur (where consensus exists) and actively causing the death of someone.
I’m not sure what you mean by moral blackmail, though. People have done studies on these issues, but I agree more research and discussion would help.
MDSkeptic,
I’m glad you would mean that and was not trying to knock you at all!
Would you agree, though, that anecdotal evidence backed up by formal inquiries into medical disasters suggest that which doctor you get and how well he copes with all this is very much a lottery? There’s also the recurring problem of money which can lead in some cases to accountants in fact making clinical decisions when they leave the professionals without options or without the resources needed.
One for your thinking pot, as I think you are more likely to be consulted than I. As I sit here I have the power to decide to kill myself. The law permits it. I am the captain of my ship, as it were.
The thing is, I have already had one stroke. Yes, I recovered and medication is keeping me in pretty good condition. Suppose, though, I have another stroke and that leaves me in a condition similar to Tony Nicklinson. Now I seem to have lost that right. But to whom did I lose it, under what power and who, now, is taking responsibility for my total well-being? And not simply for my continuing to breathe? (A very narrow definition of alive!)
I have a simple soundbite that should convince even the most ardent fascist anti-choicer.
“Prevent terminally ill suicide bombers: Legalise Assisted Dying!!!”