Triggering: Doctor-assisted suicide

[MsNobleEleanor]

This can be a very sensitive topic so please be respectful of others opinions and views.

So, in Canada the Supreme Court is looking to pass a bill for doctors to help patients in assisted suicide under certain conditions.

Awhile back in B.C (British Columbia) someone wanted her doctor to help her die because of her terminal illness which caused her a lot of pain. Since, lawyers and others brought to the Parliament of Canada to allow doctors to assist with suicide for patients. It was set as high importance for the Supreme Court and in this article it talks more about it, in depth.

I am very happy about this, I am glad Canada is doing this. Another step forward for us Canadians and our rights.

[Not_here]

While I'm an advocate of rights and freedom, I'm a little ambivalent when it comes to this topic. I stumble because I believe it should be legal whole heartedly but if it was someone I cared about I would find myself trying to talk them out of it. As much as I believe in freedom of choice I would not be so easily accepting if it was someone who told me their plan for it. I would treat it as a suicide for any other reason. But if it were me I would be angry if someone is pushing me to not do something. Maybe it is a human fault in me but I won't let myself just be like okay cool about it.
As for governments controlling that choice, that I'm against.
In that regard it should be legal.
In the regard of a family deciding while a person is in coma and did not specifically ask for it, I would be against.
Because if they can't tell you, and the doctor just wants to do it for economical purposes (happened to someone I know) and they pressure the family then I'm against that.

[Coffee.]

This is great to hear! People have the right to be able to die iwth dignity, and if they're suffering and in pain from a terminal illness, they have the right to choose to not continue in pain.

[MWF]

Not gonna lie, I despise these laws.

[dr2005]

Much as I sympathise with the aims of the assisted suicide movement, and can understand the appeal of having that option, the following issues continue to bother me about it (and I've yet to receive a convincing response to them, so any comments would be welcome):

• Much is often said of the "right to die with dignity". But does this right actually exist? If so, what of the countless millions who die in traumatic accidents through no fault of their own (or others) and are deprived of a dignified death? Should their families be able to claim a violation of their right to die with dignity? If not, why not? Also, how does one define "dying with dignity" in the first place? The moment you start to suggest something as a "right", the more potential problems it seems to create. Given the realities of how people die in various parts of the world, it seems this "right" is somewhat selective in its application and so I question the merits of describing it as such.
• It's quite commonly acknowledged that serious pain or suffering can seriously impact upon a person's reasoning. False confessions are often obtained from interrogations involving torture owing to the effect of the pain, and likewise the threat of being put into such a position can cause a person's thought process to become irrational. Similarly, if an otherwise healthy person talks about committing suicide, we seek to talk them out of it and in serious cases it is used as evidence of mental health issues. With both of those in mind, why is it then seen as acceptable for a person who is suffering from a debilitating illness to express a wish to die and this not be challenged? Indeed, the Dignitas clinic only introduced assessments a couple of years ago, which suggests up to that point there was limited evaluation of whether this wish was reasonable.
• Given the patient will by definition be in a vulnerable position, and will be more aware of their limitations etc than would normally be the case, can effective safeguards be put in place to prevent people being coerced or compelled to pursue this course of action when they might not necessarily wish it? The issue still arises when people draft their wills, for example, or seek to amend them. Likewise, can we be sure that effective safeguards will exist to prevent doctors taking matters into their own hands, particularly if put under pressure to do so by others?

There are other issues I could raise as well, such as the potential impact on palliative care facilities, but for now I think that's a decent starting point. Suffice it to say, I feel the case for doctor-assisted suicide is (to borrow the Scottish legal term) "not proven".

[Celyn]

My main problem with this is that you have to be 'competent' as the article describes. For those with incurable, end stage dementia, they still have to suffer because they are not 'competent'.

I'm supportive of doctor assisted suicide, but I think there does need to be a criteria for being eligible for such a thing. For example, I don't think doctor assisted suicide should be an option for people who are depressed or are otherwise suffering from mental illness. I think it should be reserved for the terminally ill or those who have a documented illness with no prognosis of getting better that causes a lot of physical pain and possibly psychological anguish. I think the only exception to the "physical pain" rule should be dementia.

[Adam the Fish]

My dad has Multiple Sclerosis, and I've seen him suffer with it for a good few years. I've worked hard to empathise with that, because I think it's important when considering this sort of proposal. I am personally in favour of a safeguarded way for the painfully and terminally ill to die sooner and more peacefully than they otherwise would. One reason for this is my personal wish to give everyone as much freedom as is possible, obviously within reason ie. not impacting in a hugely negative way upon others. Personally, I would like to have the option of assisted dying available in case I develop anything similar to what my dad is going through. I'm not saying he should choose assisted dying, or at what point if he did, because that's entirely up to him. I'm just saying that I'd want to be able to make such a choice if I could.

Originally Posted by dr2005

Much as I sympathise with the aims of the assisted suicide movement, and can understand the appeal of having that option, the following issues continue to bother me about it (and I've yet to receive a convincing response to them, so any comments would be welcome):

Ask and ye shall receive...

Originally Posted by dr2005

• Much is often said of the "right to die with dignity". But does this right actually exist? If so, what of the countless millions who die in traumatic accidents through no fault of their own (or others) and are deprived of a dignified death? Should their families be able to claim a violation of their right to die with dignity? If not, why not? Also, how does one define "dying with dignity" in the first place? The moment you start to suggest something as a "right", the more potential problems it seems to create. Given the realities of how people die in various parts of the world, it seems this "right" is somewhat selective in its application and so I question the merits of describing it as such.

I don't know whether it would be appropriate to call it a right, since safeguarding would prevent everyone from accessing it at all times, which is kind of what a universal right needs to be.
Even so, I don't think that means we shouldn't have the option. There are many options to which we don't have a "right" per se, but they're available because they improve quality, including quality of life.
So, even if we did not provide assisted dying as a universal "right to a dignified death", I don't see a reason why the option of active euthanasia shouldn't be allowed. I can think of reasons why that would make people happier - peace of mind, reducing suffering, etc.

I also don't think we need a universal definition of what a "dignified" death is; the point in giving the option is that an individual thinks assisted dying would be more dignified, they can choose it. If you don't think it's dignified, there are other options (ie. palliative care) available to you.
The use of "dignity" in the campaigning is simply because those who are part of those organisations are campaigning for the option to die in a way that they collectively see as dignified (or moreso than options currently available).

Originally Posted by dr2005

• It's quite commonly acknowledged that serious pain or suffering can seriously impact upon a person's reasoning. False confessions are often obtained from interrogations involving torture owing to the effect of the pain, and likewise the threat of being put into such a position can cause a person's thought process to become irrational. Similarly, if an otherwise healthy person talks about committing suicide, we seek to talk them out of it and in serious cases it is used as evidence of mental health issues. With both of those in mind, why is it then seen as acceptable for a person who is suffering from a debilitating illness to express a wish to die and this not be challenged? Indeed, the Dignitas clinic only introduced assessments a couple of years ago, which suggests up to that point there was limited evaluation of whether this wish was reasonable.

I've already said that I'd want the option available were I to develop a condition similar to MS, and I can assure you that I've thought that through as rationally as ever. I don't see why one shouldn't consider the wish to end interminable pain early as rational, anyway. In the sort of situations you're talking about where people should be talked out of suicidal wishes, that is because the pain can be, for want of a better phrase, made to "go away" (albeit through a lot of hard work) and life be returning (roughly) to a normal standard. The difference, obviously, is that the sort of painkilling techniques (ie. very strong painkillers) required for the situations I'd suggest assisted dying for are really quite seriously detrimental to one's ability to live life anyway. They just prolong things with not a lot of responsiveness from the individual being treated, especially towards the end of life.

So, definitely have safeguards, but actually, the wish to end pain is a perfectly acceptable reason to want to end life, in my opinion. I'm no psychologist, but your example of choosing to give false confession after mental breakdown from torture would perhaps demonstrate a basic animalistic urge to end pain (eg. that inflicted by torture).

Originally Posted by dr2005

• Given the patient will by definition be in a vulnerable position, and will be more aware of their limitations etc than would normally be the case, can effective safeguards be put in place to prevent people being coerced or compelled to pursue this course of action when they might not necessarily wish it? The issue still arises when people draft their wills, for example, or seek to amend them. Likewise, can we be sure that effective safeguards will exist to prevent doctors taking matters into their own hands, particularly if put under pressure to do so by others?

As far as we know, in countries where assisted dying is already legalised, this has not been a problem with their safeguards. There's no reason to my mind why their safeguards could not be reproduced satisfactorily in the UK (etc.), with any extra thought put into this. I can't claim that it would be entirely effective, because I haven't tried coercing every single individual ever into assisted dying and then watched to see if the safeguards caught it. As far as anyone can tell, current systems have worked well to prevent this.

Additionally (and this responds to your second point as well), organisations like [the campaign for] Dignity in Dying already recommend "Advance Decisions". I've already demonstrated that it's possible to rationally decide that death would be preferable to treatment for some individuals (including me!) in some circumstances, so more people making these sorts of instructive documents (as would presumably happen if assisted dying were legalised) would act as a way of safeguarding in the first place. It would be easy for those judging the mental states of those people, because the decision would already have been made (of course, changing their mind would be possible!) - the difficulties you specify would only be for those who hadn't made a decision beforehand.
As I've said, there's no evidence to suggest that safeguarding for those people is ineffective in countries where assisted dying is legal.

Originally Posted by dr2005

There are other issues I could raise as well, such as the potential impact on palliative care facilities, but for now I think that's a decent starting point.

I would suggest an increase in investment for palliative care facilities, as a safeguard for assisted dying, to ensure people don't choose euthanasia just because specific palliative care facilities are too expensive or deemed unpleasant. I believe that there would be a positive impact on such facilities as a result of the legalisation of assisted dying (as I would, naturally...).

Originally Posted by dr2005

Suffice it to say, I feel the case for doctor-assisted suicide is (to borrow the Scottish legal term) "not proven".

You don't say?

I'm in favour of it, as you may have noticed - but I suspect the things I've said might have been suggested to you before, so I'd be interested to see why you haven't deemed them sufficient responses in the past.

[Maverick.]

If you want to die why even go to the doctor in the first place and spend all the money on services, and leave your family with the bill? Why waste time that could have been given to people who want the care and make the doctors do something they didn't go to school to do which was see their patients die.

But I think people should make whatever decisions they want to.

[RadioSerenade]

Benefits can come from life, even with any illnesses, injuries or others.

I was in hospital with infection for five days and what I experienced was Depression, no interest in the Foo Fighters and no appetite. Sometimes the physical can impair the emotional and in that regard, I make very little differentiation between this and someone who comes to us for assistance regarding suicidal thoughts.

I recommend that any doctor who assists someone with their suicide be stripped of their practising licence and prosecuted in the courts, and I recommend the laws be scrapped. I can't understand how a doctor could possibly do that.

[Proud90sKid]

Originally Posted by Maverick.

If you want to die why even go to the doctor in the first place and spend all the money on services, and leave your family with the bill? Why waste time that could have been given to people who want the care and make the doctors do something they didn't go to school to do which was see their patients die.

But I think people should make whatever decisions they want to.

Well if the person is going to die anyways- I don't see why this is such a big deal. It can be hard for a family to care for a terminally ill relative. They will have medical bills anyways to pay. It isn't selfish (in my opinion) to have your death prematurely induced.

[Proud90sKid]

Originally Posted by SeventySyndrome

Benefits can come from life, even with any illnesses, injuries or others.

I was in hospital with infection for five days and what I experienced was Depression, no interest in the Foo Fighters and no appetite. Sometimes the physical can impair the emotional and in that regard, I make very little differentiation between this and someone who comes to us for assistance regarding suicidal thoughts.

I recommend that any doctor who assists someone with their suicide be stripped of their practising licence and prosecuted in the courts, and I recommend the laws be scrapped. I can't understand how a doctor could possibly do that.

There is a big difference between someone with a fairly treatable mental condition that wants to commit suicide and someone with a terminal condition that they are almost certain to die a slow and very painful death from.

[dr2005]

Originally Posted by Adam the Fish

My dad has Multiple Sclerosis, and I've seen him suffer with it for a good few years. I've worked hard to empathise with that, because I think it's important when considering this sort of proposal. I am personally in favour of a safeguarded way for the painfully and terminally ill to die sooner and more peacefully than they otherwise would. One reason for this is my personal wish to give everyone as much freedom as is possible, obviously within reason ie. not impacting in a hugely negative way upon others. Personally, I would like to have the option of assisted dying available in case I develop anything similar to what my dad is going through. I'm not saying he should choose assisted dying, or at what point if he did, because that's entirely up to him. I'm just saying that I'd want to be able to make such a choice if I could.

Much as I understand, and sympathise with, the position you are coming from, I would caution against basing any thought process about the acceptability or otherwise of a course of action such as doctor-assisted suicide on personal circumstances.There is an inherent conflict of interest at play.

Originally Posted by Adam the Fish

I don't know whether it would be appropriate to call it a right, since safeguarding would prevent everyone from accessing it at all times, which is kind of what a universal right needs to be.
Even so, I don't think that means we shouldn't have the option. There are many options to which we don't have a "right" per se, but they're available because they improve quality, including quality of life.
So, even if we did not provide assisted dying as a universal "right to a dignified death", I don't see a reason why the option of active euthanasia shouldn't be allowed. I can think of reasons why that would make people happier - peace of mind, reducing suffering, etc.

This takes us into the rather thorny topic of "quality of life", and I think this is where we are going to end up agreeing to disagree. I suspect the issue is, in my mind, "quality of life" becomes rather redundant when you're talking about ending it. The act of assisted suicide does not in itself improve quality of life, as the act does not provide for life continuing and so quality cannot conceivably improve (or worsen as the case may be). What it offers instead is a semblance of control over the situation, and I can see how in certain circumstances that may offer someone a sense of feeling their quality of life has improved. But at the same time, it is reliant upon someone retaining their agency until the time comes, and life seldom plays by those rules. A person who has made a decision to end their own life could be struck by a brain stem stroke, for example, rendering them completely incapable of doing anything. Thereafter, their decision becomes somewhat redundant. It may be a rather extreme example, but I guess I just question the wisdom of depicting it as improving quality of life when that doesn't add up. Is it in fact bordering on the territory of a noble lie?

Originally Posted by Adam the Fish

I also don't think we need a universal definition of what a "dignified" death is; the point in giving the option is that an individual thinks assisted dying would be more dignified, they can choose it. If you don't think it's dignified, there are other options (ie. palliative care) available to you.
The use of "dignity" in the campaigning is simply because those who are part of those organisations are campaigning for the option to die in a way that they collectively see as dignified (or moreso than options currently available).

But is there not also the inherent flipside that certain types of death are viewed as "undignified"? Does that not entail that persons facing such end of life scenarios may be compelled to view it as "undignified" not because it actually is by any objective standard, but because society views it as such? Is there not then the risk that such people will seek out assisted suicide, or feel compelled to agree to such courses of action if suggested, as a result? That to me seems a very real possibility once you start deeming certain types of death as "dignified" or otherwise.

Originally Posted by Adam the Fish

I've already said that I'd want the option available were I to develop a condition similar to MS, and I can assure you that I've thought that through as rationally as ever. I don't see why one shouldn't consider the wish to end interminable pain early as rational, anyway. In the sort of situations you're talking about where people should be talked out of suicidal wishes, that is because the pain can be, for want of a better phrase, made to "go away" (albeit through a lot of hard work) and life be returning (roughly) to a normal standard. The difference, obviously, is that the sort of painkilling techniques (ie. very strong painkillers) required for the situations I'd suggest assisted dying for are really quite seriously detrimental to one's ability to live life anyway. They just prolong things with not a lot of responsiveness from the individual being treated, especially towards the end of life.

This may be a somewhat controversial suggestion, but one I feel obliged to make anyway for purely academic reasons: how can you in fact be sure that your decision is a rational one? In the mind of the beholder, any thought can be deemed rational even if on closer examination it is far from being. In addition, your comments in respect of suicidal wishes fall down when confronted with people who, despite the best efforts of those around them, simply cannot be persuaded that living is better than dying and for whom life will never return to normal. There is something of a contradiction going on where we have one situation where the wish to end one's life prematurely is deemed irrational and so hindered and prevented at every opportunity, and another where the wish to end one's life prematurely is deemed rational and facilitated. Either wishing to end one's life prematurely is rational, or it isn't. Based on the common impulse to avoid meeting one's maker early if at all possible, and our attitudes towards self-killing in general, I would suggest it's more likely to be the latter. I imagine the response would be that in assisted suicide and euthanasia situations death is looming in any event - although that could equally be said for someone crossing the road if they're unfortunate enough. The only difference appears to be in knowing it, and I sense it's more a question of trying to have some semblance of control over the situation rather than because the wish to die is seemingly rational.

Originally Posted by Adam the Fish

So, definitely have safeguards, but actually, the wish to end pain is a perfectly acceptable reason to want to end life, in my opinion. I'm no psychologist, but your example of choosing to give false confession after mental breakdown from torture would perhaps demonstrate a basic animalistic urge to end pain (eg. that inflicted by torture).

It's interesting you say that, because from my understanding of the literature (admittedly not in-depth by any means) it's actually the urge to survive which motivates people to make false confessions. They use the false confession as a means of seeking to preserve their own life, on the basis that it gets them out of danger at least for that situation. Pain motivates the urge, but it is not the motivation for the action itself. Otherwise, one would just as readily expect such persons to actively pursue death as that would be the most surefire way of ending their pain.

Originally Posted by Adam the Fish

As far as we know, in countries where assisted dying is already legalised, this has not been a problem with their safeguards. There's no reason to my mind why their safeguards could not be reproduced satisfactorily in the UK (etc.), with any extra thought put into this. I can't claim that it would be entirely effective, because I haven't tried coercing every single individual ever into assisted dying and then watched to see if the safeguards caught it. As far as anyone can tell, current systems have worked well to prevent this.

Additionally (and this responds to your second point as well), organisations like [the campaign for] Dignity in Dying already recommend "Advance Decisions". I've already demonstrated that it's possible to rationally decide that death would be preferable to treatment for some individuals (including me!) in some circumstances, so more people making these sorts of instructive documents (as would presumably happen if assisted dying were legalised) would act as a way of safeguarding in the first place. It would be easy for those judging the mental states of those people, because the decision would already have been made (of course, changing their mind would be possible!) - the difficulties you specify would only be for those who hadn't made a decision beforehand.
As I've said, there's no evidence to suggest that safeguarding for those people is ineffective in countries where assisted dying is legal.

With respect, I beg to differ. Professor Theo Boer, a Dutch ethicist who sat on a Regional Review Committee for euthanasia decisions for many years, has expressed concerns about the safeguards and the regular increase in euthanasia rates since the law was introduced in 2002 (up 15% annually on average). Likewise, while Swiss law does not in fact legalise euthanasia (a loophole is instead exploited relating to the law on suicide), Dignitas made great efforts to strengthen its screening processes in light of concerns that its facilities were being abused. I haven't been able to locate anything conclusive on the Oregon laws, but I think to suggest there is no evidence whatsoever is perhaps being a touch selective.

As for advance decisions, I fear that is not a particularly good comparison. A refusal to accept treatment (which, admittedly, stems from the right to personal integrity and autonomy that euthanasia proponents rely upon) is based on a notion of "letting nature take its course" - no one is intervening to hasten their demise, it's just happening through an omission. Assisted suicide and euthanasia, by contrast, require a conscious decision to end life prematurely for one reason or another. Refusal is exercising the right to autonomy over oneself; assisted suicide and euthanasia impose said autonomy upon the will of another person (e.g. the physician). That's a different ethical and legal ballpark.

Originally Posted by Adam the Fish

I would suggest an increase in investment for palliative care facilities, as a safeguard for assisted dying, to ensure people don't choose euthanasia just because specific palliative care facilities are too expensive or deemed unpleasant. I believe that there would be a positive impact on such facilities as a result of the legalisation of assisted dying (as I would, naturally...).

I suppose the question I'd ask would be: what guarantees are there that funding for such facilities would be maintained? The palliative care movement is, ultimately, underpinned by a belief that maintaining a decent standard of life until a person's life runs its natural course is the right approach to end-of-life care. Doctor-assisted suicide and euthanasia are in direct conflict with such a belief. In circumstances where greater demands are placed on end-of-life care facilities and resources, it wouldn't take much for a more economically-led approach to determine that palliative care isn't such great value compared with doctor-assisted suicide and euthanasia, and as such reduce resources for palliative care facilities. That is already starting to occur in the Netherlands in respect of terminal cancers, according to statements last year by Professor Boer, and as a logical development it's a pretty straightforward transition from euthanasia being a fringe option to euthanasia becoming the default. Particularly when resources are only going to become more stretched in the coming years.

Originally Posted by Adam the Fish

I'm in favour of it, as you may have noticed - but I suspect the things I've said might have been suggested to you before, so I'd be interested to see why you haven't deemed them sufficient responses in the past.

See above. But in simple terms I think the problem I have is a lack of rigorous, empirical evidence supportive of doctor-assisted suicide and a lot of rhetoric instead. I deal in a field which puts little weight in rhetoric, and I've stumbled across enough articles and studies questioning the popular wisdom behind assisted suicide and euthanasia to introduce doubt. Once a lawyer gets doubt, it's very hard to shift.

[anonymouswhale]

I've taken courses regarding dying and have reviewed the laws behind physician assisted suicide, at least in the US.

There are MANY hoops to jump through. You need an affidavit, you need witnesses, you need proof from a doctor that you will not live more than x amount of time and that alternatives are not proven reasonable for your situation. There are meetings, debates, etc to really be sure that you, for lack of a better way, have no other choice other than suffering.

In addition, the patient must be the one to consume the fatal dose of medication. The doctor is simply a witness and to confirm death. They CANNOT in ANY way help the patient with the cocktail, for liability purposes of course. So, in this time, the patient may have a change of heart when they stare death in the face.

I would not want a loved one to do it over the fact that I'm selfishly attached to them, and I do think that there are other ways to end life without jumping through the legal hoops and spending the money (not that I ever justify suicide). Overall, I am against it. In my opinion it looks romanticized.

[MsNobleEleanor]

Originally Posted by Maverick.

If you want to die why even go to the doctor in the first place and spend all the money on services, and leave your family with the bill? Why waste time that could have been given to people who want the care and make the doctors do something they didn't go to school to do which was see their patients die.

But I think people should make whatever decisions they want to.

Canada's Health Care is free, we pay very little. Walk into a hospital, get a few tests done, walk out. We are safe to receive the medical care that we need free of charge.

Originally Posted by DanceCommander

I'm supportive of doctor assisted suicide, but I think there does need to be a criteria for being eligible for such a thing. For example, I don't think doctor assisted suicide should be an option for people who are depressed or are otherwise suffering from mental illness. I think it should be reserved for the terminally ill or those who have a documented illness with no prognosis of getting better that causes a lot of physical pain and possibly psychological anguish. I think the only exception to the "physical pain" rule should be dementia.

The Supreme Court is deciding what does fall under circumstances for assisted suicide, they want to protect those who are in fact suicidal. If you read the first small paragraph of the article it states that.

Furthermore, 84% of Canadians are in favor for doctor-assisted suicide and not many know but what actually started this debate to rise to the Supreme Court is because of the high importance of what happened in British Columbia British Columbia had votes showing 90% to agree to doctor-assisted suicide.

If you take a look at the percentiles of the votes and what they voted for and against, many of your answers will be answered.

The Supreme Court of Canada isn't going to allow a bill to pass without the safety of others and who might be in danger because of this bill. Many Canadians have pushed the Supreme Court to do something for the last few years. It was brought up back in 1993 but nothing happened.

[Pein]

Originally Posted by DanceCommander

I'm supportive of doctor assisted suicide, but I think there does need to be a criteria for being eligible for such a thing. For example, I don't think doctor assisted suicide should be an option for people who are depressed or are otherwise suffering from mental illness. I think it should be reserved for the terminally ill or those who have a documented illness with no prognosis of getting better that causes a lot of physical pain and possibly psychological anguish. I think the only exception to the "physical pain" rule should be dementia.

So someone depressed or suffering from a mental illness form of psychological anguish?

[Coffee.]

Originally Posted by Voldie

So someone depressed or suffering from a mental illness form of psychological anguish?

If you read the post, she said physical pain and psychological anguish.

[Pein]

Originally Posted by Coffee.

If you read the post, she said physical pain and psychological anguish.

I did, And once they have that psychological anguish it can go to the argument if they are mentally clear to make that decision or not.