[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.