There are safeguards enough in Assisted Suicide.
Dr Alison Twycross, Head of Department for Children’s Nursing and Reader in Children’s Pain Management at the Faculty of Health and Social Care, London South Bank University, writing in the Daily Telegraph, states that the call for Assisted Suicide (AS) may not be all it’s supporters believe it to be. In a frankly condescending, patronising and absurd article, Dr Twycross seems to think that the public are too uninformed to make the most important decision concerning their own lives, relies on scares and half truths, displays a religious agenda, and even attempts to reduce the argument to numbers.
Here I shall go through Dr Twycross’s arguments and attempt to show why she is deeply mistaken.
“According to the Journal of Medical Ethics, about one Briton a fortnight travels to Switzerland for assisted suicide (AS) (Gauthier et al. 2014). Rather than this being a compelling reason to legalise AS in the UK, it provides an opportunity to reflect on the evidence surrounding this topic.”
So let us in typical British fashion, reflect upon it, hum and haw, have a report, and all the time there are people suffering and seeking AS, yet being denied it. Where there is an argument of supply and demand, one does not sit on ones thumbs thinking about it, you deliver what the customer seeks, and if 26 people a year are seeking AS, that tells us there is a significant demand for it.
“From my reading, it seems to me that legalising AS is likely to have unintended consequences.”
Yet following that statement, Dr Twycross does not elaborate upon those “unintended consequences”, nor does she supply a source for her “reading”.
“Perhaps it is these which cause more than 75 per cent of doctors in the UK to oppose AS. In the debate in July on Lord Falconer’s Assisted Dying Bill (assisted suicide for the terminally ill), 50 per cent of those who contributed were against legalisation, suggesting that it is not just a few diehards who are concerned about the possible consequences of a change in the law. “
No mention of the source of those statistics you will notice. Is it 75%, or is it 50%? And while Dr Twycross claims that these figures suggest there are doctors concerned about changes in the law, she offers no proof to back up that claim.
“A common reason for supporting AS is because of a relative or friend who experienced a protracted distressing death. Publicity associated with several high-profile cases over the past few years has probably confirmed these beliefs. People often associate terminal cancer and/or dying with intractable pain and suffering.”
I could not agree more. When you have watched both your parents, who had expressed while healthy their wish never to be allowed to wither away in pain and helplessness, suffering years of pain and being reduced from vital, vibrant human beings to even more helpless than a baby, with all the indignity that involves, that tends to kind of colour ones judgement. My parents suffered terribly in their last years, and that is something I shall never forgive the British state for. Is it really so hard to understand that when you love someone deeply, you do not wish them to suffer in any way, shape, or form? Frankly, for Dr Twycross to make that statement, which seems to glibly suggest that reactions based upon emotion are of no consequence, is crass, elitist and heartless in my opinion.
It is often said in discussions surrounding AS that we treat animals with more kindness than human beings in this matter, because when an animal is suffering, we do the kindest thing in euthanising them. Few however consider the absolute reality of just what we do to human beings. It is indeed terrible for any animal to suffer, especially as they are alone in that suffering. Animals however cannot rationalise just what is happening to them. They feel pain or suffer in another way but don’t understand it. Human beings however, being sapient, all too often are fully aware of what is happening to them, and what the future may hold for them. I would argue therefore that to allow any human being to continue to go through that sort of psychological terror is not just cruel, it is downright sadistic.
“However, this need not be the case: leading palliative care doctors tell me that in 95 per cent of cases the pain can be relieved, and significantly reduced in the remainder.”
Even palliative care has it’s limits, as any medical professional involved in it, or anyone who has witnessed it’s limits, will confirm. Certainly, pain can be relieved, and “significantly reduced”. In the most extreme cases however, pain cannot be eradicated completely. Even to attempt to do so could kill the patient, which of course the doctors are not allowed to do. And while palliative care may very well help 95% of patients, what then of the remaining 5%? Just exactly what is their experience, which Dr Twycross does not elaborate upon. These are human beings we are talking about, not numbers.
“Another reason for supporting AS is the incidence of death prolongation by overzealous medical interventions at the end of life. But this would seem to be a call for health professionals to better recognise when illness is terminal, and to switch from curative treatment to palliative care.”
A switch from curative treatment to palliative care is still taking the decision out of the hands of the individual, and placing it in the hands of medical professionals. While I do not for one moment doubt the expertise of those in the medical profession, not even Dr Twycross, I would suggest that ending one’s life is not their decision to make. That decision needs to lie with each individual patient, and that patient alone.
“We need to start asking questions such as: Is it appropriate to give antibiotics to a terminally ill patient who develops a chest infection? Or, as in the past, can pneumonia be regarded as the dying patient’s friend?”
This already happens, and in some cases it happens for good reasons. My father had both cancer of the bladder and COPD. In the end it was the COPD which ended his life. The staff at the hospital he was in did their best to make him comfortable at the end, but given the cocktail of medicines he was already receiving, administering further antibiotics simply was not an option, and he basically drowned in the fluid from his own lungs. It is also quite common for Do Not Resuscitate (DNR) or Do Not Attempt Resuscitation (DNAR) orders to be placed upon patients in accordance with the wishes of the patient, or where the patient is incapable of making a decision, their family. DNR notices are covered by the following guidelines;Iif a patient’s condition is such that resuscitation is unlikely to succeed.
- If a mentally competent patient has consistently stated or recorded the fact that he or she does not want to be resuscitated.
- If there is advanced notice or a living will which says the patient does not want to be resuscitate.
- If successful resuscitation would not be in the patient’s best interest because it would lead to a poor quality of life.
In the UK, NHS Trusts must ensure:
- An agreed resuscitation policy that respects patients’ rights is in place.
- A non-executive director is identified to oversee implementation of policy.
- The policy is readily available to patients, families and carers.
- The policy is put under audit and regularly monitored.
In many cases of DNR notices, they are implemented where the patient is unlikely to enjoy quality of life following resuscitation, or the detrimental effects of resuscitation would outweigh any benefits. Sometimes it is not only kinder to just let a patient slip away, it makes sound common-sense.
“Palliative care is expensive. The average costs of inpatient hospice care is £3000 –£4000 per week. AS equates to a one-off payment of less than £500. The ongoing costs of long-term medical conditions are huge. In an age of austerity legalising AS may seem a good fiscal choice. In Oregon in the USA, two cancer patients were refused funding for chemotherapy but were told that the State would pay for their AS.”
The fiscal argument for AS vs palliative care is an irrelevance. There are few who support AS would ever reduce it to money. This is the argument of the Conservative peer, Baroness Mary Warnock, who in an interview with the Church of Scotland magazine, Life and Work, in 2008 stated, “I’m absolutely, fully in agreement with the argument that if pain is insufferable, then someone should be given help to die, but I feel there’s a wider argument that if somebody absolutely, desperately wants to die because they’re a burden to their family, or the state, then I think they too should be allowed to die.”
Baroness Warnock’s cruel and callous statements were roundly condemned by politicians, dementia charities, religious leaders, the medical profession and even supporters of AS. Anything else apart, there is no proof that people in no other than the most extreme cases of dementia have a poor quality of life. We are not in their minds, so we cannot say with any certainty that they are not happy with their lot. At the time, I suggested that given Baroness Warnock’s advancing years, perhaps she should consider euthanasia herself. Cruel? No more cruel than she was suggesting.
As much as I support AS, have we really become a society so obsessed with money that there are some would suggest to others to kill themselves rather than be a “burden”? And where does one end that? The homeless? The unemployed? The disabled? I frankly would rather an increase in income tax, even to save one life, than ever go down that road. You cannot put a price on human life.
“Some people argue that good palliative care won’t stop people asking for AS.”
No, it won’t. See my points above concerning the limits of palliative care. And aside from which, it should be the decision of the individual, not the medical profession or the state. Our lives, not theirs.
“I agree: there will always be a small number of people who want to hasten their own death. In a Swiss study, where families of people who had died after AS were interviewed, in all but one case the reason for seeking to hasten death was associated with a long-standing personal belief in favour of AS rather than issues with pain and symptom management (Gamondi et al. 2013).”
So what if those who opt for AS have a long-standing personal belief in it? Indeed, I would counter that having a long-standing belief means that the individual is more likely to look deeply into the issues and thereby make an informed decision concerning the most important step they are ever likely to take. It really is no different from Dr Twycross having a long-standing personal interest in pain management. Of is she trying to suggest here that the public are somehow too intelligent to make decisions for themselves and these are best left to the medical profession? Frankly I find such views both patronising and condescending.
“Further, in Oregon, only 24 per cent of people requesting AS cited inadequate pain control as the reason for doing so; 93 per cent cited loss of autonomy and 73 per cent loss of dignity.”
That is because quality of life means different things to different people. Loss of autonomy or loss of dignity can be equally as devastating as ongoing pain, and it need not be associated with terminal illness. A Belgian female-to-male transsexual, Nathan Verhelst, underwent gender reassignment from 2009 onwards. His full mastectomy was poorly done, and this was followed by his body rejecting his penis. He was told by surgeons that nothing more could be done, and faced with a life of being neither male nor female, Nathan instead opted for assisted dying. He was killed by lethal injection on 30 September 2013. Many people have argued since that Nathan Verhelst could and should have received greater counselling. How exactly? Anyone know of any therapists who are similarly neither male nor female? I certainly do not, and not anyone who faced the same circumstances as Nathan Verhelst could ever judge, or be of any help. Nathan was fit, healthy and only 44 years old. He faced possibly another 40 years or more of being in a gender twilight of being neither one sex nor the other. Instead he decided that the grave held less horrors, and as tragic as his case may be, that was his decision to do what he wanted with his life. Psychological terror can be as every bit as debilitating as terminal illness, and carry as much loss of quality of life.
Also, apart from Dr Twycross again not citing her sources, her figures do not even make any sense. I don’t know about anyone else, but I calculate the figures she quoted to total 190%, not the 100% it should be.
“Many people in Oregon and neighbouring Washington State give fear of being a burden to others as a reason for requesting AS. However, as the Archbishop of Canterbury said recently, it would be naive to think that many of the elderly people who are abused or neglected each year, as well as many severely disabled individuals, would not be put under pressure to request AS if permissible; a view vigorously echoed by various disability rights groups.”
Well, for a start, if Dr Twycross is going to fall back on quoting a religious leader to back up her arguments, I do not see why I or anyone else should take notice, or take her seriously as a medical professional. It certainly makes me wonder whether she places at least part of her argument on religious grounds, and whenever those in medicine mention religion, alarm bells immediately go off in my head.
As to her claims, the facts are that in countries that have legalised AS. It is not even the case in the states in the USA which have legalised it, including Oregon and Washington. Furthermore, the very people opposing AS in those states tend to be of a conservative Christian persuasion, so again I am wary of what appears to be a religious agenda. Indeed, Dr Twycross does not name these “many people” (is anyone else noticing a pattern here?) in Oregon and Washington, and the only source I can find is the Euthanasia Prevention Coalition, which has an overwhelmingly Christian membership and following. The founder of the Euthanasia Prevention Coalition, Alex Schadenberg, has written widely on abuse in AS, without supplying one shred of solid evidence of it ever having taken place.
“Supporters of Lord Falconer’s Bill argue that, if there are effective safeguards, we can give the right to die for those who wish to hasten their death while protecting those who do not. This argument was used in relation to the 1967 Abortion Act. Whatever one thinks about abortion, David Steel (who as an MP championed abortion reform in the 1960s) has pointed out that the 1967 Abortion Act was intended to stop back street abortions. There were warnings at the time about a slippery slope. And so it has proved to be: despite various safeguards, we now effectively have abortion on demand.”
There are indeed sufficient and effective safeguards covering AS in the countries which have legalised it, and again, there is not one solid shred of evidence of AS ever having been abused. So it would be in the UK were AS to be implemented here. Indeed, if there were ever to be abuse, then it is not so much families we need to be cautious of, but rather despicable politicians of the same ilk as a that of Baroness “Granny Killer” Warnock.
And with Dr Twycross comparing AS to abortion, and making the frankly absurd claim that we have “abortion on demand”, the religious alarm bells in my head are now ringing even louder. What would Dr Twycross have? No AS, and no abortion either? David Steel’s Abortion Bill was one of the greatest pieces of legalisation ever to pass through Westminster and it was long overdue. Yes, it did indeed greatly reduce back-street abortions – for those women who could afford such. It also greatly reduced the incidence of the poorest women in society attempting to perform abortions or miscarriages upon themselves, which in a great many cases ended with tragic consequences. In the least of such cases, many women concerned would never be able to conceive a child again. In the worst cases, the women attempting to abort or miscarry ended up dead. Those of us who support freedom of choice do so because we do not shout “pro-life” as a war cry; we are more pro-life than anti-abortionists.
Abortion in the UK is only available in the first 24 weeks of pregnancy, and women considering abortions are not only advised to seek counselling before hand, but many indeed do. The result of this is that there are not only many fewer terminations than there might otherwise be, but latest figures show that abortion rates are actually falling. Indeed, the 2012 report by the Department of Health showed the a drop of 5.4% to 16.5 per 1,000 women; the lowest since 1997. For Dr Twycross therefore to claim that we have gone down the “slippery slope” and now have “abortion on demand” is not only mistaken, it is disingenuous, highly insulting to women faced with one of the hardest decisions they will ever take, and smacks strongly of her own personal religious zealotry.
“Theo Boer, a Dutch ethicist who supported the legalisation of voluntary euthanasia in the Netherlands, cautions against legalising AS in the UK. In relation to the slippery slope, he said recently “We were wrong – terribly wrong.” Since 2008, there has been annual increase of 15 per cent in the number of cases of euthanasia. People with psychiatric illness and dementia are now eligible; there is a network of travelling euthanising doctors; and euthanasia is on the way to becoming the default mode for dying cancer patients.”
Hmmm, would that be Dr Theo Boer of the Christian-based Protestante Theologische Universitite, and author of “Palliative Sedation: An Exploration from a Christian Ethical Point of View” – or a completely different Theo Boer? The religious alarm bells now resemble a fire engine going at full pelt towards a blazing building.
Of course there has been an increase in the number of people asking for AS, because it is now a given option. That is supply and demand. And it may well be now eligible for psychiatric and dementia cases. If psychiatric, see my point above about Nathan Verhelst and the intolerable psychiatric torture he faced for possibly 40 years or more. If dementia, then as long as that is written into a living will before the patient is no longer capable, or has reached a point where there is clearly no dignity nor quality of life left, then I for one have no problem with that. Hands up everybody here who wants to survive, not live, a dribbling wreck, sitting in their own piss and shit?
And if AS is becoming the default mode for terminal cancer patients, then I can only champion that move. If anything, by stating that both Dr Boer and Dr Twycross destroy their own arguments. Anyone who has ever watched someone – it does not even have to be a loved one – waste away from cancer, has heard and seen them cry in pain, heard them scream as a lumbar puncture is performed on them, watched a strong, intelligent human being being reduced to a scared, helpless wreck, would immediately support that person’s wish to avoid all that and more, and to go when they can with the little dignity and quality of life they have left.
“A recent editorial in the BMJ argued that AS should be legalised because autonomy is the most important concept in medical ethics (Delamothe et al. 2014). However, it seems to me that, in matters of life and death, you cannot create freedom (to die) for the few without taking away adequate safeguards for the many.“
Except that Dr Twycross has failed to supply one iota of justified suspicion that adequate safeguards would be in any way taken away from the public. Instead, all she has supplied is a plethora of assumptions and scare stories, rarely quoting her sources, and when she does, she quotes someone speaking from a religious perspective, whose own views can be dismissed as easily as her own obviously religious-based viewpoint. And even when she does not bow to religion, she displays an arrogance which seems to suggest that the medical profession knows what is best, and the individuals concerned should have no say in whatever decisions affect their own lives.
Autonomy of the individual and control over our own lives is tantamount to any civilised society. By refusing people the right to do what they wish with their own lives, including taking them, the state is effectively saying that our lives are not our own, but are somehow the property of the state. Furthermore, that claim is based upon the influence of the Christian religion upon legislation in the UK. I completely refute any such claim. Contrary to what the UK Prime Minister, David Cameron, stated at Easter, 2014, Britain is no longer a Christian country; rather it is now a multi-cultural country made up of people of many faiths, and those like myself, of none. Our lives are our own private and personal property to do with as we wish, including ending them should that option becomes a necessity.
Life is not the property of the state, far less of any church, and I therefore do not see why my life, or that of anyone else, should be subject to any government, based on what to me is nothing more than a bronze-age book of goat-herders campfire tales.
The Daily Telegraph article can be read here: