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Euthanasia - On Terry Pratchett's 'Choosing to Die'

Enter here to explore ethical issues and discuss the meaning and source of morality.
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Laurence
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Re: Euthanasia - On Terry Pratchett's 'Choosing to Die'

#41 Postby Laurence » July 23rd, 2011, 11:32 pm

Latest post of the previous page:

What an informative and inspiring discussion.

I would want this possibility for myself, if needed and for all members of the community.

The barbiturates sound just the job.

Thank youse

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AlexVocat
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Re: Euthanasia - On Terry Pratchett's 'Choosing to Die'

#42 Postby AlexVocat » July 24th, 2011, 11:59 am

Wilson wrote:Let's brainstorm for a moment. What if an individual had unlimited access to barbiturates of the type that they use in Oregon and Washington and possibly in Europe. How could he offer a euthanasia service without getting arrested? What sort of underground network might spring up to shield the supplier from legal harm? Who would be legally liable for murder if caught - the drug dealer, the preparer of the potion (if the patient were unable), the family members who attend? Of course once the process goes underground it would be subject to abuses, and it wouldn't be impossible that some of the deaths would actually be foul murder rather than motivated by compassion.

That sort of highlights the parallels with drug illegalisation. The people don't want it illegal, so the resources to keep it illegal are greater than making such a thing legal. And the 'difficulty' in making it legal is around the same level as keeping it illegal.
Alex Vocat

Woody Duck
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Re: Euthanasia - On Terry Pratchett's 'Choosing to Die'

#43 Postby Woody Duck » October 14th, 2012, 10:03 pm

Forgive me for posting on a thread which hasn't been touched for nearly a year but I have just joined this forum and there are some very interesting points in the thread.
As a nurse I will always Dow the line of the law and act within it although I think this subject is long overdue an open public discussion. That said I do believe that euthanasia is jumping the gun a bit in a country where end of life care is in much need of improvement. In the UK we see that alot of cancer patients get very good multidisciplinary end of life care from moment of palliation to beyond death. This I am sad to say though is limited to areas of the country as opposed to uniform policy. Unfortunately once out of the realm of cancer, the story is very different with people ending up at end of life being subject to rash mismanagement because there just isn't the specialist knowledge or confidence to deal with them. I refer in particular to dementia patients so I find it interesting that the one vocal celebrity voice exploring this is a writer with alzheimers.
The dilemma is this. Someone decides that at a certain point where they lose their "personhood" or that which defines them they should be allowed to die either through withdrawal of treatment or assisted dying. Pratchett has already. Anticipated the dilemma because once he has lost capacity a number of issues emerge.
1. Is the lived experience of the person with end stage dementia as horrendous as the person with capacity anticipated. I.e. If given the choice would that person still choose to die.
2. The Drs involved even in countries where euthanasia is legal will not even go near dementia patients for this same reason. That people without capacity do not have the ability to change their mind or communicate it.
I only highlight this to point out the legal and ethical minefield involved in legalising something that will ultimately lead to one client group having wishes fulfilled over another group who Drs will not touch.
I personally do not think the UK is ready for euthanasia until uniformly in this nation everyone has the access to expertise in planning end of life care. Once measures aee in place in this aspect then I think we will see more legally justifiable cases for assisted dying such as the recent high court case that ended in a man starving himself to death.
Whilst there may be obvious justifications, I would argue that alot of people who wish for assisted dying do sp because they are scared of having to face a horrendous dying process which in this day and age of modern medicine and nursing expertise just should not happen but does
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Alan H
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Re: Euthanasia - On Terry Pratchett's 'Choosing to Die'

#44 Postby Alan H » October 14th, 2012, 10:56 pm

Woody Duck wrote:Whilst there may be obvious justifications, I would argue that alot of people who wish for assisted dying do sp because they are scared of having to face a horrendous dying process which in this day and age of modern medicine and nursing expertise just should not happen but does
Just to pick up on these two point for now...I don't think it's necessarily just to do with being scared: it can be the simple prospect of a slow dying where the person becomes increasingly incapable - and that's not necessarily even a painful death. Someone I knew wrote this shortly before she headed off to Switzerland last year:
By the time you read this, with the help of FATE and the good Swiss, I will have gone to sleep, never to wake.

For some time, my life has consisted of more pain than pleasure and over the next months and years the pain will be more and the pleasure less. I have a great feeling of relief that I will have no further need to struggle through each day in dread of what further horrors may lie in wait. For many years, I have feared the long period of decline, sometimes called 'prolonged dwindling', that so many people unfortunately experience before they die.

Please be happy for me that I have been able to escape from this, for me, unbearable future. I have had a wonderful life, and the great good fortune to die at a time of my choosing, and in the good company of two FATE colleagues. With my death, on March 1st, I feel I am fully accepting the concept of 'old age rational suicide' which I have been very pleased to promote, as a founder member of the Society for Old Age Rational Suicide (SOARS) in the past fifteen months.

Being active in the right-to-die movement, both in the UK and globally, has been an enormously important part of my life in the last few years. It has been wonderful and inspiring to meet so many amazing people who have been determined, often in the face of great odds, to help others to a peaceful pain-free death. I really hope that everybody's important and vital efforts will continue, and result in legalized assisted dying becoming a reality in many more areas of the world in the coming years.

Best wishes, Nan Maitland
I don't think Nan was scared (in fact, I'm sure she wasn't), she just didn't want to endure the 'prolonged dwindling' as she put it.

Secondly, palliative care can be fantastic, but sometimes the pain is too great and the necessary palliation so severe, that the person may not want to continue. They may be aware enough to say enough is enough, or they may have anticipated the situation and given clearly expressed instructions on what they want to happen. I think those instructions and the settled will of that person should be given the utmost consideration above all else.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

Woody Duck
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Re: Euthanasia - On Terry Pratchett's 'Choosing to Die'

#45 Postby Woody Duck » October 15th, 2012, 10:48 am

Alan you must be immensely proud to be related to such a great woman. I completely see the point she makes and it is of course a matter of choice for everyone. My only point was that there are two issues at stake in this country at the moment. First that there is a huge portion of our population who are not aware of what is available to them with regards end of life planning and care and so only see the campaigns of the great Terry Pratchett as an alternative to dying a miserable death.

The other point is that the reason there is so much ignorance about what is available is because it is not uniformly available to people even in Cancer services. For instances, how many people know that on diagnosis of Dementia, the sufferer is meant to have an immediate referral to palliative care?

I would also say that palliative care within this country is widely misunderstood to mean care for those for whom Drs have passed a "no chance of survival" ticket on them. Palliation is about symptom control and not just to do with pain either.

Whilst I revere people like your Nan and Tony Nicholson who obviously have rationally thought through their own situations, I still think that these issues can be separate for alot of cases where good end of life planning would put peoples mind at risk.

Please do not think I am trying to undermine the your Nans cause at all. I think these things need to be heard and discussed, I just think somewhere along the way, a large part of end of life planning has bee missed out of the equation. I would like to see to that end some campaigning for making this service more available to everyone.

Thanks for your insights Alan.

Matt
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Alan H
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Re: Euthanasia - On Terry Pratchett's 'Choosing to Die'

#46 Postby Alan H » October 15th, 2012, 11:22 am

Woody Duck wrote:Alan you must be immensely proud to be related to such a great woman.
Ah! No, she wasn't my Nan, her name was Nan and she wasn't related to me! She was a dear friend of some friends and I only met her a dozen or so times.

I think the point I was trying to make that while I agree that palliative care can be improved and made more widely available and known and best practice spread everywhere, some just don't want their lives prolonged by it - they want to control their end and have it in the way they want. To do this in the way she wanted, Nan had to travel to Switzerland (with two friends) - I'm sure she would have preferred to have been at home with friends and family.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

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Fia
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Re: Euthanasia - On Terry Pratchett's 'Choosing to Die'

#47 Postby Fia » October 15th, 2012, 4:15 pm

Interesting thoughts, WoodyDuck, some of which Alan has responded to.

Joined-up palliative care, should, of course be available everywhere. I'm part of our local palliative care team in the community. We Home Carers visit up to 4 times a day for personal care, and can call in local Drs and Nurses at any time. It's all free at the point of use yet still a far cheaper option than hospitalisation. Admittedly, not everyone who has the choice wants to die at home but to my mind it's essential that choice is there. Just as I think it's essential that we also have the choice, should we wish to avail ourselves of it, of euthanasia.

I do agree that dementia does pose more difficulty. End stage dementia is treated palliatively already - or at least should be according to the University of Stirling's excellent dementia training course I did recently. http://dementia.stir.ac.uk/aboutus_welcome

However, dementia is usually a long process to death, and early diagnosis is improving. After acceptance of diagnosis and well before capacity is lost I would have thought it wasn't rocket science to write or amend an existing living will should one wish to. One can be very explicit about circumstances in discussion with your GP. Just because someone has no capacity at death doesn't mean to say their last will and testament is invalid does it? With appropriate safeguards I see no problem applying the same logic to thoughtful living wills.
Woody Duck wrote:...until uniformly in this nation everyone has the access to expertise in planning end of life care.
We clearly need to have this conversation as a nation and in our families. We need to wrest death and dying back from its cultural taboo and provide joined-up services and clear information with discussion.

In short, I'd not wish to throw the baby of legal voluntary euthanasia with the bathwater of the challenges this gives us with dementing patients.

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Re: Euthanasia - On Terry Pratchett's 'Choosing to Die'

#48 Postby Woody Duck » October 15th, 2012, 6:35 pm

Fia
Great go have your thoughts especially from your back ground. The research I did for my dissertation brought up some really interesting insights. Namely that care at end of life is much more appropriate and efficient in the home provided the right resources are there. The other was that end of life planning is just not something we as a culture think about. A large number of elderly people in certain research I read were just not interested in thinking about it. My point I suppose is partly that the UK needs to mature somewhat about how it views death. Perhaps when orif he change does occur then euthanasia or assisted dying will follow on quite naturally and obviously.
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Fia
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Re: Euthanasia - On Terry Pratchett's 'Choosing to Die'

#49 Postby Fia » October 15th, 2012, 7:59 pm

Woody Duck wrote:care at end of life is much more appropriate and efficient in the home provided the right resources are there.
Provided the patient and family are happy with that then it definitely is :)

Woody Duck wrote:...A large number of elderly people in certain research I read were just not interested in thinking about it. My point I suppose is partly that the UK needs to mature somewhat about how it views death.
Cultural change often comes through small efforts. Although I think most THers have had the talk with their family about their own death and any funeral, if anyone reading this hasn't I'd urge you to do so. (Look at all the transplants that haven't happened because the deceased hadn't talked their family through their decision to carry a donor card.) It's not an easy conversation but it's a surprisingly bonding one. We talk very openly about death, dying and grief in my house. I hope this attitude will ripple out...
And it's far easier than trying to raise DNR and funerals for the very first time with someone who's in the last chapter of their lives.
Perhaps when orif he change does occur then euthanasia or assisted dying will follow on quite naturally and obviously.

To me it's natural and obvious, but I have the privilege to deal with it daily :) I'll continue to campaign for the choice of legal assisted dying, and having no qualms about appropriately talking about death and dying with anyone. Ripples...
If we wait until the penny universally drops too many people will have to go too early to Switzerland, too many families will be put through the agony of not being able to fulfil their loved ones wishes, fewer folk will complete advance directives as their wishes can't be honoured...
Death is our only certainty after all, and personally I'd like to have a say about the quality of my last chapters, however wonderful I know palliative care can be.

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Nick
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Re: Euthanasia - On Terry Pratchett's 'Choosing to Die'

#50 Postby Nick » October 15th, 2012, 9:20 pm

Fia wrote: However, dementia is usually a long process to death, and early diagnosis is improving. After acceptance of diagnosis and well before capacity is lost I would have thought it wasn't rocket science to write or amend an existing living will should one wish to. One can be very explicit about circumstances in discussion with your GP. Just because someone has no capacity at death doesn't mean to say their last will and testament is invalid does it? With appropriate safeguards I see no problem applying the same logic to thoughtful living wills.
Hmmm... but there's the rub. I have no truck with the religious view that life must be preserved in spite of (say) the wishes of someone dying in agony. I respect the wishes of those who would rather not sink into what they regard as an unacceptable level of life. I do not think that anyone travelling to Switzerland should have been stopped (though I am unsettled by the young ex-rugby player who went...) but I remain unconvinced that it is possible to frame such "appropriate safeguards".

Please excuse my non-disclosure, but I am aware of circumstances where elderly people feel a burden to their families, and feel they should do away with themselves. And worse, vice versa.

I understand, and even support, what you are trying to do, but remain unconvinced that we can adequately frame the necessary procedures.

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Fia
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Re: Euthanasia - On Terry Pratchett's 'Choosing to Die'

#51 Postby Fia » October 15th, 2012, 9:52 pm

Nick, I understand what you say, it is all to easy to think of circumstances where families don't get on or communicate well. But just because some folk wish to make their preferences abundantly clear in a hopefully binding way doesn't mean to say everyone has to.
Although I think it mighty healthy to talk about it... something that the stiff upper lip generation are not good at :sad2:

As WoodyDuck intimated, once we have great palliative care and proper information in place for all we will find it far easier to devise appropriate safeguards. Just because we can't quite see exactly how we do that now should not stop us from working towards it.

I'm sure it's not beyond the strengths of humanity to work this out. Certainly I would envisage a multi-professional approach, with a non-family health advocate (do you have one? all the adults in my own family do...) to take each case presented for assisted dying at its own value. Just as we do in Scotland with the Children's Panels. It can be done I'm sure...

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Re: Euthanasia - On Terry Pratchett's 'Choosing to Die'

#52 Postby Tetenterre » October 15th, 2012, 10:09 pm

Nick wrote: but I am aware of circumstances where elderly people feel a burden to their families, and feel they should do away with themselves.
Well, Nick, if (when?) I get to the state that I think my health status is primarily "a burden to my family" (whether or not they choose to acknowledge this status), I want the right and the wherewithal to be able to do what I think is best. I do not acknowledge that anyone else has the right to deny me that.
Steve

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Alan H
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Re: Euthanasia - On Terry Pratchett's 'Choosing to Die'

#53 Postby Alan H » October 18th, 2012, 3:20 pm

Interesting article from Dignity in Dying:
HOW WELL ARE WE COORDINATING END-OF-LIFE CARE?

Philip Satherley

13:04 BST - 18 October 2012

The Department of Health has just published the fourth annual report on progress in the delivery of the End of Life Care Strategy. It reviews key activities over the past 12 months. I’ll focus on three of these…

Electronic Palliative Care Coordination Systems (EPCCS) – which provide a means of recording and communicating key information about people’s wishes and preferences for end of life care – are being successfully rolled out across England. One example being London’s Coordinate My Care. Of those that have died on the register, figures show that 51% died in their usual place of residence (the national average is 41.7%) whilst 24% died in hospital. Crucially, this register relies on healthcare professionals knowing about their existence and knowing which of their patients should be on it (those who you might expect to die within the next 12 months).

The 1% campaign is designed to engage with clinicians and encourage them to identifying the small percentage of people who they care for who might be in their last year of life, to work with those individuals to plan their care, and to encourage colleagues to do the same. Over 2,900 clinicians have signed up, and a post-campaign survey found that two in five had increased the number of patients listed on their end of life care register. For whatever reasons (difficulties in identifying the patients? not understanding the purpose of the campaign? not having the time?) three in five had not increased the numbers registered, which suggests that further work needs to be done with GPs so that patients’ end-of-life wishes can be recorded and ultimately respected. This has obvious implications for registering dying patients on an EPCCS.

The implementation and audit of the Liverpool Care Pathway (LCP) is reported. The recent National Care of the Dying Audit assessed the LCP and found that, on the whole, people are being communicated with about medical end-of-life decisions. 94% of relatives/carers were given a full explanation of the care plan and healthcare professionals were able to discuss this with 56% of the dying people at the end of life. 97% of relatives/carers were aware that the person was dying and healthcare professionals were able to discuss this with 58% of people at the end of life. It is also reported that training is being done in how to manage difficult conversations. Whilst only a small percentage of relatives/carers are not being communicated with effectively about someone being placed on the LCP, such instances can be very distressing and it is important that loved ones are always kept up to date.

Overall, the coordination of end-of-life care appears to be improving. However, the use of Advance Decisions is not discussed in the report - perhaps it is assumed to be part of Advance Care Planning. Rather, there is an emphasis on DNACPR (do not attempt cardiopulmonary resuscitation). Deciding about artificial nutrition and hydration, the use of antibiotics and respiratory assistance are all crucial in end-of-life care and should not be overlooked – which is where an Advance Decision can come into play. Unless these wishes are recorded in advance, the medical team has to make best interest decisions (wherever possible with input from the family – see above) which may not necessarily reflect the wishes of the dying patient.

The fourth annual report on the End of Life Care Strategy: can be viewed at: http://www.dh.gov.uk/health/2012/10/end-of-life-care-fourth/
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

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Re: Euthanasia - On Terry Pratchett's 'Choosing to Die'

#54 Postby Nick » October 18th, 2012, 3:58 pm

Tetenterre wrote:
Nick wrote: but I am aware of circumstances where elderly people feel a burden to their families, and feel they should do away with themselves.
Well, Nick, if (when?) I get to the state that I think my health status is primarily "a burden to my family" (whether or not they choose to acknowledge this status), I want the right and the wherewithal to be able to do what I think is best. I do not acknowledge that anyone else has the right to deny me that.

The problem is, TT, that I think the elderly and vulnerable need protection from being persuaded that they are a burden. In an ideal world, everyone would be capable and able to choose for themselves, with perfect clarity. But we don't live in such a world. I have great sympathy with the idea of one having the right to die at a time, and in a manner, of one's own choosing, with help where necessary, but I remain unconvinced that such a system can be legislated for.

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Re: Euthanasia - On Terry Pratchett's 'Choosing to Die'

#55 Postby jaywhat » October 18th, 2012, 4:25 pm

jaywhat wrote:There is also a difference between what is required in a 'living will' (or 'Advanced directive') and euthanasia. The living will clearly contains intructions for one not to be resuscitated if certain conditions prevail. Euthansia is what we do to cats and dogs as well - we 'put them to death'.



I wrote this in June 2011 and should have made another and clear distinction between 'not to be resuscitated' and 'assisted suicide'. They are clearly different and IMO are both something which should be legal and readily available. 'Euthanasia' is a different ball game and the word itself scares the shit out of many people. I feel it is wrong to have it in the title of this thread.

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Alan H
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Re: Euthanasia - On Terry Pratchett's 'Choosing to Die'

#56 Postby Alan H » October 19th, 2012, 12:38 am

In today's Economist:
Over my dead body

Helping the terminally ill to die, once taboo, is gaining acceptance
Oct 20th 2012

VOTERS in Massachusetts will decide next month whether a terminally ill patient with less than six months to live should be able to use a doctor’s help in committing suicide. If they assent, as the polls suggest, the state will be the third, after Oregon and Washington, to legalise assisted suicide. New Jersey introduced a bill last month to decriminalise it. The Montana Supreme Court has ruled that doctors cannot be prosecuted for prescribing lethal drugs for terminally ill patients.

When Jack Kevorkian, an American doctor jailed after admitting helping 130 patients to die, first went on trial in 1994, assisting suicide was a crime everywhere save Switzerland. Now the trend is spreading far and wide (though not in Asia or in Muslim countries where it is still taboo).

In Europe the Netherlands, Belgium and Luxembourg all allow assisted suicide. Private members’ bills to legalise it are due in both the Scottish and London Parliaments early next year. In New Zealand a private member’s bill to allow the practice awaits its first reading. In Canada Quebec’s newly elected ruling party plans to bring in similar legislation. In Australia New South Wales’s Parliament is also debating the issue. Even in Catholic Ireland a High Court decision is expected imminently on whether the partner of a multiple sclerosis sufferer can help her die without himself being prosecuted.

All this reflects a big shift towards secular thinking and individual autonomy as well as growing worries about the medicalised, miserable and costly way of death that awaits many people in rich countries. Assisted suicide typically gains overwhelming public support; legislators, pro-family lobbies, churches and doctors’ groups tend to be more squeamish. They fear that legal, easy-to-get assisted suicide will have dire social and moral effects.

If you can’t fly with your own wings

Yet for the limited measures introduced so far, safeguards abound and evidence of abuse is scant. Oregon’s legislation, introduced in 1998, is widely admired. Under it, an eligible applicant must be a mentally competent adult, suffering from a terminal illness and with less than six months left to live. His decision must be “informed”, meaning he must have been told about alternatives such as hospice care and pain control, and he must have asked his doctor at least three times to be allowed to die. A second doctor must review the case both for the accuracy of the prognosis and to certify that no pressure (from inheritance-hungry relatives, say) has been exerted.

Almost all existing or proposed assisted-suicide laws contain similar safeguards. Some also require the applicant to be suffering “unbearable” physical or mental pain. Only in Belgium, the Netherlands and Switzerland, where assisted suicide has been permitted since 1942, are the non-terminally ill eligible. Yet even that liberality has not stoked the numbers. The annual total of assisted deaths among Swiss residents is still around 300, or 0.5% of all deaths. Dignitas, the only organisation in the world willing to help foreigners die, had 160 clients in 2011. In Oregon assisted suicides represent 0.2% of all deaths. In Belgium, where voluntary euthanasia is also legal, assisted dying accounts for less than 1% of the total. Even in the Netherlands, which takes a notably relaxed approach to both forms, it represents less than 3%.

Courts are an impetus for reform. Several heart-rending “right-to-die” cases have come before the House of Lords, formerly Britain’s highest court, and other courts over the past decade. That led the chief prosecutor to publish guidance on the criteria used for taking assisted-suicide cases to court. Anyone acting solely out of compassion and who had given only “minor” help (like accompanying someone to Dignitas) could expect to escape prosecution. In 2008 a 23-year-old Briton paralysed by a rugby accident went to Switzerland to end his life at Dignitas. His parents, who took him there, risked arrest on their return. But England’s public prosecutor ruled that criminal proceedings would not be in the public interest.

But the law itself has not changed: a British doctor who knowingly prescribes or administers a lethal dose of drugs could still face jail. In August Tony Nicklinson lost his lengthy “right-to-die” battle in the High Court. Stuck in what he described as a “living nightmare” after a stroke in 2005 left him unable to move or communicate save by blinking, he begged the court to allow a doctor to put an end to his life. It ruled that voluntary euthanasia remained murder, “however understandable the motives”. It was for Parliament, not the courts, to change the law, the ruling said. But British MPs appear in no hurry to do so; six in ten oppose any reform.

Many doctors throughout Europe nevertheless continue to provide a kind of passive euthanasia for patients in their final hours or days. The “Liverpool care pathway for the dying patient”, first adopted in the north-western English city in the late 1990s, is now standard practice in most British hospitals and hospices. Under it, doctors allow the patient (or his family if he is comatose) to choose whether to prolong life artificially or to remove the life-support system and let the patient die—often with the aid of an extra-strong dose of (life-shortening) painkillers. In America, beset by worries about lawsuits, such an approach is rare and risky.

The prospect of the loss of autonomy, of dignity and of the ability to enjoy life are the main reasons cited by those wanting assisted suicide. Having the option of assisted suicide means that terminally ill people can wait before choosing to end their lives. That may have been what happened to Gloria Taylor, a Canadian assisted-suicide campaigner with Lou Gehrig’s disease (a degenerative illness). After winning a landmark court case four months ago that gave her a “personal exemption” to seek a doctor’s help to commit suicide at the time of her choosing, she died earlier this month—from natural causes.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

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Re: Euthanasia - On Terry Pratchett's 'Choosing to Die'

#57 Postby lewist » October 19th, 2012, 10:34 am

At the end of Maureen's life, policy was to follow the Liverpool care pathway. I'm not sure I have an opinion, but it did help to know the doctors and the hospital were following a known routine. I had known from the outset that her illness was terminal and that she was now being eased on her way as gently as possible. As Fia would say, she was midwived out as she was midwived in.
Carpe diem. Savour every moment.

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Re: Euthanasia - On Terry Pratchett's 'Choosing to Die'

#58 Postby Woody Duck » October 20th, 2012, 9:00 am

The Liverpool Care Pathway has been invaluable on the wards in benchmarking and prompting gold standard care whilst not requiring constant input from the palliative care team who usually review patients daily.
Of course this can only work in conjunction with coordination by the palliative care team who are expert in difficult decisions and making difficult calls which take an unbelievable amount of stress of the nursing staff ward medical staff mentally.
Of course I am only used to seeing this on the ward setting and I would still maintain that the best care can be given at home. Inapropriate admissions are still a problem because of the lack of specialist knowledge regarding dying. Once again i refer to the elderly where in dementia patients, some are admitted because they are off their food. This sometimes results in a peg feed which has to be given under anaesthetic. This for someone without dementia is not nicebut for someone who is confused this can be frightening and horrendously unpleasant. What has been missed here is that dysphagia is a sign of the terminal phase of dementia or might actually be a choice of the patient themselves. Afterall those with dementia are still capable of making decisions and putting forward their preferences.
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Re: Euthanasia - On Terry Pratchett's 'Choosing to Die'

#59 Postby animist » October 20th, 2012, 1:15 pm

Alan H wrote:In today's Economist:
Over my dead body

Helping the terminally ill to die, once taboo, is gaining acceptance
Oct 20th 2012

"But the law itself has not changed: a British doctor who knowingly prescribes or administers a lethal dose of drugs could still face jail. In August Tony Nicklinson lost his lengthy “right-to-die” battle in the High Court. Stuck in what he described as a “living nightmare” after a stroke in 2005 left him unable to move or communicate save by blinking, he begged the court to allow a doctor to put an end to his life. It ruled that voluntary euthanasia remained murder, “however understandable the motives”. It was for Parliament, not the courts, to change the law, the ruling said. But British MPs appear in no hurry to do so; six in ten oppose any reform.

Many doctors throughout Europe nevertheless continue to provide a kind of passive euthanasia for patients in their final hours or days. The “Liverpool care pathway for the dying patient”, first adopted in the north-western English city in the late 1990s, is now standard practice in most British hospitals and hospices. Under it, doctors allow the patient (or his family if he is comatose) to choose whether to prolong life artificially or to remove the life-support system and let the patient die—often with the aid of an extra-strong dose of (life-shortening) painkillers. In America, beset by worries about lawsuits, such an approach is rare and risky."
if I have got this right, Tony Nicklinson was not eligible for the Liverpool Pathway because his mental anguish did not mean that he was close to death, though he must have been on life support if he could not kill himself. Yet surely the LP is, crucially, allowing the patient to decide that he or she is to be aided to die, so it admits the principle of assisted suicide; and surely it is more, rather than less, justified to apply it to someone who otherwise will suffer prolongedly than one who will soon die anyway

Woody Duck
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Re: Euthanasia - On Terry Pratchett's 'Choosing to Die'

#60 Postby Woody Duck » October 20th, 2012, 7:46 pm

Animist,
You have slightly misunderstood the Liverpool care path way. It is not a pathway that gives permission to assist in someones death. It is a pathway implemented when someones condition is such that they are likely to die within the next few days. At this point crisis drugs are prescribed to relieve discomfort and pain usually given through a syringe driver. In this case the priority is symptom relief and in general some one will usually die from the condition that they have. On occassions the balance between symptom relief and side effects of certain drugs may steer someone towards death but this is only when the analgesic need dictates. It is in no way related to euthanasia or assisted dying. In this case Tony Nicholson would have been a completely unsuitable candidate for LCP. The life threatening problems he had were reversible and thus not indicative really of palliative care or the LCP unless of course the co morbidities that might occur such as septicaemia from pressure sores ala Christopher Reeve caused irreversible damage likely to cause imminent death
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animist
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Re: Euthanasia - On Terry Pratchett's 'Choosing to Die'

#61 Postby animist » October 21st, 2012, 11:18 am

Woody Duck wrote:Animist,
You have slightly misunderstood the Liverpool care path way. It is not a pathway that gives permission to assist in someones death. It is a pathway implemented when someones condition is such that they are likely to die within the next few days. At this point crisis drugs are prescribed to relieve discomfort and pain usually given through a syringe driver. In this case the priority is symptom relief and in general some one will usually die from the condition that they have. On occassions the balance between symptom relief and side effects of certain drugs may steer someone towards death but this is only when the analgesic need dictates. It is in no way related to euthanasia
or assisted dying. In this case Tony Nicholson would have been a completely unsuitable candidate for LCP. The life threatening problems he had were reversible and thus not indicative really of palliative care or the LCP unless of course the co morbidities that might occur such as septicaemia from pressure sores ala Christopher Reeve caused irreversible damage likely to cause imminent death

OK, thanks. I knew of the practice but not the LCP label, and I did not know that patients were asked in advance. I suppose the practice is a form of "double action": since the ostensible and justifiable reason in giving heavy doses of painkillers is to ease pain rather than to kill, it cannot indeed be called voluntary euthansia or assisted suicide


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