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Assisted dying – a debate that doesn’t die

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By Ranveer Bassey

28 Oct 2012

In 19^th century Britain, a person who committed suicide would have a stake driven through their heart before being unceremoniously buried at a road side. You'd think we'd have progressed since then, and we have. Suicide is no longer the felo de se crime it used to be, but in the case of assisted dying our laws remain woefully archaic.

There exist people, fully competent, who place their life on a scale and find death outweighing life. For them, death is a good thing - something to look forward to and even strive for. We've seen it time and time again in the news. This is such an alien concept for some that they seem to refuse to accept it, but denial does nothing to help address the issue.

The circumstances in which someone chooses to end their life are always desperately sad. But they are made sadder still by the challenges the legal system presents. As a result there are deaths behind closed doors, or individuals have no alternative but to refuse food and water. Those who can travel to a Dignitas clinic in Switzerland face fears their loved ones might be prosecuted. And what does it say about Britain that we outsource our death? It has been ten years now since the first British person ended their life with Dignitas.

There are legitimate concerns about assisted dying, that vulnerable people could be coerced and that it is a slippery slope to name a few. I don't think any of them represent insurmountable issues. Other countries have successfully implemented assisted dying policies.

Pharmacists would likely be a crucial safeguard in any assisted dying process. As the suppliers of the elixirs of death* we'd have to be. No doubt the right to conscientious objection would exist. We should seek to be a vocal voice in the assisted dying debate.

It's easy to think about the issue in the abstract, as if it's an interesting ethical conundrum that affects other people. But that person I mentioned who places their life on a scale, it could be you. You chose how you lived your life, don't you think you should be free to choose how you end it?

*Dignitas uses 15 grams of sodium pentobarbital, a short acting barbiturate, in 100ml of water. Dignitas states "only very few pharmacies can supply it readily". Metoclopramide is given 30 minutes prior to ingestion to prevent vomiting. The individual falls asleep before respiratory arrest causes death.

Tue, 30/10/2012 - 19:19 – Eui-Jin Kim

To be or not to be?

To your question of don't you think you should be free to choose how you end it?

I choose to say no.

When I think of euthanasia, I think of Dr Jack Kervorkian and Margaret Garrish. http://www.skousen.name/id47.htm
Yes, Margaret had pain and yes she wanted to die, but other doctors thought that they could help with her pain and improve her condition greatly. Instead, she went to Dr Kervorkian and he helped her die.

My argument against assisted suicide is not to those who are dependent on machines and mentally unconscience. It is against those who have a sound mind, but they have physical difficulties.
I cannot speculate on why Margaret wanted to die, but the fact of the matter is everyone goes through difficulties in life. Physical challenge is just one of many problems that we all deal with in everyday life.

It was only recently that UK hosted Olympics and Paralympics. What differentiates a Paralympian, living the life to the max, and a disabled man wanting to die? Hope, I think.

What frustrates me most is that the discussion is almost always focused on the legal issues of euthanasia and its methods etc..., rather than talking about the value of living a joyful life and giving examples of others who have overcome difficulties in their lives, such as Helen Keller, Beethoven, Christopher Reeves just to name a few.

I chose to enter into a health profession to help save lives, not to push a hopeless person over the edge of the cliff.

Tue, 30/10/2012 - 19:37 – David Lumsden

Assisted Dying

It is good to see people keep discussing this issue Ranveer. I first thought hard about this when a lovely palliative care pharmacist asked us at university 'would you be willing to dispense the medicine that would end someones life?'. With some thought, I remembered the agony of my grandmother who was in great pain at the end. I can think of how it would be if I were in constant agony and, having gotten my affairs in order, was left to wait for the inevitable in the grips of agony. I quickly decided I am pro-assisted dying.

A large section of objectors appear to object on religious grounds. However, I cannot reconcile this with our evidence-based healthcare system. Others point towards the Hippocratic oath and its non-maleficence clause. My firm belief is that living in terrible agony or with a debilitating condition is less harmful than death for these people. I hope these are views many will consider and share.

With conscience-clauses and apropriate safeguards in place, I hope assisted dying is legalised in the near future and certainly before any of my loved ones require it.

Tue, 30/10/2012 - 22:50 – Ranveer Bassey

Thanks for your

Thanks for your comments.

@Eui-Jin

My view is that the judgement of the difficulties of life and the joy it does or doesn't bring belongs to the individual.

@ David

It's disappointing that the religious argument gets coverage. It doesn't add anything to the debate.

Wed, 31/10/2012 - 01:27 – Eui-Jin Kim

In Holland, when euthanasia

In Holland, when euthanasia was first introduced, people could get help in dying, provided that there were safeguards in place.

The conditions were the patient had to be terminally ill, at least 3 doctors had to confirm that the illness was terminal and that the patient gave consent to it. 3 years later, that restriction relaxed from terminally ill to chronically ill. Later, it became emotiomally ill or you could just simply be depressed and get help in dying.
What ended up happening was there was an exponential increase in assisted suicides. After all, why go through painful death as a depressed teenager, when there is a convenient way of dying at the doctor's clinic?
Also, when someone dies, nobody dies alone. It affects the people around him or her and the society as a whole. Any parents who lost their loved ones who killed themselves would go through their life with pain that would never disappear from their hearts.
Moreover, it cheapens one's life.

Why care for chronically ill and burden the NHS when it is cheaper to assist them in dying? People are living longer than before and more and more people are approaching the retirement age. If assisted suicide was legalised, I can see that the old and sick patients being looked down upon as selfish for burdening the society and getting pressured into getting euthanasia.
I cannot believe that you think those who object to assisted dying are all basing their opinion on their beliefs alone.
At the end of the day, if one decides to die, they will find a way, one way or the other. But i do not believe we as health professionals should be advocating and encouraging people to die.

Wed, 31/10/2012 - 21:58 – Ranveer Bassey

Sorry Eui-Jin, but your

Sorry Eui-Jin, but your portrayal of euthanasia in the Netherlands is inaccurate. You might like to read this journal review which found that "no slippery slope seems to have occurred". There hasn't been an exponential increase in euthanasia, indeed a decrease was recorded in 2005.

I don't think it remotely possible that legalising assisted dying might lead to a society which would pressure the elderly into an early death. In any case, that is an argument for robust safeguards rather than an argument against assisted dying.

Assisted dying would not be advocated or encouraged by health care professionals, much in the same way pharmacists don't advocate or encourage the use of emergency hormonal contraception.

It's important to consider that the current situation isn't harm-free. It robs people of their right to self-determination, forces them to live deeply unhappy lives and encourages underground practices which are more likely to lead to abuse of vulnerable people.

Thu, 01/11/2012 - 09:57 – Eui-Jin Kim

Perhaps there needs to be a

Perhaps there needs to be a clear definition between assisted suicide and euthanasia.

from wikipedia.

"Assisted suicide is the common term for actions by which an individual helps another person voluntarily bring about his or her own death. "Assistance" may mean providing one with the means (drugs or equipment) to end one's own life, but may extend to other actions. It differs to euthanasia where another person ends the life. The current waves of global public debate have been ongoing for decades, centering on legal, religious, and moral conceptions of "suicide" and a personal "right to death". Legally speaking, the practice may be legal, illegal, or undecided depending on the culture or jurisdiction."

your reference to the study indicates that euthanasia rate decreased because there had been an increase of assisted suicide to 8.2%.

"An important factor in explaining the decline in the frequency of euthanasia and physician-assisted suicide in the period 2000–2005 may be an increased use of other options to relieve the patient’s suffering, such as continuous deep sedation, which was for the first time included in the 2001 study and has increased from 5.6% of all deaths in 2001 to 8.2% in 2005 (Rietjens et al. 2008)."

So, my argument of the actual 'assisted deaths' rates increased after the legalisation only proves my point from your reference. The figures simply skewed towards assisted suicide rather than euthanasia because doctor would be subject to a lot of scrutiny and possibly be prosecuted if they didnt follow procedures.

Your second point of using EHC consultations as an example of the 'robust' healthcare. I cannot even start to think where to begin with your example. When i went for the training EHC that would enable me to provide free EHC, the advice I got from the speaker was that if I were ever in doubt, provide the EHC, because it is relatively harmless even if you werent pregnant. Are we to apply the same logic with the assisted dying??

Your last point of human rights...

I get the feeling that you do not want to consider any of my points addressed above, although you were saddened by the arguments that 'doesnt add any value to the debate'. Do you consider that the points i have raise dont have any value in them? Again, I come to the point I raised before. A desperate individual who has a strong will to die, will find a way, whether it be legal or not. My question is why make things easier for them to die, rather than encouraging them to live and show them the joy in life?

I sincerely hope that you are not playing the devil's advocate just for the sake of your argument...

Sat, 03/11/2012 - 11:55 – Ranveer Bassey

You originally said there

You originally said there was an "exponential increase in assisted suicides". This wasn't the case, irrespective of what happened in 2005. But for clarity's sake, the percentage of deaths as a result of assisted suicide and euthanasia did drop in 2005. Continuous deep sedation, which you correctly say increased in 2005, is used as part of palliative care. It is not a form of assisted suicide.

I used EHC as an example to make the point that pharmacists needn't be advocating or encouraging assisted dying. I never applied the example to safeguarding.

The decision someone makes to end their life is a monumental one, contrary to every fundamental human instinct. Given the strength of these instincts and the intense deliberation preceding the decision, I'm sceptical of the need to encourage individuals to live and to educate them about the joy of life. And this kind of encouragement and education could co-exist alongside assisted dying, with the advantage that those who still decide they wish to die can do so with dignity.

Thanks again for your comments Eui-Jin. I think we risk rehashing the same points and losing sight of the bigger picture if we continue this, so I intend for this to be my last comment.