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.
Latest post of the previous page:What an informative and inspiring discussion.
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.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.
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: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
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.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
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.Woody Duck wrote:Alan you must be immensely proud to be related to such a great woman.
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.Woody Duck wrote:...until uniformly in this nation everyone has the access to expertise in planning end of life care.
Provided the patient and family are happy with that then it definitely isWoody Duck wrote:care at end of life is much more appropriate and efficient in the home provided the right resources are there.
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...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.
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...Perhaps when orif he change does occur then euthanasia or assisted dying will follow on quite naturally and obviously.
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".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.
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.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.
HOW WELL ARE WE COORDINATING END-OF-LIFE CARE?
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/
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.Tetenterre wrote: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.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.
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'.
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.
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 anywayAlan 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."
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 suicideWoody 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