Should we have control over the end of life

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The mother of a paralysed rugby player who died in a Swiss assisted suicide clinic has defended her son's right to die. Daniel James was paralysed during a training session.

Mother defends rugby suicide son

Parents of Daniel James backed by moral philosopher Baroness Warnock

‘It took courage for the parents of Daniel James to say goodbye’

The parents who helped their paralysed son, Daniel James, die after a rugby accident have been backed by one of the most distinguished moral philosophers, Baroness Warnock

who has called for euthanasia to be legalised in the UK.Daily Telegraph

'If you're demented, you're wasting people's lives – your family's lives – and you're wasting the resources of the National Health Service. I'm absolutely, fully, in agreement with the argument that if pain is insufferable, then someone should be given help to die...

Mary Warnock

....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.’

“By the time you read this, with the help of Friends At The End 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 in the past fifteen months.”

Nan Maitland

'If you're demented, you're wasting people's lives – your family's lives – and you're wasting the resources of the National Health Service. I'm absolutely, fully, in agreement with the argument that if pain is insufferable, then someone should be given help to die...

Mary Warnock

....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.’

‘Dignity in Dying campaigns for greater choice, control and access to services at the end of life. We believe that people should have more control over how, where and when they die. Greater choice includes giving mentally competent, terminally ill adults in unbearable suffering the choice of an assisted death within strict legal safeguards.’

“A dignified death for all” “Patient choice at the end of life”

www.dignityindying.org.uk

‘Ensuring a dignified death’‘The right to die’The right to choose at the end of life’‘Easing the passing’‘Assisted dying’‘Choosing to die’‘Easeful death’‘Ending suffering when it becomes unbearable’‘People should not have to suffer against their will’‘Choice and control over how we die’

“The beginning of wisdom is to call things by their proper name…”

Anon

Euthanasia is intentional medical killing, of a person whose life is thought not to be worth living.

Physician assisted suicide is the action of a doctor helping a person to kill

themselves. The doctor decides which drugs will kill the patient, calculates the lethal dose, obtains the drugs, instructs the patient in the correct way to take

the drugs and makes sure that the patient has them. However the patient

must take the drugs themselves.

Euthanasia is not the same as:

1. Withdrawing medical treatment which is futile or burdensome, or where the patient is “actively dying”. This is good medical care.

Balancing the benefits and burdens of treatment

Benefits Burdensof treatment of treatment

Euthanasia is not the same as:

2. Giving pain-killing treatment in order to benefit the patient which may have the unintended side effect of shortening life. This is the principle of double effect – recognising the difference between intention and foresight.

What personal fears are driving the increasing pressure for euthanasia legislation?

• Fear of suffering

• Fear of indignity

• Fear of dependence

“My life is like a play. I’ve done well in writing the script so far, but I

don’t want the last act to ruin the whole performance….”

Reasons given for physician assisted suicide in Oregon

1. Controlling the time of death 2. Being ready to die 3. Dying at home instead of in a hospital 4. Existence being pointless 5. Losing independence6. Poor quality of life

Social pressures increasing demand for euthanasia

• ageing population and rise in chronic disability and neurodegenerative conditions such as Alzheimer’s disease.

• rising healthcare costs at the end of life• family break-up and increasing social

isolation • increased demands on limited social

resources

Faulkner commission on assisted dying

“Following lengthy deliberation, the Commission recommends that the following three eligibility criteria should be met before a person may proceed with requesting an assisted death…..

“The person must:1.be aged 18 or over and have a diagnosis of terminal illness2.be making a voluntary choice that is an expression of his or her own wishes and is not unduly influenced by others3.have the mental capacity to make a voluntary and informed choice, and their decision-making ability must not be impaired as a result of mental health problems such as depression.”

“The Commission has not recommended that any criterion based on ‘unbearable’ or

‘unrelievable’ suffering should be included in potential assisted dying legislation as we are concerned that a criterion based on suffering

would be too unclear and subjective for doctors to assess.”

Euthanasia legislation - the risks

• Wrong diagnosis• Wrong prognosis = prediction of life

expectancy• Abuse by health professionals• Abuse by relatives• Increased anxieties for the elderly and

unwanted• Effect of killing on doctors• Effect of euthanasia on society

“Would someone visit me for a last bit of comfort?”

“I'll call him to come, madam…..”

“There’s always an easy solution to every human problem – neat,

plausible and wrong….”

H L Mencken

'I swear by Apollo Physician, by Asclepius, by Hygeia, by Panaceia

and by all the gods and goddesses, that I will carry out, according to my ability and judgement, this oath...'

‘I will use treatment to help the sick according to my ability and judgement but I will never use it to injure or wrong them.

I will never give a poison to my patient even if asked, and neither will I suggest such a plan’

Hippocratic Oath c 200 BC

“For the first time in the history of humankind there was a complete

separation between killing and curing. Throughout the primitive world the

doctor and the sorcerer tended to be the same person. He with the power to kill had the power to cure. He who had the power to cure would also be able to

kill...

……With the Greeks, the distinction was made clear. One profession was to be dedicated completely to life under all

circumstances, regardless of rank, age, or intellect - the life of a slave, the life of the Emperor, the life of the immigrant,

the life of the defective child.......'

Margaret Mead

In Christian thinking a human life is not just a gift of God’s grace –

it is a reflection of his being.

‘Whoever sheds the blood of man, by man shall his blood be shed;

for in the image of God has God made man.’

Genesis 9:6

The ancient human taboo against the shedding of blood is linked with the indwelling image of God.

In Christian thinking, the destruction of an innocent human life is always wrong – not only because of the wrong to the individual and the community, but also because it is a profound insult to the being and character of God himself.

'Within the story of my life I have the relative freedom of a creature, but it is not simply my life to do with as I please....

Suicide... expresses a desire to be free and not also finite - a desire to be more like the Creator than creature'

Gilbert Meilaender

In the Bible and in all societies influenced by Christianity, suicide is

never glorified as a noble or honourable way to die.

Self-destruction is a harm to be avoided…., not a human right to be

assisted.

“No man is an Island, entire of itself; every man is a piece of the Continent, a part of the main; if a clod be washed away by the sea, Europe is the less…. any man’s death diminishes me because I am involved in Mankind;

And therefore never send to know for whom the bell tolls; it tolls for thee….”

John Donne, John Donne

Dependence is not an alien, subhuman, undignified condition - it is part of the

narrative of every human life.

“Carry each other’s burdens, and in this way you will fulfill the law of Christ.”

Galatians 6:2

Christian thinking about death

The death of human beings is not to be welcomed and hastened. Death is an enemy which we must fight against.

But, by God's grace, death can also become a 'severe mercy', a strange kind of healing, a gateway to a new reality.

Palliative care

“You don’t have to kill the patient in order to kill the pain”

Cicely Saunders

Palliative care

“Not only will we help you to die well, we will help you to live before you die”

Cicely Saunders

“Palliative care developed as a response to the statement “There is nothing more that we can do”. This is never true – there is always more that we can do.”

Robert Twycross

Dealing with “total pain”

• Physical pain• Psychological pain• Relational pain• Spiritual - existential pain

“Suffering is not a question which demands an answer, it’s not a problem

which demands a solution…

It’s a mystery which demands a presence”

Anon

In palliative care of the dying patient the intention is neither to accelerate the dying process,

nor to impede it.

What is a good death?

Dying well is an opportunity….

• Reordering priorities • Restoring broken relationships• Saying goodbye• Fulfilling dreams• Finding new meaning • Preparing to meet God

Good medicine must know its limits – it must know when to say, “enough is enough”.

When death changes from an enemy to be resisted, into a gateway to a new existence,

even a strange form of healing, a ‘severe mercy’.

The limits of medicine

Caring for the dying patientThree aspects of care are mandatory for all patients:

•pain relief and treatment of distressing symptoms•provision of food and fluids, as tolerated and requested•TLC - compassion, humanity and the avoidance of abandonment

1. Lasting Power of Attorney2. Advance decision to refuse treatment

What is a good death?

A good death is one where my pain and symptoms are controlled and where I am surrounded by people who love me and care for me.

A good death is an opportunity to concentrate on the most important things in life, a time for healing and reconciliation of relationships, for learning new lessons, for preparing for the next stage of existence.

www.carenotkilling.org.uk

www.cmf.org.uk