End of Life Issues & Debate

Temporary pause

2011-02-16T10:28:00.000Z

Due to unforeseen circumstances, this blog will be paused for the next few weeks. However, we hope to return to it in due course.

We apologise for any inconvenience caused.

Opposing views on assisted suicide

2011-02-07T17:32:00.000Z

The Guardian newspaper has published a debate between Mary Warnock, who passionately believes that assisted suicide should be lagal, and Cristina Odone, a Christian writer who is against its legalisation. Both women have experienced the loss of loved ones under difficult conditions. Although there is no "real conclusion" to the detabe, it is important to have positions seen and analysed in order to derive a personal perspective.

Euthanasia Series on Channel 4

2011-01-11T16:01:00.001Z

Alaistair Thompson has alerted us of a series on euthanasia which will be shown on Channel 4. All of the video clips are available in the following website.

There is also the possibility of posting comments on the wesbite. We thought it might be an interesting resource for everyone to look into.
This is the way Alaistair let us know about the series:
We would like your feedback on a series of films about euthanasia showing on Channel 4 next week.

4thought.tv encourages constructive debates about religious and ethical issues in our society. Each week we look at a different theme, and next week we are exploring attitudes towards euthanasia, and asking whether it should be legalised in Britain. We have tried our hardest to fairly represent both sides of the debate, and show both people who believe assisted suicides should be legalised to limit the suffering of terminal illnesses, and people who don't for religious and potential misuse reasons. The 90 second films will be airing after the news every evening on Channel 4 (around 7:55pm). Viewers can then share their own thoughts and feelings about euthanasia, respond to individual films and reply to other viewer comments on our website www.4thought.tv

This is obviously a contentious and extremely emotional issue. In order to generate meaningful dialogue on the website, which may be of use to individuals and support groups, it would be a fantastic help if you could ask your members, colleagues and friends to watch the films and respond online afterwards. We are interested in all thoughts related to the films, whether you agree with the speaker or strongly oppose what they say, and hope people will share also share personal views and and experiences. We always encourage people to be open and honest when commenting, and you can remain anonymous if you wish.

This is an outline of the speakers views and transmission times.

Monday 17th January, 7:55pm – Lesley Close
Lesley Close’s brother John had Motor Neurone Disease. In 2003 Lesley accompanied him to a suicide clinic in Switzerland where she witnessed his “dignified and amazing” death.

Monday 17th January, 7:58pm – Sarah Meagher
Christian Sarah Meagher’s husband died of cancer four years ago. Sarah believes that only God has the right to take a life and neither she nor her husband would have wanted his death to be hastened in any way.

Tuesday 18th January, 7:55pm – Martin Amis
Author Martin Amis believes that euthanasia is an evolutionary inevitability. Martin recently caused controversy by putting forward the idea of suicide booths on street corners and thinks that future generations will look back at how we have abandoned people to their longevity as “barbaric”.

Wednesday 19th January, 7:55pm – Michael Wenham
Christian Michael Wenham was diagnosed with Motor Neurone Disease nine years ago. He believes his life is now richer than it was before his illness and that euthanasia is a selfish act that fails to take account of the feelings of those who are left behind.

Thursday 20th January, 7:55pm – Dr Michael Irwin
Dr Michael Irwin believes that it is a doctor’s duty to ease a patient’s suffering and wants to see a change in the law that would allow doctor-assisted suicide for those who are terminally ill. He has personally accompanied patients to the Dignitas suicide clinic in Switzerland to help them end their lives.

Friday 21st January, 7:25pm – (anti euthanasia doctor)
Saturday 22nd January, 6:55pm – Dr Ann McPherson
Dr Ann McPherson has terminal cancer. She will almost certainly die within the next six to twelve months. Ann hopes that, when the time comes, she will be able to have the option of an assisted death in Britain.

Sunday 23rd January, 7:55pm –Kevin Fitzpatrick
Kevin Fitzpatrick believes that legalising euthanasia in Britain would be a terrible mistake and that many more disabled people would die as a result. Kevin believes that we should put our energies into improving palliative care services rather than trying to make it easier for people to hasten their deaths.

All of the films are available to watch online immediately after they broadcast, and for the next 6 months, here www.4thought.tv/euthanasia

Ian Galloway calls for the debate to widen

2010-12-06T14:42:00.000Z

Ian Galloway, the Convener of the Church and Society council has called for a widening of the debate on assisted suicide to include issues of palliative care. This is in response to the fact that the Assisted Suicide Scotland Bill failed to reach the required vote at the Scottish Parliament. Margo MacDonald, the proponent of the bill, agreed with Mr. Galloway that the debate mucst also include the provision for palliative care.

What do we mean by "Quality of Life"

2010-12-06T14:34:00.000Z

This is a very powerful video about a person with a genetical disorder. It has really made me think about the meaning of the concept "quality of life". Please watch it.

http://www.kierandodds.com/#/selected/end-of-life

Church of Scotland's position on the proposed End of Life Assistance Bill.

2010-11-23T13:50:00.000Z

The Church of Scotland today urged MSPs to reject the proposed Lend of Life Assistance (Scotland) Bill, to be debated in the Scottish Parliament on Thursday 25th November.

Rev Ian Galloway, Convener of the Church and Society Council of the Kirk drew the attention of MSPs to the Committee which has undertaken intense scrutiny of this proposed legislation. He said: “The conclusions of the Committee are unequivocal: no change of the law in this regard is either required or desirable, as they say in their report that “the Committee was not persuaded that the case had been made …and, accordingly, does not recommend the general principles of the Bill to the Parliament.”

The ELA Scotland Bill proposes that, under certain circumstances, assistance to end their lives should be allowed for those who wish to. The Church argues that any legislation which endorses the deliberate ending of a human life undermines us as a society. The worth and dignity of every human life needs to be emphasised and celebrated; in particular, the deliberate ending of life would be a matter to be deplored if person was perceived (or perceived themselves) as merely a burden.

Legislation of the type proposed in the End of Life Assistance (Scotland) Bill represents much more than simply a tinkering with the law. Breaching as it does the societal prohibition on the taking of human life, it carries implications for attitudes to many aspects of health and social care, not simply for the determined few who are pushing for change.

Rev Galloway continued: “An important aspect of our life as a society is in caring for the most vulnerable in society. While we are sympathetic towards the fears and desires of those who may be afraid of a painful death, what is proposed in this Bill is not the solution. Rather, there is a necessity to ensure that, as far as possible, all have access to good palliative care, which, in the widest sense, involves caring not just for the physical but also the emotional and the physical and spiritual needs of people coming towards the end of their lives.”

Scots End-of-life Bill could lead to 1,000 deaths a year

2010-10-22T16:41:00.000+01:00

Scots End of-life Bill could lead to 1,000 deaths a year. These are really stark projections of people presumably willing to commit suicide per year in Scotland. Palliative care nurses are also warning that if passed, this legislation would bring into Scotland, people willing to end their lives, pretty much in the same way as people travel to Switzerland. Cristina Odone, from the Centre for Policy Studies, has recently published a report starting that this legislation would make elderly and frail people extremely vulnerable to succomb to pressures for assited suicide. If life is considered expendible, because some people cannot contribute on economical and social terms to society, and there is a lgeal way of ending such lives, there might always be the temptation to view suicide as a normal way out. However, this position is not acceptable within a Christian outlook on life, that values everyone's contribution to society and that considers life sacred.

Fresh hope for severely brain damaged patients

2010-10-04T12:04:00.001+01:00

Thanks to functional magnetic resonance imaging (fMRI) Dr. Owen a neuro-scientist from Cambridge University has been able to communicate with a patient who had been previously considered to be in a vegetative state. Although the equipment is not portable and cannot be used for frequent communication it seems that even when people seem to be locked into vegetative states, it is possible through suitable technology to communicate with them. This opens up again fresh avenues of research into what is meant by "quality of life". Surely if a person can communicate, even through a machine, we can no longer state that the person is in a "vegetative state". Read more about this by following the link Fresh hope for severely brain damaged patients.

Protests outside the Scottish Parliament

2010-10-04T11:33:00.002+01:00

Protesters against the proposed end -of -life bill gathered aoutside the Scottish Parliament. This protest was particularly poignant becuase it was organised by dissabled people who see the proposed bill as eroding their right to life. This was taking place as debates within parliament were addressing the same issues. It was wonderful to witness the agency with which individulas irrespective of their dissability were fully engaged in exercising their civic rights. For a short film about the protest, please follow this link.

Does the proposed End of Life Bill have real support?

2010-09-07T10:40:00.000+01:00

The assisted suicide bill has received the support of a humanist group however as noted in the article published by the Christian Institute in the following link, Scots end-of-life Bill backed by humanists the data presented support the claim that the majority of people in Scotland do not support the end of life bill. "Care not Killing" delivered over 14,000 postcards against the proposed Bill and only in July, Holyrood released data of a poll that showed that the majority of those in the study did not approve the proposed Bill. Allegations of support might be branded back and forth, but, the postcards and the polls are evidence of involvement against the proposed Bill.

Euthanasia and Assisted Suicide

2010-07-08T13:55:00.005+01:00

John Wyatt has recently written a very good article on euthanasia and assisted suicied in the Cambridge Papers: towards a Biblical Mind collection. The paper argues that the arguments in favour of assisted suicide are no longer centred on unbearable suffering or pain. Instead proposers of assisted suicide and euthanasia, are stressing now the important of choice and control over the time and manner of death. This is coupled says Wyatt with "fears about the sociala dn economic consequences of increasing numbers of elderly and dependent individuals". Read the full abstract and access to the paper following this link.

Resources on End of Life Issues

2010-07-05T14:19:00.002+01:00

The UK Clinical Ethics Network provides extremely useful information on the current frameworks available to make ethical decisions concerning end of life issues. Their website links to national policy and guidelines on end of life as well as providing links to a number of medical guidelines approved by medical professional bodies on end of life issues. this website is a useful resource.

When is medical treatment too much treatment?

2010-06-29T11:19:00.004+01:00

I thought the following article was interesting. It argues that in the USA the medical industry prolongs life with expensive sometimes "unecessary" treatments. It proposes that time spent in peace within a palliative care environment is a better way of approching the end of life than through the continuouse struggle against death. I wonder if as a society we are able to move away from the culture of the beautiful and healthy, and accept that aging, and dying is the full completion of the cycle of life. Happy reading. Please post comments if so inclined.

Personal View of the Debate on the End of Life Assistance (Scotland) Bill

2010-06-21T13:08:00.012+01:00

We are very fortunate to have the personal input of Rev Dr Donald M MacDonald. He is a medically trained minister of the Free Church of Scotland with twenty one years’ experience as a doctor and surgeon in Scotland and India before becoming the minister of a congregation in Scotland and then lecturing in Practical Theology in the Free Church College, Edinburgh. He retired in June 2009. He has had MS for 27 years and uses a wheelchair. His perspective therefore is of extreme importance for us and we are very grateful for his contribution.

On Saturday 12th June I attended a debate on the End of Life Assistance (Scotland) Bill in Committee Room 1 at the Scottish Parliament. Speaking for the Bill was Margo MacDonald MSP, supported by members of FATE (Friends at the End) and others, and against was Suselle Boffey, supported by members of Inclusion Scotland and others, many of whom have disabilities. The debate was ably chaired by Rev Cllr. Ewan Aitken. No vote was taken.

Margo MacDonald argued for the Bill on the basis of individual human autonomy: each one has the right to decide when one’s life is no longer worth living because of unbearable pain, weakness, or loss of independence and dignity. People should have the legal right to be helped to end their lives when they find life intolerable. She claimed that the majority of people are in favour of such a Bill, that similar legislation in the Netherlands and Oregon is working well and that her Bill has strong safeguards against abuse.

Suselle Boffey argued for the right of people with disabilities to have all necessary support to live independently to the very end of natural life. The Bill is harmful to the interests of disabled people because it includes as eligible for “end of life assistance” those who are “permanently physically incapacitated to such an extent as not to be able to live independently and who find life intolerable.” This potentially includes many thousands of people, especially those who do not have access to the support they need for independent living. The important thing is to ensure that disabled people are treated equally under the law and that this support is available. The Bill would encourage stereotypical views of disabled people as not having a good quality of life and would put pressure on them to think of themselves as burdens on society.

People were then invited to speak briefly from the floor. The views polarised between supporters of the Bill, who appeared to think it was self-evident to any rational person that it was humane to help someone to end their life when they found it intolerable because of pain, loss of independence and loss of dignity, and its opponents, who argued passionately that people with disabilities do have a good quality of life provided they have the necessary support and equipment to live with freedom, choice, comfort and dignity.

My own view
I oppose the Bill on the following grounds:
1. The Bill attacks the sanctity of human life.
From the Christian perspective human beings are made in God’s image and likeness, and this likeness and consequent dignity is not diminished by injury, illness, physical or mental impairment or loss of function. Defence of and care for the weak and vulnerable has always been a cornerstone of the Christian social conscience. We have a duty to care for one another to the very end of life and it is wrong to deliberately end someone’s life.

2. The Bill is based on the myth of absolute individual autonomy.
The foundation of the Bill is clearly stated on page 2 of the original Consultation Document to be “the principle of autonomy, that the person has the right to determine the quality of his or her own life and its value, unrestricted by the moral, cultural, religious, or personal beliefs of others”. This would appear to give the individual an absolute right to decide when his/her life has such a quality and value that it should be ended. This extreme individualism ignores the importance of the fact that we humans exist in relationships and in community. We come into the world as completely dependent creatures and we remain dependent on one another to a greater or lesser extent throughout our lives. As well as rights we have responsibilities and duties towards others. The care we exercise towards one another is part of what makes us fully human. We should also learn to receive care as well as give it. It should not be regarded as loss of dignity to be dependent on others. I have found that becoming more dependent on others makes me more appreciative of the loving care and the sheer humanity of those who care for the weak, the vulnerable and the defenceless. We have no right to demand that someone help to end our life. Ending an innocent person’s life, even with the purpose of reducing the amount and length of suffering is not justified, especially when good long term support and palliative care are possible. Our common humanity is best represented and supported by ensuring that this kind of care is available to all and not by deliberately ending a life. I fear that this Bill, if it comes into force, would lessen people’s willingness to care sacrificially for those who have long term disabilities and those suffering from chronic, debilitating and terminal illnesses.

3. The Bill proposes an unacceptable change in the role of medical practitioners.
From the time of Hippocrates, 2,400 years ago, it has been the accepted ethical standard of the medical profession not to administer a fatal dose to a patient. This radical new proposal would have serious effects on the profession and the doctor/patient relationship. It would require doctors to be trained in “end of life assistance” – in other words how to kill people. It would cause a division in the medical profession between those who see deliberately ending a patient’s life as acceptable and the vast majority who want to maintain life with all the support necessary to reduce the suffering of those who are dying. It would undermine confidence in the medical profession as supporters of life. Of course the time does come in the course of an illness when death has to be allowed to supervene, but supportive and palliative care should continue to the end and the doctor should never intentionally bring about the death of a patient. Patient autonomy is not absolute. The patient has the right to refuse treatment that he/she considers to be intrusive and distressing and may prolong life only at the cost of increased suffering, but this does not confer the right to demand that the doctor end their life deliberately. The two situations are different.

4. The Bill is poorly drafted and, despite so-called safeguards, wide open to abuse.
I have highlighted many defects in my submission to the Parliamentary Committee, but here are a few of the most glaring:

4.1 End of Life Assistance is defined as “assistance, including the provision or administration of appropriate means, to enable a person to die with dignity and a minimum of distress”. The title of the Bill says that it is for “persons who wish their lives to be ended”, obviously by someone else (euthanasia) and not necessarily by themselves (assisted suicide). “Appropriate means” are never defined, another serious omission. The inference of the title and the definition taken together is that only by deliberately ending one’s life can one die with dignity – an insult to those practising and those benefitting from palliative care. At a time when we are trying to stem the tide of suicides among young people who see no point in going on living, this seems a strange note to be sounded in proposed legislation!

4.2 The Bill defines too loosely the categories of people eligible for “end of life assistance”. “Terminally ill” is defined as having less than six months’ life expectancy. This is extremely difficult to predict. As noted above, the inclusion of a large number of people who are “permanently physically incapacitated” is unacceptable. The main criterion of eligibility seems to be finding life “intolerable”. This is a subjective judgement and may well vary over time depending on a wide range of factors – physical, psychological, emotional and social.

4.3 There are many flaws in the procedure of application for “end of life assistance”. It lays a huge burden of responsibility on the “designated practitioner”. The role of the psychiatrist is fairly peripheral, being limited to judging capacity and freedom from undue influence. The possibility of palliative care has only to be “discussed”; the minimum age is only sixteen; the residency requirements could easily be evaded; the various time limits are too short; the requirements for witnesses are poorly defined and the impression is given of these being merely token safeguards.

4.4 The procedure at the end of life, including the means of ending life and who actually administers them, is not clearly defined. There seems to be a deliberate vagueness about the matter, with the liberal use of euphemisms.

4.5 Although the motive of the framers of the Bill is not to save money, the accompanying Memorandum notes that this Bill could actually result in savings for Health Boards, because ending a person’s life is cheaper than continuing to treat and care for the person (paragraph 97). This potential financial saving could very quickly become a determining factor in decision making in treating people with disabilities or chronic illnesses and in end of life situations and this would put extra pressure on patients and carers.

I believe that if this Bill were to become law, it would have a detrimental effect on society’s respect for human life, would damage the doctor-patient relationship, would be difficult to enforce without widespread abuse and would lead to a devaluing of the lives of people who are dependent on others because of disability or chronic illness or are nearing the end of life. Evidence from the Netherlands and the State of Oregon shows the potential for abuse of such legislation. Instead of such a law what we need is to ensure the widest possible availability of support for independent living and good long term and palliative care for all who need them.

Moral Arguments for and against Assisted Suicide

2010-06-17T10:45:00.001+01:00

The British Medical Association, BMA published some time ago a discussion paper on the moral arguments for and against assisted suicide. The argumentation is interesting and can help anyone to make up their minds on this difficult issue. The discussion paper is available here.

Nurses to express their views on end of life issues

2010-05-12T11:31:00.004+01:00

Nursing Times has developed an online questionnaire asking nurses about their feelings and experience around assisted suicide. the purpose is to gain a comprehensive picture of how nurses deal with this difficult issue in hospitals, in the community, in hospices and nursing homes. The survey is anonymous and the full results will be reported in an issue of Nursing Times and on www.nursingtimes.net soon.

If you are a nurse, please fill in the questionnaire and express your views on this important subject. It is crucial to have all medics on the front line od this difficult subject express their opinions.

The End of Life Assistance (Scotland) Bill: Views from the trenches. Part 4

2010-05-06T14:44:00.004+01:00

This posting is the fourth and final part of the article that Dr Stephen Hutchison MD FRCP(Glasg, Consultant Physician in Palliative Medicine at the Highland Hospice has written on the End of Life Assistance (Scotland) Bill.

The doctor is also responsible for determining at any stage in the process, including during the final act, whether any comment ‘however informal’ by the person indicates a wish to stop the process. How does a doctor qualitatively evaluate statements or questions in this context? For instance, do expressions of hesitation or doubt, or concerns about the family, constitute informal revocation? Can any assurance be given that where hesitation is expressed to someone else that this is passed on to the doctor, rather than suppressed with well meaning or malicious intent? In the context of the decision in hand, how can a doctor determine with the required confidence what would and what would not amount to an informal revocation. So not only is this a vague ‘safeguard’ it actually prejudices the care of anybody going through the process, because it inhibits open dialogue with the doctor which is so important when approaching death.

So, as always, there are two sides to the argument. Although there are some strident campaigners, for the most part those on each side approach the issue with compassion at heart and we should acknowledge that. If you favour this legislation, you have to address its inadequacies. And if you oppose it, you have to recognise that you are left with very difficult questions about personal choice and suffering. Let’s avoid arrogant, polarised, gut reactions. Alienating the opposition makes good journalese but doesn’t encourage informed, intelligent debate. Our politicians are exercised by this issue and public ranting doesn’t help them. They have a free vote when it comes to parliamentary debate. We always tend to think that they have a responsibility to us, but forget our responsibility as constituents to let them know what we think. Why not write to your MSPs and give them some constructive thoughts about this issue?

The End of Life Assistance (Scotland) Bill: Views from the trenches. Part 3

2010-05-06T14:39:00.005+01:00

This posting is the third part of the article that Dr Stephen Hutchison MD FRCP(Glasg, Consultant Physician in Palliative Medicine at the Highland Hospice has written on the End of Life Assistance (Scotland) Bill. The article will be posted in 4 parts to facilitate reading.

The House of Lords Select Committee made several recommendations to guide the drafting of legislation about assisted dying. It would have been wise to have accommodated these when drafting the present Bill, but unfortunately they have been largely disregarded. The Bill does not draw a clear distinction between assisted suicide and voluntary euthanasia or set out clearly the actions which a doctor may and may not take in either case. There is no guidance whatsoever on what a doctor may or may not do, or agree to, in bringing about the person’s death. It does not adequately address the need to identify psychological or psychiatric disorders. Whilst the wording regarding prognosis in terminal disease is an improvement on previous legislative attempts, the Bill does not acknowledge the everyday clinical realities of prognostic inaccuracy. It does not focus on unrelievable suffering, but only on intolerability. In making provision only for discussion of palliative care, the Bill does not require patients to experience such care before taking a final decision. And finally it makes no allowance for conscientious opt-out for doctors.
I mentioned safeguards. The Bill requires a staged formal process, with stipulated discussions at each to determine that the person knows exactly what they are asking for, is aware of the alternatives and that they can stop the process at any time. Two psychiatric assessments are required, but it is permissible for both to be conducted by the same person, who is only required to report that the patient is acting voluntarily and with capacity, and not on how appropriate it is to continue with the process. The decision as to whether the process should be carried through rests solely with the designated practitioner. Approval of the second request must be by the same doctor who approves the first. It is a stretch of the imagination to construe this as an independent second opinion! The doctor is expected to ensure, at several points in the whole process, that the patient is not acting under undue influence. There is no indication as to how this should be determined, or of what amounts to undue influence. Is it enough to ask the requesting person? Will that also require a formal statement? The witnesses also have to attest that the requesting person has not come under undue influence. Yet again there is no indication as to how this should be determined. What enquiry are the witnesses required to undertake? How would reliability be assured? What happens where there is a conflict of opinion amongst all these people about the influence? It is impossible to ascertain undue influence, because the influences under which we function are many and varied, internal and external, and can be very subtle. Doctors are used to dealing with uncertainties. Clinical judgments are not always binary – yes or no. But when the outcome is deliberate action to end a human life, the opposite principle to that under which doctors currently work, uncertainty cannot be entertained.

The End of Life Assistance (Scotland) Bill: Views from the trenches. Part 2

2010-05-05T10:33:00.008+01:00

This posting is the second part of the article that Dr Stephen Hutchison MD FRCP(Glasg, Consultant Physician in Palliative Medicine at the Highland Hospice has written on the End of Life Assistance (Scotland) Bill. The article will be posted in 4 parts to facilitate reading.

Dignity in health care has come to be synonymous with assisted dying. The Voluntary Euthanasia Society is now called Dignity in Dying, and if you go to Zurich to end your life, it is to the Dignitas organisation. All political attempts to legalise assisted dying base their case on dignity. The MacDonald Bill, as you can see, does the same, but doesn’t define dignity, or explain why it should be enhanced by the Bill.

Dignity is a complex social construct, involving honour and esteem, merit, grace, relationship and dependence, who we are and how we behave. There are ways of identifying factors which compromise dignity in health care and good evidence on how to enhance it. Dignity is cheapened by simply equating it to assisted dying. Arguably the MacDonald Bill diminishes dignity in dying because of the requirement to submit to a formal protocol, with numerous consultations, scrutiny of one’s mental health, within a short time frame and without the opportunity to discuss hesitation or distress lest that should be interpreted as a wish to stop the process, all at a time when life is already deemed to be intolerable!
So what about choice and autonomy? Isn’t autonomy a basic human attribute? Dictionary definitions of autonomy include; ‘Freedom to determine one’s own actions; to govern our will by our own principles and laws; to make choices regardless of the influence of, or effect upon others’. Proponents of assisted dying say that we should be free to make our own choices about these deeply personal issues, without having to defer to anybody else. But if we think about it a bit, is there anything we can do or decide, trivial or important, which does not have a potential or actual effect on others? In reality, is autonomy not a limited concept? Maybe it is actually a myth! We are in fact created and designed to be relational and interdependent and our very dignity is intrinsic to that. Choice is something we do have, but we must choose responsibly.

Margo MacDonald’s Bill recognises that people can come under inappropriate influence, and it describes safeguards to prevent this. Scrutiny of the safeguards reveals inadequacies, but that is not the point I want to make here. What I want to say is that when people are seriously ill or incapacitated, they are particularly vulnerable to internal and external influences. The availability of the choice for some to have their lives ended would create a powerful societal influence which would place others – a greater number of people - at risk. Exposure in the course of debilitating and terminal illness to the very influences created by this Bill would increase the risk to a vulnerable majority. One individual insisting on the right to die will affect others. When people say that life and death are individual matters, they are wrong.

What does the Bill propose? To summarise, if it should become law in its present form, it would be legal, under certain circumstances, to assist a requesting person to die, or to help someone else to assist the person to die. It is usually assumed that such a procedure would be carried out by a doctor, but this Bill makes allowance for this to be done by lay people who meet certain eligibility criteria, and provided a doctor is present. The requesting person must be at least 16 years old, with either a terminal illness with a life expectancy of six months or less, or a physical debility which renders them unable to live independently, plus they must find life to be intolerable. The formal procedure includes two independently witnessed written requests by the person, assessments by the doctor to whom the request is made, assessments by psychiatrists, discussion with the doctors about the illness or disability from which the person suffers, feasible alternatives to assisted dying, the means of causing the person’s death, who should do it, where it should be done, and the option to stop the process at any time.

Given that the doctor is the only professional mentioned in the Bill and related documentation, it is reasonable to assume that the doctor will be responsible, not only for clinical assessment and drug administration (assuming that to be the chosen means of ending life), adjudication of the degree of dependence caused by a disability and the level of intolerability of life arising from this or from a terminal illness but also for scrutinising the credentials of the witnesses, and determining that the eligibility criteria of witnesses are met. The Bill is completely silent on the means by which death is to be brought about, as this is left to the supposed expertise of doctors. There is no opt out for doctors who conscientiously object to assisted dying, and referral to a willing colleague is obligatory. It is therefore possible that the requesting person could end up being assessed by a doctor who does not know them, and who would certainly have some difficulty assessing the degree of intolerability, and the level of influence under which the person is acting, let alone the legal ins and outs. And as far as the legal side of things is concerned, it is interesting to reflect on the comments of Julia Cumberlege, former health minister, House of Lords, who said; “The medical profession is there to treat, cure, and care for sick and disabled people. Once lawyers get involved the whole premise changes: bitterness, strife, and serious money take over, families are divided, and suspicion reigns. Doctors should steer clear of assisted suicide—or more accurately of putting people to death—if they want to retain the trust of their patients.” This Bill depends largely on the cooperation of doctors to make it work, but there has been no prior focussed consultation with the medical profession. Moreover there doesn’t seem to have been any thought about the level of competence a doctor would need before providing this service, how doctors will be trained for that, or about personal and professional support for those who are willing to be involved. Nor have similar needs for lay people been considered.

Continued on next posting...

The End of Life Assistance (Scotland) Bill: Views from the trenches.Part 1.

2010-05-04T10:32:00.013+01:00

We are very fortunate to be able to publish an article that Dr Stephen Hutchison MD FRCP(Glasg, Consultant Physician in Palliative Medicine at the Highland Hospice has written on the End of Life Assistance (Scotland) Bill. The article will be posted in 4 parts to facilitate reading.

Some people because of actual or anticipated physical or existential suffering will wish to end their lives, and sometimes people with serious and incapacitating illnesses do not receive an adequate standard of care. However, it is justified to conclude from this that we need the facility of legalised assisted dying?

Most of us have strong opinions about this. We tend to adopt deeply entrenched positions, shouting from one side about suffering, choice, autonomy and rights, and replying from the other with a sort of “Thus saith the Lord: Thou shalt not kill, and nothing more need be said” approach. Maybe it is difficult to find a middle ground here, and I suppose I am in my trench too, but it is important to appreciate the view from the other trench, so that this complex issue gets more than the knee-jerk response we usually hear. We need to avoid knee jerk responses ourselves – it isn’t just others who are guilty of that.

Most of us hope to avoid severe suffering, and in that event, the option for life to be ended humanely has appeal. Many doctors, including me, facing terminal care situations where treatment is not providing sufficient relief will have been attracted by the idea of being able to gently end life and bringing release. Sometimes the distress of life’s circumstances is beyond anything that a doctor can address. One of the fundamental things about being human is that we have choice. Choice, autonomy and dignity are buzz words nowadays. When presented on the one hand with unbearable pain, loss of control of bodily functions or dependence on others for basic care, and on the other hand to have the option for our lives ended with dignity, the choice seems obvious. How could anyone think that option was wrong? And can we not devise safe legislation to enable the inclusion of this ultimate act of compassion into medical care? These are difficult questions. Glib answers don’t convey much love and compassion, and the sort of right wing intolerant so-called Christian responses I sometimes hear on radio phone-ins are particularly irritating. For goodness sake let us recognise the real challenges around this issue, and Christians in particular should be avoiding un-Christ-like hard hearted responses.
We need to approach this issue compassionately, but also intelligently. One of the problems with public opinion is that people have not been well informed about what exactly such legislation would mean for patient care, and for society generally. The report of the House of Lords Select Committee, set up to comment on Lord Joffe’s recent attempts to introduce assisted dying, contains an extensive section about public opinion. It concludes that the issue of assisted dying is extremely complex, and that the real views of the public are obscured by inadequate information and appreciation of the implications of such law, for themselves and for society. Current public opinion, whilst generally in favour of assisted dying, is largely superficial and does not have sufficient rigour or quality to guide legislative change.

The policy Memorandum accompanying Margo MacDonald’s Bill mentions several distressing instances of suffering. They certainly should distress us. However, it is a matter of fact that people usually think they would like assisted dying to be available just in case they get severe pain, or other symptoms, in a terminal illness, rather than the actual experience of these. In other words it is fear of pain rather than actual pain which underlies the request. People experiencing terminal illness have a similar spread of opinion as the wider public. Of those who do express the wish for their lives to be ended, many have depression. Anecdotally, others change their minds once they have received good palliative care. So when I read about pain, distress and suffering in the Policy Memorandum, I wish I had more information about the level of care these patients received, and if it wasn’t good enough, I want to know why – because in the UK we have a magnificent standard of palliative care and that should have been available. We also need to be a bit careful about the assertions in the documentation that assisted dying goes on under cover anyway and it would be better to legalise and regulate it, and also that is compatible with palliative care. There is good evidence that doctors in the UK rarely engage in such practices, and if we look at the definitions of palliative care as well as the experience of palliative care practice in societies where assisted dying is legal, the claim that the two are compatible becomes less than convincing. The debate on assisted dying will inevitably be passionate, on both sides, but we need to be careful how we interpret evocative anecdotes about suffering, and not take everything at face value. We need to subject the information we are fed to careful scrutiny if we want to develop an intelligent opinion about this.

Margo MacDonald’s Bill declares its purpose as the “provision or administration of appropriate means to enable a person to die with dignity and a minimum of distress”. The wording sounds wholesome, and implies that the Bill makes provision for this. But provision for that is already made in health care, and palliative care in particular is directed to precisely these objectives. Opponents often say that we should call a spade a spade – this is killing and we should use that word. That may be true but it sort of implies a callous or murderous attitude, and whilst one of the undoubted dangers of such legislation is the potential for malicious motivation, compassion for the requesting person is likely to be the predominant influence. Maybe it would be more honest, to describe the purpose of the Bill as the legalisation of intentional ending of life.

.... Continued on next posting.

Choose Life Programme.

2010-04-09T13:18:00.004+01:00

Suicide is one of the principal causes of death for young people in industrialized countries, including Scotland. An advertisement will be aired in prime time television highlighting the need for everyone to support individuals contemplating suicide. The ad mentions that help might be as close as your nearest cabbie or your hairdresser and goes on to propose that people from all walks of life can be trained in providing help to potentially suicidal people. The ad is part of the Scottish Government’s Choose Life Programme, which is a 10 year plan aimed at reducing suicides in Scotland by 20% by 2013.
Rev. Ian Galloway, Convener of the church and Society Council mentioned in his blog that suicide is everyon'es business and that the Choose Life programme with its emphasis on early intervention and provision of initial help by trained members of the public was to be commended. It should be noted however, he continued, that there are many potential reasons for young people to become suicidal and that the advice of trained professionals and counselling staff carries the weight of evidence-based research.

The opinion polls on Assisted Suicide

2010-03-22T11:24:00.002Z

Dr Calum MacKellar, Director of Research at the Scottish Council on Human Bioethics has written a letter to The Herald, explaining the danger that leading opinion polls can have in swaying public opinion in Scotland in favour of the assisted suicide bill proposed by Margo MacDonald. According to Dr. MacKellar, the results of the polls are contradictory and do not consitute a basis for ammendment of legislation. Follow this link to read the full letter.

The Royal Dutch Medical Association against Assisted Suicide Amendment

2010-03-09T11:33:00.003Z

The Royal Dutch Medical Association has expressed its reservation over the proposed amendement to current legislation on assisted suicide in The Netherlands. A campaign group claims to have collected enough signatures to force the proposal to be discussed in parliament. The proposal consists of "training non-doctors to administer a lethal potion to people over the age of 70 who "consider their lives complete" and want to die. The assistants would need to be certified and make sure that patients were not acting on a whim or due to a temporary depression, but from a heartfelt and enduring desire to die".
Currently, two medical doctors need to certify that a patient is suffering unbearably and has no hope of recovery before a lethal injection can be applied. The Royal Medical Association feels that the proposed amendment would reduce the direct involvement of medical doctors on the decision-making processes and has therefore expressed its reservations.

Statistics on Assisted Suicide

2010-03-03T11:49:00.004Z

Simon Rogers from the Guardian has published statistics on the number of people that have carried out assisted suicide in a notable clinic in Switzerland. According to the data, since 1998, more UK citizens have used the clinic than Swiss nationals. Overall,German nationals are the most frequent users of the clinic. It would be interesting to reseearch the reasons behind this heavy use and whether they are tied in to provision of palliative care facilities.

According to the EAPC Task Force on the Development of Palliative Care in Europe, in 2006,

There is no national data about the palliative care workforce in Germany. It is estimated, however, that each palliative care unit has at least one full-time physician who is trained in palliative care. Inpatient hospices usually have no in-house doctor but work together with local GPs, of whom an increasing number have participated in a palliative care training course

Summary of the DPP Guidelines

2010-02-26T10:59:00.004Z

The following summary of the DPP Guildes was provided by Care not Killing.

DPP REVISED PROSECUTION GUIDELINES

These guidelines are a considerable improvement over the interim version because:

- They no longer suggest that a more lenient view will be taken of assisting the suicide of sick or disabled people than of assisting the suicide of others;

- They no longer give special protection to spouses and family members as assisters of suicide.

- They also make clear that assistance given by a doctor or nurse to a patient under their care would be regarded as an aggravating factor.

These are all very important and welcomed changes.

The new guidelines also make clear that the law has not changed and that anyone who assists a suicide must expect to be prosecuted unless there are clear and compelling reasons to suggest otherwise. The guidelines will give no immunity from prosecution. We welcome this reaffirmation.

Everything depends on how the CPS operates the guidelines in practice. There must be transparency over prosecution decisions. We will be watching carefully to monitor practice.

Other Messages

On the concept of publishing prosecution guidelines:

The remit given to the DPP by the Law Lords - that he should make clear his prosecution policy for assisted suicide - is inherently unsound. To tell us how far we can go in breaking the criminal law without being prosecuted risks encouraging law-breaking up to the limits suggested. It poses very real dangers to public safety.

The CPS does not tell us how much we can steal before being charged with theft or how much injury we can inflict without being charged with assault. Assisted suicide should be treated in the same way.

On the revised guidelines generally:

The law has not changed. Assisting another person’s suicide remains a criminal offence.

We are pleased to see that the DPP has emphasised that nothing in these guidelines should be interpreted as implying that a prosecution will not take place if certain boxes are ticked. Anyone minded to assist another person’s suicide should pay heed to that before embarking on such a course of action. We are also pleased to see that the DPP has emphasised that a prosecution can be expected to take place unless there are clear and compelling circumstances to suggest that that should not happen.

Recent prosecutions (eg the Gilderdale case) have shown that the Crown Prosecution Service will not hesitate to prosecute where necessary.

On the revised guidelines more specifically:

The DPP has taken on board many of the concerns that we expressed in relation to his interim guidelines. The revised guidelines are not perfect – for example, it is not clear how it is to be established that a suspect was “motivated wholly by compassion” . But they are a considerable improvement on what went before. Much will depend on how the new guidelines are put into practice. There needs to be complete transparency of prosecution decisions if public confidence is to be maintained that vulnerable people are not being put at risk.

Should you wish to see the full documentation available on the CPS website:
1. DPP Final Guidelines: Please follow this link.
2. Detailed summary of responses to the consultation: Please follow this link.
3. The Code for crown prosecutors: Please follow this link.

Snapshot on Public Opinion on Assisted Suicide

2010-02-25T16:10:00.006Z

Keir Stamer, QC Director of Public Prosecution published a policy on assisted suicide on the 25th of February. Nearly 5000 responses were received by the Crown Prosecution Service following a consultation started in September. The report on the consultation exercise is available here. In the words of Mr. Stamer, "The policy is now more focused on the motivation of the suspect rather than the characteristics of the victim. The policy does not change the law on assisted suicide. It does not open the door for euthanasia. It does not override the will of Parliament. What it does is to provide a clear framework for prosecutors to decide which cases should proceed to court and which should not". The full policy is available here.

Briefing paper on End of Life Assistance Bill

2010-02-22T11:36:00.004Z

The Scottish Churches Parliamentary Office, SCPO has provided a very interesting briefing paper on the End of Life Assistance Bill. It provides wonderfully clear background reading on the Bill. Please follow this link to read the full text.

Is there a bias in BBC coverage about right to die?

2010-02-03T10:13:00.004Z

The BBC has been accused of pushing the ‘right-to-die’ agenda by giving hours of airtime and leading news bulletins to the opinions of campaigners and publishing the results of opinion polls in a selective way. The BBC website has presented the views of celebrity fantasy fiction writer Terry Pratchett (last night’s Dimbleby lecture) and Mrs Kay Gilderdale (last night’s Panorama programme produced by Jeremy Vine) without giving similar space to opposing opinions.

If you care strongly that other views on this crucial issue be heard, please complain to the BBC about the bias of the coverage, and about the way that the views of disabled people in particular have been marginalised in a debate which affects them so personally. The complaints form can be accessed here.

Alternatively phone them on 03700 100 222 or write to BBC Complaints, PO Box 1922, Glasgow G2 3WT

Choosing Life, Choosing Death, book review

2010-01-14T14:26:00.004Z

Dr. Murdo Macdonald, Policy Officer of the Science Religion and Technology Project, has sent us a link to to a book review that addresses important issues in our understanding of the reasons behind an educated choice against assited suicide. It’s a review of a book, “Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law” by Charles Foster. A couple of quotes from the review (I haven’t read the book itself...!)

"(Autonomy)… is commonly translated in the legal arena in positive terms of self-determinism and negative constraints of non-interference…..autonomy has arguably established itself as the dominant principle in medical ethics, operated above all else. This 'tyrannous' rule of autonomy is Foster's subject matter"

“Foster argues that autonomy, as a guiding principle, is at best unhelpful in determining a course of action (it lacks the prescriptive function the law so requires) and at worst leads to unsavoury conclusions.”

Care not Killing Campaign

2010-01-05T14:55:00.006Z

A bid to block Members of the Scottish Parliament discussing a new law for assisted suicide in Scotland has been launched through the Care not Killing Campaign. The bill was put forward by MSPS Margo MacDonald and it is expected to come to Parliament in January. Please consult the Care Not Killing website in order to take action and support the campaign.

Assisted Suicide & the Value of Human Life

2009-11-03T13:39:00.004Z

Margo MacDonald will be presenting to Parliament a Bill in draft form to legalise assisted suicide in Scotland. She has been a long campaigner for this issue and managed to secure the necessary support to prepare the Bill in draft form. Lord Advocate the Rt Hon Lord Advocate Elish Angiolini QC stated that legal guidelines on assisted suicide will not be prepared in Scotland despite of announcements on the law south of the border. "It is important to recognise the different legal landscape in Scotland, where involvement in a suicide might amount to homicide, as well as a different system of public prosecution". She said that any change in the law should “properly be a matter for the Parliament”. We are against a change in this law.

Palliative Care Bill

2009-11-03T13:33:00.003Z

End of Life issues are on the agenda at the Scottish Parliament this month. Gil Paterson's proposed Palliative Care Bill has gathered enough support from MSPs to be taken forward. The draft Bill can be read here. The Scotsman published an interview with Mr. Paterson where he discusses his reasons for proposing the Bill. We are supportive of the principles of this Bill.

Care not Killing Alliance

2009-11-02T12:09:00.006Z

Dr Peter Saunders, Director of Care Not Killing Alliance will be speaking on current moves to introduce assisted suicide and euthanasia into UK law,and how Care Not Killing is mobilizing support to oppose these moves. The venue is Renfield St Stephens Church Centre (Kirk Lounge)
260 Bath Street, Glasgow G2 4JP
Thursday, 5th November, 2009
8-9.30pm

End of Life issues Presentation and Service

2009-10-26T13:09:00.011Z

Last night I was at the evening service at St Andrew's Parish Church in Bo'ness where members from churches in the neighbourhood met to listen to a talk on end of life issues by Dr. Murdo Macdonald. Dr Macdonald is the policy officer of the Society, Religion and Technology Project at the Church of Scotland. He presented us with a much needed update of the current legal framework for assisted suicide in Scotland and the differences between the Scottish position and the position in England. His comments were based on the End of Life Issues report to the General Assembly last year.
After the talk, there was the possibility for questions and also prayer as some of the issues talked about were intensily emotional.

The Voluntary Euthanasia view on the Living Will

2009-10-12T13:35:00.006+01:00

The VES wishes to make the provisions of a living will binding upon the medical staff involved. They see this as a first step towards fully legaliseing eithanasia and, for the same reason they wish to see a proxy document separately legislated for, as a separate deed from a living will. No Will can 'work' without the appointment of an executor. the appointment if a 'health-care proxy' to be in effect the executor of the living will would greatly assist the effectiveness of such a document.

At present, only the person making the living will has the right to enforce it, and he is by definition incapax (incapable of making valid legal decisions). To give treatment against the expressed wishes of the patient, however, is already assault at common law, and there is therefore nothing to prevent the patient refusing in advance. The wisdom of restricting the judgement of the doctor responsible for care at this sensitive time of life is a matter which would require careful consideration. The style of living will published by the EXIT, the Voluntary Euthanasia Society of Scotland (VESS) proposes the appointment of a tutor dative (an agent appointed by the court) by the Court of Session, but this is a cumbersome and expensive procedure.

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Living Wills

2009-10-05T12:55:00.008+01:00

An Advance Directive, is a document in which an individual lays down instructions as to health-care management and treatment to be applied in the event of their incapacity to make such decisions or convey such instructions at the time of occurrence of the circumstances envisaged. In different states in the USA there is some diversity of definition between 'Living Will' documents, 'Advance Directives' and 'health-Care proxy' documents, but the Voluntary Euthanasia Society (VES) in a careful study of the matter perceives no need to impose such distinctions. They suggest that 'Living Will' is a concept sufficiently understood to be generally used.

The Limitations of a Living Will

The popular view that a will is inviolable is not true, even in the case of a property will, and conditions which are contrary to established law or public policy cannot be enforced. This is certainly the case in the Living Will instance, since such a will cannot instist that a doctor or anyone else should put the Will-maker to death.

What do doctors think about Living Wills?
The medical view as expressed by the British Medical Association, is that a Living Will may be welcomed as an opening for the discussion of the difficult questions raised by terminal illness, and considerable use has been made of them in the context of AIDS care and counselling. neither the BMA nor the AIDS support agencies, the Terence Higgins Trust and Milestone House, nor the Association for Palliative Medicinesee any need for legislative change.

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Biblical Truth and the affirmation of Life

2009-09-14T14:34:00.003+01:00

"No one can keep himself from dying ort put off the day of his death. That is the battle we cannot escape; we cannot cheat our way out".

Legalisation of euthanasia will not produce a solution to the needs of the individual sufferer; or address the health-care challenges of contemporary society. It is the expression of an attitude to life which belittles the sovereignty of God, diminishes the importance of sustaining relationships, and inhibits the pursuit of life-affirming answers for people in need and distress. Christians must be active in promoting positive alternatives derived from Biblical truth, so that the momentum toward intentional killing may be curbed. The Church of Scotland has an obligation before God to assert God’s interest in life, rather than in death; to exercise Christian compassion towards the sufferer, the disabled and the dying; and to encourage the relief of symptoms and improvement in the quality of life for such people. The Church cannot support euthanasia as a means to anything of these ends, and rejects the introduction of death as a treatment option in any clinical situation. Jesus said: ‘I am come that they may have Life, and that they may have it more abundantly’ (John 10:10). This declaration applies at the end of life or in the midst of distress, just as much as it does in any other circumstances, or any other time.

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How do we go about caring?

2009-09-09T15:13:00.012+01:00

In the previous post we spoke about Christian actions in caring for at-risk people. In this post we will be providing examples of practical actions.

We can

1) Provide spiritual, emotional intellectual and physical support for the sufferer and for carers, who may be themselves 'fellow sufferers'.

2) Help to patients and carers in defining their own needs.

3) Emphasise that a relationship is being developed by the patient, the carer, medical professionals and God. This relationship is developed in the positive context of Christian HOPE. The Church can and should be taking this as a challenge since it is a matter of 'coming alongside to help'. 'Paraclete' (one called alongside to help) is the word for, and the work of, the 'Spirit of God'. 'Bear ye one another's burdens and so fulfill the law of Christ'. (Galatians 6:2).

4) Provide consistent and practical support for care establishments.

5) Facilitate the extension of the care principles applied in specialised contexts to general hospital and home care and practice. Hospices and specialist care establishments are only part of the answer.

6) Provide regular visiting and supporting the terminally ill or disabled in their homes or in hospital and meeting their specific needs as they become apparent. This si clearly as relevant for the spiritual needs of people in serious or terminal illness is as essential as the physical ministrations of medical or nursing professionals.

7) Make use of Christian 'homes'. The Lord commended this to His followers with the words 'I was a stranger and you took me in'. as well as 'I was sick and you visited me'. The CARE Home programme addresses rthis concept and relief has been given sometimes to terminally ill people themselves, but, more often, to their carers who are in need of respite. The Good Samaritan is a firther example of someone who while he did not use hos own home to receive the injured man, did apply first aid and paid the hotel charges and the treatment costs.

8) Campaign and motivate those in local and national government to improve resources; to stimulate professional bodies and organisations to take an interest in symptom relief as much as in cure; and to demand a positive alternative to the so-called 'easy option' of euthanasia, 'masterly inactivity', or therapeutic nihilism.

Credits
The photograph of the Good samaritan's stained glass window was taken by Lawrence OP.

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Christian Action in Caring for At-Risk People

2009-09-04T16:09:00.006+01:00

It is not enough to oppose the progression of pro-euthanasia arguments, nor simply to oppose voluntary euthanasia societies and similar bodies. If the Church is not say 'no' to euthanasia, it must be ready to say 'yes' to life-affirming alternatives. The Christian Gospel is a Gospel of HOPE and in particular of hope in the context of death and hopelesness. In the situation of terminal care the challenge is to bring effective relief within the context of Christian hope. It has been characteristic of the Church though the ages that it has been in the forefront of work for the suffering, the dying, and the hopeless. The hospice movement owes its existence largely to Christian initiatives which, while they have been followed by secular involvement, remain a positive motivation.

The roots lie in the need for Christians to do, rather than merely protest. A belief in the eternal worth and dignity of human beings is the mark of the Christian since the Lord Himself gave the worth of His own life and death to each one and afforded us the dignity of His eternal love.

Where the elderly, the disabled, the dying and the dementing are held in respect as fellow human beigns, they cease to be seen in negative terms. They also cease to be seen as an alien 'other' kind of person for whom the best thing is to give up on life, but are valued as individuals and to the Christian as individuals for whom Christ died. To quote from Dr. John Wyatt, a prominent paediatric specialist:

In summary, Biblical Christianity does not devalue individuals becuase of their disability. In fact, from a Christian perspective, all of us are disabled in some sense.... and the differences between us are therefore only iun degree. The essence of humanity is not in our functional ability, which may be impaired rto a greater or lesser extent, but in our creation as beings made in God's image. Functional impairment in itself does not impair our dignity or worth as human beings. The central purpose of human life is seen not in the selfish pursuit of pleasure through use of our bodily functions, but in mutual loving relationships with others and with God Himself. In Christian terms it is these personal relationships of love and self-giving which give life its 'quality'. (Survival of the wakest: CMF Publication).

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The Christian Response

2009-08-31T10:35:00.004+01:00

We have been discussing issues relating to the availability of euthanasia for children. It is therefore appropriate to ask what is the Christian approach to this difficult topic. The traditional Christian approach is as follows:

1. Palliative Care with response and resources and higher motivation.
2. Better communication in respect of the child, taking account of the need for counselling and a recognition and respect for the child, equally, as a person formed in the image of God.
3. Valid motivation: the phrase ‘compassion mingled with respect’, attributed to Mother Teresa, perhaps sums up the most constructive attitude and is very much in keeping with the spirit of the Lord’s words – ‘In as much as ye did it unto one of the least of these, my brothers, ye did it unto me’ (Matthew 25:40). The irreducible minimum of care was defined as – fluid and nutrition, analgesia and tender loving care (TLC). If a community is to claim to be civilised, it must care for its disadvantaged.

Here are some references if you wish to read more on the subject.

H Tristram Engelhardt, A Smith Iltis (2005)
End-of-life: the traditional Christian view.The Lancet.

RM Hare(1975)
Euthanasia: a Christian view.Philosophic exchange

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The factors in change in paediatrics

2009-08-20T14:36:00.001+01:00

Five general changes were noted as influencing practice in children:

1 Technical advances, making things possible which could not happen before – often bringing problems as well as advantages

2 The possibility of assigning prognosis to conditions found by screening raises the problem of information being available which it may not be appropriate or helpful to possess (e.g. a bad prognosis given ante-natally, which is not fulfilled post-natally may have a negative effect upon parental attitude towards the child). This is important because a high rate of false positive results is encountered in screening procedures. Unless action is to be taken on the results of the screening – e.g. termination of pregnancy – the screening may be counter-productive.

3 The new consumerism has an effect upon attitudes when things go wrong with the neonate. Society, as well as the individual, are seeking control of life’s events; technology seems to offer this, including control of the arrival of children on time and perfect. A baby may be viewed as a ‘consumer product’ or accession and biological variation may not be acceptable: a view which leads readily to the attitude – ‘if it is not right, dispose of it’.

From the Christian perspective, GOD has control – we do not. Our lives are in God’s hands at the beginning and the end. Human goal setting, ambition and consumerism must give way to our accountability and stewardship of life and relationships, for which we are answerable to God Himself. The question, ‘Am I my brother’s keeper?’, still evokes the answer ‘yes!’ from the highest authority in the matter.

4 Secular philosophy – discussed above – proposes the idea that babies are potential people, not real people. They are capable of life to the full, but if they are seen as not ‘capable’, they are likely to be considered disposable.

5 Health-care economics. Pressure on resources requires allocation of priorities. Babies may not be seen as a priority, especially if deformed or abnormal! Economics asks the question, ‘Is this expense good value for money?’.

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Neo-natal care

2009-08-19T10:53:00.012+01:00

The specialist field of neonatology came into being to meet the needs of infants delivered in difficult midwifery situations. Low birth weight (premature) children - less than 3.5lbs - account for about 1% of births and survival for such children before specialist intervention occurred was bout 25%. this is now around 75%.

Malformed children account for about 1-2% of all births and, with the important exception of brain malformations, the prognosis for normal life for many of these children is fairly good as neonatal intensive care and surgery have improved. Many previously lethal malformations are treatable with good out6come if diagnosis is made early, and detection techniques are imporving so that early treatment is made possible.

Professional attitudes to this type of work are ambivalent. Some consider these infants as 'nature duds' and would not feel that any treatment was appropriate, especially in view of the high costs involved. 'Foetal medicine' - concerned maily with screening ofr abnormality and termination of pregnancy, if such abnormality is found - has been developing in parallel. In this context it is permissible both in Scots law, and more recently in English Law, to terminate a pregancy for reasions of severe foetal abnormality right up to term.

It has been observed that in deciding how much should be done in such cases of malformation and birth abnormality, a good deal of reliance may be placed on the intuitive responses of parents and others involved, since the general philosophy is still towards the concept of sanctity of life. This may pwe something to the general awareness of a Judaeo-Christian heritage and background.

In some areas of secular philosophy, however, opinions may differ markedly from this approach. Some would express the idea that a child is not yet fully a person, but only a potential person and therefore should have no rights until it has self-awareness. This view is reminiscent of the arguments about personhood in the abortion debate. It is striking that ethicists seem to differ quite markedly from the general public in these matters.

Additional Readings

It is not always possible to provide links to the full texts of related documents to the posting, however whenever possible, I am including links to the abstracts.

Sklansky, M. (2001). Noenatal Euthanasia: Moral Considerations and Criminal Liability. Journal of Medical Ethics.

Kon, AA. (2007). Neonatal Euthanasia is unsupportable: the Groningen protocol should be abandoned. Abstract available here.

Costeloe, K. (2007) Euthanasia in Neonatals. Abstract available here.

This link details to choice made by a mother concerning a screening during her pregnancy.

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Petition opposing Legalisation of assisted suicide

2009-08-11T16:23:00.006+01:00

Hannnah Caldwell, from CNK Alliance LTD is asking for support towards a petition against the legalisation of Assisted Suicide in the UK. Here is what she has emailed us.

We invite you to sign the following petition opposing the legalisation of assisted suicide. The petition is available in the following link

It declares: "We the undersigned petition the Prime Minister to retain the
law that makes it a criminal offence to assist another person to commit
suicide".

Thank you for supporting the Care Not Killing Alliance and our efforts to promote palliative care and to oppose euthanasia.

Best wishes,

Hannah Caldwell
Administrator, CNK Alliance Ltd

.

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The Demand for Euthanasia for Children

2009-08-11T13:40:00.006+01:00

There is no demand from parents for intentional killing and the matter is raised more by ethicists and theoreticians than by anyone in the practical field. The majority of paediatricians are against intentional killing and medically assisted suicide, but there is a small group who would support its introduction.

One report indicates that children have been supplied with a lethal injection and have been encouraged to administer this to themselves 'when all eslse has failed'. In such a situation, you wonder whether compassion and care had indeed failed the child!

Unconscious Children
These are usually sufferers from trauma, head injury, and brain lesions of various kinds. The most freqeunt problem encountered is head injury related to traffic accidents. They have often been dealt withi in adult intensive care units until recently, when paediatric units have been opened. The criteria for brainstorm death are the same as in adults. Similar debates occur over brainstem death in children as in adult cases. 'Switch-off' decisions are generally made on the same grounds of negative expectation of recovery, but practice varies.

The parents have the veto and often wish to continue life support initially, but may reach a point of acceptance of the futility of this after an opportunity to come to terms with the realities of the situation. Improved resucitation techniques have really introduced these problems, since many would have died without these being applied.

Where the life support requires to be switched off, this is usually done with the parents present, one of them helding the child in the period after the switch off.

The normal expectation is that death will occur. However the expectation of death may not always be fulfilled, and a brain damaged child requiring a major level of support remains. In one incident following which the child was fosteres in a loving home with excellent care, major guilt still produces problems for the parents. The case for euthanasia in such cases would rest more upon the suffering of the parents rather than that of the child.

Additional readings
Some of these readings might be useful
Shepperdson, B. (1983). Abortion and Euthanasia of Down's Syndrome Children. the Parents view.

Journal of medical Ethics

.

Engelhardt, T (1989). Ethical Issues in Aiding the Death of Young Children.An excerpt is available here.

Macdonald WL (1998)> Situational factors an attitudes towards voluntary euthanasia. The abstract is available here.

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Euthanasia in Childhood and Infancy

2009-07-29T10:59:00.010+01:00

In the practice of paediatric medicine there are two main areas in which eithanasia may be relevant-paediatric terminal illness and neonatal intensive care.

Paediatric terminal illness: the concious child.
Most conscious children requiring terminal care are cancer patients, but some have meningitis or other progressive conditions. Palliative care for these has recently received new emphasis, as expansion in the filed with specialised hospice provision for children has occurred. By contrast in Holland, where the euthanasia concept is widely accepted, there is no such specialist provision. Euthanasia is overtly perceived as the solution to these problems.

The emotional aspects of caring for a dying child are difficult for parents and for staff to handle, irrespective of the symptoms of the condition. Carers must consider the autonomy of children, as well as considering them as people who do have a right and a need to know what is happening to them in terms which they can understand. A child, like an adult has the right to have wishes, feelings and preferences and to express them.

It is responsible and necessary to give factual information to a child as much as to an adult, and experience has shown that children may handle the terminal care situation better than many adults. Family involvement, which includes siblings in decisions results in easier relationships and management of difficult situations. counselling of a whole family is often necessary and involvement of other children in family grief has a healing effect. Long family silence about a dead child is found to be common, but it may have a destructive effect.

Adequate symptom relief, sometimes self-administered and controlled by the child (who can become very skilled at it) and support for the family through the time of trauma, result in the elimination of the need for intentional killing.

The following websites have relevant information about this topic.
Terminal illness
Child Trust Fund
Facing Bereavement

Credits
The picture of the sick child was taken by Shainlee

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Alternatives to the Progression of Euthanasia

2009-07-27T10:08:00.011+01:00

There is increasing evidence that requests for euthanasia come from patients whose sympotm control has been less than adequate, and these requests are very rarely sustained after good symptom control has been established. Often the demand arises out of fear of unbearable suffering. When it becomes apparent that this fear is unfounded and that relief will be available, the fear itself is allayed and the apparent need for euthanasia is diminished.

Hospice care and palliative medicine

Over the past three decades the Hospice Movement has led the way in improving the care of dying patients. This improvement has been achieved not only by in-patient units, but also, and more extensively, by the community of palliative care services provided by Macmillan Nurses and Marie Curie Nursing staff. The underlying philosophy of the movement has been the recognition of the importance of quality of life involving physical, emotional, psychosocial, intellectual and spiritual aspects of that quality.

Much of the development has been towards patients with advanced cancer, but the principles are just as appliclable to other conditions and the benefits should be available to all. Palliative care has tended to be sought by hospital as well as general practitioners, as a last resort, towards the end of the course of an illness but there is much to be said for earlier referral. The skills of palliative care require to be applied as an integral part of the management of the condition and should be considered much more often and applied at an earlier time if the greatest benefit in terms of quality of life is to be obtained.

Multi-disciplinary Caring

An integrated approach to the patient's problems is achieved best by a multi-disciplinary team which will involve medical, nursing, paramedical and other professional personnel, and the input of religions institutions is by no means irrelevant in this context. The hospital chaplain or minister may be an extremely important member of the team.

The principle challenge is to duplicate the hight standards of patient care and symptom relief as established in the field of cancer care, to influence the approach to the terminal stages of many other diseases.

Pain relief is a major issue in the quality of life.Pain relief has improved significantly even in the area of non-malignant pain which can be very debilitating and has proved more difficult to control. Pain control clinics while patchy in availability are making advances in methods and approaches to persistent pain.

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Trends relating to suicide

2009-07-15T17:11:00.011+01:00

An increase in suicide amongst young men was reported in an article by C. Pritchard in the British Journal of Psychiatry. Several reasons for this increase have been proposed notably, lower rates of marriage, higher divorce rates, high rates of unemployment, misuse of alcohol and drugs, the threat posed by AIDS and increase risk of imprisonment. This trend has been noted in several countries of the European Community however, the increase in the rates amongst men in the 15 to 24 age group was worse in the UK when compared to the rates in most other EU countries. Unemployment has long been recognised as a major risk factor for suicide (see for example the work by Bartley and Plewis) and although the impetus for job creation schemes is often purely economic, the reality is that unemployment also has severe health implications.

The position of the Church of Scotland on suicide remains clear. It offers compassion and understanding rather than condemnation.

Credits
the photograph of the young man was taken by Dr. John
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Assisted Suicide vote in Parliament

2009-06-22T16:58:00.014+01:00

We are starting with a series of postings by relevant academics and end-of-life activitsts who will present their own persoanl viewpoints on the ethical issues around the end of life debate. Our first panelist is Phillipa Taylor Senior Researcher, Bioethics and Family, CARE.

In late June/ early July Peers in Westminster will have a free vote on whether it should become legal to assist someone who wants to commit suicide. The Bill is the Coroners and Justice Bill which includes welcome provisions to make it an offence to encourage suicide via the web. However, attempts are being made to use this bill to change the law on assisted suicide.When the BiIl was in the Commons amendments were put down at Committee stage removing the offence of assisting someone to commit suicide but these were not put to a vote. An amendment was put down at Report Stage to allow people to help others (such as relatives) travel abroad to a country like Switzerland where they can access a suicide clinic. This amendment was not considered because parliament ran out of time, so the Bill emerged from the Commons without any change in the law. Now the Bill is in Committee Stage in the Lords and three amendments seeking to liberalise the law have been put down. Unlike in the Commons, the Lords will not run out of time so these amendments will be debated and quite possibly voted on unless the tabling peers withdraw them.

I, along with many others, believe that weakening the law on assisted suicide is unethical, unnecessary and dangerous.

1. It is unethical because the long held society-wide prohibition on intentional killing would be weakened by these amendments. Those who are tempted to commit suicide are highly vulnerable and need protection and counselling, not help in killing themselves. As the Prime Minister recently said: “It is necessary to ensure that there is never a case in which a sick or elderly person feels under pressure to agree to an assisted death or that it is the expected thing to do.” This is in stark contrast to euthanasia campaigner, Baroness Warnock, who has described dementia sufferers as “wasting people’s lives” and “wasting the resources of the National Health Service”. We should not value someone because of their “usefulness” but should recognise their inherent dignity in being human and, with compassion, seek to improve their quality of life, whilst not sacrificing the principle of the sanctity of human life.

2. It is unnecessary because, as it stands, the present law is clear, right and protects the vulnerable. Society already accepts many limits on an individual’s autonomy and personal choice for the greater good, recognising that we are not entitled to make choices which endanger the reasonable freedoms of others. For example an individual’s freedom to drive at whatever speed they like is limited in order to provide safety to others and themselves. Overturning the agreed principle of no intentional killing would have a wider impact on society, especially the vulnerable. Moreover, in most cases, good palliative care provides sufficient physical pain relief. Every patient is different, but using present techniques it is estimated that 90% of pain can be treated successfully.

It is dangerous because if Parliament accepts that people can travel abroad to assist a suicide, there will be more calls to allow assisted suicide here. Oregon, where physician assisted suicide (PAS) is legal, shows the difficulties of establishing fool proof safeguards to prevent abuse and ensure all acts of assisted suicide are truly voluntary. There is a reported lack of transparency over the practice of PAS there, minimal oversight and ineffective safeguards. In 2008, 50 per cent of patients requesting suicide were assisted to die by a doctor who had been their physician for eight weeks or less.

It is vital that the message society sends to vulnerable people should not, however subtly, encourage them to seek death, but should assure them of our care and support in life. The truly compassionate (although not always easy) and holistic response to demands for assisted dying lies in good medical treatment and in meeting patients’ physical, social, psychological and spiritual needs.

Credits
The photograph of actors around a death-bed was taken by Littlelovemonster. the picture of the house of Lords was taken by UK Parliament

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Compassion should never lead us to kill

2009-06-03T14:16:00.021+01:00

Lord Falconer's article in The Times entitled "A more civilised approach to suicide" argues in favour of decriminalising relatives who escort a loved on to a suicide clinic abroad. He then makes an appeal for compassion for the families of the terminally ill, who are already under tremendous pressure. Compassion should never be equated with facilitation of a medically assisted death.

Compassion need not kill
The treatment of illness and the relief of suffering have advanced very considerably in the past decades. Symptom control has also made major advances. Our understanding of the nature of pain and human responses to it are increasing steadily. Pharmacological and physical methods for its relief are available and effective for conditions and circumstances which would have been previously resistant. Drug delivery systems, special formulation, chemotherapeutic agents, physical techniques such as TENS (Transcutaneous Electrical Nerve Stimulation) are pushing back the thresholds of pain and bringing relief to those who are appropriately assessed and treated.

The Ethos of Medical Practice
It is no part of the doctor's tradition or ethos to kill. This option was open in pre-Hippocratic Medicine, but Hippocratic tradition, and later, Judeo-Christian teaching set out to change this and to oblige the doctor to preserve and sustain life by every means possible. It has always been accepted that death could not be postponed indefinitely, but the duty of the doctor as expressed by Ambroise Pare 'to cure sometimes, to alleviate often, to comfort always', has stopped short of death as a treatment option. There is still in most doctors an abhorrence of killing, even accidentally, and a deeper abhorrence of doing so intentionally.

Doctors who have to deal with the very ill and terminally ill will admit to having been tempted at some time to bring a patient's life to an end. Doctors, with a few exceptions are not in the forefront of the demand for eithanasia or medically assisted suicide. They are however involved in the ethical, moral and practical issues (Lack of information, or equipment or resources) around terminal care. There is a basic need is for better clinical awareness of the principles of good management of troublesome symptoms and, as a consequence, better education and training of health-care professionals in these principles. Good clinical judgment is based on knowledge, compassion and integrity.

Ian Galloway, convener of the Church & Society Council recently presented the views of the church of Scotland in an articpublished an article on Interfaith Matters. In there he states

Pain management is a significant component within palliative care. Since its inception, palliative care education has used the model of multidisciplinary education. Palliative care is synonymous with holistic care which includes physical, psychological, social and spiritual needs. It is an approach which seeks to maximise the quality of life of patients and their families facing problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems. In recent years the provision of spiritual and religious care has benefitted greatly from multi-faith and multicultural approaches to healthcare and the move towards professionalisation of healthcare chaplaincy. If palliative care includes good spiritual care and a managed approach to pain, then some of the issues leading to calls for physician assisted suicide may be resolved.

Rvd. Galloway's views have been picked up by other bloggers.

The irreducible minimum of care has been defined as -fuid and nutrition, analgesia and tender loving care. The phrase 'compassion mingled with respect' attributed to Mother Teresa, perhaps sums up a more constructive attitude towards end-or-life issues. If a community is to claim to be civilised and compassionate it must care for those facing the last moments of their lives withou hastening that end.

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You are precious in my eyes and I love you!

2009-05-29T10:38:00.026+01:00

By Revd Ian Galloway, Convener of Church of Scotland’s Church and Society Council has written a passionate defense of the Christian approach to end-of-life issues.

"You are precious in my eyes and I love you”. This could be the refrain of a popular love song, but it is not; it comes from the Hebrew Scriptures (Isaiah 43:4) and is one of the foundations to understanding a Christian approach to end-of-life issues. How can honour and love be at the heart of the euthanasia debate? A Christian understanding of the value of human life derives from the belief that we are made in the image of God and that God loves, honours and respects us. There is something of the sacred within each one of us. This perspective on the value of human life has particular consequences in our ageing population where there are inevitably scarce resources available to take care of the aged, the frail and the infirm. Medical advances, life-supporting technology and pharmacological solutions have increased life expectancy and the expectation of cure to the point that illness and death are perhaps less accepted as part of normal human experience.

The full article is printed in the Interfaith Matters newspaper which is the organ of the Edinburgh Interfaith Association, EIFA. The full newspaper can be downloaded here.
Reverend Galloway's article was "in print" about the same time that Margo MacDonald MSP put forward a Proposed End of Life Choices Bill to the Scottish Parliament. Since then the end of life debate has grown across the country.

On the other hand a different approach to dealing with difficult end of life issues has been proposed by Roseanna Cunningham. She presented a Proposed Palliative Care (Scotland) Bill
The Proposed Palliative Care Bill and the Proposed End of Life Choices (Scotland)Bill and can both be viewed and downloaded at the Scottish Parliament's website.
If you have any comments on the article or on any aspects of these issues please express your comments right here on the blog.

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Assisted Suicide

2009-05-07T11:02:00.010+01:00

Assisted suicide is seen with justification, as the first step towards euthanasia. It is suggested by the supporters of euthanasia that both doctors and carers are regularly dealing with the intractable symptoms of seriously or terminally ill patients in this way, making available the means of self-destruction, but allowing the person concerned to take the definitive action which is required to end life. They call for an end to the 'hypocrisy' of this approach.

However, it is striking that in many instances of distressing and painful illness, a supply of medication which would be entirely sufficient to end life is left in the full control of the patietn with instructions for safe self-medication and in only a few cases is this trust manifestly abused. Nor is it often abused when suich instructions are given to the principal carer. It is doubtful whether the legal sanction by itself is enough to totally inhibit such action, but legalisation of physician assisted suicide would carry the same problems as the legalisation of euthanasia of any nature - it would loosen the ethical basis of much medical practice.

Legalisation of a defence of assisted suicide by relatives, carers or anyone else would be even more unsafe and would expose the caring situation to even greater pressures of a very serious nature.

Suicide and assisted suicide are neither a safe nor a satisfactory answer to the relief of a distressing illness. Thise who do promote such legislation make much of the anomaly that, while suicide has been decriminalised, assisting suicide remains a criminal act. While it may be possible to interpret the intent of the suicide - him or herself - in the light of illness or psychological disturbance, such extenuating arguments cannot be applied to tjhe person who assists. The motivation of compassion may be claimed, but many other factors mat also be playing a part, and the safeguards of the law remain appropriate.

Over the years the medical and nursing professions have steadfastly set their faces against such a change in the law, and with a few vociferous exceptions, doctors and nurses feel that they neither need it nor want it.

CreditsPhotograph by Anthea

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Conference on Patient's rights and Public Involvement in Healthcare delivery.

2009-05-04T09:01:00.008+01:00

A conference exploring the challenges and opportunities of strengthening patient rights and public involvement in healthcare delivery will take place on Tuesday 26 May 2009, at the MacDonald Holyrood Hotel, in Edinburgh

Featured speakers include:

Margo MacDonald MSP, Author of the Proposed End of Life Choices (Scotland) Bill; Professor Kenneth Boyd, Professor of Medical Ethics and Director of Clinical Skills, Personal and Professional Development, College of Medicine and Veterinary Medicine, University of Edinburgh. Cathy Jamieson MSP, Shadow Cabinet Secretary for Health and Wellbeing; Professor John Smyth, Assistant Principal, Cancer Research Development, University of Edinburgh.

The Scottish Government's vision for a ‘mutual NHS' outlined in the Better Health, Better Care Action Plan is beginning to take shape. The shift from viewing patients as ‘service users' to ‘active partners' will have a profound effect on NHS policy and practice. There are significant concerns that statutory patient entitlements will create a culture of litigation and that legally enforceable healthcare standards will have huge implications for service providers. How will the implementation of such legislation be monitored, what form of sanctions will apply should it be breached and will this lead to resources being diverted from direct patient care? Health professionals are confronted with an increasingly diverse range of ethical dilemmas throughout their careers. An increased emphasis on patient rights and public involvement in the NHS is likely to ensure such dilemmas become more common than ever and that ethical judgments - often made under the extreme pressures of limited time and resources - may become increasingly subject to legal review.

This conference will review the Government's proposals for developing a ‘mutual NHS'. It will explore the proposals outlined in the Patients' Rights Bill and the potential implications for service providers and will encourage discussions on a range of medico-moral dilemmas which test the boundaries of patient rights and involvement in healthcare delivery. If you have any queries regarding the conference or would like find out more information, please email mbellamy@mackayhannah.com

Medical issues in Euthanasia, and Suicide

2009-04-30T12:43:00.007+01:00

The whole are of the management of the terminal phase of illness and the end of life is one in which medical practice is, of necessity, deeply involved. the manner in which the patient dies, whether in acute illness or in longer term chronic illness, may even be something of a touchstone for the quality of medical care. Since the dawn of the profession, doctors have been involved in dying; relieving its distresses, seeking to support tha patient in the process, whether long or short.

Acceptance of Death One of the most difficult disciplines for the physician or surgeon is to come to terms with the ultimate failure of all the therapeutic measures available to them and with which they have practiced. Death may be posponed, even avoided, but not ultimately evaded. If it is difficult for the doctor to countenance death, seeing it as the ultimate failure of art and skill, it would be even more difficult for the doctor to see him or herself as the personal agent of that failure. The wise and experienced doctor will certainly seek to use the skills of medicine to alleviate the pains and distresses of death, and indeed to make the process of dying as free of distress as possible for the terminally ill person.

Suicide
Suicide, although not an offence in law, is perceived among the most negative of emergencies to be handled in the casulaty and intensive care areas of general hospitals and, while compassion and understanding are readily extended to the unsuccessful victim, that sympathy and understanding are directed towards the person, rather than towards the act. The suicide of a patient who has been under regular care, whether terminally ill, psychiatrically depressed or in severe distress for other reasons, is a particular trauma to most health care professionals who may carry, in addition to the sense of failure when the patient dies, an equally distressing feeling that in some way they have failed that person while they were still alive and still amenable to supportive help.

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Suicide: the taking of one's own life

2009-04-24T15:04:00.002+01:00

While no change has occured in the definition of suicide, it would appear that public condemnation of suicide as an act is less than in previous times. Suicide is still recognised by most people as a tragedy but not a sin. This may be related to change in the personal view of life and death and of one's responsibility for life associated with a widespread rejection of Christian views and values. Even prior to 1961, when suicide ceased to be a crime in Enmgland, suicide was not criminal in Scotland. The position of the Church of Scotland on suicide remains clear. It offers compassion and understanding rather than condemnation.

Non Voluntary Euthanasia

2009-04-21T17:51:00.003+01:00

Non voluntary Euthanasia is ending the life of a person who lacks the capacity either to know or express his or her own wishes as to continued existence. Such a situation would arise in infants; in patients with severe brain damage or dementia; in severly mentally impaired people; and in people in a persistant vegetative state. The distinction between 'involuntary' and 'non-voluntary' is more than academic since the person in the former case would be capable of making a decision if given the opportunity. It is particularly important to bear in mind the situation of infants and children in terminal or severe illness and handicap.

Much of the debate concerning euthanasia revolves around adults, notably the elderly and the younger adult with progressive illness, but the problems may arise just as acutely at the earlier stages of life. the law is, in fact, the same for every age.

Koelzer and Brittingham: The Ethics & standards of Euthanasia and Palliative Care

2009-04-16T15:23:00.014+01:00

Viktor Koelzer and Sara Brittingham have presented an excellent overview of the ethics and standards of euthanasia and palliative care

This is an article recently published on The Lancet Student. The authors review research that shows that there is alot of insecurity and misinformation in the provision of end-of-life care amongst medical staff. As the authors are medical students themselves they speak with knowledge about the need to have more information about end-of-life issues in order to develop their skills and confidence on dealing with terminally ill patients. The authors then go on to review the historical, ethical and leval aspects of palliative care and voluntary euthanasia in Europe. They reiterate their emphasis on compassion and respect in the provision of end-of-life care whilest respecting and adhering to the law and the ethical principles of our society. Koelzer and Brittingham then proceed to compare and contrast palliative care approaches with voluntary euthanasia approaches. They authors present contrasting approaches to addressing issues such as pain management, patient autonomy, spiritual support and communication.

Both voluntary euthanasia and palliative care options currently co-exit in Europe. It is clear that each country within the EU is addressing this issue in relation to its cultural and ethical framework, however, what seems clear if that some elements such as the Hippocratic oath and a common Judeo-Christian perspective are prevalent within the palliative care approaches in Europe. The authors state their view as follows

..."In the early stages of medicine, hardly any disease could be cured; instead, the patients were accompanied and comforted, trying to palliate suffering (10). One of the earliest medical codices, the Hippocratic Oath (400 B.C.), stated that doctors must never “give deadly medicine to anyone if asked nor suggest any such counsel”. This definite statement leads us to assume that disagreements about medically assisted death were already a matter of debate during this time. With the rise of Christianity in Europe, arguments against VE were further based on religious beliefs. Thomas Aquinas(approx. 1225-1274), one of the most important Catholic scholars of the middle ages stated in his main work “Summa Theologiae” that not only killing but also suicide was a capital sin, and emphasized the Christian virtues of “caritas” (Lat. benevolence) and “misericordia” (Lat. mercy) in the care of patients. In our opinion these values are still central in palliatice care today, emphasizing the Christian roots of the palliative care movement.

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This is thoughtful article for anyone interested in this debate.

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Different kinds of euthanasia? Some Definitions

2009-04-16T09:47:00.011+01:00

The last post mentioned the need to examine the language that we are using to refer to end of life issues and in particular euthanasia. The different forms of euthanasia are futher explored in the following article from the BBC.

Active Euthanasia is doing something, such as giving a drug with the intention to bring about death.

Passive Euthanasia is the deliberate shortening of life through an omission to act. The term "passive euthanasia" is applied quite inapprorpiately to treatment withdrawal, where the treatment concerned is proving ineffective in achieving recovery and should rightly be stopped. Neither the withdrawal of inappropriate treatment nor the decision to refrain from using it can correctly be called euthanasia. These decisions are the expression of good clinical judgement.

A failure by a doctor to provide a patient with treatment thought by responsible medical opinion to be necessary in the circumstances, could well be a criminal omission, whereas at the other end of the scale, no doctor need resport to 'heroic methods' to prolong life.

Voluntary Euthanasia: is ending the person's life at their specific request. this category has been at the centre of attempts to legalise euthanasia. The 'specific request' is currently interpreted by supporters of the procedure, not only as a request at the time of the distressing illness, but also in advance, for instance by means of a Living Will.
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CreditsThe picture of the lfying bird was done by Kashyap-HC

Changes in the Language of Dying: some definitions

2009-04-15T16:41:00.012+01:00

The original definition of euthanasia derived from two Greek words, eu thanatos -'dying well' or 'good death'. This concept of an easy or good death is one in which the relief of symptoms is sufficient to allow the patient to continue normal relationships and cognitive thought right to the immediate pre-terminal phase of life, without the intrusion of pain or other distress. This original meaning has changed.

Today, euthanasia means deliberately terminating the life of another person by an act or omission in the context of terminal, painful or distressing illness. Mercy-Killing is also used, defining motivation as much as action. In the context of the euthanasia debate it is interesting that groups seeking the introduction of voluntary euthanasia and assisted suicide tend to use language which conceals the lethal nature of the acts proposed. One no longer commits suicide- one performas 'self-deliverance'. A physician under a "right to die" law would no longer gie a lethal injection, he would administer an "aid in dying measure" This quote is an excerpt from na book by Joni Eareckson Tada entitled When it is right to die?

We shall be exploring in the next few post different words and meanings within the end-of-life debate.

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Credits
The picture of the floating feather was taken by Lutz-R Frank

Why is Euthanasia such a hot topic?

2009-04-14T13:10:00.024+01:00

The national increase in the number and proportion of elderly people in the population in Europe and in the UK is well documented. This is usually contrasted to the decrease of the younger population by a falling birth rate. Families are smaller; people travel and work abroad far more easily now than 20 years ago and our communities lack cohesion precisely because of the increased mobility. All of these factors have reduced the availability of potential carers for older and disabled people, throwing an ever greater load upon voluntary and statutory health-care and supportive services.

Medical advances, life-supporting technology and pharmacological solutions have increased the public’s expectation of life and the expectation of cure to the point that illness and death are less accepted as part of normal human experience. Our bodies are healthier, medical know-how is available to sustain life for longer spans and as a result, our society is living longer. In an ageing population, questions are being asked about our financial capacity to continue care at current or increased levels, and the option of voluntary euthanasia or physician assisted suicide is continuously being presented as an option. These issues are no longer discussed in the privacy of hospital rooms or churches, but under the public glare of the media. The public seems eager to know of the harrowing details of the very personal confrontation with death of individuals afflicted with pain and terminal illness.

In the UK, pressure for the introduction of euthanasia as a legally acceptable treatment is constant and a number of countries in Europe have already legalised assisted suicide options. However, what does this move towards seeing life as disposable, say about our society? Where have our cultural roots been filed in this ethical connundrum?

One of the primary and fundamental principles in the Judeo-Christian ethic is that of the sanctity of human life. This also applies in most other religious systems and it is enshrined in article 2 of the European Convention for the Protection of Human Rights and Fundamental freedoms, and in article 6 of the International Covenant of Civil and Political Rights. “You are precious in my eyes and I love you”. This could be the refrain of a popular love song, but it is not; it comes from the Hebrew Scriptures (Isaiah 43:4) and is one of the foundations to understanding a Christian approach to end-of-life issues.

How can honour and love be at the heart of the euthanasia debate? A Christian understanding of the value of human life derives from the belief that we are made in the image of God and that God loves, honours and respects us. There is something of the sacred within each one of us. Our lives, no matter how frail are not disposable.

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Credits
The photograph of the dying rose was taken by Zivash

Hello World

2009-04-14T11:54:00.000+01:00

This blog has been created to examine a variety of issues surrounding the end of life debate. The pressure for the introduction of euthanasia as a legally accepted teatment option in the UK and internationally is prevalent. This blog will present current positions surrounding voluntary euthanasia and assisted suicide whilest being informed by a perspective that proposes compassion for patients and their carers through the strengthening of palliative care options.