Opposing views on assisted suicide

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.

What do we mean by "Quality of Life"

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

Does the proposed End of Life Bill have real support?

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

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.

Moral Arguments for and against Assisted Suicide

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.

Choose Life Programme.

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 Royal Dutch Medical Association against Assisted Suicide Amendment

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

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

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Care not Killing Campaign

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

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.

Care not Killing Alliance

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

Petition opposing Legalisation of assisted suicide

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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Trends relating to suicide

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

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

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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Assisted Suicide

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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Medical issues in Euthanasia, and Suicide

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

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.

Changes in the Language of Dying: some definitions

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?

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