‘To Be Or Not To Be’

The  assisted dying debate gains momentum again, with MP Richard Ottaway securing a Commons Backbench debate on the issue next month for the first time in a decade, and Terry Pratchett funding the campaign through ‘Dignity in Dying’ having  gained credence from his film on Newsnightlast June.I have my own views on assisted dying as I’m sure we all do, mine have certainly shifted over time.  In the beginning I was horrified by the mere thought there were even discussions around this.  Life being the most reverent gift and must be clung to at all costs.  Not willing at this time to accept further medical care in some cases may be futile.  These initial thoughts were pre-medicine.  When I lived naively in the knowledge that whilst life is a trajectory process with death inevitably at the end, it came as a final event .  A final event being relatively short and painless, with palliative care being the key to alleviate any suffering.   Whilst some of these thoughts still hold true, I passionately believe in individual circumstances an individual should be able to make the decision to end their life, not as an act of despair and futility but as a positive affirmation done with dignity and respect.  “There is something to be said for leaving an on-going party, rather than waiting till the bitter end”[i].The current arguments for and against assisted dying are as stark as night and day.   One side discussing autonomy and free will.  Patients demonstrating capacity are able to make their own decisions regarding treatment choices and whether to accept them or not.  And yet it is considered unethical to extend these principles to enable patients suffering unbearably with a terminal illness to end their lives.  The argument centres around a compassionate society being able to respect these wishes and offer help in support in achieving them.The flip side of this is that this is taking personal liberty and independent autonomy a step too far.  The current law in the UK places an absolute ban on assisting another person to die. Assisting a suicide is an offence under the Suicide Act 1961, punishable with up to 14 years imprisonment.  This is watertight and the concerns raised are if the law is changed, vulnerable individuals will be liable to influence or exploitation.  Where would the line be drawn with patients not demonstrating mental capacity – would family be able to make the decision and in whose best interests would this be.

It is clearly a difficult one, but surely one that we need to get right. Interestingly the state consistently providing the best palliative care in the USA is Oregon, both Oregon and Washington allow assisted dying. A number of countries have enacted legislation to provide terminally ill people with the choice of an assisted death, within legal safeguards.  These safeguards have protected vulnerable people whilst ensuring that terminally ill patients do not suffer unnecessarily against their wishes.

Whilst the debates continue and the 2010 revised guidelines now make a clear distinction between compassionate acts to assist someone to end their own life and malicious encouragement or assistance of suicide, what actually happens?  As far as I can tell the options are firstly palliative care – this can control most of the physical pain of diseases such as cancer in most patients.  This is not an absolute given and it depends on individual circumstances and whereabouts.  Whether delivered in a hospice, at home or on a general hospital ward will greatly influence how this goes.  I have been witness to good deaths and bad deaths,  this is a real bug bear of mine. There are no second chances it has to be done well and anything less than that is unacceptable.  I think some are scared of using high doses of drugs for pain, this taboo really needs to be broken down and their use compassionate.  The doctrine of the double effect recognises high levels of medication can suppress breathing, but allowing someone to die in pain rather than accept this side effect, in my mind is unthinkable.

The second option is to go down the Dignitas route.  Whilst Parliament decides what to do with current legislation this is an option which several have taken.  Ludwig Minelli the founder of Dignitas has helped over 1000 people to end their lives, interestingly according to his research 80% of those given the ‘green light’ to go through with assisted dying do not, this is in keeping with figures from Oregon.  Minelli firmly believes that once you give someone the freedom to talk about assisted dying this reduces their desire to go ahead with it.  He also believes offering the option gives people peace of mind that they are not ‘condemned to linger on’ should the suffering become unbearable.

I personally believe the Dignitas option to be a good one, allowing patients the respect, compassion, autonomy and dignity they deserve.  What I object to is that these patients have to travel to Switzerland to find it. 

What I now hope for is a change in law to allow assisted dying in certain circumstances, to provide a safe means of dying with checks and balances against abuse or coercion.  Patients, families and loved ones facing tough choices deserve this. Whilst waiting for common sense to prevail we can work on providing good palliative care regardless of our specialty.

[i] Andrew Eastaugh, GP Southwald


3 thoughts on “‘To Be Or Not To Be’

  1. Dear Medical Marble Mum: Does the “success” of Dignitas mean that the inhabitants of Switzerland are less religious than those of other countries? Probably not, so what is (are) in your opinion the other reason(s)? .
    My father was a very active man until a CVA struck him and left him almost crippled. Knowing that he would not recover a bit, he wanted the doctor to write the fullstop after having lived happily for more than 88 years. The doctors assured themselves that he was fully conscious; they respected his wish and helped him to die peacefully.
    Two years later, in a home for elderly, my mother was nearing 93. She was quite healthy but too tired to continue living alone, after almost 67 years of marriage. Her doctor fully understood that you cannot give a meaning to another person’s life, and he also assisted her.
    I live in Argentina, but both cases occurred in Holland. My parents had signed an authorization to apply euthanasia, but none of the medics asked me to show them the letters. Both cases were simple, they had my and my sister’s consent, that was enough.
    I think this fits well with your description …..dying with checks and balances against abuse or coercion…..
    Thank you for allowing me to express my opinion, have a nice day and receive my best regards,


    • Dear Federico

      Many thanks for taking the time to comment on here and to share such personal stories. I tend to agree with you that religion probably has very little to do with the operations behind Dignitas. Why people tend to favour Dignitas to other places offering assisted dying may well be due to publicity. Certainly in the UK it is known about, mentioned in news stories not infrequently – both the spoken and written word, and there is very little known about alternative options.
      From my research the only places that today openly and legally, authorize active assistance in dying of patients, are:

      1.Oregon (since l997, physician-assisted suicide only); Washington (since 2008);
      2.Switzerland (1941, physician and non-physician assisted suicide only);
      3.Belgium (2002, permits ‘euthanasia’ but does not define the method;
      4.Netherlands (voluntary euthanasia and physician-assisted suicide lawful since April 2002 but permitted by the courts since l984).

      I think they are have different forms of assessment and checks against coercion depending on the local legislation. It’s certainly an interesting and area of conflict on legal, ethical, moral issues. I’m sure those who have seen loved ones in pain and distress have very different views to those who have been lucky enough to not experience this.

      Best Wishes

      • Euthanasia was permitted by Dutch courts since 1984 – but always under the same STRICT RULES that were maintained later on in the definite legislation. I am always keen on learning small but interesting details, such as the fact that Luxemburg also allows assisted dying, as well as the state of Montana does, on the other side of the ocean;
        But most of all I enjoy reading eye-opening posts like yours, for instance this one, on legal, ethic and moral issues in an area of conflict where they will remain until a non-existing hell freezes over.
        Have a nice week-end,


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