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Terminally-ill patients could legally end their own life

Doctors could be given the right to be able to help terminally-ill people to die, a report said today.

Adults who are likely to have less than a year left to live could be given the chance to ask their doctor for a dose of medication that would end their life, the year-long Commission on Assisted Dying said.

But stringent safeguards must be in place to protect those who might not have the mental capacity to make such a choice, or who might be clinical depressed or experiencing pressure from friends or relatives.

The commission, chaired by former lord chancellor Lord Falconer, said that, under their proposals, a terminally-ill person would need to be able to take the medication themselves, as a clear sign their actions were voluntary.

The findings will anger campaigners against a change in the law who have warned that it would risk increasing the pressure on vulnerable people to end their lives out of fear they might become a burden for others.

It could lead to around 13,000 deaths a year, the Care not Killing alliance said.

Since new guidelines for prosecutors in assisted suicide cases were brought in in February 2010, anyone acting with compassion to help end the life of someone who has decided they cannot go on is unlikely to face criminal charges.

But assisted suicide remains a criminal offence in England and Wales, punishable by up to 14 years in prison, and individual decisions on prosecution will be made on the circumstances in each case.

The commission has taken evidence from legal, medical and religious experts, and people with personal experience - such as Alan Cutkelvin Rees, who helped his partner Raymond Cutkelvin to travel to the Dignitas clinic in Switzerland to die in 2007, and Debbie Purdy, who has multiple sclerosis and has campaigned to know if her husband will be charged if he helps her travel to Dignitas.

 

 

 

Readers' comments (19)

  • Long term conditions are difficult to predict and many sufferers have relapses that they recover from, making it impossible to predict when they are likely to die. Debby Purdy is mentioned in the article but she suffers from MS, a condition that often does not shorten life so she would not even be eligible. It should be about quality of life not length of life.

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  • The report is only concerned and boundaried by a terminal diagnosis.

    I found this publication to be really useful in clarifying some of the issues.

    http://www.dignityindying.org.uk/includes/spaw2/uploads/files/A%20matter%20of%20facts%20May%202011.pdf

    I see a lot of responses in this debate cited around 'patient choice' and then our duty as professionals, however I feel strongly that this debate hinges not on us as patients but as people with personal choice and the right to self determination.

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  • Also worth posting, the actual report itself.

    http://www.demos.co.uk/files/CoAD_-_web.pdf?1325710486

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  • tinkerbell

    Anonymous | 5-Jan-2012 6:35 pm

    Thank you for the report. This is such a huge dilemma. I couldn't access the report above Anonymous | 5-Jan-2012 6:10 pm

    I thought I mostly disagreed with assisted dying (because of potential abuses) until i watched the documentary by Terry Pratchett who went with a gentleman to the Dignitas Clinic and filmed the gentlemans assisted death. I found it made me think very deeply again as i felt chilled to the bone by the documentary.

    I didn't feel there was any dignity in having to travel to another country to end your life earlier than you might have chosen to so that you could make the journey before you became too ill to travel abroad. If that is the choice that people are being given,( I assume those that can afford it), then maybe it would be kinder to provide it here, free obviously, so people can die in their own homes with dignity without having to make this horrendous journey and end their life sooner in a foreign country. This is before taking into account all the moral, ethical, social, spiritual and religious aspects.

    A doctor on the tv tonight said that if we properly cared for terminally ill people with effective pain relief then we wouldn't need to consider 'killing them'.

    I think those who finally decide for or against whether assisted dying is legalised will need the wisdom of Solomon.

    I really don't know one way or the other at this time as i realise there are strong moral/ethical arguements for both sides.

    Terry Pratchett said tonight he didn't think it would be legalised within his lifetime (he is currently 60 with early onset Alzheimers) but he did think it would be eventually legalised. I think he is probably right.



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  • you raise some excellent points Tinkerbell. There are so many complex issues which have to be considered so that a law can be made which will suit the needs of the majority offering an option to determine the end of one's own life whilst minimising the risks of abuse and protecting the vulnerable, which seems an almost impossible task.

    Whilst active euthanasia is not legally practiced by the medical profession in Switzerland at least this option, which is subject to much controversy, is offered by Dignitas and Exit but at very high financial cost to those who wish to take this route and as you say, having to travel from abroad for this service is far from ideal, but at least it does exist for those who see no alternative for themselves.

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  • We should not even be considering the introduction of assisting individuals to kill themselves. If there is a problem with palliative care then fix it, invest time and effort into maintaining and improving the quality of life. Individuals have always had the ability to bring an end to their own life they don’t need an angel of death or a Harold Shipman to assist them. If we introduce the cheep and easy option of assisting individuals to kill themselves where will the drive to improve palliative care come from? Who will draw the line between assistance and encouragement and how can we hope to ensure that everyone walks that line without crossing it.
    As with many moral issues people will hold fixed and firm opinions on both sides of the argument, but my feeling is that if there is the potential for one person to die as a result of a misdiagnosis, a flawed prognosis, or as a result of coercion then that is one person too many. As a profession we need to focus on the quality of life to the point of death and leave death to religion, but please don’t leave the decisions to the politicians.

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  • It seems really important to separate the issue of the quality of palliative care and the drive to maximise that, from the right to self determination here as well as the definitions of euthanasia as opposed to assisted dying.

    I don't think any of this is clear cut or easy.

    Its also necessary to separate what we might believe the right thing to be and want for ourselves as people, from respecting the same for others and then how that impacts our professional position.

    The dignity in dying info gives some interesting figures around the lack of uptake of the option of assisted dying once people knew it was an option.

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  • tinkerbell

    Anonymous | 6-Jan-2012 8:28 am

    Anonymous | 6-Jan-2012 9:31 am

    Exactly!

    Those who see no alternative -v- the drive to provide consistent, excellent 'pain free' palliative care. The crux of the matter.

    There is no sanctity in being left in unrelenting pain without any hope.

    Totally agree it shouldn't be left to a government to decide then it will probably be down to the cheapest option.

    Who should decide?

    People may choose to end their own life as things stand and end up still alive and worse off. It's probably easier for an anaesthetist or a doctor who can get hold of the drugs to end their life, as one of our consultants said once, after one of our anaesthetists killed himself 'if an anaesthetist can't kill themself properly, who can?'

    How can someone totally bed bound have the ability?

    Maybe we shouldn't even be considering it as practitioners, but i am only considering it from from the perspective of 'what if i or my loved ones were in that position?' My pain, distress & hopelessnes would over ride any intellectual debate. Promise me that i will receive a humane death, can't promise that then what's the alternative?





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  • Call me selfish, but I can't help wondering whether nurses would in any way be called upon to become involved in the "assisted deaths".
    In regard to the medics, I presume that only doctors without any moral or religious objections to helping someone to die would be involved? There would have to be something in place to safeguard doctors' wishes as well as patients.
    These comments do not mean that I am without deep sympathy for anyone who feels they wish to die, for whatever reason.
    The article mentions clinical depression as being an obstacle to making the decision but surely long term depression has equal effect on a person as other more physical conditions?

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  • I disagree, we need to be considering and exploring the issue because we will be involved in situations and need to be aware of what we think/feel, professional issues and how to respond to people asking the questions. I don't think its a question of selfish unless you feel it to be particularly anon above, but I agree that other conditions that can be unbearable will be discussed at some point too. I also agree that a starting point of considering how you might feel affected on an individual level is a valid place to start from too.

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  • Interesting debate indeed. I note with interest the comment regarding nurses potential input as I am a student nurse myself. However, I cannot help but put myself in the patient's shoes first. My mother, who is 83 and still going strong, has said for the last 35 years that I can remember, that she never wants to be incapacitated (she uses her own words to describe what she wouldn't want) and that if she was we should give her a pill.

    I doubt I would ever find the strength to do that but it serves to illustrate just how differently people think. I know how strongly my mother feels about her dignity. It's of paramount importance to her. It seemed to me that the gentleman in the Terry Pratchett documentary was cut from the same cloth as my mother in that respect.

    Yes I agree we really must ensure stringent rules to avoid any mistakes and I agree with the earlier comment that one mistake would be one too many, but I can't help leaving my heart all out on a limb for those who truly, truly don't want to take life to the bitter end, just for the sake of it.

    I know what I want to do with my body after my death and I have the right to that choice, it's in my will, why can't I have the right to decide what to do with it when the end is certain?

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  • It is quite possible to have both an excellent palliative care system and a valid assisted suicide system simultaneously.

    The Oregan system seems to be a reasonable one: the patient is psychologically evaluated, a prescription is provided which must be filled within a set time to remain valid. More often than not, the patient dies 'naturally' without it because this is all about power and control over one's life and death.

    What I don't want to happen is the poor old nurse getting 'delegated' to the job of 'killing' the patient when they can no longer manage the task themselves - I may support the patient's right to choose death but I don't want to help them do it!

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  • tinkerbell

    Anonymous | 6-Jan-2012 8:27 pm

    Thanks for the reference. As it says on their website no one is flooding Oregan to die, maybe it's just the safety net of a contingency plan that reassures people. Knowing they have choice.

    As someone who believes in an intelligent force, God, him/her, fluffy beared man in the clouds, whatever one chooses to call him/her I do have all the ethical/spiritual/religious issues to resolve within myself, especially as a Catholic schooled by the nuns with an A level in guilt. But if God is such a despot that he/she would rather we all die an inhumane death when there is an alternative then we will have to part company. Thank God i no longer believe this dogma that was drummed into me from an early age.

    I agree with you that whilst i may support someones right to choose, even for myself, i do not want to participate in the act. Does that make me a hypocrite? Cos' then surely someone would have to help me to die also and pass me the cup of poison.

    When my friend in her early 40's with terminal ca breast asked me to help her take her own life (she has since passed away, bless her) I told her 'i will do anything to help you but i won't do that'. She phoned to ask if i would take her to Beachy Head (if she got really desperate). In the end i said i would take her if only for us to discuss and dissuade her on the way, however, then i would be bringing her back again and i didn't think it was an option plan as a bit too Thelma and Louise. At the end of our discussion we both ended up laughing, a release of the tension for both of us, but she never mentioned it to me again and she received adequate pain relief from her GP and community nurse team, as far as i am aware and she told me they were really good. She never complained of severe pain (maybe she was stoical) and died a peaceful death in a hospice.

    One day towards the end she just put her arm around me while I cried. She asked me 'why' and i said 'because this is all just so awful'. Wherever you are me old mate 'thank you'.



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  • George Kuchanny

    The pivotal thing here is that we should be adamant about one thing. The person who wants to end their own life must administer the fatal dose themselves.

    No ifs buts or caveats. Then it is suicide. Otherwise we may get to the situation of pre 2nd world war Germany or the current situation in Holland where people are culled without concrete evidence thatthis is what they wanted. Sad but true.

    Systems get lax and eventually abused over time. 'Clever' interpretations of law begin to proliferate. Another reason why medicine and Government should stand at arms length in my opinion.

    Otherwise 'economically inactive' people may, in some horrible future be simply killed. Nasty thought eh? So let us not be swayed by arguments of helping by actually administering fatal doses (opiates I would imagine) to others. If they really want to go then they have to start the syringe driver themselves. No exceptions.

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  • tinkerbell

    George Kuchanny | 7-Jan-2012 0:51 am

    Well said. This is the truly frightening part of the whole matter.

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  • George Kuchanny | 7-Jan-2012 0:51 am

    SUCCINCT!


    words like this should be published in the media so that the public fully understand what they are talking about and ALL the implications of their slippery slope arguments.

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  • Suicide in this country is legal - but most people are worried that they do not know enough to do it painlessly or what to use to ensure this - and no one should die alone anyway.

    What is not legal is 'assisting' that suicide = but define 'assist' - dispensing the drug knowing it is for the purposes of suicide even though one is not adminstering it - would still be a huge step for me personally. I do not want patients to suffer unnecessarily and I respect their right to chose if that choice is a valid one but I still do not feel ready to take an active part.


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  • tinkerbell

    The NMC also issued a statement reminding nurses that laws on assisted suicide remained unchanged at present.

    Just in case we don't realise and aren't taking the matter seriously.

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  • Thanks George for bringing this debate down to earth. Perhaps we could move the debate on to discussing how we can improve end of life care and give our patients the respect and dignity they deserve. If end of life care was all that we would desire then the question of prematurely ending life would not arise.

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