Ever since The Incredible Dement described an on screen Dignitas death as ‘a result’, much as parent might comment on the inspected contents of a toddler’s potty, Dr No has been somewhat less impressed with the ID’s own ‘results’. The ID’s latest ‘result’, a cooked report, produced on his behalf and at his expense, by an assembly of pro-snuffers, pipes the payer the tune he wanted. The ID has now moved on to his next project, which is grow daily in appearance more like the Archbishop of Canterbury. On latest sightings, it appears that this project too may soon produce ‘a result’, and we shall no longer be able to distinguish one from the other. Reporters and organisers of conferences on assisted snuffing might care to take note, lest they find the talking beard before them delivers ‘a result’ rather different to that which they were expecting.
Results aside, Dr No sees the Commission on Assisted Dying’s report as more non-result than result. Just as an assembly of hanging judges might find in favour of capital punishment, we simply cannot know whether the collected evidence gave rise to the conclusions, or the conclusions gave rise to the collected evidence. This is a flaw of such capital proportions that it quite takes the res out of any result, such that we are left with a deflated ult – and the suggested possibility of an ulterior motive.
The trouble with these ulterior motives is that they no know bounds. However carefully the Commission may lay down safeguards and checks, it is human nature that creep will occur. This is the experience in the Netherlands today; as it was too in the Nazi Aktion T4 programme. Once a Rubicon is crossed, it is downhill all the way; downhill down the slippery slope; that is the lesson of history.
Lately, Dr No has become more persuaded than before that the law is simply to crude a hammer to crack the delicate but oh so tough nut of bedside end of life decisions. The hammer falls, and the nut either shies away and is lost, or is shattered and destroyed. He remains decided that a person – not a patient – of sound mind and settled intent has a clear right to decide their fate, and that includes ending their own life. But when the law attempts – as we have seen the DPP attempt to do – to distinguish between acceptable and unacceptable assistance, a quagmire of legalities emerges.
How proximate dare the assistance be, before it becomes culpable assistance? To place the fatal draught in reach, or in the hand, or on the invalid’s tongue: at what point down that road do we cross the line between acceptable – if it is ever acceptable – assistance, and the intentional killing of another? And what too of the legal doctrine of common purpose, or joint enterprise, where association of presence and intent is sufficient to give rise to joint liability? If – notwithstanding that this doctrine has been challenged – it can give rise to joint liability for gang murder, does not a similar application give rise to a joint liability in ‘assisted dying’ – and so assistance in, at best, suicide, or, at worst, murder?
These are muddy waters indeed, and the Commission on Assisted Dying’s report does little to clear those waters. For the time being, we should resist the application of legal hammers to delicate nuts. For there is an old saw that when the tool in your hand is a hammer, everything looks like a nail. Dr No worries that when doctors start to carry sachets loaded with sodium pentobarbital, rather too many patients will start to look like patients who want to die; only they just don’t know how to ask.
“An increase of euthanasia acceptance among the general public took place over the last two decades in almost all West European countries, possibly indicating a growing support for personal autonomy regarding medical end-of-life decisions. If this trend continues, it is likely to increase the public and political debate about the (legal) regulation of euthanasia under certain conditions of careful medical practice in several West European countries”.
http://eurpub.oxfordjournals.org/content/16/6/663.full
Don’t forget there is nothing more frightening in the minds of some people than the idea that “you can’t get out” – why should such people suffer because of the long shadow cast by biblical, and other religious stories?
http://www.youtube.com/watch?v=ZUN496K1MxM
A&E CN – I agree – this is a very difficult problem. I would hate to have a patient who felt (and it is what they feel, not what I think they should feel, that matters) he or she ‘couldn’t get out’. It is difficult to imagine a more horrible place to be.
I quite accept the situation over suicide is as it should be: no one of sound mind and settled intent should be criminalised for deciding their own fate. Nor am I religious in any formal sense, so I am not pushing my unwanted ‘long shadow’ of religion into this. It is more that it goes strongly against my first principles as a doctor: that we should cure sometimes, relieve often and comfort always.
Where it does get really difficult is where the only apparent option to provide relief let alone comfort is to offer a ‘way out’.
And then there are all the – to me – very convincing arguments about creep: as sure as night follows day, it will happen: and then some who are not of sound mind and settled intent will get the ‘final comfort’, whether they want it or not. The ‘bar’ of finding two agreeable doctors to provide ‘cleared for take-off’ statements will never be that difficult; and the decision-making is likely generally to follow the path that abortion decision-making has taken.
I sure as Hell don’t know the answer(s), but I also know as sure as Hell that we need to keep on talking about it until we do get an answer!
And …
*when the tool in your hand is a hammer, everything looks like a nail*
But would you hit everything that looks ‘to you’ like a nail? I think not. I think the probability is that you will, because of this perception, make 100% sure you will hit a nail, or you will not at all. Full stop
‘Dr No worries that when doctors start to carry sachets loaded with sodium pentobarbital, rather too many patients will start to look like patients who want to die; only they just don’t know how to ask.’
… and so, if doctor carried these sachets about, not only will doc try their atmost to convince patient not to take the offer and endeavour to find an alternative for patient, but patient, seeing the hammer in doc’s hand, will not only not ask for the favour, but be terrified to tell of their symptoms too no matter how horrible they are … maybe this is ‘The’ answer!!
Why don’t you give it a try Dr No, just for an illustration of what I mean … kinda research, academia, you know!
🙂
“decision-making is likely generally to follow the path that abortion decision-making has taken” – does the evidence in countries where euthanasia is practised bear this out?
My understanding is that there is at most a very modest increase in the number of cases and nothing remotely like the quadrupling we have seen for abortions performed in the UK?
There is another obvious difference – the rights, or rather lack of rights for the foetus – a problem that IN THEORY should not apply when capacitated adults make decisions.
More food for thought
http://www.rsc.ca/documents/RSCEndofLifeReport2011_EN_Formatted_FINAL.pdf
A&E CH – Anna and the WD both provide links describing what is going on in the Netherlands – and the move to include broader definitions of suffering certainly looks like creep to Dr No.
The point about following the path that abortion decision-making has taken isn’t about abortion itself, more a general observation about how creep can and does progress: a variant, perhaps, of ‘familiarity breeds contempt’ (for what was once considered unacceptable). Again, something like this happened with the Aktion T4 programme (and again, Dr No is using it as a general example of the tendency to creep – of course we would never have an Aktion T4 programme here…).
The question of capacity is likely to prove an especially thorny one. In some cases it will of course be crystal clear, but many of the Gilberts and Biddies for whom the question of ‘assistance’ arises may well have fluctuating or uncertain capacity. The scope for arm-twisting, and the opportunities for ‘hired guns’ (the two independent’ doctors) to go about their new and grisly business will be remarkable.
The Canadian report you have linked to looks very interesting.
Anonymouse – your penultimate paragraph illustrates just how the possibility that the doctor may turn out to be an ‘angel of death’ has the potential to corrode the doctor-patient relationship, and may even in some cases increase suffering (because, as you suggest, the patient isn’t honest about their symptoms, for fear that they will be bumped off if they do admit to them).
“What I have to look forward to is a wretched ending with uncertainty, pain and suffering whilst my family watch on helplessly – Why must I suffer these indignities? If I were able-bodied I could put an end to my life when I want to. Why is life so cruel?”.
http://www.guardian.co.uk/society/2012/jan/23/locked-in-syndrome-high-court
A&E CN – response by way of a new post.
Euthanasia became legal in Belgium in 2002. Physicians must adhere to legal due care requirements when performing euthanasia; for example, consulting a second physician and reporting each euthanasia case to the Federal Review Committee.
http://www.ingentaconnect.com/content/rcgp/bjgp/2010/00000060/00000573/art00004
The study set about measuring “adherence and non-adherence of GPs to legal due care requirements for euthanasia among patients dying at home in Belgium and to explore possible reasons for non-adherence”.
It concluded “Substantive legal due care requirements for euthanasia concerning the patient’s request for euthanasia and medical situation were almost always met by GPs in euthanasia cases. Procedural consultation and reporting requirements were not always met”.
Now, I see in the Daily Heil GPs are being instructed to quiz elderly with serious health problems about ‘how they want to die’ – I am not sure if these, aherm, discussions will, or will not include the subject of euthanasia?
http://www.dailymail.co.uk/news/article-2091377/GPs-told-quiz-elderly-want-die.html
Just a passing comment (or two or three or more:…)
Although My Black Cat has not yet read the whole Canadian document referred to by A and E charge nurse on 19/01/12, her beady eyes have just noticed that it is possible that Scotty (Professor Sheila McLean) has been beamed up from Glasgow and down to Canada to mark the occasion.
Maybe there is another Canadian Professor McLean, of course, but MBC has quickly searched the whole document and there is no mention of the name other than on the front page. Odd that the Canadians are not given more information within the report itself on the background of those on the expert panel. Doubtless it will appear in obscure minutes somewhere or another and be visible only to those with enough tenacity and time to check it out.
Incidentally, we witches hate these “caring” photographs such as young hands “comforting” old hands on formal documents and reports. Although the artwork is good, and we appreciate art, we feel it is a subliminal, and in our view a rather tacky approach to a serious subject that has been stolen from the “toolkit” of the marketing gurus.
In fact we think the true meaning of word “caring” and “carer” is becoming lost in over use.
http://www.guardian.co.uk/society/2012/jul/21/mother-dementia-care-elderly-michael-wolff