Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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"Strict" criteria and lazy reporting
- Timothy James (2 November 2001)
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Look into your hearts, not to your neighbours
- Sam Hjelmeland Ahmedzai (3 November 2001)
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Re: "Strict" criteria and lazy reporting
- John Keown (3 November 2001)
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Issues of loss vs growth
- Leslie Piet (3 November 2001)
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Response to Ahmedzai
- Karen Sanders (7 November 2001)
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Response to Piet
- Karen Sanders (7 November 2001)
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Re: Issues of loss vs growth
- Peter Bradley (7 November 2001)
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Timothy James, Senior Lecturer University of Central England
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It is lazy journalism, and encourages lazy thinking among readers of the BMJ, to write of "strict criteria" in this context. I do not think I have yet read a report of a projected euthanasia law, in any jurisdiction, which did not use this adjective, but the extent to which the criteria proposed will actually restrict anything varies greatly. It would be better to avoid what is simply a cliche. The proponents of any liberalisation of the law invariably, in my experience, reassure the nervous by asserting that strict rules will govern its exercise. Politicians, with their love for the rhetorical, pick up the phrase, which becomes progressively more meaningless. A report should describe the proposed criteria, and leave the reader to judge whether they are sufficiently strict. It would of course, assist our judgement if it were to include an assessment of extent to which similar criteria have in practice restricted undesirable practices. Considerable data are available from the Netherlands, for example. Comparison with the impact of regulation on other matters of ethical concern (the obvious comparator in the UK is therapeutic abortion under the 1967 Act) would also assist thoughtful readership. |
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Sam Hjelmeland Ahmedzai, Professor of Palliative Medicine University of Sheffield
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Sir, Rory Watson reports that Belgium is shortly expected to change its law in order to decriminalise euthanasia. Two factors were quoted as influencing the Belgian Senate. First, a view from their senior lawyers that the current Western love for ‘self-determination’ means that the ‘right to life’ can somehow, as a non-sequitur, include the duty of doctors to end it at the request of the public. The second factor was even more specious: that was the recent approval given by Belgium’s neighbour, the Netherlands, to change their law. No doubt many in other nearby countries will wonder if they should follow these free-thinking leaders of opinion. I would suggest, however, that we should stop and consider the context of the cultures in which such decisions are made. I cannot speak for Belgium, but I hold that a country like the Netherlands, which tolerates huge consumption of unnecessary ‘recreational’ drugs, which allows open displays of pornography and the public degradation of near-naked women (a bizarre reversal of the equally hideous Talibans' covering up of females), should probably not be seen as a moral guide to the rest of the world. Dutch people, as I know personally, are fine and caring. Their society, however, is in a cultural mess and only history will tell if its current fascination with killing people who feel value-less (or whom some doctors feel are value-less), will be seen as a major advancement of the human race. |
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John Keown, Senior Lecturer in the Law & Ethics of Medicine University of Cambridge
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Timothy James is right to criticise the question-begging use by journalists of 'strict' to describe guidelines for euthanasia. Journalists too often seem to think that 'strict guidelines' is one word, and to overlook the fact that guidelines may in fact be lax. The Dutch guidelines for euthanasia are demonstrably lax, both in theory and in practice (see my EUTHANASIA EXAMINED (CUP, 1995)chapter 16). The proposed Belgian guidelines, as reported in the BMJ, are certainly no stricter. Journalists would indeed do well to exercise caution in their choice of adjective, and to ensure that their description fits the reality. |
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Leslie Piet, Nurse Educator Johns Hopkins Healthcare
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Issues of loss are certainly difficult, especially during the final season of living. What so many fail to recognize is the opportunity for growth and development in the end of life. This time period is incredibly significant for the opportunity for self-actualization. It can be a time of great healing, love, finishing up business and saying goodbye. To end a life, prematurely, denies this opportunity. Those who remain are often left with an uncomfortable case of the "what ifs" and "if I had only known". Some of the greatest "living" can and is done in the end of life. | |||
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Karen Sanders, Senior Lecturer in Health Care Ethics South Bank University, London
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Response to: Look into your hearts, not to your neighbours Sam Hjelmeland Ahmedzai, Professor of Palliative Medicine, University of Sheffield bmj.com, 2 Nov 2001 [Response] Whilst I would strongly agree that the serious subjects of Voluntary Euthanasia requires full and open discussion, I fear that publishing this response from Sam Hjelmeland Ahmedzai does not contribute to this. His personal Prejudies and unsubstantiated statements concerning Dutch society and behaviour have nothing to do with this issue. Those who wish to consider this important issue seriously may wish to consider how two countries with very different cultures and religious beliefs have both come to the same conclusions regarding this matter. |
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Karen Sanders, Senior Lecturer in Health Care Ethics South Bank University, London
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Response to: Issues of loss versus growth Leslie Piet, Nurse Educator , Johns Hopkins Healthcare bmj.com, 3 Nov 2001 [Response] In regard to Leslie Piet's comments, these comments would all be relevant if the debate were about life being ended without the consent of the person involved, but voluntary euthanasia allows all of what Mr Piet wants to happen to be done should the person so wish. |
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Peter Bradley, GP Springwood, Brisbane, Australia
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The issue of euthanasia always brings forth lots of high-sounding, and perfectly valid rhetoric, especially from those involved in palliative care, on the one hand - as they tend to see it as an accusation that they are somehow not delivering properly, - and on the other hand, from those paranoid doubters in the community who have no faith in their fellow man (doctor) to continue to do what we have always strived to do in good faith, and that is to do what is best for our patients. I guess I might once have also felt reservations about taking this last (logical) step in delivering that care until my own mother died in 1994 of bowel cancer. I remember clearly the feeling of grief and despair, that after having flown 3000 kms to be at her bedside, just in time for her last breath, she was so wasted away I could not even recognise her, my own mother, and I kept thinking about funny things like, if maybe I put her glasses back on her face, it might somehow help her to look like I remembered her. I was crying at the bedside of a stranger! My brother, driving his heart out to be there in time, did not make it. It came to me then - surely there is a basic 'rightness' about being able to choose the time of out departure. We have no choice about our birthday, or how, when, or where we enter this earth, but surely we should be able to choose our 'deathday'. So that once we are in a state of irretrievable decline, and before we lose the dignity of control of our bladder and bowels, or ability to eat, - or more importantly, speak, - we can summon our loved ones from wherever they are, to rally round so we can say those last things we all want to say, - then hit the button, so to speak, and off we go, with their good-byes the last thing we hear. The funeral is then logically follows soon after, and all can be there, then return to the many scattered places around the globe from whence they came - a modern phenomenon, but one which will not change. Now why would anyone want to deny someone a good death like that? It is not a criticism of palliative care, it is just a fact, that sometimes to maintain adequate comfort, one has to be obtunded enough meaningful discourse is precluded, and so is attendance on ones bodily functions. Loss of dignity, in a nutshell. Add to that the need for relatives who live widely scattered but want to attend at the end, but are unable to tarry for weeks away from home and work, and you have a pretty powerful imperative for change, don't you think? |
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