Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Assisted Suicide: multiple loopholes!
- Dr.Naseem A. Qureshi MD, IMAPA, LMIPS (9 May 2004)
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Am I breaking the Law again?
- Michael H.K. Irwin, None (9 May 2004)
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Euthanasia: a problem facing GPs
- Francesco Carelli (10 May 2004)
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Against a "lenient" attitude to assisted suicide
- Alison Davis (10 May 2004)
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The best approach: House of Lords Select Comittee
- Dr Murray Earle (11 May 2004)
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The end of the euthanasia debate
- Philipp Conradi (11 May 2004)
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Whose life is it?
- SUDEEP KHANNA (13 May 2004)
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Law and professional ethics
- M ichael B Howitt Wilson (15 May 2004)
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You are wrong, Dr. Howitt Wilson
- Michael H.K. Irwin (17 May 2004)
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VES will have nothing to do with unlawful activity
- Richard Belton (19 May 2004)
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Assisted Suicide
- Mary Knowles (20 May 2004)
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Situation in Under developed countries needs to be gauged
- Abdul M Khan (21 May 2004)
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Re: Unlawful Activity
- Elspeth Chowdharay-Best (25 May 2004)
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Dr.Naseem A. Qureshi MD, IMAPA, LMIPS, Medical Director(A), Director CME&R Buraidah Mental Health Hospital, Postcode:2292, Saudi Arabia
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Dear Sir: The editorial entitled "Assisted Suicide" by Huxtable (2004) is illustrative of many loopholes in medical-ethical practice and the interfacing law, in particular related to end of life decisions that may lead to either preservation of life or quick end of life. This compromised approach adopted by courts and the lords of courts is because each presented case is unique in itself and the differences of intention to die or call for assistance to die early are coupled with conflicts of interests of involved partners and are palpable in the mentioned cases of assisted suicide. According to my interospection, such dilemmas with regard to assisted suicide will continue to haunt our mind as long as there are no precise ethical guidelines wedded to assisted suicide. Medical personnel and public at large and also law personnel should have sound knowledge of these laws because all are sharing the responsibility of assisting or defering suicide. According to Huxtable's excellent, critical analysis of illustrative cases, time is mature and right in the favour of proper modifications in the pre-existing guidelines and laws in order to plug all revealed loopholes. Finally, presevation of life is better than ending it early by any sorts of assistence. Reference: Richard Huxtable. Assisted suicide.BMJ 2004; 328: 1088-1089 Competing interests: Against-Assisted suicide |
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Michael H.K. Irwin, Retired GP Cranleigh, Surrey GU6 8BZ, None
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Editor - In the editorial by Richard Huxtable, he refers to my justified arrest by the Isle of Man police last December for conspiring to assist in the possible suicide of my terminally-ill Manx friend, Patrick Kneen (in fact, when I finally saw him, Patrick was too ill to commit suicide, and he died after being heavily sedated by his GP). However, when terminally-ill individuals have travelled from the UK to Switzerland where, with the help of Dignitas (a Swiss organization based in Zurich), they have committed suicide, the relatives who assist them have not been prosecuted in this country. In this connection, Huxtable notes the example of Reginald Crew (terminally ill with MND) whose widow, Winifred, escaped prosecution. Dignitas has about 600 members in the UK: this membership provides what can be considered as an "insurance policy" in view of the present law on assisted suicide in this country. During the past year, since I joined Dignitas last June, I have spoken to eleven other members in the UK on how this organization could perhaps, or perhaps not, help them, at the appropriate time. I have told three of this number, who are fairly seriously ill, how they can get, from their doctors here, the medical reports which the Dignitas physicians will require if an assisted suicide is to occur. And, I have advised one terminally-ill person on how to make her final journey to Zurich (where she committed suicide last November). So, in the past year, I have "aided, abetted and counselled" (to quote the 1961 Suicide Act) one suicide, and I am involved in possibly three future suicides. But, as the suicide occurred, or perhaps will occur, abroad, am I guilty of committing a crime in this country? It seems that no one in the UK presently knows the proper legal answer! I was questioned by the Isle of Man police on 12 December last year. I had a further interview at the Guildford police station (near my home) on 2 March this year (mainly in connection with the death of Patrick Kneen). The police are aware of my activities with Dignitas. But, so far, nothing has happened. I agree with Richard Huxtable that there is an urgent need for "greater clarity...of the law governing the end(ing) of life". Michael Irwin Retired GP Former Chairman, Voluntary Euthanasia Society (England and Wales) Reference: Huxtable R. Assisted Suicide BMJ 2004;328:1088-1089 (8 May) Competing interests: None declared |
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Francesco Carelli, EURACT Council ,National Representative - RCGP 43017 - GMC 4256757 - EGPRN - Italian College of GP 20123 -Milan - Italy
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Sometime ago, a famous Italian journalist, Indro Montanelli, wrote in Corriere della Sera : “ About euthanasia, it’s important to speak about, at least to speak about “ Therefore, we, as General Practitioners, welcome this invitation and speak about it for two reasons: the first one, none of us goes through, as wrote Kirkegaard, the death of our patients; the second one because the problem is increasing, in an ever ageing society with more and more surviving to the impact of illness. Every day, we see how our terminal patients suffer, without walls, differently from the situation in hospitals or clinics, where the medical nurses are at work to see the final step of human beings, as we see as General Practitioners. So, it would be correct try to say our opinion about this problem, as it comes from our daily real competence. The topic is complex because of ethical, religious and legal problems, also developing big debates after some national legislation about it. Research we presented at WONCA Congress 1999 in Palma de Mallorca, indicated that patients interviewed by a questionnaire were strongly willing to end their life as smoothly as possible, and indicated the General Practitioner as the most involved in this process. It’s true: it’s difficult not to wear clothes coming from Sturm Staffen, but we have to speak about. Also, a Catholic Country has to think about: A) our research on Italian patients, was significative also for “ active religious “ ones; B) the Netherlands, as an Active Christian Country, is half and half divided between Protestant and Catholic, with not few Catholic members of Parliament in favour, with the opposition from some Protestants – Calvinists. C) data coming from national journalistic questionnaires, indicate a “ positive trend “ to the majority concerning the “ endless therapy “. What about our medical deontology ? How could this happen in future not in contrast with deontology ? These questions have to be discussed in Bioethics Committees, where General Practitioners have to play the most important role, to find concrete and complex answers to these life dilemma. Which the obstacles to avoid that “ legal suicide “ could be transformed in a solution for many problems in our young and efficient society ? Who will decide about the users of this “ service “ ? It will be easy for us to put on a table the “ cocktail “ as we can read for Petronio Arbitro in Sienkewitz’s “ Quo vadis ? “ ? Fortunately, we are unable to answer these questions, but we feel we must be prepared for unexpected coming events. Sigmund Freud, conscious, suicided anticipating a painful death. Was this a conscious choice or a necessity to avoid big suffering with a solution ? We don’t know but we have to think about, as General Practitioners, in a General Practice context, before others could speak and decide for us, attributing responsibilities and psychological difficulties bigger than the ones we daily are suffering. So, we must speak about. Competing interests: None declared |
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Alison Davis, Patient Home DT11 0LE
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I write as a patient with several severe conditions including spina bifida and hydrocephalus, osteoporosis and emphysema. I use a wheelchair full time, and experience severe spinal pain which is not always well controlled, even with morphine. I have recently been in hospital with a chest infection which did not respond to treatment. I was alarmed to read Richard Huxtable's attempt to argue for a continuance of the "current legal compromise" and a "lenient attitude" towards assisted suicide. I agree with him that a change in the application of the law is needed, but I would disagree with him about the nature of the required change. Nineteen years ago I wanted to die, due to a combination of uncontrolled pain and other factors. At that time several doctors belived my life span would be very short. It was a settled wish that lasted about 10 years. During the first five of those years I attempted suicide several times, and was saved only because my friends intevened and arranged for me to be sent to hospital, where I was treated against my will. Had euthanasia been legal then I would have requested it, and under the supposedly "strict criteria" proposed by Lord Joffe in his "Assisted Dying for the Terminally Ill" Bill I would have qualified for it. Huxtable appears to think lenient sentences for those who kill a disabled person are entirely right. I disagree. If it is right to kill a person because they are disabled and/or terminally ill and say they want to die, then it would have been wrong to initiate the treatment which saved my life. There can only be one reason for approving leniency for those who kill disabled people, while (presumably) deploring it in the case of those who kill non-disabled people - a negative view of the value of disabled lives. I reject such a view. I am glad that my life was saved, but it took me many years to feel that gratitude. Had I been "mercifully" killed no one would have known that the future held something good for me, and the killing would have appeared entirely justified. The only truly "compassionate" way of dealing with those who are suicidal is to try to help the individual regain a sense of the value of their own life, whether or not they are disabled or ill. If assisted suicide is deemed acceptable, then in effect a message is sent out that disabled lives have less value, and are less worth saving. Normally saving a life is regarded as laudable, and doctors presumably become doctors because they want to save lives. Transforming doctors into killers, and condoning killing by non-medical carers, far from being "compassionate" presents a terrifying vista to me. Alison Davis Competing interests: None declared |
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Dr Murray Earle, Senior Research Specialist Scottish Parliament
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Richard Huxtable is correct that the House of Lords rejected the Lord Joffe's bill, although in the year since that happened, the Patient (Assisted Dying) Bill, has been amended and resurrected as the Assisted Dying for the Terminally Ill Bill [HL]: http://www.parliament.the-stationery- office.co.uk/pa/ld200304/ldbills/017/2004017.pdf The main amendment limits the application of the bill to the terminally ill and permits provision of the means to end life only if the patient is physically unable to do so. That the issue has been resurrected in bill form and that the House of Lords has authorised the setting up of a Select Committee to consider the bill, is evidence that the issue is still alive and that steps are being taken to move beyond ambiguity. One should not prejudge the outcome, however, because opposition in the House remains strong, despite the amendments. The Select Committee will hold its first meeting on 7 July 2004 - a move supported opponents of the bill on the ground that an in-depth inquiry deserves support (House of Lords Hansard, 10 March 2004 Col 1321, per Baroness Finlay of Llandaff). Competing interests: None declared |
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Philipp Conradi, part time GP Bloomsbury health centre, nechells, Birmingham B 7 5 DT
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Euthanasia should not be subject of a medical discussion but good palliative care should be. May I draw the attention of all readers to the obituary of the late Deborah Doniach written by Carol Richmond in one of the recent issues of the BMJ and the subsequent email responses. British Hospices are at the forefront of good palliative care and I was always glad to be able to access our outstandingly cooperative and professional local palliative care team at St. Mays Hospice in Selly Oak. Competing interests: as expressed in text |
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SUDEEP KHANNA, Consultant gastroenterologist and Chief research officer Pushpawati Singhania Research Institute for Liver, Renal and Digestuve Diseases,Shiekh Sarai Phase I
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Sir, The article by Richard Huxtable raises a very pertinent issue.Euthanasia and asissted suicide are very complicated and confused issues. It is unfortunate that people who decide about the patients' right to live or die can never understand what a patient suffering from a terminal disease with a prolonged course goes through.I personally believe that a patient should be given the right to choose if he wants to carry on with a poor quality of life with no hope of the disease being cured or take help from his doctor or nearest relations to end his misery.The law makers will never understand the deliemma of these patients unless they are in the same boat.In a country like India, the issue of asissted sucicide is never talked about. it is time we grow up and stop taking decisions for others. Competing interests: None declared |
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M ichael B Howitt Wilson, Musculoskeletal Physician Woking Nuffield Hospital GU21 4BY
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Richard Huxtable advocates greater clarity in the definition and application of the law on assisted suicide. Judgements may be confused, but the law remains clear. Aiding and abetting a suicide is a felony. One hopes that it will remains so, for if another acquiesces in a suicide bid, he confirms a person’s negative view of life, just when he/she needs affirmation. That Michael Irwin and Mr Kneen’s wife were not charged suggests that there was insufficient evidence of a crime, not a contradiction in the law, which was not tested. Lenient sentences do not involve compromise on principle. It is right that if the motive of the one who offended was merciful, so should the law show mercy. The law of course demands our obedience, except where it contradicts the higher moral order, when it becomes null and void. But why this quibbling about legality, by doctors? Medical practitioners belong to a profession, known traditionally for its high ethical principles, one of which is: “I will not kill anyone.” The health of their patients must be their first consideration. Liberal laws should not influence the medical conscience, whose principles must be higher than merely acting within the law, for a doctor is in a position of special trust. When he breaks that trust he should not attempt to shelter behind the law. The medical profession must ultimately retain responsibility for its own ethics or it ceases to be a profession in which the public can have any confidence; in fact it ceases to be a profession. Competing interests: Chairman, British Section, World Federation of Doctors who Respect Human Life |
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Michael H.K. Irwin, Retired GP Cranleigh, Surrey GU6 8BZ
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Editor - Dr. Howitt Wilson is completely wrong to write, on May 15th (see above), "That Michael Irwin and Mr. Kneen's wife were not charged suggests that there was insufficient evidence of crime....". Speaking only for myself, I gave the Isle of Man police, last December when I was arrested, a detailed diary of my involvement in planning to assist my terminally-ill Manx friend, Patrick Kneen, to commit suicide last October. And, if Dr. Howitt Wilson looks at the website www.worldrtd.net, he will read my detailed confession ("Arrested for Showing Compassion") of this conspiracy, along with a possible explanation as to why Mrs. Kneen and I were not charged earlier this year. Competing interests: Former Chairman of the Voluntary Euthanasia Society (England and Wales) |
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Richard Belton, Chairman VES 13 Prince of Wales Terrance, W8 5PG
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Dear Sir, I welcome Richard Huxtable's contribution to the much needed debate on the issue of patient choice, but I am not at all enthusiastic about the subsequent letter from Dr Irwin over the sub line “Former Chairman of The Voluntary Euthanasia Society”. Immediately the Board of the Voluntary Euthanasia Society became aware of Dr Irwin’s activities, it called on him to resign from the Board. I should like to emphasise that The Society, dedicated to campaigning for reform of the current laws, will have nothing whatsoever to do with unlawful activity. Yours sincerely, Richard Belton Chairman: The Voluntary Euthanasia Society Competing interests: None declared |
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Mary Knowles, Chair - First Do No Harm London SW3 4WJ
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From First Do No Harm www.donoharm.org.uk The Editor British Medical Journal 18th May 2004 Sir. Assisted Suicide The European Convention on Human Rights, now part of UK law, unequivocally states “Everyone’s right to life shall be protected by law” (Article 2). The ruling in the European Court of Human Rights in the Diane Pretty case established that no-one has the right to be killed. Using a relative to facilitate your suicide is not the same as refusing medical treatment, as in the case of Miss B. The office of hangman exists no longer. Who is going to be Executioner in Chief if the law is changed to allow death on demand? It would be appalling to expect a doctor to fulfil this role. He would be in the invidious position of not being allowed to resuscitate a young boy or girl who had taken an overdose in response to stress, and who when properly cared for would be very happy to be alive. How would we know, when someone was found dead, if the victim had genuinely requested to be put to death? There might be only the evidence of a relative who alleged a persistent demand for help in dying. The existing law on assisted suicide is not ‘opaque’, as you state (Editorial 8th May). The State is bound to uphold the right to life. Yours faithfully, Dr Mary Knowles - Chair Competing interests: None declared |
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Abdul M Khan, Medical Student The Aga Khan University Medical School, Karachi PAKISTAN
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Dear Sir, Developing countries like my own are under a double burden of disease. Here infectious diseases co-exist with non infectious diseases of the developed world. We have to take care of diarrohea, pneumonia, tuberculosis, hypertension, ischaemic heart disease and many more before we come to think of the issue of euthanasia. Still the little improvement that is reaching the doors of patient care in our countries has made the idea of Euthanasia more pertinant. It seems more important when we see that our health care system has to take care of increasing number of patients due to the double fold burden. Also limited resources provide for a fertile ground to the argument in the favour of euthanasia. Yet there has been very little work done in Pakistan on this topic. There is a need to explore public opinion and in the light of that carve out the contingency plan. For that time is not far away when question of euthanasia and mercy killing will be primary in our health setup. Competing interests: None declared |
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Elspeth Chowdharay-Best, Hon. Secretary ALERT - Defending Vulnerable People's Right to Live 27 Walpole Street, London SW3 4QS
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The Editor British Medical Journal 23rd May 2004 Sir, Richard Belton, Chairman of the Voluntary Euthanasia Society, testifies (19th May) that the Society will have nothing whatsoever to do with unlawful activity. It was not always so. VES News in January 1997 featured on its front page an appeal by the President, Sir Ludovic Kennedy, for doctors to “admit publicly” to voluntary euthanasia “and by thus challenging the law to bring about a change to it.” Unfortunately, some people can be inspired to carry out euthanasia without any request from the patient. The French nurse Christine Malèvre was a heroine in the Press when her book “My Confession” was published, but bereaved relatives complained that her victims had never asked to die. She was sentenced to ten years’ imprisonment for causing the deaths of six patients, one of whom had just bought a car and was planning to move house. Yours faithfully, E. Chowdharay-Best Hon. Secretary, ALERT Defending Vulnerable People’s Right To Live Competing interests: None declared |
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