Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Why disabled people oppose assisted suicide
- Dr Peter J Saunders (27 August 2009)
-
Assisted Dying: disability has everything to do with it
- Alison Davis (27 August 2009)
-
What's disability got to do with it?
- Ann E FArmer (28 August 2009)
-
A Reasoned Observation?
- David Jeffrey (28 August 2009)
-
The vulnerable are being used
- Simon Kenwright (28 August 2009)
-
Personal choice for whom
- Joan McClusky (28 August 2009)
-
BMJ 2009;339:b3422
- Ronald NC Douglas (29 August 2009)
-
Assisted suicide isn't just an issue for young or mid-life disabled people
- David Oliver (29 August 2009)
-
Hijacking informed choice on assisted dying
- Claud Regnard (29 August 2009)
-
The Vulnerable
- Christine M Hudson (30 August 2009)
-
Right of reply
- Ilora G Finlay (31 August 2009)
-
Safeguards put in place will be broken.
- Szamme M. Jamieson (31 August 2009)
-
Overuled by the courts.
- Suzanne M. Jamieson. (1 September 2009)
-
Euthanasia and assisted suicide
- Eugene G Breen (1 September 2009)
-
Not just the content, also the tone
- Paul W Keeley (1 September 2009)
-
Another Baroness on the Bus
- Elaine Murphy (1 September 2009)
-
This Was Your Life
- Martin Kelly (2 September 2009)
-
In praise of irreverent tone
- Richard Smith (2 September 2009)
-
Medical rationing lead to euthanasia and the holocaust 70 years ago
- James DM Douglas (2 September 2009)
-
Re: In praise of irreverent tone
- Paul W Keeley (2 September 2009)
-
In Praise of Disabled People
- Hugh Mann (3 September 2009)
-
Re: Why disabled people oppose assisted suicide
- Michael P G Harper (3 September 2009)
-
Where are the disabled supporters?
- Joan McClusky (3 September 2009)
-
Why Should the BMA Ballot Its Members?
- Jay Ilangaratne (4 September 2009)
-
What does disability have to do with it?
- Debbie A Purdy (7 September 2009)
-
The Assisted Dying Debate has been hijacked
- Mary Knowles (7 September 2009)
-
Assisted dying
- Nick Moore (7 September 2009)
-
Re: Assisted dying
- Isky Gordon (7 September 2009)
-
Not a disability issue, but who does speak?
- Michael G Peckitt (7 September 2009)
-
Equality for the disabled means the same choice as the rest of us
- Elisabeth Liza Macdonald (9 September 2009)
-
Doctors' attitudes to assisted dying
- Clive Seale (9 September 2009)
-
The Day Irony Was Given A Lethal Injection
- Paul W Keeley (9 September 2009)
-
Let's have evidence-based law reform
- Oliver B. Coles (10 September 2009)
-
A scheme for assisted dying
- Michael Rosen (23 September 2009)
|
|
|||
|
Dr Peter J Saunders, Director CNK Alliance Ltd, PO Box 56322, London SE1 8XW
Send response to journal:
|
Dear Sir, May I direct readers to the letter signed by over 30 leaders of disability rights organisations and sent to all members of the House of Lords at the time of the debate on Lord Falconer's amendment to the Coroners and Justice Bill. This outlines their concerns about assisted suicide legislation very well. It is reproduced below and is also available on line (1). The letter reads as follows: 'As leaders of the disabled people’s movement in the UK and the USA, we are extremely concerned about how the proposed amendment to the Coroners and Justice Bill will impact on the lives of disabled people. If Lord Falconer’s amendment succeeds in the House of Lords on Tuesday 7 July then those who assist ‘terminally ill’ people to go abroad to end their lives in ‘suicide clinics’ would be immune from prosecution. The phrase ‘terminally ill’ is not defined in the amendment, and could apply to people with a very wide range of chronic progressive illnesses some with life expectancy stretching to decades. Disabled people who experience progressive conditions understand far more than non-disabled people about what it is live with these pressures. We know what is acceptable as disease or disability progresses, and for the huge number of us who say no to assisted suicide, it is because we fear the changing culture such an amendment would bring. People without experience of disability, including our friends and families cannot predict what each stage of our personal journey will mean. Furthermore, financial and emotional conflicts of interest will always present an added burden to the situation. A law decriminalising assisted suicide would undoubtedly place disabled people under pressure to end their lives early to relieve the burden on relatives, carers or the state. These concerns are not side issues that only affect disabled people. We are like society’s ‘canaries in the coalmine’ who can often see the dangers of potentially discriminatory legislation before others, as it impacts on us even before the deed is done. We are scared now; we will be terrified if assisted suicide becomes state-sanctioned. The existing law, with the penalties it holds in reserve, causes potential assisters and those wishing to die, to think very carefully before acting. The discretion within the current law enables judges to exercise compassion in hard cases. What is not broken does not need fixing. Disabled people have been largely silent in this debate which has been carried out in the media by clerics, non-disabled commentators and a small handful of individuals with terminal conditions who are supported by Dignity in Dying. Until people like us are present to engage in this highly complex and ethical debate, we must strongly oppose any device such as Lord Falconer’s amendment to get assisted dying in through the back door.' Peter Saunders 1.http://www.carenotkilling.org.uk/pdf/disabledpeoples_leadersLetter.pdf Competing interests: None declared |
|||
|
|
|||
|
Alison Davis, Patient Dt11 0LE
Send response to journal:
|
Tony Delamothe, who thinks the assisted suicide debate has been "hijacked" by disabled people, is guilty of sloppy thinking, at best. He states at the outset that he is "in favour of [assisted dying, assisted suicide, assisted killing] for terminally ill adults of sound mind who want to die. He then goes on to express his support for the death wishes of Daniel James, a quadriplegic who was not terminally ill,and who died at "Dignitas" and for Debbie Purdy, who has MS, really wants to die in Britain and not in Switzerland, as her case suggested, and is also not terminally ill. Ms Purdy has actually admitted that she is now determined to campaign for "suicide assisted by a doctor to be made legal in Britain for the terminally, chronically or incurably ill." (Sunday Express 2 August 2009 p.46) My own case is relevant here. I have spina bifida, hydrocephalus, emphysema, lordosis/kyphoscoliosis, osteoporosis and osteoarthritis. I use a wheelchair full time. Twenty years ago,when doctors thought my life expectancy was very short, I decided I wanted to die. It was a settled wish and lasted about 10 years. During the first five of those years I attempted suicide seriously several times. I was saved then because doctors rightly gave me life saving treatment against my will. I was very angry with them then. Now I'm very grateful. Had Tony Delamothe's favoured vision been law then I would have requested death, and could not have been treated. I would have died, and would thus have missed the best years of my life. And no one would ever have known that the doctors were wrong in thinking I didn't have long to live, and that the future held good things for me. At the time I wanted to die I was suffering severe spinal pain. I still have it now, and morphine does not entirely remove it. What has changed is not my disability, or my pain. What has changed is simply my outlook on life. Mr. Delamothe appears to suggest that it is acceptable to sacrifice the peace of mind of a majority of suffering people for a minority to exercise their supposed "right to choose" their own time of death. In view of this maybe he thinks it wouldn't have mattered much if I had been killed unnecessarily all those years ago. I suggest, however, that individuals do matter. Why should those individuals who are suffering now and want to die be denied the chance which I was given to change their minds, and to live, however long or short that life might be. My experience is proof enough that life with considerable disability and severe pain can still be worth living. Alison Davis Competing interests: None declared |
|||
|
|
|||
|
Ann E FArmer, housewife IG8 9QP
Send response to journal:
|
Since all of the high-profile cases in the present campaign to change the law on assisted suicide/euthanasia have focussed on disabled people, it is a bit strange to start asking what it has to do with disability. Perhaps if the proposed changes to the law enshrined the option of getting help when we need it, disabled people like me might feel less threatened. I seem to remember that Leslie Burke, who fought a legal battle to continue to receive nourishment should he be unable to ask for it at some time in the future, had his case thrown out - the Department of Health argued that to guarantee tube feeding for all would be too expensive. The Patients' Association has just published a report detailing the most horrific neglect of the elderly and vulnerable in our hospitals. In the 1930s the newly-formed Voluntary Euthanasia Legalisation Campaign wanted euthanasia for children, for insentient adults, for handicapped newborns. Assisted suicide IS euthanasia - it has not been illegal to commit suicide since 1961, and if disabled people wanted to commit suicide we would have taken advantage of this 'choice' - but we haven't. If this debate is about choice, it is the choice made by people in good health to give someone permission to kill them at some unknown future date if they should become disabled. It will give people the choice NOT to become disabled by allowing them to be killed by prior appointment. Assisted suicide has everything to do with disability. Competing interests: None declared |
|||
|
|
|||
|
David Jeffrey, Locum consultant palliative medicine Acute Paliative Care Unit, Ninewells Hospital , Dundee DD 9SY,
Send response to journal:
|
Delamothe’s ‘Observations’ do not seem to be in the spirit of a journal which aims to publish rigorous information that will influence international debate. To have a view in favour of assisted dying is one matter but to demean the courageous, thoughtful Baroness Campbell, who is physically disabled , by describing her as a “star turn” is unfair. Delamothe then dismisses Professor Finlay’s view as “sniffy”, surprising language from an editor of a medical journal interested in reasoned debate. Professor Finlay is an inspiring compassionate doctor who has encouraged many doctors around the world to train in palliative medicine and taught us much about engaging with suffering. Delamothe admits that his observations include “a cheap shot” , perhaps if we wish to read a balanced debate on the issue of assisted dying we should follow his example and read The Lancet. Competing interests: None declared |
|||
|
|
|||
|
Simon Kenwright, Physician retd 2007 East Kent , TN25 6BD
Send response to journal:
|
Tony Delamonthe highlights the way in which those opposed to assisted dying are trying to consolidate their position around “the vulnerable” just as Ilora Finlay argues that its supporters seem to concentrate on “autonomy”. There is of course a whole spectrum of opinion and arguments with no very clearly defined lines except at the extremes. Apparent concern for the “the vulnerable” allows a more united opposition as those whose views are dictated by objections based on a particular religious view without mention of their personal views about God. Evidence is limited but one survey suggested the views of those with disabilities is more in line with those of the general public than with those who profess to speak on their behalf. Meanwhile the “vulnerable” are used to resist law change. At the time of the Joffe Bill it was deplorable that some of those with major intellectual disabilities were used totally inappropriately to raise emotional objections to the Bill. Similarly , some years ago at the time of a high profile case the argument was made that someone with a severe disability who was refusing life sustaining treatment should be kept alive on a ventilator because of the disability. This would be a way of showing that Society valued their existence. Currently the majority -but by no means all - of doctors seem to accept that there are circumstances when the withdrawal or withholding of treatment can be justified on medical grounds and patients with capacity can refuse potentially life saving interventions. Just how we should protect the so-called vulnerable from excessive medical intervention seems a much more clinically relevant issue but one on which those who should speak on their behalf seem relatively silent. There seems no intention to move beyond the emotional and engage in a debate about trying to see how the “vulnerable” might be protected when the law on assisted dying changes if that is what is needed for reassurance. Perhaps we should consider specifically excluding any disability from being a qualifying condition unless it is in a terminal phase? Competing interests: Member of Dignity in Dying |
|||
|
|
|||
|
Joan McClusky, Medical writer New York, NY 10003
Send response to journal:
|
Tony Delamonthe asks to be shown "easy cases" regarding assisted dying. He then takes on the task himself, quoting Harris and Times polls showing that a majority agree that "terminally ill people should be allowed to die"--as if that were not in the cards already. He uses these results as evidence that the laws about assisted dying need to be changed. He also asks why the rights of the disabled to be free from coercion to kill themselves supersedes the rights of the terminally ill to freely kill themselves. The answer is simple: because life trumps death. According to his argument, the desire for death by a few trumps the desire for life by many, whom, he acknowledges, might face pressure to die --or have that decision made for them. In other words, the right to die becomes the obligation to do so. No one should have to defend why they want to live. Competing interests: None declared |
|||
|
|
|||
|
Ronald NC Douglas, Retired GP Retired G43 2SU
Send response to journal:
|
Assisted Suicide - "Doctors steer clear" I very much agree with the opinions expressed by Baroness Julia Cumberlege. Having practised through the period of introduction of the Abortion Act of 1966, I see a clear parallel in the attempts to legalise physician assisted suicide. We were assured, I am sure in good faith, by David Steel that termination of pregnancy would only be available on the certificate of two doctors 'in good faith' but we all know that the end result has become 'abortion on demand.' I greatly fear that introducing the law into this field would similarly lead down a slippery slope to patients feeling obliged to ask for 'euthanasia,' and the loss of trust between patient and doctor at the end of life. Ronald NC Douglas, BSc, D.Obst.R.C.O.G, F.R.C.G.P. [31 Burnhead Road, Newlands, Glasgow G43 2SU] Competing interests: None declared |
|||
|
|
|||
|
David Oliver, Visiting Professor City University, London, School of Community and Health Sciences EC1 A 7QN
Send response to journal:
|
Editor It is a shame that in a rush to condemn Delamothe's deliberately provocative comments on the role of the disability movement in opposing assisted suicide, which were deliberately provocative in order to stir debate, the other half of his message has been virtually ignored in the rapid responses. Concerns expressed that disabled people with valuable and meaningful lives might be under undue pressure to die prematurely, or victims of medical nihilism are totally understandable. Even for those with burdensome long term conditions or who are terminally ill , it is also completely understandable that various commentators from the palliative care movement assert that if only better palliatve care were available for all, if only misguided fears about distressing death or worries about being "a burden" were confronted, if only the underlying depression or anxiety leading to a wish to die were recognised and treated, then no-one would want assisted suicide. In reality, there are many people out there, cognitively intact, free from outside coercion, with sufficient information and decision-specific capacity to decide that they want to choose the time and manner of their own departure. And many of them are not suffering intractable symptoms in need of palliation. They have simply decided autonomously that they have had enough. And who are we to second guess them? Of course we need to have enough safeguards to ensure that people don't feel "obliged" or pressurised to die. Of course, most doctors may feel that they do not wish to be involved in assisting suicide or euthanasia and that this is consistent with the ethical underpinnings of the profession. But for all this, when we talk of the "slippery slope" we must remember that it has two sides. The slope less often highlighted is the one where a minority (sometimes arguing from religious premises) opposed to assisted suicide compromise the autonomous wishes of large numbers of (often secular) individuals. I would not want to be involved in assisted suicide myself but I have treated many patients, not depressed, not in intractable pain, not under any coercion, not cognitively who have told me in no uncertain terms that they have "had enough" or "dont want to wake up" and asked "can't you just give me something doc". It is professionally arrogant to discount their views David Oliver Competing interests: None declared |
|||
|
|
|||
|
Claud Regnard, Consultant in Palliative Care Medicine St. Oswald's Hospice, Regent Avenue, Newcastle upon Tyne. NE3 1EE
Send response to journal:
|
Tony Delamothe clearly feels an injustice exists in the way that assisted dying is being portrayed.(1) His defence of the right to patient choice seems entirely reasonable. But there is an irony in his complaint that disability ‘lobby groups’ have hijacked the debate, since this reads like another example of the views of disabled people being sidelined.(2) His criticism of the BMA having ‘flip flopped’ on assisted dying ignores the reality that two thirds of doctors remain against a change in the law, with the highest proportion (up to 91%) in the specialities of care of the elderly and palliative medicine.(3) Presumably he believes that doctors who regularly care for dying patients are another lobby group hijacking the debate. He reserves his strongest criticism for those who express the fear that people with non-terminal illness will start accessing assisted dying. His assertion that such a view is a ‘cheap shot’ implies both unfairness and factual error. The facts are that in Switzerland as many as two thirds of people accessing assisted dying do not have a terminal illness and that the proportion rose by half between 1990 and 2004.(4) In the Netherlands, assisted suicide or euthanasia are acceptable as long as the patient considers their psychological suffering to be intolerable, even if they are physically fit. This liberal approach demands close regulation and agreement, and yet large differences are seen between Dutch doctors in their judgement of suffering.(5) It is not the debate on assisted suicide that is being hijacked, but the right of patients and the public to the evidence needed for an informed choice. 1. Delamothe T. The assisted dying debate has been hijacked. BMJ, 2009; 339: 484. 2. Office for Disability Issues. An In-Depth Examination of the Implementation of the Disability Equality Duty in England. London: Department of Work and Pensions, 2008. 3. Seale C. Legalisation of euthanasia or physician-assisted suicide: survey of doctors’ attitudes. Palliative Medicine 2009; 23: 205–212. 4. Fischer S. Huber CA. Imhof L. Mahrer Imhof R. Furter M. Ziegler SJ. Bosshard G. Suicide assisted by two Swiss right-to-die organisations. Journal of Medical Ethics. 2008; 34(11):810-4. 5. Rietjens JAC, van Tol DG, Schermer M, van der Heide A. Judgement of suffering in the case of a euthanasia request in The Netherlands. Journal of Medical Ethics, 2009; 35: 502-7. Competing interests: None declared |
|||
|
|
|||
|
Christine M Hudson, Full-time Mother Plymouth PL3 4EH
Send response to journal:
|
Tony Delamothe takes issue with those labelled as 'terminally ill' or 'disabled' - a vociferous minority - for spearheading opposition to Dignity in Dying's campaign for assisted suicide - a campaign currently headed by Debby Purdy, in a long line of activists primed by Dignity in Dying to win public sympathy and support. Tony Delamothe, whom I presume is not terminally ill or disabled, irritably seeks to dismiss the opposition of this minority and their desire for life because he wants to foist the right to die on the rest of us. However, this 'spearhead' of the terminally ill and disabled, also represent very many peoples in various stages of chronic illness too ie.the vulnerable. The vulnerable are a burgeoning group which includes your elderly and sick parents and mine, and any other relative who may feel under intense pressure to save sons, daughters, nieces and nephews the stress of having to take on caring roles as health and faculties diminish with illness and age. As such, therfore, this is not a vociferous minority, but a body representing the bulging demographic of the baby boomers, a much larger membership than those paid up members of the minority group, 'Dignity in Dying'or the 'Voluntary Euthanasia Society' as they were called until recently. Life has always been seen as good and it always will be. It is a right. This is ably displayed by the number of procedures very ill people will undergo to give themselves a few more weeks, months or years of life. The day that we legislate against this principle and force doctors to work against the Hippocratic Oath, will be a sad day, and indeed, who is to know how many more Harold Shipmans are out there waiting for their moment? The 100+ people out of 61 million in this country, who have travelled to Switzerland to take their own lives cannot be allowed to impact on British Law. Down through the centuries, our Laws have been passed for the common good. Assisted suicide is not for the common good. We allow it at our peril. Competing interests: None declared |
|||
|
|
|||
|
Ilora G Finlay, Professor of Palliative Medicine Cardiff Univ. and Velindre NHS Trust CF14 2TL
Send response to journal:
|
Tony Delamothe’s article (“On the contrary”) is right about one thing - that we should not equate disability with terminal illness. Not all disabled people are terminally ill, though it is a fact that many terminally ill people are disabled in one way or another by their illness. The vulnerability of disabled people to collateral harm from the legalisation of ‘assisted dying’ depends essentially on the impact that their illness has on their lives, the degree of dependence on others which it brings and the beliefs of some that their lives are in some sense less worth living. In this respect it is undeniable that many disabled people are more vulnerable than most – as Dr Delamothe appears to recognise, albeit somewhat grudgingly. It is also worth noting that the strident campaign that is being waged to legalise assisted suicide for the terminally ill is being built around a lady, Debbie Purdy, who is disabled and chronically ill rather than terminally ill – i.e. likely die to within a few months. Large numbers of disabled people find themselves in just this situation. It is hardly surprising therefore that they view with concern the underlying message of the campaign - that, if you have a disabling and degenerative illness like Ms Purdy, the way should be cleared for you to have assisted suicide. Dr Delamothe’s main thesis, which is summarised in the opening line of his article, is that “the debate on assisted dying has been hijacked by disabled people who want to live” and that “it needs to be reclaimed for terminally ill people who want to die”. One would hope that the supporters of an ‘assisted dying’ law would see it as providing a narrowly-defined facility to be exercised under wholly exceptional circumstances. Simply limiting it to “terminally ill adults of sound mind who want to die” is not nearly sufficient to meet this requirement. A means also has to be found of filtering the handful of determined applications by strong-minded individuals from the much larger number of potential requests from less resolute people who consider ending their lives because they feel they are a burden on their families as a result of the dependence their illness imposes or who are suffering from suicidal depression or (and we have to face the unpalatable fact that it exists) who may be being pressured, however subtly, in that direction by others. By contrast, Dr Delamothe’s vision of ‘assisted dying’ seems somewhat laissez faire. . He sees it rather as an ‘option’ to be made available to those who ‘want’ it – or say they want it - rather than an exceptional resort for a very small number of resolute individuals. His article does not suggest that he has understood the seriousness of the fundamental change in the criminal law that he is advocating. Dr Delamothe cites my article in The Lancet on Dying and Choosing. His argument is not easy to discern. Suffice it to say, however, that the point I was making in The Lancet is that, if (as now seems to be the case) ‘assisted dying’ is being justified on grounds of personal choice and control rather than unrelievable suffering, it has effectively lost its link with terminal illness and is therefore more open to drift to encompass people who are not terminally ill. Dr Delamothe also cites, in support of his view that ‘assisted dying should be legalised, the recent shift of the Royal College of Nursing towards a position of neutrality on the subject and he contrasts this with the BMA’s recent vote confirming its opposition to a change in the law, which he says was based on “votes numbering in the low hundreds from an organisation with more than 140,000 members”. Presumably, in the light of these remarks, Dr Delamothe will be challenging the RCN’s change of stance, which was based on the views of just 1200 nurses out of a total membership of 390,000? He calls for “a carefully worded secret ballot” (one wonders what ‘carefully-worded’ means) of BMA members. Indeed, let us have one – Dr Delamothe may be surprised by the result given that polls of doctors consistently show that nearly three out of four are opposed to any change in the law. But let us have one among RCN members too! Dr Delamothe claims that the Archbishop of Canterbury led the opposition to Lord Joffe’s ‘assisted dying’ bill three years ago. If he had read the Hansard record of the debate, he would know that this is nonsense. Lord Joffe’s bill was challenged, not by any of the bishops, but by Lord Carlile, a barrister who is not affiliated to any religious persuasion; and that the overwhelming majority of the interventions against the bill expressed concern over the dangers to public safety rather than private morality. Dr Delamothe is simply recycling well-worn propaganda of the pro-euthanasia movement. In summary, while I agree on the need to avoid equating disability and terminal illness, I believe Dr Delamothe is under-estimating the pressures which a change in the law would place on disabled people, not least as a result of an ‘assisted dying’ campaign for the terminally ill that is being built around a disabled person who has a progressing chronic illness rather than is currently terminally ill. Competing interests: author of one of the papers he comments on |
|||
|
|
|||
|
Szamme M. Jamieson, Housewife SS13 3BS
Send response to journal:
|
As a severely disabled person I am very saddened by Mr Delamothes article:- Assisted dying. What has disability got to do with it? He has ignored the fears of a large group of people who he seems to think will not be affected by decriminalising assisted dying. I do not see why we need to change the law on assisted dying/euthanasia. No matter what safeguards are put in place supposedly to protect the elderly,the disabled, the mentally ill and other groups will be broken and abused. One has only to look at studies in Holland to see the evidence. Even in the U.K.the courts allowed the death of Tony Bland who was in a persistant vegetative state according to his doctors, but he was not dying. That case has since been enshrined in law allowing other people to apply to the courts to allow patients in PVS to die, but not all the patients were strictly in PVS. So the Bland Judgement is being abused already. Competing interests: None declared |
|||
|
|
|||
|
Suzanne M. Jamieson., Housewife SS13 3BS
Send response to journal:
|
Further to my earlier submission, I feel I must mention more on the Tony Bland case. Tony Bland was a football fan severely injurred during the Hillsborough desasster. Hs injuries left him in a coma. His doctors concluded that although he could breathe unaided, there was no other response from him and no way of communicating with him. They also concluded that there was no hope of recovering consciousness, although he could live for another thirty years in the state which his doctors termed persistant vegetative state that he was in. The doctors and his parents applied to the courts to have his feeding tube removed. after deliberation the courts agreed. So Mr Bland's feeding tube was removed, thus starving him to death. If that is not physician assisted euthanasia without consent I don't know what is. The doctors went against the law of the land which the courts overuled. contrary to ths doctors conclusions, comatose people often do recover concsiousness in varying degrees with the right help. So even now although assisted suicide/euthanasia is illegal in the UK. It is broken because of the powers of the courts and disabled and other groups of vulnerable people have every cause to be worried. Competing interests: None declared |
|||
|
|
|||
|
Eugene G Breen, Consultant Psychiatrist Mater Misericordiae Hospital, Dublin 7, Ireland.
Send response to journal:
|
Mr Delamothe`s editorial on assisted suicide and euthanasia skirts around the real issue. People unfortunately kill themselves every day, but the issue at stake is whether this is acceptable behaviour, and whether it should be encouraged and sanitised, and the tabooes and stigma surrounding it be air brushed from conscience. The debate taking place under various smoke screens is in essence about the morality of self harm in its extreme form, and about quality control of lives. We already are autonomous, and we can and do do what we please, so whats all the fuss about? People who want to kill themselves want others to do it as well, so they dont feel so bad about it, and want that it becomes an acceptable behaviour. What hurts is when what we do or would like to do, is frowned upon by society or authority.... so lets get them to endorse our behaviour, and our conscience will somehow be at rest. The opponents of euthanasia and suicide or assisted suicide, value life for what it is. It is something we are gifted with and which is ours to protect as long as is lasts. The quality of that life is not what we or others calculate, since we are not the creators of life and really dont know much about it. From a scientific point of view it began at a definite time for each person and will finish at a definite time for each person. In between we have to live it as best we see fit because when its gone, its gone and from a human point of view thats all we know. I support the protection of life for all, because its definite and its all we have, and if there are issues making it burdensome they can and should be treated or at least palliated. Competing interests: None declared |
|||
|
|
|||
|
Paul W Keeley, Consultant Palliative Physician Glasgow Royal Infirmary, G4 0SF
Send response to journal:
|
Other voices more eloquent than mine have skewered the moral vacuity of Tony Delamothe's piece, http://www.bmj.com/cgi/content/full/339/aug26_1/b3446. It is not merely galling to read the content of such a dismissive piece, it is also distasteful to note the tone in which he dismisses those he disagrees with. Does Baroness Campbell 'chirrup'? Is she a 'star turn'? Is Baroness Finlay 'sniffy'? Do the disabled 'hijack' a debate in which they do have a stake (as is conceded by Baroness Warnock)? Does he have to express 'The Rights?' of disabled people in the astonished tones of Lady Bracknell? Is it absolutely necessary to dismiss concerns about the slippery slope from the terminally ill, imminently dying to quadriplegic 23-year-olds with quite such a 'cheap shot'? If Tony Delamothe is really serious in wanting a grown-up debate on these issues, might I suggest he moderates the tone of his pieces and starts exercising a little common courtesy towards his opponents? Competing interests: None declared |
|||
|
|
|||
|
Elaine Murphy, Retired doctor House of Lords, SW1A 0PW
Send response to journal:
|
Hooray for Tony Delamothe's invective against the curious confusion of the anti-assisted dying lobby between those who are terminally ill and those who have a disability. I understand the fears of disabled people of poor care and can understand their anger at not being listened to by those who treat them but the way to address that is to lobby for better understanding and improved services, not to campaign for another group of people, the terminally ill, to be treated without respect to their wishes. And DO keep up the style; there's far too much pompous posturing on this subject both inside and out of parliament. Competing interests: Baroness Murphy is an active supporter of a law to allow mentally competent terminally ill people to seek an assisted death at a time of their choosing. |
|||
|
|
|||
|
Martin Kelly, Call centre operator (no longer able to practice as solicitor) Glasgow
Send response to journal:
|
Tony Delamothe's edgy views on 'assisted suicide', a practice some of us prefer to describe as 'medical murder', tend to leave some chronically disabled - OK, well, me - on edge. Can we just leave the Thatcherite ethics of choice out of a debate which, if the pro-deathers get their way, will result in the advent of medical murder? After all, we now have social abortion, and had it only a very few years after we were told it would never happen. If history is any guide, precisely the same thing will happen with medical murder. No pill, potion or procedure can remove this fact from the record. The end of my earthly life is an event which I would prefer to come about uninfluenced by somebody else's ideology. If they are successful, those who demand choice for themselves, as if the manner of their dying is of no greater significance to them than a preference for a particular type of breakfast cereal or the colour of their cars, will result in my choice being taken away from me (they'll take my life with it, by the way, but hey, what's the point in living when you don't have choices?). This is the effect of all ideology. It is nothing to do with medicine. It is everything to do with people with very high profile bully pulpits attempting to direct the law towards a conclusion which only a very, very few people such as them want to see. Like breathing, eating and having to relieve oneself, dying a natural death is an unfortunate consequence of being alive - of being a human being; and those who wish to put down like lame horses might take note that their arguments are knackered. Competing interests: Sufferer of severe Gills de la Tourette Syndrome |
|||
|
|
|||
|
Richard Smith, Professor of some sort University of Warwick
Send response to journal:
|
The commonest strategy if you are losing an argument is to make an ad hominem attack on the proponent of the argument. A variant is to attack his or her tone. Tone irritates those losing arguments because it means that the proponent has used exciting, engaging, colourful, and often amusing and irreverent language to attract readers or listeners. Even those who are infuriated by piece can’t stop reading it. It’s because of tone that Dickens and modern polemicists like Richard Dawkins are so widely read and influential. I don’t doubt that the real life Mrs Gamps objected to the tone in which Dickens described them. It’s a serious mistake to think that serious debates can be had only in serious tones. Because for serious read boring. And boring means no readers, no listeners, and no influence. Competing interests: None declared |
|||
|
|
|||
|
James DM Douglas, General Practictoner Tweeddale Medical Practice,Fort William PH33 7AQ
Send response to journal:
|
Tony Delamothe claims the assisted suicide debate has been high jacked by disabled people who want to live while he campaigns as a medical journalist for a change in the law. He has personally high jacked the debate with journalistic power away from doctors with recent clinical experience with patients and families in general practice, neurology , oncology, psychiatry or palliative care. The busy clinicians who have experience to consider the consequences on society and the profession of the biggest change in UK professional practice since Hippocrates have no time to formulate replies when pitted against the power of the BMJ deputy editor. Most importantly he fails to reflect on the history of euthanasia, rationing and disability. Euthanasia began after the First World War in German mental hospitals ( ref. 1) where people with a disability where judged “to have a life unworthy of a life” as a means of rationing health care resource after the country was bankrupt from war. This path of medical judgment and eugenics lead to the holocaust by the Nazis.70 years later we are again short of money during a war and the new genetics can predict illness and future disability. It is easy and medically stimulating to challenge old dogmas to advance medicine and society while castigating those who urge caution and reflection from life experience and professional observation. The independent lawyers warning from Baroness Cumberledge to the profession is correct for pragmatic clinical practice ( ref 2).Doctors should be warned that when we cross the euthanasia Rubicon cheered on by Delamothe that the lessons of history will come back to haunt us again like the well meaning psychiatrists in Germany of 1920 faced with food shortages for the “mental defectives” in their long stay hospitals. Reference 1 Burleigh M , Death and Deliverance Euthanasia in Germany 1900 -1945 Cambridge University Press 1994 Reference 2 Cumberledge J BMJ letters BMJ 2009;339:b3422 Competing interests: None declared |
|||
|
|
|||
|
Paul W Keeley, Consultant Palliative Physician Glasgow Royal Infirmary, G4 0SF
Send response to journal:
|
Really, Professor Smith? I'd suggest that far from winning the argument, snide comments ('star turn', 'sniffy' and the like) indicate a degree of desperation and a failure to engage in meaningful debate. It also shows a lack of manners. It always helps in the debate, especially when the weight of response is overwhelmingly negative, if your former editorial colleagues can chip in and shout some useful, if vapid, nonsense from the sidelines. I'm saddened too that a member of the legislature takes it as 'pompous' when people threatened by proposed changes to the law have the temerity to raise objections. How dare they? I suppose the last year has told us exactly what the ruling elite think of us. It should come as no surprise when Baroness Murphy confirms it in black and white. Competing interests: None declared |
|||
|
|
|||
|
Hugh Mann, Physician Eagle Rock, MO 65641 USA
Send response to journal:
|
The world is full of disabled people who are routinely stigmatized, marginalized, and ostracized. We shun the disabled, because they frighten and depress us by reminding us of life’s dangers. Let’s reverse this systematic exclusion of the disabled by recognizing that the disabled are not unfortunate, irrelevant burdens, but rather heroic figures who can teach us how to face and overcome life’s inevitable challenges. Competing interests: None declared |
|||
|
|
|||
|
Michael P G Harper, Consultant in Palliative Medicine St Richard's Hospice, Worcester, WR5 2QT
Send response to journal:
|
Why does Tony Delamothe, who cannot comprehend the views of the disabled, not simply accept their views? - as clearly laid out in the letter cited by Dr Peter Saunders. He does not need to comprehend, but accept. He thinks there is no basis for concern; they disagree, and they do say why. I think it may soon be necessary to form (or resurrect) a worldwide professional grouping, perhaps "Doctors for Life", to whom the frightened disabled may go, knowing that these doctors at least will always act to maximise their living, to ease their dying and provide genuinely good syptom control when it becomes necessary; but never ever take life. Meanwhile, and in the hope that society as a whole listens, we should simply respect their views. That letter speaks of their being terrified at the concept of legalised assisted dying within society. We (corporately), the "able", may rebut that perspective. For myself, I'll trust the canaries. I hear their cry. I'm with them. Competing interests: None declared |
|||
|
|
|||
|
Joan McClusky, Medical writer New York, NY 10003
Send response to journal:
|
"Hijacking" usually describes actions by a few extremists, as opposed to the reasoning majority. Given this, the disabled "hijackers" must thus be vastly outnumbered by the supposedly more rational disabled, who would readily support assisted- suicide legalization. And surely their voices and opinions would be cited by those who would dismiss the noisy "lunatic fringe." Curiously, they appear to be absent from this debate. Competing interests: None declared |
|||
|
|
|||
|
Jay Ilangaratne, Founder www.medical-journals.com
Send response to journal:
|
With reference to the BMA, Mr Delamothe says,"it’s time for a carefully worded secret ballot of all its members". First,it is important to know that BMA is a doctors' trade union, and it has no special privileges/rights to influence legislation particularly as to 'assisted suicide'. Is 'assisted suicide' such an important issue for majority of BMA members to warrant an expensive secret ballot of all members? Above all, even if a consenus can be reached following a such mass ballot,what guarantee is there that the BMA would be able to produce the desired legislative changes? Whilst above issues are open to debate,I think, costs of such ballot would far outweigh any actual benefits to wider BMA membership, so it is sensible that the BMA has not proceeded as suggested by Mr Delamothe.At best, such a ballot would be limited to a politically-correct academic exercise but nothing more.Perhaps, the low voter turn out at ARMs is ample proof that this issue is not a priority for BMA members. Competing interests: None declared |
|||
|
|
|||
|
Debbie A Purdy, wheelchair racer home, BD3 0JX
Send response to journal:
|
The 'disabled' are not an homogeneous group with a unifying interest. It is as ridiculous to speak of disability as 'heroic' as it is to exclude us, and it is patronising for anyone engaged in this kind of social debate to claim to be speaking 'on behalf of the disabled' the 'leaders' that Tony Delamothe referred to are appointed to their lucrative jobs in government quangos by politicians, They are not elected. While their opinions are honestly held and need serious consideration, they are personal opinions and do not accurately reflect the breadth of opinion of the disabled community. People with disabilities represent as wide a spectrum of opinions as the able-bodied. People with disabilities vote Green or BNP in pretty much the same percentages as society as a whole, the polls that have separated the views of the disabled have found that opinions on assisted dying are pretty much the same across society. This debate, the right of competent adults to make life choices for themselves, needs to be debated honestly and openly without recourse to spurious claims of disabled people opposing the discussion. I am involved as a 'simulated patient' at Leeds Medical School and in various capacities on Nurse training courses in Yorkshire and my experience is that other service users confirm the accuracy of the polls. a majority in favor of a change in the law, some opposed and certainly some serious concerns aboutt safeguards. As a disabled women i am concerned that we are portrayed as capable, competent and valuable members of society. I may make decisions others disagree with even bad ones but i demand that my right to make them is respected, the medical profession is beginning to consider patient choice rather than 'doctor knows best' thinking, We don't need to be set back decades by exchanging that for 'Baroness Campbell knows best'. Competing interests: None declared |
|||
|
|
|||
|
Mary Knowles, Retired from full-time employment The Old Bells Bramley, Tadley Hamps RG26 5DD
Send response to journal:
|
Dear Sir, The sense of doom over lives lost in Afghanistan was heightened by the observations penned by Tony Delamothe (ON THE CONTRARY BMJ August 29, 2009). Why emphasise Baroness Campbell's desire to live? That is her basic right. We live in a democracy. Baroness Warnock's view of the disabled "the vulnerable about whom we hear in my experience, all too much" was shattering. Baroness Hale is the advocate who is serious about "protecting autonomy". One wonders how much autonomy any of us has about anything. You can refuse treatment in a NHS hospital. However you have no right to demand treatment not considered in your best interests - no autonomy there. In October 1933 the New York Times disclosed the Nazi aims when the Ministry of Justice issued a memorandum outlining its plan to authorise physicians to end the sufferings of incurable patients "in the interests of true humanity". Dietrich Bonhoeffer's psychiatrist father refused to pursue the management of his vulnerable patients. Results from polls do not decide government policy. That is why we vote in general elections. Yours faithfully, Dr Mary Knowles Competing interests: None declared |
|||
|
|
|||
|
Nick Moore, Consultant Taunton TA4 2RU
Send response to journal:
|
Let us be clear. The issue is about whether or not terminally ill, mentally competent adults should be able to choose to receive help to end their lives. Some disabled people may fall into that category. If so, they should have the right to choose, along with everyone else. However, when people like Baroness Campbell, who has stated publicly that she personally does not want to have the right to choose, use the fact of their disability to bolster their campaign to prevent anyone from having the right to make the choice, then they should rightly be criticized, and the BMJ should be applauded for providing a platform for that criticism. Competing interests: Chairman of the Board of Dignity in Dying |
|||
|
|
|||
|
Isky Gordon, Emeritus Professor paediatric Imaging Retired
Send response to journal:
|
The disabled have been a disadvantaged group in our society for some time, but this has changed greatly in the last decade or more. Yet the opposition from this group to both Lord Joffe’s failed bill and to Lord Falconer’s failed amendment suggest that the disability group remain convinced that society does not value them and does not respect them. There is a failure of the disability group to recognise that the Right to Live and the Right to Die require equal support. We live in a society where patient choice is one of the highest priorities, especially in the health service. If there is true choice for desperately ill and terminally ill to refuse treatment, then it seems illogical that these same patients should not have a choice about when to die. The attempted change in the law is about an individual who has capacity and who is terminally ill making an informed decision for himself or herself that they wish to die. There is no evidence from Oregon State, USA, that the disabled group have been abused where assisted dying has been legal for the past 10 years Competing interests: Board of Dignity in Dying |
|||
|
|
|||
|
Michael G Peckitt, Academic Hull, HU5 2DA
Send response to journal:
|
I agree with the gist of 'Assisted dying: what’s disability got to do with it?' (August 26th), the disability lobby is always in danger of hijacking these issues. However, as a patient and someone with a disability it would be nice if medics were more vocal, the BMA has taken a position of netruality in the past on euthanasia as have the Royal College of Nursing. Competing interests: None declared |
|||
|
|
|||
|
Elisabeth Liza Macdonald, Retired oncologist Guys Hospital
Send response to journal:
|
What a refreshingly perceptive article from Tony Delamothe. I am strongly supportive of the right of anyone disabled to have the same choices as the able-bodied. That means to me in this debate the right to choose the timing of death for those suffering at the end of life. No-one needs to participate who does not choose to do so whether disabled or not. Dr Liza Macdonald Competing interests: None declared |
|||
|
|
|||
|
Clive Seale, Professor of medical sociology Barts and the London School of Medicine and Dentistry, Queen Mary University of London
Send response to journal:
|
Tony Delamothe argues that it is "time for a carefully worded secret ballot" of UK doctors, having reported that 79% of the general public in a Harris poll believe in a 'right to die' for the terminally ill. The need to clarify medical views on this subject was precisely what motivated my own recently published survey of a large, representative sample of UK doctors on this subject (1). The questions used were exactly the same as those used in surveys of the general public in regular British Social Attitudes surveys which, like the Harris poll, have demonstrated substantial public support for the legalisation of assisted dying. The survey showed that the majority of UK doctors are opposed to the legalisation of euthanasia or physician-assisted dying, whether in cases of terminal illness or not. There are some variations between different groups of doctors, the most significant of which are whether a doctor is religious or not. Doctors specialising in palliative medicine are the most opposed, with doctors specialising in care of the elderly being the next most opposed. These findings are consistent with studies in several other countries where careful comparisons of medical and public opinion have been done. Yours, Clive Seale (1). Seale, C. (2009) Legalisation of euthanasia or physician- assisted suicide: survey of doctors’ attitudes Palliative Medicine 23, 3, 205-212 Competing interests: None declared |
|||
|
|
|||
|
Paul W Keeley, Consultant Palliative Physician Glasgow Royal Infirmary, G4 0SF
Send response to journal:
|
You might all like to know my Staff Home Page has alerted me to Suicide Prevention Week:
"Suicide. Don't hide it. Talk about it."
The slogan?
'Choose Life'
Competing interests: None declared |
|||
|
|
|||
|
Oliver B. Coles, Retired None Home;CA10 3XU
Send response to journal:
|
The BMJ and its professional audience very properly insist that proposed interventions be evidence-led.Yet the reform discussed here ,(i.e. essentially the clarification and strengthening of law to protect individual choice at the end of life )has been depicted by opponants as both unenforceable and a threat to all people with disabilities.The most relevant hard evidence available in this context is (1) that a big majority of Britons support reform and (2) that a small number of people with progressive disabilities ,such as my late wife, yearn, as law abiding,courageous people of sound and non-suicidal mind, to be able to make a considered choice about their own life.The law can readily be tailored to this group. Yet opponants repeatedly claim that all disabled people are gravely threatened by the reform, that Parliament is incapable of drafting legislation that can be enforced, and that British society consists of dysfunctional families in which the young scheme to murder the frail and dependent old, and would do so more successfully if the old had a legal right to make personal choices. Bring on the evidence!We would never have a ban on smoking if opposition of this kind were treated at least as seriously as the medical science. Competing interests: None declared |
|||
|
|
|||
|
Michael Rosen, retired professor cf23 6tz home
Send response to journal:
|
Dr Delamothe's review of the recent literature on assisted dying (BMJ 26 August 2009) indicates that there are important objections to changing the law which will have to be met. The Objections Conditions to be fulfilled
These proposals would incur costs--fees--which might be met from charitable sources in the test period. Competing interests: None declared |
|||