Mobile “life’s end” teams start work in Netherlands

Aspects of Do-it yourself and Assisted Suicide – 2 personal views

A Good Death.

To enable this is one of a doctor's duties.

What is the definition of Euthanasia?

What came to DL's mind was "An easy mode of death"(Chambers first definition).

What came to PT's mind was "Mercy killing" ( Chamber's second definition )"the art or practice of putting painlessly to death especially in cases of intractable suffering".

PT a GP of over 30 years has all her life been against the second for humans (not for animals), in general because of the risks of abuse by interested parties. Active euthanasia is killing which is completely different from passively allowing someone to die by withholding possible treatment (antibiotics for example), which all doctors may do in suitable cases.

However in recent years (with advancing age and watching the problems of and caused by an increasingly old and frail population) she has been thinking that there could be a middle path: we could allow the patient (who asks, and many of us have been asked) a choice ie to provide the wherewithal to kill him/herself in a dignified way. We can all buy paracetamol OTC (over the counter) but paracetamol overdose is an uncertain, long-drawn out and painful way to die. She has a stockpile of what she hopes will be effective for herself if she chooses.

Should we not allow each person the dignity of choice, and of avoiding if s/he wishes a painful or undignified death? We probably all have an example within the family or acquaintance of a case suitable for discussion.

So far she is in agreement with Dr Raymond Tallis’s reasoned argument (1), that prosecution of doctor-assisted dying is a “residual cruelty that needs to be addressed”. However she differs on the degree as to which doctors should take part; in her view we should be able to make available a suitable lethal dose for administration by the patient or family, rather than the doctor (Nazis chose to provide their leaders with a cyanide capsule, animals receive a lethal injection of a barbiturate, sedative cocktails are slow). Of course this would be preceded by careful preparation and assessment, the use of a Living Will (Advance Decision or Directive), the safe storage of medication etc. Doctors should not kill; patients may choose to kill themselves.

The elder of us (DL) is an academic clinical pharmacologist who is aged 89 and an eleven-year survivor of bowel cancer etc. His view is that doctors have always had a duty to facilitate the peaceful ending of their patients’ lives (euthanasia). The term has now acquired multiple meanings, one of which involves the supply, on request, of sufficient doses of prescription drugs that patients may store and use for themselves unsupervised when they decide their life has become unendurable. No doubt some hope that their doctor will attend to assist if required. They are unaware of the massive ethical and legal complexities of such procedures, which are well known to doctors. Though the evidence is only anecdotal he believes that patients nearing the end of life are increasingly asking their personal doctor for such help.

Many years ago he thought that he might create a store of drugs for personal use to end his own life, but he never really thought it out. He has been occasionally consulted about the choice of drugs for this lonely purpose, which has concentrated his mind. He no longer thinks this is suitable for himself, and doubts it is for others. Principal concerns include his unpredictable mental state at the moment of decision, physical practicalities, absence of professional help if matters began to go awry (risk of vomiting and so on), and the question of what, if anything, he would say to his family beforehand. Of course nothing can replace a swift easy death, but active procedures need to be carefully handled lest they fail.

Such means as he has put in place to mitigate his likely situation include a Living Will, a Lasting Power of Attorney (replacing the old Enduring Power of Attorney), the hope of access to a Hospice if appropriate, or if not available, a NHS hospital that implements the Liverpool Care Pathway (for terminal care), which latter he only discovered during his wife’s final illness.

Details of all these are easily accessed via the simplest computer search, and in his opinion are too little known or adopted by doctors and the public.

We believe in our rapidly aging society it is important that these matters, ethical, spiritual, legal, medical and practical be openly and widely discussed. And we welcome the article Dying Matters, Let’s talk about it (Seymour J E, et al)(2).

The issues are complex and urgent and resolution will inevitably be slow and controversial. The debate in House of Commons (March 28 2012) contributes little, and it has been quickly followed by the startling news that “Dutch mobile euthanasia units” are to make house calls to “sick people whose own doctors have refused to help them end their lives at home” (3).

The very least that can be done now is for Parliament to commission and distribute a booklet in language that ordinary people can understand clarifying what is available and, most important, what is not.

References

1 Tallis in the Guardian newspaper 27 3 2012
2 Seymour et al in BMJ 2010; 341; c 4860
3 guardian.co.uk/world/2012/ mar 01/dutch-mobile-euthanasia.