Tuesday, June 14, 2011

Assisted Dying

Last night, the BBC broadcast a documentary on what I thought would be assisted suicide. One of the things this programme taught me is that, actually it’s assisted dying. Now this may seem like semantics to you, but I think it’s important to make the distinction, suicide has a lot of negative connotations which I believe we need to move away from in order to have a grown up debate on the subject. The documentary, presented by author Terry Pratchett, made it clear that the decision which those who wanted to die took, was a clear, cognizant and ultimately, personal choice. These people had chosen to die, with their families around them and with dignity.
Assisted dying is a very emotive subject. Maybe on the one hand it is through centuries of religious conditioning that we believe in the sanctity of life. Or as human beings we have an inbuilt will to survive, like any other animal and to take our own life seems to be an anathema. For those in favour of assisted dying it’s about an individuals right to determine the course of their own life.
Here’s my review of the programme. I missed the opening few minutes, but filling in the gaps, I guess that Terry Pratchett (TP) explained his situation, that he is pro assisted dying, and is himself suffering from a degenerative and incurable disorder in Alzheimers. It seems that the programme was a way for him to look at the choices available to him, should he chose to end his own life, before his condition causes him to deteriorate and leaves him unable to make his own choice.
I picked the programme up with TP meeting with the Smedleys. Peter was an ex hotelier living in Guernsey and suffered from Motor Neuron disease, which affects muscles, eventually leading to difficulties with breathing, speaking and swallowing. Peter seemed to be reasonably healthy, but was fully aware of what was awaiting him in the future. With this knowledge, he had discussed with his wife and had decided that the best option for him was to attend the Dignitas clinic in Switzerland and end his life, in the way he felt was appropriate. His wife, although not 100% comfortable with the decision supported her husband in his decision.
We also met Andrew Colgan, who suffered from M.S. a disease where the average life expectancy of suffers is 5-10 years. Andrew had already tried to commit suicide twice, and had survived. He felt that Dignitas was his best choice, and despite his familys wishes decided to travel to Zurich to die.
In between Peter and Andrew’s stories was that of a London Cabbie, who also suffered from M.N.D., but who had opted for hospice treatment. He was typical London boy and wanted to fight to the bitter end, his attitude was “lets have another throw of the dice”. Later in the Newsnight debate that followed, the Bishop of Exeter told of his support of the hospice movement and the right to “live with dignity”.
The programme followed both Peter & Andrew to Zurich and their last few days. It was highly emotional viewing, although both men showed extraordinary courage and fortitude, it was the attitudes of their families that struck me the most. Andrew’s mother tells TP, that whilst she wants to spend more time with her son, that it is her “selfish” desire and she has to let her son decide. And Peter’s wife holding his hand as he died, still not 100% comfortable with her husbands decision, but respecting his right to choose.
In all honesty, I have to admit that I was already in favour of assisted dying, and this programme reinforced my opinions that people must have the right to choose especially when faced with such difficult circumstances.
Detractors of assisted dying use some of the following arguments to dissuade us from having the choice to determine our own futures. The former Bishop of Rochester, Michael Nazir-Ali, said in response to the programme it “was propaganda on one side.” And “life is a gift and has infinite value”. The bishop was not the only one to accuse the programme of propaganda, several other pro life charities voiced their concerns as well. In response to the accusations of propaganda, well to some extent they are correct, we are left in no doubt at the end of the programme what the mindset of TP is. However, throughout the programme it was shown, time and again that this was those peoples choice. And importantly, that there is another way. It was interesting to see in Dignitas’ offices the number of folders of people who have been there, but who have not taken up the option of assisted dying. Maybe they feel comfortable that they are provided for should their conditions become such that death is their only option, or actually deciding that like the cabbie, they want another roll of the dice.
In terms of life being a gift and having infinite value, well, I disagree on that first point. A gift is something that brings joy and happiness to the recipient. All life is precious, and should be treated as such, and who better to make that decision than the person living it. Life is not a gift when you are stuck in a bed, unable to feed yourself, wash yourself, and control your bodily functions. Life is not a gift when those whom you love so very dearly visit you, and you can’t remember who they are, when you can’t even recognise them.
I respect the rights of those people to die in a hospice, and agree with the Bishop of Exeter, that we must invest more in hospice and palliative care for those who are terminal or who can no longer look after themselves. The hospice movement is a vital part of the care system in the UK and it needs investment in order for it to continue to flourish. That should not detract though, from the right of someone who wishes to die to do that. If I can choose to end my life in a hospice, surely I should have the right choose to end my life, at a time and place of my choosing.
The documentary, as I have mentioned, was followed by a Newsnight debate. Well, frankly, this is where I found myself getting quite angry. Particularly at Liz Carr, a comedienne and campaigner for rights for those with disabilities. I found her arguments to be extremely flawed and actually felt that she had no real grasp of the situation being debated. She frequently espoused the view that if we had assisted dying in the UK that the disabled would be running scared from their own families who would put them down. That because of the financial crisis people wouldn’t want the burden of caring for someone. As a disabled campaigner, I of course expect her argue vociferously for rights for disabled people. However, it seemed to me that she completely disregarded the rights of those who are terminally or incurably ill. I found it truly awful that she has such a low opinion of humanity! That we live in a society desperate to do away with cripples to free up bed space and funds for those who need them. There will always be people who are nefarious and will try to “off” family members for an inheritance – history is littered with them.
There was a slightly disturbing element to the documentary though. Apparently, 21% of the people who chose to end their lives in Dignitas, do so because they are “weary of life”, not because they have an incurable or terminal illness. This was something that the film makers did not go into a great deal of detail about. I hope, and expect that the law has legislated for such persons so that all other avenues are explored and appropriate counselling has been given before they are allowed to terminate their own life.
In the UK, this is where Parliament really has to step up. We need good legislation that protects people from the greedy and malicious and that stops the abuse of the system. The current system of turning a blind eye will only suffice so far. How will current legislation react if I took one of my parents to Dignitas, because it was their choice, but my brother disagreed and forced the police to enact the law and prosecute me?
If Liz really paid attention to the programme she would have learnt 2 things. 1) The Swiss have legislation that requires doctors to assess the state, both physical and mental, of the person requesting assistance and 2) that you can only use the services of Dignitas if you are able to administer the drugs yourself. They cannot be administered for you by a medical professional, family member or anyone else. Right up to the point you take the lethal dose of Barbiturates, you can say no.
In summation, I am fully supportive of the campaign to bring assisted dying to the United Kingdom. It seems to me a basic human right that I have determination as far as my life is concerned, indeed, it is enshrined in the European convention of Human rights. It seems somewhat sick to me that in a society where it is wrong to leave an animal in a state of suffering, where it is acceptable to “put an animal to sleep” in order to end it’s suffering; that we cannot grant that right to our fellow humans, that we have to insist on prolonging their suffering because of the “Sanctity of life”. Dying is part of the cycle of life and we need to break this last taboo and start having open and honest debate in the UK about assisted dying, I see this programme as a good starting place.

23 comments:

  1. Assisted Suicide
    There is little doubt that suicide is the ending of one’s own life. Dying is the end of a life. Assistance from another to end one’s own life is assisted dying but is more accurately assisted suicide. I reject the notion that describing the condition or actions in a more accurate manner in any way detracts from the maturity of the discussion.
    Regardless of the opinions presented in the programme this was a poor documentary and a poor addition to the debate. Terry Pratchett enters the debate with a clear and publically declared bias. The documentary made little attempt to offer the opposing view except for a fleeting, intellectually weak and rather irritating attempt. I will attempt to redress the balance here and ask the respect of those who may disagree. Before forming an opinion a rational human should form at least a casual familiarity with the opposing view. From the Liberal tone of the blog in the past I assume we are all pluralists here.

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  2. The argument of individual choice
    The social contract
    In any society the individual gives up some of its rights of freedom of action pools resources with those with whom they feel a common bond and achieves superior outcomes for themselves and for the rest of society. We have a highway code that restricts speed to 70mph, some individuals can drive faster safely but we agree to limit our speed as some individuals are not able to control their vehicle at that speed and if we make a mistake there is the possibility of damage to ourselves and an increased risk of damage to others. Individuals do not always have the right to determine the course of their own lives.
    This issue reaches further than a simplistic view around the rights of the individual but has wider consequences around public policy, ethics and law.
    There will inevitably be individuals who are pressured into ending their lives prematurely or who because of misdiagnosis have their lives ended prematurely. How many early deaths are acceptable so the presumed right of the individual to die is protected?
    If we accept that the death of another is preferable to life surely we need to take into consideration the rights of those who are subjected to suffering by watching the illness. Whose rights to a better quality of life take precedence?
    I did not see a serious attempt to answer any of these issues in the documentary. The drama was a poor substitute.
    Where does personal choice end
    If we accept that assisted suicide is a valid medical ‘treatment’ on the basis of elimination of suffering where are the limits, how do we demark them and defend the position in a sensible way. Who will draw the line on ‘suffering’. If assisted suicide is for the reduction of suffering why should we restrict it to the terminally ill? Are there conditions where an individual’s life subjects them to so much suffering that they should have the right to terminate their life? Who should make the judgement on who should be forced to live and who should be given the assistance to commit suicide?

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  3. Why give this choice only to those who have a terminal diagnosis
    Who is more likely to make a balanced decision regarding their assisted suicide, a person who has been told that they are terminally ill or a person living a normal everyday life? If this is about empowerment for the individual surely everyone who is judged to be of sound mind and at the age to take responsibility for their actions (over the age of 18) should have the right to assistance in their suicide? Anything else is intellectually incoherent.
    Why restrict it to a choice
    If we accept that death is a treatment for suffering why restrict it to a choice? Why should an individual be denied a treatment that ends suffering?
    The argument that changing the law to allow assisted suicide is based on the alleviation of suffering as an individual choice is not intellectually defensible. Arbitrary requirements (age, medical condition) contradict the personal choice argument on which the assisted suicide position rests.
    Minelli is the founder of the dignitas clinic in Zurich. http://www.timesonline.co.uk/tol/news/uk/health/article706150.ece For the purposes of ease I have copied a section of the article here which is a Minellis discussion on an attempted assisted suicide law that was introduced into the British parliament in 2006
    “Minelli’s plans, however, go far beyond the scope of the bill. He insists the mentally ill have the same rights as those with stable minds to choose how to die.
    “The idea of a terminal illness as a condition for assisted suicide is a British obsession,” he said.
    “We need to set up advisory centres where people can openly discuss problems and seek advice about methods and risks, without the fear of losing their freedom and being put in an institution. These centres can only be credible if they offer assisted suicide.”
    At this point it is worth adding that Dignitas is also a biased source. I will restrict myself to saying that they stand to gain financially from a change in the law. A less generous person would characterise this as an opportunity to make financial gain from the fear and depression of others.

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  4. Practical objections
    Medical Diagnosis
    I have much admiration for the medical profession and for medical science but they are not infallible. There is a risk of misdiagnosis or that post assisted suicide a cure for the illness could be discovered. No system is 100% accurate, lives will be lost unnecessarily. In my own experience medical knowledge is incomplete and uneven (as is often the case in complex systems). A transplant described as only being available in the USA was available 22 miles down the road in the UK and the doctor was unaware.
    Better near death care
    There is no restriction on the administering of drugs to alleviate pain. I have been witness to deaths that have been accelerated by the use of pain relief medicine. If the problem is pain there is no reason for a person near death to suffer. This is the approach we take with our pets. At point of suffering we administer enough pain relief to relieve pain regardless of the consequences. This is distinct from suicide and governed by a different set of assumptions. A better assumption is life for as long as possible subject to pain relief, not death at the arbitrary decision of an individual or their families or other interested parties.
    Measuring the value of life
    The presumption that a life spent unable to feed yourself or having any other disability is not worth living is alien to those who are prolife and dangerous if accepted by society or conferred with legitimacy by the law. It is only a short step to start terminating the sick and ill because their lives are deemed to be of less worth and disabled people who are aware of history are fully aware of this. Life is more than our own experiences. The individual can provide value to their family or to the wider community without having full faculties or physical abilities. A simple smile or encouragement or even their physical presence can be inspiring and uplifting and should be valued. Failure to recognise the value that disabled people can bring to our society is corrosive to our civilisation and has more in common with a Spartan or National Socialist view of the value of the individual hence the reason the religious and the thoughtful enlightened view the idea of assisted suicide with some alarm.
    Most people are familiar with the ideas espoused by Nazi racial purity, less are aware of their ideas around the creation of the perfect race by the liquidation of “ members of their own 'Aryan race' who they considered weak or wayward (such as the 'congenitally sick', the 'asocial', and homosexuals)”. Source (ironically) the BBC.
    http://www.bbc.co.uk/history/worldwars/genocide/racial_state_01.shtml
    If I were a free thinking Liberal I would be deeply uncomfortable finding myself supping from the same cup of ideas around the value of life and the nature of the individual as National Socialism.

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  5. Anger post review
    The blog mentions irritation around the rights of the disabled. Unfortunately I did not see this component but I will answer the main rebuttals with facts rather than irritation in an attempt to move the debate forward:
    70% of disabled people fear that the introduction of an assisted suicide law feel that they would be placed under pressure to end their lives prematurely
    56% believe it would negatively impact the way society views disabled people
    Source http://www.scope.org.uk/news/poll-on-assisted-suicide
    It would seem that the contributor was simply articulating the fears of those she campaigns for. The law is in place to protect the vulnerable. The fact that history is littered with the nefarious simply strengthens the case to retain the current legal settlement. Changing the law to allow assisted suicide devalues disabled people in much the same way that Abortion devalues the unborn.
    The legal safeguards
    The safeguards that you mention sound remarkably similar to the safeguards around Abortion which were meant to prevent “abortion on demand”. These have failed spectacularly. Abortion far from being the last resort of a desperate parent or rape victim is now routinely used as contraceptive. In an interesting parallel the disabled are devalued and abort-able until birth. Once the genie is out of the bottle regarding assisted suicide it will be equally difficult to put it back and the legal safeguards will be useless.
    The position in Oregon
    The broadcast failed to provide a balanced view of assisted suicide.
    We don’t need to discuss this in theory as we have a model to study where the law has been passed and where data is readily available.
    The Oregon Department of Human Services provides an annual report and representatives from the House of Lords have visited and inspected the facilities and the application of an assisted suicide law.
    Of 246 instances on assisted suicide there were 13 instances of reported complications, (Barbituates are known to cause nasty side efffects, often the recipient drowns in their own vomit) http://www.ncbi.nlm.nih.gov/pubmed/10684914 This is widely accepted to be underreporting the complications. Additional data and info available here http://findarticles.com/p/articles/mi_qa3798/is_200701/ai_n19430383/pg_8/
    To balance the rosy presentation in the programme in the link below there are numerous instances of deeply unpleasant deaths and experiences for example, after being unconscious for 65 hours the recipient awoke. There was no investigation.
    In another instance a patients own physician decided she was not capable of making the decision around assisted suicide. Her daughter was described as “somewhat coercive”. They kept asking until they found a doctor happy to authorise the assisted suicide. The New England Journal of medicine noted many patients had to shop to find a doctor willing to assist them. Lots more abuses here. http://www.dredf.org/assisted_suicide/18_Oregon_abuses.pdf
    Assisted suicides based on financial concerns according to official report 7. It is worth mentioning that 36.5% of patient deaths were on medicare for seniors and Medicaid for the poor. The poor and the poorly educated are many more times likely to commit suicide and the Oregon experience shows that this does not change when the state doles out death on demand.
    Most disturbingly patient pain control has deteriorated in Oregon. Inadequacy of meeting patients needs up 50% since the application of the assisted suicide law according to a spokesman for the Oregon nurses association.

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  6. Summary
    Far from increasing personal choice for a tiny minority a change in the law will reduce choice, devalue the disabled, break the social contract, expose the vulnerable and make us a poorer society. The idea that a life is worth less because of disability finds echoes in humanities darkest episodes. Rather than base our view of assisted suicide on a biased programme I would encourage readers of the blog to look at the evidence. Drowning in your own vomit, botched deaths, fear of family, death of the poor and poorer patient experience for those who decide not to commit suicide are the unpleasant side effects. The proponents of an assisted suicide law are on record as already wanting to allowing death to be used as a treatment for children as old as 6. I hope I have gone some way to provide some of the balance that was missing from the documentary.
    Best Paul

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  7. Paul, cheers for the comments! Really appreciate the input! I'll have another read and try and redress some of your points later. Off to work now... I'm sure my think rant colleagues will have something to say though!

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  8. Steven: Thanks for putting together this blog post. It was very interesting I didn't find myself disagreeing much.

    Paul: Thanks for taking the time to leave your comment. We always try and respect people who share their views; but respecting a view itself is another question. I wouldn't want anybody to confuse criticism of their ideas as personal attacks. I will quote your specific points and address them.

    "Assistance from another to end one’s own life is assisted dying but is more accurately assisted suicide."

    I'm not interested in getting side-tracked by definitions, so if Steven wants to take this up then that's up to him.

    "this was a poor documentary and a poor addition to the debate. Terry Pratchett enters the debate with a clear and publically declared bias. The documentary made little attempt to offer the opposing view except for a fleeting, intellectually weak and rather irritating attempt."

    You seem to be under the impression that a documentary should necessarily be balanced or unbiased. As I said, I'm not a fan of quibbling over definitions, but if your argument is based on one then I guess I'm going to have to highlight it. At least the documentary was honest in its declaration of bias, as you identified. To dismiss a documentary because it only gives one viewpoint is itself bias. Not a good start.

    "From the Liberal tone of the blog in the past I assume we are all pluralists here."

    Pluralism in the context of philosophy, ethics and social/political theory can have a variety of meanings. Perhaps you need to expand on what you mean because you may find your assumptions wrong.

    "The social contract..."

    Completely irrelevant. Somebody else could mention the social contract and then go on to justify eugenics by saying an individual should give up their right to life if it serves society; just like you're attempting to say they should give up their right to self determination if it serves society.

    "There will inevitably be individuals who are pressured into ending their lives prematurely or who because of misdiagnosis have their lives ended prematurely."

    Your use of the word inevitably makes for a very bold asserstion. How about you provide some evidence? Or is this the start of a shameless slippery slope argument?

    "If we accept that the death of another is preferable to life surely we need to take into consideration the rights of those who are subjected to suffering by watching the illness. Whose rights to a better quality of life take precedence?"

    At last, an interesting point which should be debated. However, the fact that we haven't answered it yet is not an argument against assisted dying.

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  9. "The drama was a poor substitute."

    You're assuming it was meant as a substitute.

    "If we accept that assisted suicide is a valid medical ‘treatment’ on the basis of elimination of suffering where are the limits, how do we demark them and defend the position in a sensible way. Who will draw the line on ‘suffering’. If assisted suicide is for the reduction of suffering why should we restrict it to the terminally ill? Are there conditions where an individual’s life subjects them to so much suffering that they should have the right to terminate their life?"

    Again, these are questions that need to be discussed, not just thrown down in an effort to muddy the waters on discussing the right to die. Questions are not arguments.

    "Who should make the judgement on who should be forced to live and who should be given the assistance to commit suicide?"

    (Using your language) At the moment the judgement is that we should force all people to live. Who made that? Again, your questions are not arguments.

    "There is a risk of misdiagnosis or that post assisted suicide a cure for the illness could be discovered. No system is 100% accurate..."

    An appeal to absolute knowledge is ridiculous. We don't have 100% certainty of any facts of reality, does that stop you from making a decision or moral distinction in any other matter? I think not. Again, another red-herring.

    "Better near death care..."

    I am all for better palliative care. However, again, this has nothing to do with whether people should have the right to die. Are you asserting that by giving people the choice will necessarily lead to a decrease in the quality of end of life care? Please explain how and provide evidence.

    "It is only a short step to start terminating the sick and ill because their lives are deemed to be of less worth..."

    The mother of all slippery slopes. Stop with the appeals to emotion and give us some evidence please. There are quite a few countries that allow assisted dying so if there was evidence of this nightmare scenario you're predicting then we would already be seeing it.

    "The individual can provide value to their family or to the wider community without having full faculties or physical abilities."

    Did you actually watch all of the documentary or are you intentionally straw-manning its position? Nobody is advocating the "offing" of the infirm as you describe. You're attacking the slippery slope future that only exists in your mind. We are only talking about the right for people to choose to die, not for the right for other people to commit homicide.

    "A simple smile or encouragement or even their physical presence can be inspiring and uplifting and should be valued."

    If somebody close was in pain or in fear of losing their mind and wanted to die you would force them to endure it just so you can see them smile? What a selfish and repugnant idea.

    "Failure to recognise the value that disabled people can bring to our society is corrosive to our civilisation..."

    I see this kind of thinking a lot when I watch The Big Questions etc. This idea that being able to allow assisted dying or selecting against genetic abnormalities would somehow devalue people who have disabilities. Lets do a thought experiment! Say tomorrow we allow assisted dying. In your mind would all the disabled people around you become of less value to you? I can answer for myself: they wouldn't to me. In fact, I've never heard anybody say that would be the case. Therefore it would seem that your concerns are baseless and are derived from an overactive imagination that loves slippery slopes.

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  10. This comment has been removed by the author.

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  11. "...the religious and the thoughtful enlightened..."
    Lol.

    "If I were a free thinking Liberal I would be deeply uncomfortable finding myself supping from the same cup of ideas around the value of life and the nature of the individual as National Socialism."

    Poisoning the well. Ideas stand/fall on their own merit, not by who is associated with them. Are you writing a book on logical fallacies because you seem to be going out of your way to provide textbook examples. I'm also amused (in a geeky way) that you fell foul of Godwin's law in your first post! Again, your comparison of the right to die with enforced eugenics is a straw man argument.

    "Far from increasing personal choice for a tiny minority a change in the law will reduce choice..."

    You haven't supported this statement.

    "...devalue the disabled..."

    Or that one.

    "...break the social contract..."

    I'm beginning to think you don't know what that is.

    "...expose the vulnerable and make us a poorer society."

    This is my last appeal for evidence, rather than bare-faced assertions and appeals to emotion.

    "Rather than base our view of assisted suicide on a biased programme I would encourage readers of the blog to look at the evidence."

    I agree. We need to base our view on facts and evidence. But even biased programmes can contain facts and to dismiss the facts because you don't agree with the position is dishonest. But apparently you're about to provide us with evidence...

    "Drowning in your own vomit, botched deaths, fear of family, death of the poor and poorer patient experience for those who decide not to commit suicide are the unpleasant side effects."

    But you didn't. You just threw out some more appeals to emotion and slippery slopes.

    "The proponents of an assisted suicide law are on record as already wanting to allowing death to be used as a treatment for children as old as 6."

    Citation please. And even if it's true, it doesn't mean I agree with it or whether it has any bearing on whether somebody has the right to decide to die.

    "I hope I have gone some way to provide some of the balance that was missing from the documentary."

    You provided something, I can assure you of that.

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  12. ...

    Wow.

    Are we encouraging people to comment so we can fall on them with glee and give their arguments a kicking? Tut tut tut ... okay!

    Thanks for your comment Paul. Very thoughtful but lacking evidence (as John pointed out).

    In fact the argument that we should instead put more money toward palliative/hospice care is an argument FOR assisted dying. The countries that are enlightened enough to allow it also seem to have better provision of terminal care (possibly a coincidence, maybe a result of the debate but apparently the case).

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  13. John and TJW
    There is a section missing from the post that examines the Oregon experience which is the evidence I allude to. I have copied it below.
    Anger post review
    The blog mentions irritation towards a discussion around the rights of the disabled. Unfortunately I did not see this component but I will answer the main rebuttals with facts in an attempt to move the debate forward:
    70% of disabled people fear that the introduction of an assisted suicide law feel that they would be placed under pressure to end their lives prematurely
    56% believe it would negatively impact the way society views disabled people
    Source http://www.scope.org.uk/news/poll-on-assisted-suicide
    It would seem that the contributor was simply articulating the fears of those she campaigns for. The law is in place to protect the vulnerable. The fact that history is littered with the nefarious simply strengthens the case to retain the current legal settlement. Changing the law to allow assisted suicide devalues disabled people in much the same way that Abortion devalues the unborn.
    The legal safeguards
    The safeguards that you mention sound remarkably similar to the safeguards around Abortion which were meant to prevent “abortion on demand”. These have failed spectacularly. Abortion far from being the last resort of a desperate parent or rape victim is now routinely used as contraceptive. In an interesting parallel the disabled are devalued and abort-able until birth. Once the genie is out of the bottle regarding assisted suicide it will be equally difficult to put it back and the legal safeguards will be useless circumvented.
    The position in Oregon
    The broadcast failed to provide a balanced view of the outcomes in a system that offers assisted suicide.
    We don’t need to discuss this in theory as we have a model to study where the law has been passed and where some data is available.
    The Oregon Department of Human Services provides an annual report and representatives from the House of Lords have visited and inspected the facilities and the application of an assisted suicide law.
    Of 246 instances on assisted suicide there were 13 instances of reported complications, (Barbituates are known to cause nasty side efffects, often the recipient drowns in their own vomit) http://www.ncbi.nlm.nih.gov/pubmed/10684914 Complications are widely accepted to be underreported. Additional data and info available here http://findarticles.com/p/articles/mi_qa3798/is_200701/ai_n19430383/pg_8/
    To balance the rosy presentation in the programme in the link below there are numerous instances of deeply unpleasant deaths and experiences for example, after being unconscious for 65 hours the recipient awoke. There was no investigation.
    In another instance a patients own physician decided she was not capable of making the decision around assisted suicide. Her daughter was described as “somewhat coercive”. They kept asking until they found a doctor happy to authorise the assisted suicide. The New England Journal of medicine noted many patients had to shop to find a doctor willing to assist them. Lots more abuses here. http://www.dredf.org/assisted_suicide/18_Oregon_abuses.pdf
    Assisted suicides based on financial concerns according to official report 7. It is worth mentioning that 36.5% of patient deaths were on Medicare for seniors and Medicaid for the poor. The poor and the poorly educated are many more times likely to commit suicide and the Oregon experience shows that this does not change when the state doles out death on demand.
    Most disturbingly patient pain control has deteriorated in Oregon. Inadequacy of meeting patients needs up 50% since the application of the assisted suicide law according to a spokesman for the Oregon nurses association.

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  14. Apologies, this section sits between the final 2 sections I pasted in yesterday

    Anger post review
    The blog mentions irritation around the rights of the disabled. Unfortunately I did not see this component but I will answer the main rebuttals with facts rather than irritation in an attempt to move the debate forward:
    70% of disabled people fear that the introduction of an assisted suicide law feel that they would be placed under pressure to end their lives prematurely
    56% believe it would negatively impact the way society views disabled people
    Source http://www.scope.org.uk/news/poll-on-assisted-suicide
    It would seem that the contributor was simply articulating the fears of those she campaigns for. The law is in place to protect the vulnerable. The fact that history is littered with the nefarious simply strengthens the case to retain the current legal settlement. Changing the law to allow assisted suicide devalues disabled people in much the same way that Abortion devalues the unborn.
    The legal safeguards
    The safeguards that you mention sound remarkably similar to the safeguards around Abortion which were meant to prevent “abortion on demand”. These have failed spectacularly. Abortion far from being the last resort of a desperate parent or rape victim is now routinely used as contraceptive. In an interesting parallel the disabled are devalued and abort-able until birth. Once the genie is out of the bottle regarding assisted suicide it will be equally difficult to put it back and the legal safeguards will be useless.
    The position in Oregon
    The broadcast failed to provide a balanced view of assisted suicide.
    We don’t need to discuss this in theory as we have a model to study where the law has been passed and where data is readily available.
    The Oregon Department of Human Services provides an annual report and representatives from the House of Lords have visited and inspected the facilities and the application of an assisted suicide law.
    Of 246 instances on assisted suicide there were 13 instances of reported complications, (Barbituates are known to cause nasty side efffects, often the recipient drowns in their own vomit) http://www.ncbi.nlm.nih.gov/pubmed/10684914 This is widely accepted to be underreporting the complications. Additional data and info available here http://findarticles.com/p/articles/mi_qa3798/is_200701/ai_n19430383/pg_8/
    To balance the rosy presentation in the programme in the link below there are numerous instances of deeply unpleasant deaths and experiences for example, after being unconscious for 65 hours the recipient awoke. There was no investigation.
    In another instance a patients own physician decided she was not capable of making the decision around assisted suicide. Her daughter was described as “somewhat coercive”. They kept asking until they found a doctor happy to authorise the assisted suicide. The New England Journal of medicine noted many patients had to shop to find a doctor willing to assist them. Lots more abuses here. http://www.dredf.org/assisted_suicide/18_Oregon_abuses.pdf
    Assisted suicides based on financial concerns according to official report 7. It is worth mentioning that 36.5% of patient deaths were on medicare for seniors and Medicaid for the poor. The poor and the poorly educated are many more times likely to commit suicide and the Oregon experience shows that this does not change when the state doles out death on demand.
    Most disturbingly patient pain control has deteriorated in Oregon. Inadequacy of meeting patients needs up 50% since the application of the assisted suicide law according to a spokesman for the Oregon nurses association.

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  15. Hi John,
    Don't really have a great deal of time to get into one of those awful long online debates where posters become unpleasant under the veil of a serious discussion. Comments like "you provided something" and "fall on them with glee and give their arguments a kicking" seem to be heading in that direction. It would seem that liberals are becoming less Liberal but I am moving away from the point.
    I never really seriously considered a single post would overcome your groups entrenched view. As I stated the objective is simply to supply an alternative to the one sided view provided by the documentary.
    On the social contract the eugenics point is an interesting one. The point is we sacrifice a measure of choice to protect the vulnerable and to provide social goods. Eugenics has been proven to not protect the vulnerable.
    “I'm not interested in getting side-tracked by definitions”
    Unfortunately you then go on to discuss definitions of the social contract. Lol. Clearly definitions are important as they frame the discussion but I won’t labour the inconsistency.
    “You seem to be under the impression that a documentary should necessarily be balanced or unbiased. “
    Not at all, but an unbiased documentary is better at informing debate than a biased one.
    “At least the documentary was honest in its declaration of bias, as you identified. To dismiss a documentary because it only gives one viewpoint is itself bias. Not a good start.”
    Not true John. To accept a biased documentary because it validates your viewpoint is not a good start. Suggesting that a biased documentary adds little to the debate is factual not bias. Do you understand what bias means? My suggestion around the need for an honest balanced debate (which is the point of the post) and is a sensible and logical place to start.

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  16. “Completely irrelevant. Somebody else could mention the social contract and then go on to justify eugenics by saying an individual should give up their right to life if it serves society.”
    Interesting that you say this John, eugenics is the end result of a society changing its assumptions about life and its value. Are you validating the slippery slope? (tongue in cheek).
    “just like you're attempting to say they should give up their right to self determination if it serves society.”
    I suggest you read the analogy again. All self determination exists with consequences for other individuals. The point I am making is that implementing assisted suicide has costs on other members of society that need to be taken into consideration.


    “Your use of the word inevitably makes for a very bold assertion. How about you provide some evidence?
    The evidence already exists. See the examples in Oregon and take a look at European history prior to the second world war for what happens to a country when individuals or the state start to make decisions around the value of an individuals life.
    “Or is this the start of a shameless slippery slope argument?”
    The slippery slope is real. Calling something “shameless” while providing no evidence to support the conclusion is great theatre I had hoped for a sensible logical rebuttal. There is a working model of the slippery slope in the abortion laws. No one in the 60’s wanted abortion on demand but today it is a reality. No one envisaged partial birth abortion but it is a reality. We have a situation where a baby can survive or be aborted dependent on where in the hospital it is born on a given date all because of assumptions made around the value of a life.
    “At last, an interesting point which should be debated. However, the fact that we haven't answered it yet is not an argument against assisted dying”.
    This point was made tongue in cheek. This is eugenics by another name. If you are seriously suggesting this is up for debate that is deeply disturbing. Brettie, you have a strange choice of friends.
    “You're assuming it was meant as a substitute”
    No I don’t claim to understand fully the intentions of the producers nor does speculating about my thoughts or those of the producers add to a discussion of the issue. A documentary that offered a serious debate would be more informative than a one sided documentary for those who want to see serious discussion of the issue. To argue that point is surely just a little silly.

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  17. “Again, these are questions that need to be discussed, not just thrown down in an effort to muddy the waters on discussing the right to die. Questions are not arguments.
    You misunderstand, the questions are rhetorical. Answering them would cripple the logic around personal choice that the documentary and it would seem your entire position is based on.
    "Who should make the judgement on who should be forced to live and who should be given the assistance to commit suicide?"
    “(Using your language) At the moment the judgement is that we should force all people to live. Who made that? Again, your questions are not arguments.”
    Lol. I suppose the earliest judgement about the sanctity of life is Hammurabi’s legal code. Since all at some point in their lives want to live that would seem a sensible presumption on a practical level. Your point is meaningless. We are alive. This law would not exist in an intellectual vacuum. You need to justify your position with real world examples to be taken seriously.

    “An appeal to absolute knowledge is ridiculous. We don't have 100% certainty of any facts of reality, does that stop you from making a decision or moral distinction in any other matter? I think not.”
    Not true. Death is a physical certainty. It is true that uncertainty of the facts does not prevent you or I from making a decision or moral distinction. That is not the point I was making. We balance risk in our lives, the risk of medical error or the possibility of finding a cure verses certain death at our own hand is a poor one.
    “I am all for better palliative care. However, again, this has nothing to do with whether people should have the right to die. Are you asserting that by giving people the choice will necessarily lead to a decrease in the quality of end of life care? Please explain how and provide evidence.”
    Attached earlier today. It has already happened according to nurses in Oregon. If you truly are open minded the Oregon experience should raise serious questions around your support for this amendment to the law.

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  18. "It is only a short step to start terminating the sick and ill because their lives are deemed to be of less worth..."

    “The mother of all slippery slopes. Stop with the appeals to emotion and give us some evidence please. There are quite a few countries that allow assisted dying so if there was evidence of this nightmare scenario you're predicting then we would already be seeing it.”
    We already are. We have a working model in the Abortion laws where the disabled can be terminated right up until birth. In Oregon the poor are more likely to be terminated as a result of their own alleged choices. The evidence is already with us. I humbly suggest you take the time to read the practical experiences before constructing a position based on theory or philosophy.
    "The individual can provide value to their family or to the wider community without having full faculties or physical abilities."
    “Did you actually watch all of the documentary or are you intentionally straw-manning its position? Nobody is advocating the "offing" of the infirm as you describe.”
    This point is wider than the documentary. I am not interested in emotive language. You are the one introducing the term “offing”.
    Who is nobody? I think you are misinformed unless you mean nobody here. I suggest you read here:
    http://www.timesonline.co.uk/tol/news/uk/article625477.ece
    http://www.bbc.co.uk/news/10631843
    http://www.msnbc.msn.com/id/35370263/ns/us_news-crime_and_courts/t/family-friends-torture-kill-disabled-woman/
    http://www.topix.com/forum/uk/loughborough/TMHT59JPP4I6005VB
    People can be unpleasant and the law is supposed to offer shelter not an additional mechanism for abuse.
    I suggest you take a lesson from history of what happens when a society decides that one person’s life is worth more than another based on an abstract idea of what they think is valuable in an individual’s existence. That is the decision an assisted suicide law would put on doctors who are representatives of the state.
    “You're attacking the slippery slope future that only exists in your mind. We are only talking about the right for people to choose to die, not for the right for other people to commit homicide.”
    You are na├»ve if you genuinely believe that the vulnerable won’t be pressured into early death or that introducing this law wouldn’t fundamentally alter the culture of our health services. Read the articles in the links above. There is prima facie evidence of women being coerced into Abortions by abusive partners. You need to supply the evidence that an assisted suicide law would not end up the same way.

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  19. "A simple smile or encouragement or even their physical presence can be inspiring and uplifting and should be valued."

    “If somebody close was in pain or in fear of losing their mind and wanted to die you would force them to endure it just so you can see them smile? What a selfish and repugnant idea.”
    I hesitate before responding to what appears to be grandstanding. Giving you the benefit of the doubt of being sincere in your opinion I would come to the conclusion that this is why you do not understand the disabled position on this. Life is valuable regardless of the suffering. There is value in more than ability or utility. I hesitate to use your inflammatory language but It is selfish and repugnant to force fear and risk of abuse onto thousands of disabled people for a tiny minority who seek to end their lives. The more equitable solution is better near death care.

    "Failure to recognise the value that disabled people can bring to our society is corrosive to our civilisation..."
    “I see this kind of thinking a lot when I watch The Big Questions etc. This idea that being able to allow assisted dying or selecting against genetic abnormalities would somehow devalue people who have disabilities. Lets do a thought experiment! Say tomorrow we allow assisted dying. In your mind would all the disabled people around you become of less value to you? I can answer for myself: they wouldn't to me. In fact, I've never heard anybody say that would be the case. Therefore it would seem that your concerns are baseless and are derived from an overactive imagination that loves slippery slopes.”
    Civilisation and culture do not exist solely in the minds of this generation. The people of Sparta didn’t wake up one day and decide that it was time to kill any baby with a defect for up to six days after birth. You argument is also circular, clearly you would say this but the fact that you believe you can make a case that an individual can themselves devalue their own life to the point of termination tells me all that I need to know about how you value the lives of the disabled. That’s what happens when you drink ideas from poisoned wells see your comment below.
    "...the religious and the thoughtful enlightened..."
    “Lol.”
    I thought that you would like that!

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  20. "If I were a free thinking Liberal I would be deeply uncomfortable finding myself supping from the same cup of ideas around the value of life and the nature of the individual as National Socialism."

    Poisoning the well. Ideas stand/fall on their own merit, not by who is associated with them.

    Not true. Ideas shape cultures and civilisations. Ideas group together into ideologies. Like minded thinkers influence and develop them. Since the value of a life is fundamental to other assumptions about life and order in any society there is merit in looking at the historical record to see where the idea came from and how the effect of accepting the assumption that some lives are worth living and others are not were developed in each instance.
    “Are you writing a book on logical fallacies because you seem to be going out of your way to provide textbook examples. I'm also amused (in a geeky way) that you fell foul of Godwin's law in your first post! Again, your comparison of the right to die with enforced eugenics is a straw man argument.”
    Glad you are amused. Happy to answer a point about the issue if you have one. Some evidence would be nice.
    "Far from increasing personal choice for a tiny minority a change in the law will reduce choice..."
    “You haven't supported this statement.”
    I have, it reduces choice for those pressured into terminating their lives early for financial or because of other outside pressure
    "...devalue the disabled..."
    Your assumptions around the value of a disabled life and that anyone would want to terminate it already have.
    "...break the social contract..."
    “I'm beginning to think you don't know what that is.”
    No. By applying it to eugenics you misunderstood the application of the concept.
    "...expose the vulnerable and make us a poorer society."
    See the missing paragraph for details of how that has already happened.

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  21. “This is my last appeal for evidence, rather than bare-faced assertions and appeals to emotion.”
    Interesting that you assume the language and roll of a judge. Does this hint at a psychosis? I sincerely hope not. Even if the entire post was a bare faced one sided emotional tirade it would have equal value to the documentary that you defend in your next comment as having value. This is inconsistent and shows at best a basic hypocrisy by giving value to emotive content that supports your existing position while dismissing allegedly emotive content that does not support your position.

    "Rather than base our view of assisted suicide on a biased programme I would encourage readers of the blog to look at the evidence."

    “I agree. We need to base our view on facts and evidence. But even biased programmes can contain facts and to dismiss the facts because you don't agree with the position is dishonest. But apparently you're about to provide us with evidence...”
    I refer you to the answer to the previous point. I have sought to inject balance. You need to re-examine your logic (which is ironic given your rather rude criticism of mine).
    Evidence with citations has been attached of a current model. This in itself is an interesting insight. Apparently the bar for admission of opinion is higher for viewpoints that you do not agree with.
    "Drowning in your own vomit, botched deaths, fear of family, death of the poor and poorer patient experience for those who decide not to commit suicide are the unpleasant side effects."
    The citations are now in place. I hope you have the integrity to find concrete unbiased examples of how assisted suicide has improved the delivery of health services for a society before promoting it further?
    "The proponents of an assisted suicide law are on record as already wanting to allowing death to be used as a treatment for children as old as 6."
    Citation please. And even if it's true, it doesn't mean I agree with it or whether it has any bearing on whether somebody has the right to decide to die.
    Google it and file it away under slippery slope. From the research I undertook in 2006 I believe it was one of the members of the Lords who supported the original bill. I suspect you won’t recognise the slippery slope until you are on it. Hopefully our lawgivers will retain their current position and it will be an issue that we will never have to deal with.
    "I hope I have gone some way to provide some of the balance that was missing from the documentary."
    “You provided something, I can assure you of that.”
    I assume this is sarcasm? This is interesting given your stated objective not to launch personal attacks. I have provided context to the discussion and an opposing viewpoint with supporting evidence. This is more than the BBC has provided even with its vast resources. I have also probed the topic a little deeper asking some uncomfortable largely rhetorical questions. It may or may not change your opinion but the debate has value in itself. I sincerely do not have the time to get dragged into a lengthy debate and am happy to offer you the last word.
    Most of all John, I wish you a long and happy life

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  22. Hi. Good to see you back, Paul, but crikey ... where to start. Let me just dip my toe into a few of the problems I see in your post.

    The point about "definitions" was "is your entire argument predicated on definitions?" The fact that John then clarified a definition and you claim it's the same thing is like telling somebody who corrected your punctuation that you saw them use a full stop.

    The "Oregon Nurses" point was from a handful of anecdotes. The data in subsequent studies showed no evidence to support them.

    Saying that there ARE absolutes is just not true. Look at NICE and their use of "Qual"s to assess the value of treatments. We are already judging these things, just not out in the open.

    You have NO JUSTIFICATION to claim that only a tiny minority of disabled people want assisted suicide. Because of the difficult nature of the task many sufferers wil keep the desire secret to spare family members (often with tragic results). Neither of us can know. Plus the disabled are already a minority - do you mean to say we/they shouldn't have a voice to self-determine? If you believe in slippery slopes then where the Hell is that one taking you?

    There's more but I'm tired. Maybe more ranting later. (I hope you enjoy this ranting and don't take any of our bitching to heart. Cheers.)

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  23. I am going to be addressing the slippery-slope / thin end of the wedge argument, the anecdotal evidence for abuse and opinion poll "evidence" in the podcast on Friday night. I know Trevor also has some serious venting to do.

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