Assisted Dying

Last night a friend of mine died. She starved herself to death.

Erina was 74. She couldn’t eat (she was fed through a ‘peg’). She couldn’t walk (she used a wheelchair). She couldn’t talk (she used a ‘possum’ – think Stephen Hawking). She had wanted to die for a long time. She had asked me to look into taking her to Switzerland.

Dignitas Logo

Dignitas Logo

But then she fell. She spent – yet another – night on the floor, mired in her own excrement. It was the last straw. She cut her feeding tubes.

The machinery whirred into action. She was taken to a nursing home. Psychiatrists were brought. They judged her mentally capable. To feed her forcibly would be assault.

Nursing Home

Nursing Home

I wondered if the home would change anything. She was surrounded by people. She had her hair done. She had visitors. She sat in the garden drinking in the fresh air.

But she refused every offer of sustenance, moistening her lips with a wet sponge. It took her a week to die.

Erina had been a GP. She had a fierce intelligence, undimmed by her physical condition. She could read, watch television, listen to the radio, use the internet and email. Not such a bad life, you might think, even given the drawbacks?

But for the last two years (at least) Erina had believed her life had no quality.

So here’s the question. Is it right that Erina had to starve herself to death? Would it not have been better, kinder, to end her life quickly, painlessly and without the indignities of her final week?

Saga Photo of Mum and me

Saga Photo of Mum and me

I asked the same question about my Mum, who had Alzheimer’s. She too said she wanted to die. Of course Mum didn’t have mental capacity. If she had refused to eat she would have been forcibly fed.

I considered ending Mum’s life. I didn’t because I couldn’t be sure I was acting on her wish to die, rather than on my wish she should die. I loved her dearly and couldn’t bear the situation.

With Erina I had the same problem. But for different reasons. Erina wasn’t the easiest of people. Like most depressed people she was hard work. Very hard work.

But can you see the problem? Again, how would I have known that I was ending Erina’s life because she wanted to die, rather than because I wanted her to die?

You might argue it doesn’t matter. If I had ended Mum’s life, or Erina’s, everyone would have understood. I would almost certainly have been treated leniently.

But isn’t this carte blanche to end the life of anyone who is disabled, physically or mentally? What if Mum or Erina hadn’t wanted to die?

Archbishop Carey

Archbishop Carey

Like Archbishop Carey I believe we should change the law on assisted dying.

But I do not believe this as easy as people seem to think.

 

 

About Marianne

Marianne is Director of Studies in Philosophy at Oxford University's Department for Continuing Education
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20 Responses to Assisted Dying

  1. John-Brian Vyncent says:

    My sincerest condolences on the loss of a dear friend.

    Regrettably, assisted dying shall never become a reality as society is constitutionally incapable of the paramount quality necessary to permit such actions: respect for the individual.

    All societies are fundamentally constructed on the premise of divesting from the individual for the prosperity of the general populace. As long as there are religious, societal or collective institutions that believe (either in earnest or out of delusion) that their vested interest has the power to annul the wishes of the individual we will continue to condemn tortured souls to a miserable existence.

    Teaching society that assisted dying is a respectful, necessary endeavor — for those who capably and willingly decide on such a course of action for themselves — is fruitless. Teaching humanity that true love for our brothers and sisters means enjoining our respect for their right to self-determination answers the question all unto itself.

    • Marianne says:

      Thank you John-Brian. I disagree with what seems to be your premise that respect for the individual is inconsistent with the general good. But simultaneously I recognise that there will undoubtedly be conflicts. I do think that it would be possible to put together a law that permits assisted dying, even assisted suicide, perhaps even voluntary euthanasia, without risking individuals. But that law will preclude the possibility of helping many people who need help. For example those with dementia who express no wish to die before becoming demented. Are we just to assume that having dementia is sufficient for the will to die. I think that would be a dangerous assumption.

      • John-Brian Vyncent says:

        Curious position and one I wish we had the forum to debate.

        To clarify, I would extend your understanding of my premise as such: respect for the individual is, at times, inconsistent with the contemporaneous desires of the general good. When such putative conflicts do occur, the rights of the individual are ascendant to the general good provided they do not usurp the natural and inalienable rights of another individual.

        For example, a society may desire the imposition of slavery on a class on individuals but the natural right of every person to be free from subjugation abrogates the ability of any society to compel slavery. To permit otherwise, I believe, is morally and intellectually bankrupt.

        Good luck with the website! I hope to be in one of your classes or lectures one day as I believe I would learn much from you.

      • Marianne says:

        Ah yes,so, for example it might lead to the greatest happiness of the greatest number that a certain group of people should be enslaved (so Utilitarianism, arguably, would permit it), but if those to be enslaved have the right to freedom, then enslaving them would be right even if it would lead to the greater good?

        This is an excellent position and one that (at least on the surface of it) is very hard for a consequentialist to undermine.

        Thank you for your good wishes. I hope you do get to a class of mine. I shall be teaching the first online course in Critical Reasoning if that might be a good course for you to do…..?

  2. Katherine hill says:

    Marianne, what makes you so doubtful that your mum and your friend truly wished to die? How could they have expressed their wish such that you would have believed them? If a registered doctor had witnessed this, could he/she not be considered an appropriate person to judge, along with you, the sincerity of their wishes? And to look at the overall context, to see that the situation was not one where any recovery was at all likely? Could that not be considered ground enough to allow them the right to die? (Or 2 doctors? Or 1 doctor and one official from another branch? Just ideas for discussion.)

    • Marianne says:

      Hi Katherine.

      I am not doubtful, either about Mum or Erina, that they wanted to die. It is true of Mum, though, that she no longer wanted to die after she moved to a home. My question was intended to highlight the possibility that I might have ended their lives, and society might have forgiven me for it, on the grounds it was understandable, even though they didn’t themselves want to die.

      The fact is that people are so willing to assume that the life of someone with dementia, or some physical disability, is so lacking in quality that of course they’d want to die. In fact research shows that those with a given condition are likely to rate their quality of life far more highly than those without that condition will rate it.

      My reservations involve the fear that if we make it acceptable to end the life of (kill) someone whose life WE deem of unacceptably low quality might this not lead to abuses? I note that groups of the disabled are very afraid of a change in the law: http://www.ukdpc.net/site/position-statementsbr/assisted-suicide

      I did note that I do not think it beyond the wit of man to frame a law that would make assisted dying legal in those cases where it is beyond doubt that someone has a settled wish to die.

      I wasn’t arguing against a change in the law.Just noting a difficulty that would have to be allowed for.

      • Katherine hill says:

        I still can’t really see where the dilemma lies. Both these individuals clearly expressed the wish to die, and you say that you do not doubt that they were sincere. These 2 cases then are for me quite clear. I can understand your doubts and concerns in cases where it is not possible to communicate with the person concerned, or where they are judged mentally incapable of making such a decision. Then (for now) I would not advocate ending a life, barring perhaps a panel of experts agreeing that levels of pain and discomfort are such that they should not have to be endured, and will not lessen over time.

      • Marianne says:

        I completely agree that these two cases are quite clear. I mention them to show that I do understand the views of those who argue for a change in the law.

        You ask where the problem lies. I don’t think (though others do) there is a problem if the question is SHOULD we change the law to allow for assisting a suicide, or hastening an inevitable death where the person longs for that death. The problem comes in the formulation of the law so that it doesn’t imply, or lead to the belief, that a life lacks quality simply because a person is disabled or mentally incapacitated. Could it be the case, for example, that if we permit assisted suicide less money will be spent on palliative care on the grounds that death need never be drawn out? Or could we unwittingly set up a situation in which disabled people are treated as having ‘bottled it’ for continuing to live when it is clear they would be better off dead( and society would be better off without them? Or a situation in which we end the lives of the mentally ill prematurely because we can’t imagine that they wouldn’t prefer to be dead (I have already mentioned the research that suggests that healthy people greatly underestimate the quality of life enjoyed by those who have various conditions.)?

        I do not think we have done enough thinking about the extent to which disability is socially determined. If society chooses it can do what needs to be done to make a disability nothing more than a difference (this is the aim of the Disability Discrimation Act). If society chooses it can make a difference into a disability (being female in Afghanistan is a huge disability, being gay in Iran equally so). Might permitting assisted suicide lead to undermining the thought that (I think) we need to do on such issues?

        As the law stands at the moment, we value life itself, whatever the quality of that life. If we start to value only lives that have a certain quality, then we enter the arena of having to judge whether others’ lives have that quality. Fine if the person concerned is able to do the judging (which is why I am for a change in the law). Not so fine if a change in the law leads to a situation in which the judging is done by others, and done badly.

        I am wary of slippery slope arguments. But when abortion was introduced people argued that it would lead to abortion on demand. People responded that we value life too much for that. But the abortion law DID in effect lead to abortion on demand. This might be no bad thing. But it does illustrate that slippery slope argument are sometimes prescient.

      • As I said in my reply to the article about disabled people, and to answer your point (“My reservations involve the fear that if we make it acceptable to end the life of (kill) someone whose life WE deem of unacceptably low quality might this not lead to abuses? “), so long as it is based on the expressed wishes of the person concerned, and tested by medical professionals, is that not sufficient.
        I understand your worry about abuses and coercion, and those could arise. But is it right to let so many die in pain and suffering, when their cases are clear-cut? If the bar is set high enough, so to speak, I would hope those cases would be few if any.

      • Marianne says:

        I hope I have answered your question: no it is NOT right (in my opinion) to let people die in pain and suffering when their cases are clear cut. My worry is that you can’t see MY worry about the shift from valuing life to valuing only those lives with a certain quality, and the possibility of a slippery slope from the situation both of us agree would be good, to a situation that would not be good at all.

        Your position might be (probably is) that this worry can be dismissed because the law will be formulated properly. But if people don’t see that THERE is a worry, my fear is that the law, even if it were initially formulated properly, would be allowed to leach into a situation that would not be acceptable. The change from valuing life itself to valuing only lives with a certain quality is a HUGE one.

  3. Martin Rushton says:

    Hi Marianne. I am going to sidestep the philosophical discussion and just simply reach out and express my condolences. I looked after my father for ten years after he suffered a severe stroke from which he never recovered.

  4. Sorry for your loss and you pain. This subject has always been very important to me…for many reasons. As for me, dying is a part of death…not life, though keeping patients alive (against their will and wishes) doesn’t prolong life, it prolongs the road to death, it prolongs dying -not living.

    • Marianne says:

      Hi Nonsmokingladybug (!), thank you for your reply. I think you are quite right that keeping patients alive against their wishes prolongs the road to death. It does, of course prolong life too – by definition. But not a wanted life or a life that its’ ‘owner’ thinks of as having any quality.

  5. Kris says:

    Hello Marianne,

    First of all my deep condolences with the loss of your friend. I regret the state in which she was living wasn’t of that quality for her to pursue continuing it. It is a sad story nevertheless we can learn hard lessons upon it.
    In Belgium, the procedure for assisted dying is, in contrast to other European countries, not very compelling in a legal sense. I’m not aware of the detailled situation on the subject in the Uk, but that’s not where I want to go. Maybe you heard about an actual case, momentary issued in my country and republished in the press a few weeks ago about a prisoner who is condemned to a life sentence for murder and rape of a minor and who inquired a legal assisted dying procedure for himself. The reason for his demand, is the unbearable suffering in his current state and the lack of any prospect. He came to say these things in an interview for the Belgian television, a few years ago…The man is ‘residented’ for 30 years now where he’s sitting, but in fact also has a record of some mental condition. Considering all this, but after a lot of debates between all sorts of instances, there was (two weeks ago) the final announcement of the approval for his demand from the designated courtroom. The man is granted now two days in a hospital where he could say goodbye from his family and loveones and where the following procedure could take place. Of course, you could expect, debates on it are vividly here nowadays. Facebook-messages are spread openly with on the one hand, convictions of his situation and on the other, messages of support for his action (with the paradoxical result you can imagine)…

    Do you have an opinion on this series of events? I know one of the personal supervisors of the condemned is turned is his views, thereby admitting, the system failed not to bring a proper solution for the case and fearing the international critique that would rise afterward that Belgium hasn’t the capacity to deal with psychological disabled persons with severe sentences to endure. Do you think that Frank (the condemned) has the right to ask this or he’s just looking for a way to escape and what do you think of the Belgian legal system who’s euthanasia-debat was finally came to rest, but is now again shaken to its fundaments by this.

    Sincerly, Kris

    • Marianne says:

      Hi Kris,

      Thank you for your condolences. No I hadn’t heard about this Belgian case. How very interesting. We go to great lengths here to prevent prisoners from taking their own lives. This is right, of course in many cases (especially the cases of the very young). But It has often occurred to me that, with respect to those given life sentences with no possibility of parole, the option to kill themselves might usefully be on offer.

      The fact he might be mentally disturbed however is itself very disturbing. I hope he was first given treatment for it (if treatment is possible)?

      But it is a fascinating case, thank you for mentioning it. In fact I might put it on Facebook. I am sure people would like to discuses it.

      Thank you.

      Marianne

      • Kris says:

        Hello,
        Maybe you picked up this article?

        http://www.bbc.com/news/magazine-30708585

        After reading that I must clarify one thing. The article suggests that it was the Belgian Ministry of Justice who decided to reverse the allowing for the case for Frank, but that wasn’t actually so. In fact, it was the Medical Doctor itself, the one who formerly approved in the assisted dying of Frank, who (suddenly) changed his mind, and dropped out.

        Maybe something had to do with some leaks in the press about the imminence of it. And it is remarkable that during that same period, certain alternatives showed up that could make a difference to the ongoing procedure that were apparently impossible formerly. I speak about specialized care.
        It was heard that Frank and his family took a structural attitude towards this unexpected chain of events. A political goal to handle all this sort of demands is now in a development stage.

        On the philosophical part, I have little to add, except then that I see myself into the YES-camp. Every man, I think, has the fundamental right to express himself, even if this leads to the confession of your own will to die. This right needs to be sustained and is in my opinion sacred.

      • Marianne says:

        This is a fascinating article Kris, thank you. I am putting it on my FB page. I am in the ‘not sure’ camp here. I do not agree with the death penalty. But I do think those consisted for a long period ought to have the choice of suicide. But in this case his mental condition complicates it. My instinct is to help him. But even this is complicated by the ghastliness of his crimes.

  6. Kris says:

    That’s fine Marianne, also entered the discussion there…

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