Euthanasia for non-terminally-ill patients

Great Debates
201

From my own study of the T4 program - which, admittedly, is from the standpoint of a layperson reading other peoples’ research - I think it was a combination of the things. Back then they had just as many maiming injuries or severe birth defects as we do, any modern situation you can think of involving injured adults or severely defective infants where we currently raise the question of whether or not such a life is worth living/ should there be treatment or just palliative care/should we consider euthanasia also occurred back then and would have been under the purview of T4. There probably were some maimed adults - remember, they had all those guys from WWI and didn’t have as much reconstructive surgery as now, or prostheses nearly as good - who would welcomed a way out of their suffering that otherwise had no end. Some of it was cost containment, looking for way to avoid paying for the expensive care required by the handicapped and ill (sound at all familiar?). The thing is, it didn’t stay with just the “hopeless” wards, it spread.

And yes, some of it was for… I’m not sure “purifying” is the word we’re looking for here, more “eliminating the weak” with the idea that that would somehow make society stronger. You have to remember, these people didn’t see themselves as the bad guys, they regarded themselves as heros, improving their society.

I wish to quote the Wiki article on Godwin’s Law, specifically the portion about

Contrary to what you seem to believe, there is not an internet ban on saying the word “Nazi” or using their actions as an example where relevant to the actual topic at hand. As it happens, they had an excellent example of a state-sponsored euthanasia program that, by our standards, ran amok. Thus, for this thread they are an entirely appropriate example to use.

No, because the guys on the Court are the ones who will be putting the program into action. It won’t come back to the courts until there is an accusation of abuse having occurred, which in such a case would be someone has already died.

There are numerous cases from around the world of medical personnel, typically either doctors or nurses, who took it upon themselves to kill patients under their charge. There was the rather infamous Dr. Kevorkian. If such things occur even with assisted suicide being illegal then the possibility exists for them to continue, or become more widespread, under permitted physician-assisted suicide. Safeguards can’t just be words on paper, they have to exist in the real world and actually be effective. We can’t know that they will be until quite some time has passed.

When it’s third parties making the decision for a person who can not consent, who can not say yes or no, who can not act in self-defense then I think it is entirely appropriate to question the motivations and ethics of the people involved. For a terminally ill person who is still functional enough to understand swallowing a handful of pills will result in death and able to bring the pills to their mouth and swallow them down on their own that’s not such a concern. For infants, or people with brains so damaged they are no longer conscious, and so on the whole situation becomes much more problematic.

I am concerned that formulas will be drawn up - for example, I’ve heard people say they would find living with locked-in syndrome intolerable and such people should be “put out of their misery”… yet we had a poster here who had locked-in syndrome and wanted to live despite his disability. On average, the able-bodied consistently rate the situation of disabled people as worse or much worse than the actual handicapped do. The severely handicapped do fear that either they will be “euthanized” out of misplaced notions of “mercy”, or that they will face coercion to end their own lives. I don’t think those fears are entirely irrational. Surely, if you want to argue that a person has a right to end their life a person should also have a right to continue their life. Maybe YOU wouldn’t want to live as a quadriplegic, or someone deaf and blind, but if such a person wants to live then their life should be safeguarded every bit as much as the life of an able-bodied person, and that includes being free of coercion to end their lives.

As is probably obvious, I am not particularly enthused about the notion of permitted suicide. I think it should be rare. If society does decide to allow it I want very stringent and effective safeguards.

202

Actually, some people think the point of prison shouldn’t be suffering so much as either protecting the rest of society from bad people, or prison should be attempting to rehabilitate bad people into good, law-abiding citizens.

203

Hey, I’m all for advocating advance medical directives - my parents both had them (dad still does) and it was an enormous relief to know what they did and didn’t want during a medical crisis. On the other hand, my parents were educated, thoughtful people and these last few years they had a child with an MD to help them with the specifics.

Making a useful medical directive isn’t as easy as you might think because most people just don’t have the knowledge base to understand the nuances.

If we lived in a society with legal euthanasia and someone had an advance medical directive spelling out that they’d prefer a mercy-killing than to living under X, Y, or Z conditions that would definitely qualify as patient consent. Don’t ask me to be happy about that, but I would definitely agree with following the patient’s directive and legally protecting any medical personnel involved in doing that from any angry and dissenting relatives.

My biggest concerns are:

  1. People who have not in the past, and can not at present, express their wishes or consent, and
  2. People being pressured to choose death rather than life.

I don’t think it’s *impossible *to deal with those two points, just that we shouldn’t assume there will be safeguards and no abuses, we need to be vigilant to make sure things happen as they should.

204

Sorry, think I forgot to address this earlier:

The fact that most life insurance policies explicitly state they will not pay out in cases of suicide should indicate that someone at some point tried exactly that - took out a policy then attempted or actually killed himself for the payout, usually for the benefit of the family. Such attempts do occur, though fortunately rare.

205

I just wanted to say that, yes, I’m aware I just made a bunch of posts in a row. Due to some personal circumstances I can no longer spend a lot of time on line each day (which I’m sure gladdens some hearts) so when I do show up I feel there’s some “catch up” to do.

The thing is, sometimes it’s not a matter of “final hours” but “final weeks” or “final months”.

This is somewhat timely for my own family, as my father was diagnosed with advanced lung cancer just last month. He’s also 85, which means nothing works as well as it used to. After running a bunch of tests, the doctors concluded that he can not tolerate chemotherapy, his kidneys and liver just aren’t up to handling it, and the therapy would kill him before the cancer would. Surgery won’t fix the problem. Radiation isn’t terribly effective for his type of cancer, it’s not curative, it’s not certain it would give him more time, and it would definitely increase his suffering due to side effects, it might even hasten death.

Yet he probably won’t die for some months yet, even a year.

So… why do anything else but make him comfortable for his remaining time? There is no known medical therapy that will make him better at this time. There’s not even one guaranteed to give him a few more days of life. It’s not a matter of “being alive and in pain vs being dead”, he’s going to die pretty much at the same point regardless, so what is there to do for him but alleviate suffering?

A prognosis of death can be made surprisingly far out these days.

(As for what dad wants - he has stated over and over his main concern is avoiding pain, which currently he does not have, and he wants no heroic measures. At this point he’s DNR for anything, and he and my sister, who has medical power of attorney for when he becomes incapacitated, are reviewing his advance directives in case an update is needed.)

We hope to keep dad at home as we did mom, but we’ve already discussed that if his condition can not be adequately dealt with at home he’ll be transferred to in-patient hospice. It’s even been determined where he will go (sister being a doctor helped with that).

The fact that in many instances those prescribed a “suicide package” never wind up using them is an indication to me that safeguards are working where these sorts of things are allowed.

206

It can be pretty clear that someone’s terminally ill long before “their final hours”, and at that point, what’s the point of making someone go through all the discomfort and anguish of continued treatment, if instead you can remove their pain and lessen their symptoms and let them live what life they have left with dignity and comfort, even if the price of not treating them means they’ll likely die a month or two earlier?

Roughly a year ago I saw my aunt undergo this exact situation- she and her family chose the continued treatment option, and she was more or less miserable for her last 3-4 months. I’d have personally much preferred to have seen her die a couple of months earlier, but had her be comfortable and happy during the process. And the effects on the family would have been mitigated as well. It’s not like that extra couple of months changed anything- she just endured a couple of months of discomfort and pain to stave off the inevitable.

It’s a tradeoff - quality of live vs. time alive. In an extreme sense, most proponents of euthanasia are arguing the exact same thing, only with the death part being more deliberate and final, and the quality of life part being somewhat more nebulous than the clear-cut issue of someone dying by inches from cancer or some other terminal illness.

207

I’m sure such things have happened, though the logic doesn’t actually follow (the insurance companies’ policies may be a pre-emptive measure).

But I was responding to the point about organ donation. I think it’s moot anyway; the change to the law being discussed in this thread will not make anyone able to kill themselves that cannot now, so should not make the issue of suicide for organ donation more or less common than it is now.

208

The key word being temporal. But that is not what we are talking about here. In some cases we are talking about people for whom the remaining years will consist of lying in bed unable concentrate on anything but the burning they feel in their arms and legs. To them oblivion is far preferable. The fact that you can no conceive of chronic pain so severe that oblivion is preferable, just means you have been lucky enough not to have experienced true pain. For the record I haven’t either, but I know those who have and it is clear that they know what they are talking about.

For you to say that no pain is so severe that death is preferable, is like a straight man saying that gays can’t really attracted to members of the same sex, because they themselves can’t imagine finding men sexually attractive.

209

IMHO the potential for organ donation to be an incentive for suicide would be exceedingly rare. A lot of organs can be donated from a living donor. For those that cannot, it would require that a person be a suitable donor that is a medical match to a particular recipient, who has not been able to acquire an organ through traditional means, and that the donor care enough about this recipient to die for them. It just doesn’t seem plausible that the desire to help anonymous strangers would incentivize many suicides.

210

No, but it might be incentive enough for a relative to do it - say, a parent kills him/herself to save the life of a child.

There has been a case of a child receiving a parent’s heart, but that was very clearly an accidental death and not intentional.

211

The compassionate part of me says if a parent chooses to make that sacrifice for a child, who are we to stand in the way?

The analytical part of me says the law could specify that organs donated from a suicide have to be distributed in accordance with standard procedure, not earmarked for a particular recipient.

The practical part of me says this occurrence would be so rare that we shouldn’t base law on it.

212

Take these sort of off-topic personal remarks to The BBQ Pit.

[ /Moderating ]

213

How many hours do you grant? 4? 24? 72? 168? 0.5?

Your opinion obviously means a lot to you, but you have hardly established your opinion as fact on this point. Better to be alive in pain than without pain and dead? Who says? How much pain? how long a life?

You have, throughout this and similar discussions acted as though life (or merely surviving) has some sort of necessary component that requires that one cling to it beyond any hope of anything other than existence. I am not sure why you feel this way, but your repeated assertions, backed up by nothing more than repetitions of those assertions, is utterly unpersuasive.
If you cannot provide an actual reason, you are going to continue to fail to persuade anyone of your personal beliefs.

214

I don’t want to keep harping on this Nazi analogy thing, and I’m not doing it just to be argumentative. I’m doing it because I believe it’s a completely invalid analogy. You brought it up as an example of a program that “ran off the rails” as you put it yourself, and have again stated it’s “an excellent example of a state-sponsored euthanasia program that … ran amok.” No, it isn’t. It was pure evil from the very start, intended from the beginning to do precisely what it did, engineered by the same fine folks who brought us the Holocaust. The cautionary tale here isn’t that well-intentioned euthanasia programs can go wrong, the cautionary tale is that we are all subject to a herd mentality that is capable of great evil if reinforced by peer behavior and sanction by authority. That, however, has absolutely nothing to do with the present topic, which is really about the most noble aspect of society, compassion.

That said, I think your posts are well-reasoned and articulate and we’re not really that much in disagreement. I share your belief that strong safeguards are wise, but not your concern that there is any particular inclination towards abuse. Such concerns remind me of right-wing allegations that if you let the evil government run health insurance, they will start cutting costs by undermining care for the frail and the elderly and will eventually euthanize your grandmother. It just doesn’t happen. I’ve lived under single-payer health care all my life and all my elderly relatives have been cared for with the greatest skill, professionalism, and compassion.

Obviously you meant “are not the ones…”. Yes, but the court established the minimum baseline safeguards, including the requirement for clear consent. Many additional safeguards will be in the legislation, as is the case in all other jurisdictions that have such programs.

And my response is what I said above.

This is getting a bit off topic, but I have to say that I find the very thought of such a law utterly reprehensible. I can’t imagine any legislators ever being willing to enact it, or any authority being callous enough to enforce it. What on earth would be the purpose of such a law?

The matter of life insurance not paying out in the event of suicide is entirely different. It’s simply a contractual matter. If the insurance company wants to contractually limit their coverage in certain ways, then as long as the terms are clear and laws and basic human rights aren’t being violated it’s their prerogative.

215

We’re going to have to agree to disagree, then. I am not convinced by your arguments, nor you by mine.

Oddly enough, I agree with you on the single-payer health system notion. I think the opposition to it in the US is driven more by business interests, specifically, though who would be out of a job should it come to pass, than any actual ideological desire on the part of the electorate. Problem is, voters can be manipulated by special interests.

216

I’m a bit confused. You seem to be suggesting that I was advocating a separate law that would provide for parental suicides so they could donate organs to their children. I was only discussing the subject of this thread, euthanasia for non-terminally-ill patients.

It had been suggested that such a law would be problematic because some people might be motivated to commit suicide so that they could become organ donors. I pointed out in post #209 that I believe the potential for organ donation to be an incentive for suicide would be exceedingly rare. Broomstick then described the extreme case of a parent sacrificing themselves for a child. In response, I pointed out that this extreme subset of an already rare set should not be the basis on which the euthanasia law should be written. I also pointed out how the euthanasia law could be written to allow organ donations without incentivizing suicides (as I stated in my previous post, it doesn’t seem plausible that the desire to help anonymous strangers would incentivize many suicides.) And in my first statement in the response, I was trying to express how such a profoundly personal issue should not involve the state legislature. I was not advocating a law that would encourage parental suicide. I simply believe that the government has no business being involved in that situation. If you were ever in a position where you had to choose between your life and your child’s, would you want to be bound by some law written in the state capital?

217

Um… no, that’s not what I did. I very explicitly said that the donor had a clearly accidental death.

The child - an adult by the way - was on the donor list. The father was involved in a fatal car accident but his body survived long enough that viable organs could be obtained from it, and were. As it happens, his heart wound up in his daughter via normal organ donation channels (other organs went elsewhere). The father in no way “sacrificed” himself and it was only some time afterward that it was learned who the donor of the heart was.

To say there were mixed feelings on the part of the recipient and the rest of the family would be an understatement.

It was clearly a statistical fluke situation, it would be exceedingly unlikely that such a situation could occur by chance… but it did. Because rare events can and do happen.

Just wanted to clarify the situation.

218

My apologies for poor wording. I intended to refer to the first sentence in your post. “No, but it might be incentive enough for a relative to do it - say, a parent kills him/herself to save the life of a child.” Perhaps I should have said, “Broomstick then brought up the possibility of an extreme case in which a parent might sacrifice themselves for a child.”

219

I just want to applaud how articulately and calmly you put your point here, at a point where many people would already be quite frustrated.

220

You’ve completely misunderstood my comment. I never claimed that you were advocating any law, let alone “a separate law that would provide for parental suicides”, nor was I arguing with you. You had mentioned three hypothetical responses to the situation of a parent committing suicide to provide organs for a child, one of which was “The analytical part of me says the law could specify that organs donated from a suicide have to be distributed in accordance with standard procedure, not earmarked for a particular recipient.” I was simply reflecting, as a passing comment, that that particular hypothetical response strikes me as bizarre and callous, and I couldn’t image such a terrible law ever being enacted. That’s all. In your later response you say “I simply believe that the government has no business being involved in that situation. If you were ever in a position where you had to choose between your life and your child’s, would you want to be bound by some law written in the state capital?” and I agree completely. Apparently we are in violent agreement on this!

Thank you for your kind compliment, I appreciate it. :slight_smile: