Two Women Who Want to Die.

Great Debates
1

This link decribes the case of one English woman identifed as “B”, and at the end mentions a similar seeming case involving a woman named Diane Pretty.

The Similarities:

  1. Both are permanently paralized.
  2. Both are conscious and artiulate.
  3. Both wish to be allowed to die.
  4. Both have been denied that wish, until B won that right today

The Differences:

  1. “B” needs a respirator to survive, but may survive for many years if she is kept on it.
  2. Diane needs no direct medical treatment for immediate survival, but is terminally ill. Presumably, in the not too distant future, she will need such treatment for survival.
  3. Diane needs external intervention to die painlessly.
  4. “B” can be “switched off”, more or less.

In legal terms, "B"s victory today was based on the right of refusal to consent to medical treatment. The hospital has been ordered by a court to obey "B"s demand to remove the respirator.

Diane, who has bleaker long-term medical prospects, is requesting an assisted suicide. So far, apparently, she has not wone that right. If British medical law is similar America’s, she would not be allowed to starve herself to death. American courts have consistantly held that the provision of minimal hydration and nutrients is NOT medical treatment. So when she faints, they can stick an IV in her to deliver it.

Are these two really so different? Is the medical tech who switches off "B"s respirator (and perhaps gives her a sedative so her hast few minutes aren’t a suffocating agony?) doing anything more or less than what Diane requests her husband be allowed to do (presumably, OD her on something to give her a painless death)? I’m also reminded of Karen(?) Quinlan 30 or so years ago, in a persistent vegetative state and on a respirator. Everyone expected she would die quickly when it was removed, but she breathed on her own for several years to come. "B"s death may not be the quick one she hopes for.

2

In both of these cases you run into the idea of “playing the role of God”, but the biggest objection IMHO is the “slippery slope” argument. There are cases of people running around injecting older people with deadly doses for what almost seems to be the fun of it. There are cases where relatives would be more than glad to get rid of their “rich uncle”. What are acceptable reasons and what reasons are unacceptable? If you make it easy for these two women, where and how do you draw the line in other cases?

My wife and I have “living wills”, which is a step in the right direction, but even that is such a new field that our state has changed the law and we had to draw up new ones. So my answer I guess is that we need to move towards making it easier to solve questions like those posed by these two women, but we do not need to rush into it.

3

If we should do what “the law” did : Torturing people to a slow death, we’d be in prison for years.

4

Not necessarily; it may depend on the doctor and the jurisdiction. For instance, when my aunt had terminal cancer, she told the doctor she did not want any “heroic” methods used to prolong her life. (The doctor may have had her sign a written statement, I don’t recall.)

She was hospitalized and fell into a coma. With IVs and similar, the doctor told us that she could have remained in that state for weeks or months before dying. The doctor therefore took her instructions of “no heroic efforts” to exclude the IVs. Three times a day, the hospital staff brought her a meal tray – she was in a coma, I usually ate the meal. They did NOT give her an IV, and she died within a few days, never regaining consciousness.

It seemed somewhat silly to bring out a meal tray for a woman who was completely unconscious, but that was the law – they couldn’t deprive her of food. However, they apparently did not have to force it down her.

At the time, I was a bit ambiguous about the doctor’s view that IVs are “heroic”, but it certainly saved a great deal of medical costs and stress/strain on the family.

Laws may differ in different jurisdictions, of course.

5

Calling an IV a “heroic” measure is curious to me, too. I was of the understanding that “heroic” or “extraordinary” measures were those which had a slim chance of succeeding and/or a serious chance of doing considerable harm to a patient. (Something like an untested, possibly dangerous medical treatment, an animal organ transplant, etc.) Things like IVs and respirators, as far as I know, are considered ordinary measures. I guess if you wanted to be creative with your definitions, anything that would prolong the suffering and economic damage to a terminally ill person with no chance of recovery could be considered an extraordinary/heroic measure (significant damage, slim to no chance of recovery) but that seems like a stretch.

6

Is there any firm legal definition of what “heroic measures” are?

7

Would it make any difference if either of these women could claim religious exemption? AFAIK certain denominations can refuse medical interventions (I’m thinking of the Jehovah’s Witnesses in particular, but I’m sure there are others…Christian Scientists?)

8

You can refuse medical intervention regardless of religious intervention. Diane Pretty’s problem is that she needs intervention in order to die. “B” needs medical intervention in order to live, and has won the right to have it removed.

9

I don’t see how. Both of these cases are of a person wanting to end their own life. It doesn’t involve any other person except them and their doctors.

Seems many people don’t like the idea of -anyone- ending their own life. Oregon has an physician assisted suicide law that keeps getting obstructed by the federal government (I think the current thing is to revoke the licence of any physician that does it, but I really don’t remember, I havn’t payed much of any attention to it).

10

Simple, actually. It doesn’t apply, apparantly, in these two specific cases, but you can very quickly find yourself in disagreements about mental competance, undue influence, and the like.

Death and estates already are fraught with emotions: Guilt, grief, doubt, anger, greed, and a whole host of others. All you need to do to turn a disfuntional family into a messy brawl of litigants is to add a little uncertainty to the issue, and a “right to die” decision would do that nicely.

In general, I’m in favor of self-determination, but the Law has an obligation to proceed slowly in that department, because the consequences of Getting It Wrong are too high.

11

A person whose faith did not allow medical intervention wouldn’t be in the instant situation.

I think those who are clearly able to make the decision for themselves, although one does get into the problem of mental competence, how do you determine it, etc., should have the choice to direct their physicians to discontinue medical intervention, whether such discontinuance ends in death or not.

Families of those who are unconscious or otherwise unable to let their wishes be known at that time (not through a possibly outdated Advance Directive for Health Care [if that’s still what it’s called in AL]) should NOT be able to make such decisions for the patient and should bow to the physician’s decisions.

The physician should take into consideration the wishes of the family and any advance directive of the patient. Just MHO.

12

kniz wrote:

This is a big, fat red herring.

The OP made it abundantly clear that these two women were lucid, competent, and clearly able to make decisions about their own treatment. There is not even the slightest suggestion that there is any pressure on them from “people running around injecting older people,” or “relatives [who] would be more than glad to get rid” of them.

Certainly, any legislation which attempts to legalise some forms of assited suicide will have to take into account the mental competency of the person who is going to die, but issues of mental competency are determined by the courts all the time in a variety of different cases. The fact that any such determination is based on subjective criteria doesn’t mean it can’t become part of the legal system. The whole legal system is a subjective institution, the protestations of some lawyers and judges notwithstanding.

Personally, i think that assisted suicide should be legal as long as it can be reasonably ascertained that the person who wants to die has made the decision for him or herself, and understands fully the implications of that decision. But to invoke the slippery slope argument with such ridiculous comparisons as made by kniz doesn’t advance the debate at all.

13

Actually, in the case of “B”, you can throw in Roman Catholics. Over 40 years ago Pope Pius XII articulated the idea that one did not need to exert medical efforts to merely prolong breathing/living where there is no chance of recovery.

Regarding the view expressed (and actions taken) by Dex’s aunt’s doctor, I am not sure whether or not that would be viewed as “heroic” measures or “mere prolonging” or something else. In general, the RCC does not consider simple hydration or nutrient supply to be either “heroic” or “merely prolonging.”

The RCC, of course, would oppose Ms. Pretty’s appeal based on opposition to direct homicide, euthanasia, or whatever.

14

I’m not sure why this issue of religious faith has slipped in here. As far as the legal and medical authorities are concerned, religion is not a factor at all. One does not need to claim adherence to some particular faith in order to refuse consent to medical treatment. This is not like being a “consciencious objector”.

15

Angel Fish raised the issue of a “religious” plea, specifying a couple of possible examples. I noted that, in some cases, the “religious” claim might extend beyond the examples she provided, then (anticipating further questions along those lines) expanded the information regarding other situations.

The law should not be based on religious dictates. However, the law has not yet been clearly written to cover all these situations and a knowledge of where various religious opinions may fall may help illuminate the way people wish to consider the laws they favor (even if it is merely to react against any religious voice).

16

I was thinking about starting this debate myself, and here it is. How about on the other end of things, with premature babies, for example? I was watching a documentary on preemies, and one mother felt she should have had better information from her doctors when her preemie was born; she didn’t come right out and say it, but I believe that she would have preferred her baby dying immediately over the life that it will have (the baby was so premature that it will be blind, on a respirator, and severely brain damaged, with very little quality of life possible). She felt that her doctors should have told her more of the consequences of taking heroic efforts to keep this very marginal preemie alive, rather than simply focusing on keeping the spark of life in this tiny baby.

I am coming to the conclusion that we are in a position in medicine where we have the ability to keep many people alive long after we really should. I think we need to change our way of thinking from saving everyone, every time, to making more informed, thoughtful choices.

17

I’d assume it would be something like throwing yourself in front of a bus to inject a snakebite victim with an anti-toxin. But that’s just me.

18

When my grandfather had cancer, he refused all medical measures including ever being taken to a hospital because he thought he should be allowed to die a natural death.

He had to sign papers that said he didn’t want to be kept alive by ‘artificial means’, which ruled out feeding tubes, IVs, and respirators.

He’d said that no matter how bad it got, he was absolutely not going to the hospital to be treated like a pin cushion.

He lived 9 months after his diagnosis, and he died at home in his favorite chair. The only medicine he ever took related to the cancer was a painkiller for the last 3 weeks of his life.

I think it would’ve been cruelty to make him go to a hospital or to feed him through a tube. And I don’t think I could’ve been arrogant enough to tell him that he had to keep living a life that he personally didn’t find worth living. So how come that seems to be the general tenor of the legal/medical communities? Prolong life at all cost - no matter how much the person whose life it is finds that life to be a torture they’d rather not endure.

19

The case of Miss B is open and shut- and should not have even gone to court. There was existing case law that made clear that mentally competent patients may refuse intervention. It was the obdurate opposition of the medics and the hospital (and the spinelessness of the psychiatrists) in refusing to refer her to physicians who would implement the law, that led to the court case. The legal finding by Lady Butler Sloss not only ‘gave’ Miss B the right to refuse treatment, but also said that the doctors and the hospital had assaulted her by refusing to do as she wished.

The Diane Pretty case is different in essence, but similar in its effect on case-law. Her husband and she had sought assurance that he would not be prosecuted for assisting her suicide. Recent court cases make it very likely that the husband would either not be brought to trial for this, or if he was, a court would have aquitted. The appeal to the European Court of Justice is an attempt to enshrine in case-law what is currently in that limbo state of ‘likely outcome’.

This is one of the problems when governments are too frightened to make statute law- real people are severely harmed in needless court cases. A full review of the law on ‘the end of life’ is called for, but governments are too scared to do this.

20

i agree with Pjen.

Miss B should never have had to go to court. her docotrs argued not that she was incompetant to make the ecision but firstly that she was not properly informed as to her future quality of life as she had not undergone 6 months of intensive rehabilitation.

she argued that she was sane, medically able to refuse treamnet and that her physicians were keeping her prisioner in their facility as other hospitals were willing to turn off her respirator.

she is paralysed from the neck down, she will feel no pain, nor any suffocation and will lose consciousness and die very quickly.
in several doctors opinion it was an act of cruelty to extend her life with the ventilator in the first place. she has no dependants and is single, so no pressure was placed by family to keep her alive.

i pray for her to have a peaceful and beautiful death.
Mrs Pretty will face a longer, drawn out process tnan Miss B, but efforts should be made to make it as dignified and peaceful as possible. she is obviously terrified of dying, and of dying in pain, without dignity, but hopefully medical and psychological services can help to prevent that and reconcile her to what will happen.

this would seem to be a better outcome than leaving her husband with her death on his hands.

i won’t call it murder, but i still feel that killing another person is bound to weigh heavy on anybody. even if it is done out of a motive of mercy and kindness)

i would personally recommend anyone with elderly relatives or family members who have terminal illnesses to sign DNR orders.

there is nothing worse than a man dying of cancer to be shocked back to life to die in an ICU where his family can only visit him once a day for 15 minutes at a time.

or a 90 year old woman resucitated 3 times in the ambulance, once in the ER, unconscious and on a ventilator, before her consultant sees her on a ward and agrees to the DNR.
or somone who has requested that they be allowed to die at home, ventilated against their wishes, at the request of their family, and dying in a hospital they don’t know.

doctors are scared of wrongful death lawsuits from relatives, more than they are concerned about allowing a patient to die in peace, at home, with family and friends around them.

i know how i’d like to go, and will be signing a living will or a DNR order if i am ever in a position which may require it.