Some death is unpreventable. Some death is unforeseeable. Car Wreak, Rubella Blindness, and Missed Cancer up there are all tragic. But they were not foreseeable. No one could have stopped it. Old Man Dying of Agonizing Liver Cancer is also tragic, and could not be foreseen or prevented. Assisted suicide can help him end a life that is, essentially, already over. But not everyone’s life is already over. I may not be able to prevent the suicide of a depressed 22-year-old. But I don’t think I should be required (or even asked) to take part in it.
Don’t tell me I owe it to that 22-year-old to end his life, and then look his mother in the eye when she asks me how I could do such a thing? Because all of that, ‘what if?’ guilt that weighs down a family after a suicide? That guilt will now be mine, perhaps a dozen times over.
For those who believe anyone (let’s assume of age) has the right to a medically assisted suicide - do you believe in any regulations? Should the person have to present a reason? Take part in counseling? Do they have to have a disease? Somatic, or will mental do? Can they walk into a clinic and get it done that afternoon?
I did read your post. I admit, I didn’t fully grasp your point - you said that allowances needed to be made for people with Alzheimer’s/senility. I agreed that, if a living will is made declaring the wish for suicide when a person has lost major cognitive ability, I could support that. But I wouldn’t agree to kill a still functioning individual. I suppose the definition of ‘still functioning’ would need to be established, probably by an ethics board. But if they could still communicate with family and friends, I don’t think I could possibly kill them.
The “Joe off the street” comment was more directed at people who believe assisted suicide should be a free for all. Although, in a sense, if you (or anyone with Alzheimer’s) came to me, I’d have to say no - because you still had enough cognitive ability to make an appointment, drive yourself in, and ask for it. Alzheimer’s, it seems, is a tough grey area. It’s a case I’d leave to an ethics board.
Then you went on to tell me your suicide plan. I don’t know what to say to that, except that I’m sorry. I had a plan once - still have one, I suppose, because once it’s there, it doesn’t ever really go away. It’s a horribly painful thing to experience.
Small Hen, my father may or may not have been assisted along.
I do know that he was ready. I was present when he made Mom swear that she would not, ever, get him put on a respirator, with myself and a nurse as witnesses. No tracheotomy, that was his “limit point.”
I do know that Mom refused to accept that he was dying. So were my brothers, and his siblings, and everybody except him, me, my sister-in-law (who is a doctor), and his friends from the hospital (including his doctors and nurses).
I do know that the hospital where he died is the one where he’d worked for the 12 years prior to being diagnosed for the first time.
I do know that he’d asked to never be put on a respirator. No “extreme procedures” is the legal term here.
I do know that if he’d somehow managed to be braindead but breathing, I would have been perfectly willing to perform active euthanasia on him, rather than spend another three, four, five… however many years sitting at his bedside, unable to get or keep a job because of the demands of caring for him, while my mother and brothers kept deluding themselves and dumping everything on me.
Selfish, I know. But he was ready - I wouldn’t have been willing to do it if I hadn’t known he was.
First: It’s simply not true Old Man’s death could neither be forseen nor prevented. Depending on the type of cancer and stage at diagnosis, his death my well be inevitable at the time of diagnosis. His life expectancy may, at that point, be measured in months or a small number of years. Should he be able to request assisted suicide at the time of diagnoses? If not, how sick should he have to be before he can ask for help in dying?
Also, let’s say, for the sake of argument, that his illness could have been prevented had he done something (quit drinking, avoided exposure to environmental toxins, sought early treatment for liver disease) several years prior to diagnoses. Perhaps someone even told him that if he didn’t take action, he could expect to develop liver cancer later on. Does this make assisted suicide more or less OK in this case?
Second: Many, many people would disagree that Old Man’s life is “essentially over.” These people would argue that there is no “essentially” about it - until he expires naturally, any action undertaken with the intention of hastening his death is murder.
On the other hand, let’s say the 22-year-old has undergone a psychiatric evaluation. It’s determined that his condition isn’t responding to psychotherapy or medication, he’s clearly suffering mentally, and his mental illness prevents him from living a satisfying life. Further, it’s known that people in his condition will almost certainly attempt suicide on their own eventually. Why can’t we say that his life is also “essentially over?” Why should we not allow him the option of dying with a minimum of suffering instead of essentially ensuring that he’ll die with a maximum of suffering?
Clearly, there’s a huge gray area between the Old Man and the suicidal (but physically healthy) 22-year-old. How do you decide that one life is essentially over, but not the other? How sick should someone need to be?
I discussed this in my earlier post. I would like to see assisted suicide limited to people who made a request while they were rational, in a living will or similar document. Preferably, this would be while they were still healthy, but I can envision circumstances where the request was made after the person became ill.
I don’t think a person should be required to have a reason beyond the desire to control the manner of their death.
I do think that mental illness should qualify, but it absolutely complicates things. If a person has terminal cancer, he’s probably still rational at the time of diagnosis, and can make a rational decision about end-of-life care. If a person makes a request after he’s become mentally ill, how do we know that this request is rational? I think someone with a history of episodic mental illness could make a request during a lucid period. Someone whose illness is currently controlled with medication could craft an advance directive that would become effective after the illness has progressed to an uncontrollable state.
I don’t think this is something that should be available on a walk-in basis. I do think that the requirement of documenting one’s desires and intentions would eliminate that possibility, in any case.
I don’t understand the need for injection. I think inhaling simple gasses like nitrogen or helium will make you pass out and pass on without any trauma.
I’d say the only law you need is one saying what happens to your life insurance policy.
In the event that your father was assisted along, I would not condem you. I wouldn’t call you a murderer, and I would recognize that you were carrying out your father’s last wishes. But I would not legalize what you did. In my eyes, the likelyhood of misuse and abuse is simply too great.
I’m sorry you were in that position.
It wasn’t foreseen, nor was it prevented, just as many people’s diseases are not foreseen and prevented. Since not everyone can reasonably be saved, let’s say Old Man represents that population.
I believe MA suicide should be reserved for those suffering with end of life pain. I believe that treatment (if any available) should be attempted first. If a patient rejects treatment, I believe that they should be eligible for MA suicide within a time period nearing their death (if the doctor estimates that they have six months or a year or some set time period left). I don’t believe it should be available for people with non-terminal diagnosises.
I don’t think the reason for a person’s illness should be a factor. We judge such things in order to ration livers, but Morphine is readily available. Dying is dying.
True. I’m not one of those people. Neither are you. I’ll argue against that point when I run into someone who holds it.
I’m not a fan of this hypothetical condition stuff because it’s hard to argue. Schizophrenia? Bipolar? Meds help majority of these people. Full on psychotic? Probably doesn’t feel like he suffers. But, I’ll do my best. This person suffers, day in, day out. She’s young. No meds are helping. Death, she decides, would be better than this barely functioning life. Through all of this, she is somehow able to make a rational and legal choice to commit suicide. I would still flat out refuse to administer the Morphine. Knowing the extreme states from which people with depression, schizophrenia, bipolar disorder, and drug addictions have come back, I could not. She still has hope and chances for life in a way that Old Man does not.
What if the “communication” in question consists of begging for death, at least when they are semi-lucid? “Tough luck, Grandpa. Sit there and suffer!” is hardly a humane response.
What rules would I implement? As long as you passed a simple test proving you wasn’t being coerced, you could go out anyway you wanted to, providing it would not traumatise witnesses.
‘What if’ can cover dozens of possibilities. That’s why we should come up with a set of baseline rules and consult the hospital board of ethics for outlying cases.
I have, on several occasions, heard patients beg for death. Some of them got better.
I believe that to have the right to life means you have the right to end that life. I support anything that gives people a way out, one where they can plan their last day, let the people around them know when they’ll be leaving. I’ve been to too many funerals for people under 21, and I’d rather they’d had ways out that would’ve allowed them to tell other people what they were planning without those other people being able (legally) to stop them from carrying through with their plans.
Your patient above doesn’t have hope for a better life; you have hope for her to have a better life. This is the end distinction for me, that you wish to force other people to have the hope that you do. You want to avoid the grief of death so much that you are willing to force someone else to know the grief of life. You know that no one is going to force you to be the one helping someone on their way, any more than any one would force you to perform an abortion. The caregiver’s rights are not going to be trampled on, any more than the suicide’s are.
To give a complete, and contrary to my initial desire serious answer to the OP:
[list=I]
[li]Yes, I’d accept the nomination. I’ve known several suicides, and been there when a close relative elected to end care. I’ve spent a fair amount of time thinking on this subject, and I’d want to make sure that the rules were made with due consideration.[/li]
[li]Constraints on the panel that I would require are based my ethics. Note that is only my ethical response to the active solution proposed in the OP and does not consider things like high doses of painkillers given to suffering patients.[/li][list=A][li][list=i][]Formal consent of the individual is required, and no proxy may give this consent. This must be witnessed by a doctor and a JoP, and one other person.[/li][li]There will be a required waiting period of 9 calendar days after the consent is given before to toxin may be administered.[/li][li]The consent must include a day and time for the procedure, if the patient does not show up, the consent is removed. If the patient can show that they were unduly restrained from showing up, the waiting period on the next consent may be reduced to three days. The patient must be offered a place to await the day if they fear that they will be prevented from showing up, the place must have access to common means of communication.[/li][li]Counseling services will be made available to the patient and their family and friends, this service may include monitored meetings between the patient and their family and friends at the patients discretion.[/list][/li][li][list=i][]I will ensure that no constraint is in place where a hold may be placed beyond the waiting period without a finding of incompetence, and that no finding of incompetence may be started after the consent form is signed, nor is the existence of the consent ever admissible as evidence, except to place the signers at the location of the signing, or that the form itself exists.[/li][li]Following on that thought, suicidal ideation is no longer evidence of incompetence.[/list][/list][/li][*]I fear that until this procedure has been around for at least a generation or so that there will be people who are confined by those who would rather have them live.[/list]
a. I accept this nomination. I am extremely angered by the assumption of governments throughout history that a person’s body belongs to society, or their specific king or whatever. While any material possessions one accumulates during life can be partially reasoned to be a part of the state in which one was born into (and thus not wholly yours), the body is solely, completely, utterly self-owned. I will do with my body whatever I want, and because I don’t give a damn about other people’s reasonings since I WILL assume they come from an irrelevent moral, religious, or traditional position.
ii.
a. As little constraints as possible. If you are an adult, you have the right to end your life because it is yours. I would tailor any limitations to this towards the criminal aspect; I don’t want my citizens being blackmailed to commit suicide. However, other than that, I really see no good reason to set any limits. You can be a perfectly healthy 25 year old, lose your girlfriend and want to die, and I’ll welcome it. Hey, its your funeral (literally). I would not make this simply an option of the terminally ill
I don’t really care about diminished capacity either. If one is depressed or crazy, I see that as little reason to deny what the nutjob wants right now. So they might get better, so what? They may get worse. As I am an atheist, I care not for speculations about the afterlife. Once you’re dead, I believe, you don’t have any more opportunity to regret things. So a long life cut short for “bad” reasons is not harmful to the individual himself because he’s not around to grieve for the loss. Death is not bad and is not harmful. Dying may be, but death itself is the cessation of all value judgements. I find the kind of catch-22 absolutely intolerable where one is said to want death only because one is depressed, but if one is depressed he cannot be trusted to make that decision. Bullshit. If you’re depressed and want to die, go for it. You wont be depressed after you die
b. The most difficult issues will arise when people do not have the capacity to ask for death or apply it themselves. That’s a more lawyer-y question than I’m capable of dealing with but I do want the existence of ways in which people can ask for death for someone they are in charge of. I would work hard to ensure that the person asking does not benefit from the death, or benefits little.
I would also make exceptions for children, for if an adult’s body belongs to themselves, then so do childrens’. However, due to biological limitations, children are not completely capable of being their own masters. Yet if a child is in a situation in which life is unbearable, say for example severe pain, then I would make an exception. In those cases, suffering is the only necessary justification I need. I do not want people to be put into a position to say “Suffer some more, it’ll go away later (maybe), because I think your suffering is nothing compared to my discomfort in letting you die”. That is about as horrible a thing as you can say to anyone, anywhere.
iii. I forsee, and hope for, the rather pleasant consequence of people ceasing to value life as some kind of inherent good. Life is neither good nor bad, it just is. You make it good or bad.
I would fear that people who dont believe as I do would brainwash the masses into an opposing point of view, which is about guaranteed. I would fear that religious people would somehow come out of this unharmed because of their idiotic pro-life, anti-death stance. I would fear that people continue to assume their bodies are not their own
So long as it’s being done “under the table,” so to speak, so long as it’s a secret, you have, instead of people (those who are rational, which isn’t always the case) talking about the possibility rationally, a doctor prescribing the maximum amount of morphine she can prescribe without breaking protocol…
and the next one upping it, because protocol indicates you can up it a given % over the previous prescription…
and we go from “we must do everything to keep him ‘alive’, no matter what” to “oops” without a real chance to consider the options.
I would have done it. But Mom (and notice that in the listing I gave, she takes precedence over me) wouldn’t.
And don’t bother “condemn me” for something I did not do. Neither did I have the means nor would I have done it - because Mom did not accept it and the spouse takes precedence over the children. I could put this in other words, but that would take us to the Pit.
By the way, I would appreciate seeing your responses in the concise format the poller provided. So far all I get is that you don’t want this procedure to be available at all, only maybe yes but really no.
Do you accept this nomination?
In reality, no. I don’t have any qualifications, and the panel wouldn’t have any legitimacy in the eyes of the public with me at the helm. In a hypothetical where that sort of thing doesn’t matter . . . well, probably still no, since a total lack of legal and medical experience would probably mean I’m not competent at the job. I wouldn’t have an ethical problem with it, though.
What constraints do you try to place on the procedure?
Not many. There should be consent from the patient himself or, if he is unable to give consent, from someone with durable power of attorney.
Any medical professional who doesn’t want to take part in an assisted suicide may refuse to do so, and such refusal may not be the basis for disciplinary action.
What constraints do you work hardest to keep off the table?
Any limitations on who qualifies. If you want to end your own life, and you’ve found a trained professional willing to help you, it’s really no one else’s business.
A short waiting period *seems *reasonable, but in reality is impractical is a huge percentage of cases. There will be an awful lot of instances in which someone has a matter of hours to live and is in agony; telling them that there’s a three day waiting period on their assisted suicide is a terrible outcome.
What you could do is set it up so that there’s a waiting period only for those whose death is not imminent.
In my example, she doesn’t have hope. You have hope for her. She may well have chances (better meds might come along, a different kind of therapy might work where others have failed, etc.), but she’s tired of waiting and trying. Ultimately, I don’t think this is substantially different from someone with an intractable physical illness - there’s a point where we agree that the person has exhausted the reasonable options.
Now, just because I believe that our hypothetical young woman should be allowed to avail herself of this option, I do not believe that you (or any specific professional) should be required to administer it. We already recognize that individual doctors, nurses, and so forth have significant freedom to choose the kind of procedures that they perform - some OB/GYNs won’t do abortions, etc. However, I’d want to ensure that it’s impossible for a third party to insert themselves, without invitation, into the dialog between a willing professional and a person who wishes to die.
I agree. If you’ve been to see your GP, s/he’s sent you along for a mental proficiency test which reveals you are not being coerced, and someone is prepared to do it, that’s all the authority you should need.
No. An ethics board looks at individual cases to see if the patient in question meets the preset criteria. We are laying down the criteria they will follow. A grey area “what if” question would go before them, and they could decide if the 22-year-old girl with phonyitus qualifies based on our guidelines.
But you have to agree, it could eventually come to that. If everyone has the right to die, all of my patients would have the right to die. Just as many people (myself included) believe that a pharmacy should have to sell Plan B, is it such a stretch to imagine a nurse being called in on disciplinary charges because he or she refused to perform a doctor’s order? After all, they would be denying the patient the right to death.
I honestly had no idea how cavalier this board was toward the subject of suicide. I’m starting to think that if a friend came up to one of you and said that he missed his ex-girlfriend too much and was going to end it, you’d buy him the bullets.
“Phonyitus?” I think that sound I just heard was the sound of your veneer of objectivity peeling off.
No, I don’t have to agree, and I don’t. I believe that pharmacies ought to sell plan B, and I believe that if the pharmacy sells a medication, then all pharmacists working there should be required dispense it if a patient requests a valid prescription. If a pharmacist wants to be assured that he or she will never have to hand over a box of Plan B, then that pharmacist should seek employment at a pharmacy that does not sell Plan B at all. My beef is with the pharmacists who agree to work at a store that sells Plan B but then refuse to dispense it - they are not performing the jobs they were hired to do, and they are preventing their employer from carrying out its stated business.
Similarly, a practitioner who wants to be assured that he or she will never have to be associated, even indirectly, with a case of assisted suicide or euthanasia should seek employment with a facility offers neither. I’m thinking of a hospital whose religious affiliation precludes offering those services, a hospital whose administration has simply decided that the procedures are too controversial, or be a facility that simply doesn’t deal with end-of-life issues (say, a sports medicine clinic). I don’t have any sympathy for a practitioner who doesn’t want to be associated with abortion in any way, shape, or form but who works in a facility where abortions are performed - even if that person doesn’t perform abortions, they may be called upon to prep women prior to the procedure, take women to a room where the abortion is performed, or care for women who have just had abortions.
The board isn’t cavalier regarding suicide so much as it’s fiercely defensive of a right to individual autonomy, privacy, and self-determination.