Friday, November 14, 2008

On Voluntary Euthanasia #1

There are two things on my mind at the moment; euthanasia and party dresses. I got to writing about euthanasia and it got so long it will become two posts, but I'll do the one about party dress in between. If only I could post a cake recipe and some advice on dieting, this could be the blog equivalent of daytime TV!

Truth is that I long ago established that suicide might be one way to go. Much later on, if things get really grim. It is a rather morbid thought for someone who is neither depressed nor in any imminent physical danger, but it means I don't worry too much about future some worst-case scenario in which everything is suffering and pain. Might never happen, but if it does, I shan't be stuck here.

Meanwhile, I believe people should be allowed to do whatever they like with their bodies as long as they don't harm other people. However, the debate on voluntary euthanasia has always troubled me. It is one of those debates where I find myself disagreeing with everyone, so I am going to try and unpick this for myself.

We'll start with something relatively straightforward.

The Sanctity of Life

Human life is very precious, but I have no God to make it sacred. Death may be final, but it is not the worst thing that can happen to a person – which is a relief, since it's going to happen to everyone of us. Yes, maybe even you, should you accidentally eat some garlic or if someone set your alarm clock to go off before dusk. Meanwhile, the value of a life is all about quality, not the number of years, months, weeks or days that it can be sustained. Life-sustaining treatment is not always in an individual's best interests. Nor is it always reasonable; in the UK it is too high to effect many of us, but there is a limit on the resources that can be dedicated to maintaining any given pulse. I don't believe in life at any cost.

What's more, we bring life to a premature close all the time when the dose for effective pain-relief during the end stages of terminal illness becomes deadly. We don't take years away, but maybe a few days of agony here and there. An American friend told me of her childhood preacher who objected to diamorphine on the grounds that dying people could no longer feel the flames of hell licking at their feet and might miss their final opportunity to repent. But that's the only objection I've ever heard of.

If we are happy with this, it seems that there seems no fundamental problem with ending life. There is some argument about a big difference when killing is not the primary intention, but clearly it is regarded as an acceptable side-effect in these very extreme circumstances. It seems to me that in the case of someone who is dying and in great physical suffering but wants to shorten their suffering (and thereby, their life) by months or years, the only difference is one of timescale.

However, not everyone who seeks euthanasia is on their way out.

Manner of death vs. quality of life

There have been two news stories about voluntary euthanasia in the last month. I don't wish to write about individual cases, since these are ordinary people's lives and deaths, but the contrast between them is very important.

One story is about a lady with the sort of MS that can kill you, who says she would like to go on forever but she was seeking reassurances that, should the situation arise, her husband could travel to an euthanasia clinic abroad and not face prosecution on his return. Her case has failed. The other story is about a young man whose parents took him to Switzerland to undergo assisted suicide. This chap was in his early twenties and had been tetraplegic (quadraplegic) for just eighteen months. His parents supported and facilitated his choice in order to relieve their son of what they considered a second class existence. It is unclear as to whether they will be prosecuted.

These two stories demonstrate a big problem for me because one case seems totally reasonable - I instinctively wish that the lady didn't have to travel abroad to do what she wants to do - and the other makes me feel very uncomfortable indeed. One is about the kind of death a person hopes to have, the other is a rejection of a certain sort of life.

The life of someone in the latter stages of a terminal condition is as precious as anyone else's, but having decided that they want to die, it is extremely unlikely that they would change their mind should they survive. There is unlikely to be the time to develop a completely new perspective. The things which might make life pleasurable are only likely to decrease as the things which make life seem intolerable increase.

Someone whose life is not in any danger – especially someone whose condition is stable and might even improve – has a lot more to lose. I don't think there are any statistics on this, but I wouldn't be at all surprised if most people with any kind of acquired impairment, an injury or chronic illness, experience a period of despair. Similarly, people experiencing a nasty divorce, sudden bereavement, a terrible assault, financial ruin, some great personal humiliation or other, are likely to have a spell when they can't see how they could ever be happy again.

But they will be. When people say, “If I went through what you've been through, I would have killed myself,” the chances are that they wouldn't. Most disabled people were once non-disabled and almost all of us survived the change. So why should we condone someone's pessimism just because they have a physical impairment? How is a spinal cord injury different from a broken heart or bankruptcy?

I suppose there are three differences. The first is that we kind of think of non-medical disasters as recoverable from. One's heart is broken, it will heal with time, whereas physical symptoms won't go away. I'm not entirely happy with this. Physical symptoms can often be improved, and most certainly the impact of those symptoms on one's quality of life can be changed completely. Not always, not necessarily, but very very often.

The second difference is that one acquires impairment in a culture which completely accepts the idea that we live a second-class existence. If the whole world believes your life must be rubbish, then your own suicidal feelings on the matter are likely to seem completely reasonable.

But perhaps the most pertinent difference is that something like tetraplegia and certain other conditions, a person who is desperately unhappy about there situation can't escape it without help - or without a terribly painful and degrading death like starvation. We encourage one another to stick it out through the bad times, but there is no law against suicide. Which brings us onto the matter of Human Rights.

Which I shall write about after I've written about party-dresses. I bet you can't wait!


Anonymous said...

Ah, I believe I can help here.

Gluten Free Apple Cake

beat together 175g of margarine and 175g caster sugar. Beat in three eggs (or egg replacer if, like me, the real things don't do you much good). To that mix, beat in two grated apples and 225g of mixed dried fruit and stir in 120ml of apple juice. Sift together 100g rice flour, 150g soya flour, 15ml of gluten free baking powder and half a teaspoon of either ground cloves or mixed spice depending on your taste. Fold this dry mix into the wet mix.

This can be baked in a bread maker if you have such a device, or it can be baked in the oven at 180c/gas mark 4. Let it cook for an hour and a half and then set it aside for 10 minutes before turning it out of the pan.

And my diet plan - don't eat the cake.

The Goldfish said...

Excellent! Now we need one of those adverts for compensation lawyers.

Have you been hurt in an accident at work? Bobo broke his leg when his unicycle skidded on a banana skin. He called Clowns Direct and received a thousand pounds compensation...

Anonymous said...

And, of course, you've already written the relationship advice column. I would say we're turning into Fern and Phillip...but I've never cared for either. Richard and Judy? AJ might get jealous. Pinky and Perky? Far be it from me to ask how perky you are, and I'm certainly not. Even Zig and Zag won't work as they were too energetic. We are truly unique.

Anonymous said...

My own view on voluntary euthanasia is currently a work in progress, so I read your post with interest and look forward to installment #2 :)

Definitely agree with you that there is a big difference between someone who is terminally ill and someone whose life is not in danger. I was totally shocked by the story of the quadraplegic guy... I felt irrationally disappointed that he hadn't given life a bit more of a go, just in case he might have found a way to get used to it, a compensation worth living for.

It was a thought-provoking case anyway, and I tried to discuss it with my bf the other week to see what he thought. Sadly he jumped down my throat immediately - possibly fearful I was about to bring religion into it - but more I think because he genuinely couldn't see that someone who was paralysed might have a life worth living. When I tried to suggest they actually *might* I was told that if I had his insight into caring for disabled children I would never express such a dumb viewpoint. Hmmm.

From what I read in the Swiss press anyway they were all pretty shocked over there when news of that particular case broke, and are potentially going to look at modifying their euthanasia law.

The Goldfish said...

Stephen – I always found Fern Britten rather attractive. Very sensual woman, talks like she's on the verge of laughter all the time, at least so I recall (it is many many years since I've seen any of that stuff). Yes, I think it's fair to say our daytime television programme is quite unique. Especially as it's not on television - talk about innovation!

Radio – Yup, I felt much the same as you about the young man. Particularly because of the short-time span – eighteen months is no time, barely enough time to get over the trauma of it all let alone come to terms with such a different kind of life.

It's heartening to here what you've read in the Swiss press. And yes, I even saw a quote from someone at Dignitas along the lines that this wasn't the sort of thing they had set out to do.

Cusp said...

I can see that the decision by that young man might be seen by some as almost defeat in the face of a great challenge. However, in the end, in a sense, we all choose the life we have and the way we deal with what happens to us. That's what matters for me --- the choosing.

Each person wil react differently to a challenege, no matter what it is and each person will react differently to the sort of accident, injury, illness he may acquire. I don't think any of us can judge that chap's decision any more than we can judge the woamn with MS. We can only say what we'd do and even we don't really knwo until faced with the same situation. I know people who have levels of disability as great or greater than his. Some are content, making lives, seeing opportunties where some can only see gloom and despair.

On a lighter note, thanks for the recipe Stephen. I shall knock up a cake tomorrow in the bread maker and to hell with any diet ;0)

The Goldfish said...

Cusp, this isn't about judging how the young man felt - I think it was a pretty normal way to feel and given his feeling, a natural way to behave. I also wouldn't want to say anything about his folks, who must have done what they thought was the right thing and it must have been horrendous for all of them. However the matter at hand is whether or not something should be allowed in law in this country.

I'll get onto this in the next post on the matter, but we wouldn't accept the assisted the suicide of a non-disabled person who felt that their life had been ruined for any reason. In fact, we'd do everything we could to prevent it. But I'm not done yet, I'm not certain about any of this stuff to be honest.

Tayi said...

I'm looking forward to your second post on this topic. The idea of assisted suicide is one that I've been thinking about lately, since there was a bill up in the recent election in my state to make it legal for someone with a terminal diagnosis to obtain medication specifically for the purpose of suicide. I voted for it, and the bill passed, but I still feel conflicted about it.

On the one hand, I know how bad pain can get, and I know what a load of crap it is when doctors promise that they can control pain and make you perfectly comfortable so you would never feel that your suffering is so great that you'd rather die. Pain is real and significant and like you, I think that there is a point where I would rather be dead than in more pain, and I'm comforted by the thought that I have a way out if all else fails. And I absolutely believe that people have the right to do whatever they want, for whatever reason, with their own bodies as long as they're not harming others.

But on the other hand I wonder if people will feel pressured to just die and get it over with for convenience or because their insurance won't pay for radical treatments to try to preserve their lives. I guess you don't have to deal with insurance in the UK, and maybe someday it won't be an issue here in the US, but for now it's a big factor. And I wonder too if assisted suicide remained illegal if it would be somewhat easier to encourage research into pain relief and such.

So its a tricky question, and I look forward to hearing the rest of your thoughts.

Mary said...

Also looking forward to the next instalment. It's a tricky topic.

I fear I've spotted a typo which I wouldn't mention except if it IS a typo, it's a significant one, and if it ISN'T, then I've misunderstood the gist of the paragraph... first paragraph about "Sanctity of Life", you've said "Life-sustaining treatment is always in an individual's best interests" and I feel sure you meant to put a "not" in there somewhere.

Cusp said...

Well I think it IS about how people feel and how they should be allowed to act upon those feelings and feel safe (and their relatives should feel safe) within that law - disabled or not, requiring assistance or not.

The Goldfish said...

Thank Tayi, yes having socialised healthcare must make a difference, and also fairly good social services. That is to say, if you're sick, even if you have no money or family to support you, the roof over your head, the medicine you need and some standard of care is guaranteed - even though people don't always get what they are entitled to. Certainly here, the decision to die is much less likely to be an economic one than in a society where both medicine and assistance is the responsibility of individuals and their families.

Thanks Mary and yes, well spotted! I shall correct it next time when I publish my nonsense on party dresses.

Thanks Cusp, yeah, I share your feeling about this, but I think it's more complicated - I'll get to that very shortly.

Gone Fishing said...

Maybe I look from another side.

I have lived with a degree of different ability all my life and the challenges that presented have made life an interesting and always dangerous and adventurous course.

I have achieved many things apparently I should never have been capable of and am still "happy"

Possibly because I am not really aware of any different form of "normality" or what it is like to be without pain.

Years ago I was also diagnosed as having developed a sensitivity to chemicals I had worked with and later to brain injury resulting from the same expsoure.

I guess the dangers of being confined to "Mental" rather than physical pursuits and occupations.

I possibly would not mind if it was I who considered euthenasia as a way out.

But having seemingly some of the Accident compensation system staff at times provide me with conditions which may well have ended my life (Mainly to hide apparently fraudulent alterations to files to gain bonuses or KPI's).

One does wonder IF euthanasia were legally sanctioned, just who would really make the decisions as to who died.

and for what reasons.

and where would as always the lines of discriminating between who should live and who should die be drawn??

Once dead you can no longer look out and enjoy that magnificent view of the mountains.

Sort of what a world renowned Cinematographer said on Telly of his Sons suicide last night

The Goldfish said...

Gone Fishing,

"Once dead you can no longer look out and enjoy that magnificent view of the mountains."

That's exactly it.