Euthanasia in the news again

[Borachio]

It also seems like you're okay with someone being given so much painkilling medication that it kills them (which is what end of life palliative care actually consists of), but aren't okay with that same person asking for something which specifically kills them. What's the important distinction here to provoke such passion?

My understanding is that this is simply not true. Indeed, quite the reverse - painkilling medication and sedation can actually prolong life. Not by much to be sure, but there's no reason to think it will shorten it.

For the rest of your post, and for Andvare's, I shall have to consider some more. And if you prefer that I keep quiet, please say so. I have no wish to have the last word on this issue.

(And I wondered when the esteemed Mr T.P. would make an appearance.)

 

[Arwon]

Nah, it's a thing.

The doctrine of double effect

This doctrine says that if doing something morally good has a morally bad side-effect it's ethically OK to do it providing the bad side-effect wasn't intended. This is true even if you foresaw that the bad effect would probably happen.

The principle is used to justify the case where a doctor gives drugs to a patient to relieve distressing symptoms even though he knows doing this may shorten the patient's life.

This is because the doctor is not aiming directly at killing the patient - the bad result of the patient's death is a side-effect of the good result of reducing the patient's pain.

Many doctors use this doctrine to justify the use of high doses of drugs such as morphine for the purpose of relieving suffering in terminally-ill patients even though they know the drugs are likely to cause the patient to die sooner.

Everyone on all sides of the euthanasia debate needs to be able to engage with the fact that sometimes reducing pain also involves killing a patient and that there is a form of euthanasia already going on everywhere there is palliative care. From the pro-euthanasia side perhaps this means we don't need explicit legalisation of euthanasia after all. From the other side, it certainly means that absolute statements about the sanctity and dignity of life need to be qualified somewhat.

If you want to defend this practice as distinct from more active euthanasia then fine, there's certainly a distinction to be made. But if your goal is to maintain and extend life then you have to accept that this often isn't medically compatible with reducing suffering. The two things are necessarily in conflict. If maintaining life and reducing suffering were always compatible then there actually wouldn't even be a euthanasia debate.

 

[Borachio]

On the other hand:

sedatives and opioids are known to decrease the demand for oxygen in patients with cardiorespiratory distress

To get back to the specific topic of the thread:

Here's a good argument:

http://www.hawking.org.uk/

Here's another:

http://www.livingwithdignity.info/

 

[Arwon]

Disability and terminal illness are different things. What are you suggesting that the existence of people with disabilities in general has to say about people who are dying and want to control how that happens?

I mean yeah some disabilities also bring pain and early death but the two things are not co-terminous. Euthanasia isn't just, or even mostly a debate about people with debilitating disability. So can you clear up your view on the dying seeking euthanasia? Euthanasia in non-terminal situations is a different discussion to euthanasia, period.

It is way too convenient to just be all ''well we don't need euthanasia to alleviate suffering because painkillers make you live longer anyway." If that were the case why would the right to die for the terminally ill even be an issue? Why would the doctrine of double effect ever be needed by doctors?

 

[Borachio]

Disability and terminal illness are different things. What are you suggesting that the existence of people with disabilities in general has to say about people who are dying and want to control how that happens?

I mean yeah some disabilities also bring pain and early death but the two things are not co-terminous. Euthanasia isn't just, or even mostly a debate about people with debilitating disability. So can you clear up your view on the dying seeking euthanasia? Euthanasia in non-terminal situations is a different discussion to euthanasia, period.

I believe we are all disabled, to a greater or lesser extent, and have a terminal illness. And I don't see how you can untangle the two in any absolute way.

Notice that Baroness Campbell was diagnosed with spinal muscular atrophy and given a prognosis that she would not live to reach the age of two years.

Living with dignity requires us to both take control of our lives and to enable others to do the same by offering and receiving the right support when needed. Life presents many problems, solutions are seldom easy but they are always there when we are willing to look hard enough.

Notice too that Hawking has motor neuron disease, the same as the man Sir Terry Pratchett was talking to.

It is way too convenient to just be all ''well we don't need euthanasia to alleviate suffering because painkillers make you live longer anyway." If that were the case why would the right to die for the terminally ill even be an issue? Why would the doctrine of double effect ever be needed by doctors?

It is an issue because the media has made it one.

It is just such an easy topic to pick on - preying on people's fears of dying and dying in pain.

I don't believe death or pain are anything to fear.

BUT my opinions are simply that. YMMV

 

[Arwon]

So now we of course get to the question about why what you believe should be the basis for the law, as opposed to individual choice being the basis of law. YMMV implies that you recognise other people feel differently, so why shouldn't the law respect that?

If you believe death and pain are nothing to fear, then don't get euthanised. But if someone else believes their last painful months/weeks/days/moments aren't worth living, then why prevent them from exercising their choice?

 

[Borachio]

Why do I get the feeling you're having a dig at me?

This is an absurd - and highly entertaining - accusation.

No one takes any notice of anything I say.

The legislators make their own minds up on the basis of far more information and intelligence than I have at my disposal.

I could ask you the same question.

 

[Arwon]

Your view is currently the law, and it's therefore enforced on everyone. People are prevented from seeking to be euthanised to alleviate unbearable pain and indignity due to the law that says they can't ask for euthanasia. This is a law which is premised on exactly the sort of dignity of suffering and absolute value of life extension which you're espousing.

If euthanasia were legal, you'd still be free to have this view and live by it, but other people would be free to exercise their choice too.

 

[Borachio]

Hmm.

So when you're terminally ill, say, and the doctor comes and explains to you you are legally entitled to end your life prematurely, what do you say? You would feel no pressure either way? Your choice could be entirely uninfluenced, do you think? I don't know whether this situation would ever arise or how it would be handled or whatever. I give in. Have it your way.

How does a person seeking euthanasia for terminal cancer differ from a person seeking suicide for depression?

Imagine a person on top of a building ready to jump. Do you say to them "go on, this your choice"?

(There is no dignity in suffering, per se, IMO. Suicide as a cure is a bit OTT.)

 

[Arwon]

I don't think a doctor mentioning it would be the overriding determinative factor, no. That's just silly. The existence of legalised euthanasia is not an inducement to seek euthanasia. I think you're rather radically under-estimating how severe the pain and indignity of end of life situations can be, if you think that conversation is going to be a more powerful motivator. Furthermore, no conversation about euthanasia or assisted suicide is anywhere near that flippant - that's a strawman. It's expected to be a detailed and considered discussion.

And yeah, suicide outside of near death and severe pain contexts, that's a different conversation. At the very least, there's absolutely more rational and less rational reasons to want to end one's life. I think it's a bit insulting to suggest that the terminally ill patient looking at a few months of increasing agony and indignity is as irrational and unjustified in wanting to die as, say, an investment banker who's just lost everything standing on a bridge.

Moreover, it doesn't take much more than a basic theory of mind and a little bit of professional medical judgement for responsible people within a medical setting to distinguish someone who wishes to die due to pain and suffering (that they know won't get better) from someone who is suicidally depressed and requires treatment for that. The legality of euthanasia doesn't mean everyone who vaguely says "I want to die" is a candidate for euthanasia.

And actually, on a side note, the conversation about how severe, permanent, debilitating and unbearable some mental disorders can be (we know major depressive episodes are temporary, but I'm thinking of severe bipolar and skizophrenic disorders for instance) needs to be had. Some of them are absolutely as crippling as the sort of physical illnesses that lead some people to seek euthanasia. Bit of a furfy really, though, because even though there's an argument about how justified someone in this situation is in killing themselves, there's no impediment to fully able-bodied people killing themselves without assistance.

There is, however, an existing legal impediment to people we know are suffering horribly and we know have a valid wish to die, in exercising that choice. Instead the best they can hope for is slipping into a morphine coma, never to awake, since currently a doctor can legally do no better than follow the doctrine of double-effect regardless of patient wishes.

 

[Borachio]

I don't think a doctor mentioning it would be the overriding determinative factor, no. That's just silly. The existence of legalised euthanasia is not an inducement to seek euthanasia.

I rather think it is.

I think you're rather radically under-estimating how severe the pain and indignity of end of life situations can be, if you think that conversation is going to be a more powerful motivator. Furthermore, no conversation about euthanasia or assisted suicide is anywhere near that flippant - that's a strawman. It's expected to be a detailed and considered discussion.

No. I don't think my experience leads me to under-estimate the severity.

Yes, I would expect a detailed and considered discussion. Just that once one is begun, the longer it goes on, the more difficult it becomes to get out of it. (I can well imagine.)

And yeah, suicide outside of near death and severe pain contexts, that's a different conversation. At the very least, there's absolutely more rational and less rational reasons to want to end one's life. I think it's a bit insulting to suggest that the terminally ill patient looking at a few months of increasing agony and indignity is as irrational and unjustified in wanting to die as, say, an investment banker who's just lost everything standing on a bridge.

Moreover, it doesn't take much more than a basic theory of mind and a little bit of professional medical judgement for responsible people within a medical setting to distinguish someone who wishes to die due to pain and suffering (that they know won't get better) from someone who is suicidally depressed and requires treatment for that. The legality of euthanasia doesn't mean everyone who vaguely says "I want to die" is a candidate for euthanasia.

And actually, on a side note, the conversation about how severe, permanent, debilitating and unbearable some mental disorders can be (we know major depressive episodes are temporary, but I'm thinking of severe bipolar and skizophrenic disorders for instance) needs to be had. Some of them are absolutely as crippling as the sort of physical illnesses that lead some people to seek euthanasia. Bit of a furfy really, though, because even though there's an argument about how justified someone in this situation is in killing themselves, there's no impediment to fully able-bodied people killing themselves without assistance.

You do realize, I hope, that suicide, under all conditions, is incredibly difficult.

There is, however, an existing legal impediment to people we know are suffering horribly and we know have a valid wish to die, in exercising that choice. Instead the best they can hope for is slipping into a morphine coma, never to awake, since currently a doctor can legally do no better than follow the doctrine of double-effect regardless of patient wishes.

I guess we can agree to differ. I am in favour of the legal impediment. You wish to remove it.

I can only reiterate that suicide is a very poor solution to any problem. Legalizing, or rather institutionalizing, it can, I fear, only make the discovery of better solutions less likely. Or the impetus to such discoveries may (or must) be to some extent lessened.

 

[Arwon]

That would tend to suggest, for example, a policy of keeping people who are terminally ill chained down so they can't try to commit suicide themselves. It would also suggest there should be less morphine given to people who are dying and in pain.

 

[Borachio]

Now, we're straying into areas where my knowledge is definitely lacking.

Medical ethics is dodgy ground for the amateur. I have heard of people with learning difficulties being strapped to the bed for their own good - in medical situations. A practice more common in continental Europe than in the UK where sedation tends to be preferred - and sedation is possibly not as good for the patient.

On the subject of morphine, I can't see much to object to with giving patients enough to handle their pain even if that hastens their end - in the absence of a better alternative. The primary focus must be the alleviation of suffering, of course. I think on this we can agree.

 

[Akka]

@dirtyparrot Baring sudden death, we all are following in their footsteps.

When you're paralyzed and unable to move and can only wait, doing nothing for years, maybe you'll change your mind.

Anyway, it's their own life, and if there is something someone possess in its entirety and should never be overruled about, it's his own life.

 

[El_Machinae]

@dirtyparrot Baring sudden death, we all are following in their footsteps.

Hence, my cry to be pro-active.

 

[Borachio]

@ Akka I can't answer this without repeating myself extensively, so, if you don't mind, I won't.

edit: no, I really can't see anyway of answering you satisfactorily without rehashing everything I've already said.

 

[aelf]

So when you're terminally ill, say, and the doctor comes and explains to you you are legally entitled to end your life prematurely, what do you say? You would feel no pressure either way? Your choice could be entirely uninfluenced, do you think?

Are you also anti-abortion? I don't recall.

 

[fishjie]

its so ludicrous that religious people are against stuff like euthanasia. its similar to their opposition to gay marriage. people have a right to do what they want to, so dont impose your morals (or lack thereof) on them. if you think its a sin, that's great. once they die, god will torture for an eternity in hell, so who cares? you'll get to gloat on in heaven.

perhaps, just perhaps, if you were in as much horrific pain and suffering as some people who wanted euthanasia, you'd understand. don't worry jokes on them, cause god will make em burn in hell and experience even more pain after they suicide! roflz!!!

 

[Traitorfish]

Are "religious people" against euthanasia, gay marriage, or anything else? They're not a homogenous bloc, and you'll find far greater political variation within that category than you will between most religious people and most non-religious people.

 

[aelf]

perhaps, just perhaps, if you were in as much horrific pain and suffering as some people who wanted euthanasia, you'd understand. don't worry jokes on them, cause god will make em burn in hell and experience even more pain after they suicide! roflz!!!

Come on, don't make Borachio repeat himself. We all know it's a fate worse than death.