Sunday, May 14, 2006

Euthanasia

Apologies for the lack of posting: your humble Devil has been ridiculously busy on a number of Content Management System projects—which he has actually been enjoying—and so blogging has been a wee bit light. Also, there seems to be little exciting happening in the world. So, inspired by Timmy, euthanasia seems a fun topic to address.

Unlike Master Worstall, I am generally in favour of euthanasia. As you know, I have worked with people who have the most appallingly crippling conditions. One of these people was a 29-year-old with multiple sub-arachmoid haemorrhages. He was unable to feed himself, walk, or even to read a book and, by the time that I finished working at the home, his wife had left him. There was no hope of recovery, and almost no hope of any kind of meaningful improvement. The prognosis was, as they say, not good and he could live for another forty years like that (I do not actually know whether he is still alive), but he was not actually, actively dying.

Tim refers to Dr Crippen, writing on the same subject (ironically, given his posting name).
I have looked after more terminally ill patients than I care to think about and, as I get older, it gets more and more difficult. I have never killed a patient. I have never been asked to kill a patient.

Doctor Crippen is rather luckier than I was: my patient asked me a number of times if I could kill him. I could not—I had no access to drugs—and would not (I have no desire to go to prison for murder). It was a slightly invidious position in which to place me, but I cannot blame him: I would want to be given the option to die if in the same position.

Whilst I appreciate that legislating to allow euthanasia is a very slippery slope, I would love to try to find a compromise. Indeed, I must attempt to find one in my own mind: I could not live like my patient. But I must find a workable compromise for, one day, that person pleading repeatedly for death might be me. It is not, as Dr Crippen says, that dying is a bugger: it is that living is.

7 comments:

Longrider said...

This is one where I think Tim is being too rigid. I don't think it is a slippery slope when someone is sufficiently compos mentis to make a rational decision about their own quality of life. It does not mean that we are stepping towards bumping of the over 75s because they are clogging up the health system, which seems to be the way the argument is leading...

My fist of flounce said...

Something that sticks in my mind regarding this debate is that when Dr Jack Kevorkian was doing his rounds in the nineties, 75% of all people he put to death were not terminal cases. He believed he was acting responsibly. I think the slippery slope consists of others gradually believing themselves acting responsibly as well, no matter how morally deleterous this may seem to the rest of us.

Dr John Crippen said...

Hi DK

I can go with the emotional call of saying that sometimes life is so intolerable that suicide is a reasonable solution. I don't think that doctors should do it, that's all. Someone else should. It is not difficult.

Much more interesting, from the academic and legal standpoint, is how do you draw up the rules.

Let us assume that you and I agree that assisted suicide should be allowed, draw me up the protocol which facilitates is but also prevents abuse.

It is not easy


John

Katy Newton said...

John,

There isn't one.

If you permit assisted suicide then you have a choice between leaving it in the hands of the doctors (subject to informed consent from the patient) or in the hands of close relatives or perhaps people nominated under a living will. I imagine no one would seriously suggest that it should be left in the hands of close relatives because the potential for abuse is just overwhelming.

That leaves doctors. I don't know how much time Longrider has spent in geriatric wards recently, but I watched my grandmother die in one and was appalled at the way patients complaining of mild pain (as in the patients described the pain as mild and were quite perky and talkative) were put on huge doses of morphine. My grandmother was one of those. At 3pm she was talkative and bright, an hour later she was put on a morphine pump and she died later that evening. Geriatrics are already dying because doctors decide that their lives are not worth living. Geriatrics are a strain on NHS resources. It may start with assisted suicide on an informed consent basis only, but I have no doubt that it will lead eventually to doctors being allowed to pick and choose between their patients.

I agree that it is a very difficult situation for terminally ill or profoundly disabled patients who want a quick end of their choosing.

Katy

Devil's Kitchen said...

John,

As Katy said, it is possible that there really isn't a protocol. My gut feeling is that, in some extreme cases, assisted suicide should be an option.

However, I can completely understand your reluctance to be the one to do it, and I also realise that - given the inevitable abuse - that there is probably no protocol that we can draw up.

Thus I find myself in the bizarre position of being in favour of euthanasia, but against legislating for it.

DK

Tim Worstall said...

Oddly, rather than being too rigid on this I’m actually not being rigid enough.
I’m well aware that euthanasia already happens. I just don’t want it to become legal so that it becomes more prevalent.
As far as I can see the current system is that it is illegal, we all know it happens and much of it is imply not mentioned.
Occasionally a case is prosecuted (I remember one in the 80s where a doctor killed, quite deliberately, someone with, was it a type of arthritis? and was tried.)
Then it’s up to a jury to decide: Murder, manslaughter, or good medical treatment.
That Doctor was found to have provided good treatment BTW.
This is a fudge, it’s a very British compromise, and I think it’s exactly what we should stick with.
There is no possible protocol that doesn’t take us down that slippery slope. We’ll just have to leave it as it is, a fudge, with the might of the law ready to come down on those who go too far and a lot of winking and nudging about whether it happens at all.
Some things, including the way we go out of it, simply cannot be solved in this life.

Katy Newton said...

In relation to what Tim said, generally speaking if a relative is convicted of manslaughter for having effectively assisted the suicide of a profoundly disabled or terminally ill person, they would be very, very unlikely to go to prison and I agree with him that it is a very British compromise. In a situation where it is clear that that has happened I understand that the CPS would usually charge manslaughter rather than murder on public interest grounds. It's the law's way of acknowledging that there are circumstances in which killing someone may be understandable, without taking the further and (in my view) very wrong step of saying that it is acceptable. Thin line, I know, but I think it's right.

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