Suicide and Voluntary Euthanasia

[Julia]

Dink,

Great post. Thank you.

However, not all situations work out as easily as you suggest. My late grandmother had a very healthy cardiovascular system, no cancer or other disease, but was completely incapacitated by a form of arthritis which meant she was in pain all the time, couldn't wash or feed herself, or get to the toilet.

Her doctor told her she could live for many more years like this. What pleasure did she have in life? All our reassurances that she wasn't a burden were completely irrelevant. She was in her late 80's and simply had had enough. What would you suggest as a solution for her?

NB She eventually managed to crawl outside to where a discarded old laundry tub had filled with rainwater and drowned herself. I found her some hours later with the flies crawling all over her.

Julia

 

[2020hindsight]

Dink, Great post. Thank you. ... grandmother ... What would you suggest as a solution for her? Julia

Dink - thanks for clearing up voluntary, passive, active - you're right - unless we define our terms, it's useless to argue.

BTW http://en.wikipedia.org/wiki/Euthanasia gives:-
Euthanasia (from Greek: ευθανασία -ευ, eu, "good", θανατος, thanatos, "death") is the practice of terminating the life of a person or an animal because they are perceived as living an intolerable life, in a painless or minimally painful way either by lethal injection, drug overdose, or by the withdrawal of life support. Euthanasia is a controversial issue because of conflicting religious and humanist views.

BTW also, I just wish that this thread was simply called "Euthanasia", (implying merciful release) - important that we downplay the S word - "unnecessary euthanasia". Happening every 4 days in the bush
Please, folks out in the bush - keep hope.

A bloke at work scribbled down some notes (not even complete quotes) he'd collected. Maybe some are relevant to folks in distress?.
- for whereever life can be, it is
- 'precisely', he said, 'precisely'! And he really seemed to mean it.
- the fate of a puddle on a summer's day
- we would better call our planet not earth but water
- like a whirlwind spinning through a junkyard and leaving behind a fully assembled jet
- over and over , year after year.

Now these are not even complete thoughts !! - (intentionally so ) - but maybe you can fit em together in a constructive way.

Here's a concept as well:- from a quote I found and posted on the depression thread. (where there are many excellent positive thoughts expressed.)

Found a quote on http://www.wisdomquotes.com "The best remedy for those who are afraid, lonely or unhappy is to go outside, somewhere where they can be quiet, alone with the heavens, nature and God. Because only then does one feel that all is as it should be and that God wishes to see people happy, amidst the simple beauty of nature...."

If I tell you the author I think it will mean more....(Anne Frank)

 

[Knobby22]

Dink,

Great post. Thank you.

However, not all situations work out as easily as you suggest. My late grandmother had a very healthy cardiovascular system, no cancer or other disease, but was completely incapacitated by a form of arthritis which meant she was in pain all the time, couldn't wash or feed herself, or get to the toilet.

Her doctor told her she could live for many more years like this. What pleasure did she have in life? All our reassurances that she wasn't a burden were completely irrelevant. She was in her late 80's and simply had had enough. What would you suggest as a solution for her?

NB She eventually managed to crawl outside to where a discarded old laundry tub had filled with rainwater and drowned herself. I found her some hours later with the flies crawling all over her.

Julia

That is a very sad story, but isn't the question really what could have been done to make her life more bearable?

She should have been offered better pain therapy and government help. For instance it is a well known practice in Canada to adjunct the pain medicines with marihuana (not yet legal in Australia unfortunately).

Unfortunately for your grandmother treatments have improved greatly over the last ten years but she world have had the disease well before that so the disease would have progressed cruelly.

Like anything serious, the answer to the euthanasia question is grey. I am very scared of lawyers, pschycholigists and burocrats ruining my last days, so I am afraid I agree with commentators like Terry Lane of the "Age" that governments should not be involved with personal issues such as death but need the power to prosecute evil people who kill their elderly to gain money.
Maybe this gives a clue as to how it gets resolved.

The other problem is where families do not want a relative to go and yet have to be complicit in their death and have all the guilt associated with their failure to make the persons life bearable.

Another example is where a person may be suicidal and she should be encouraged to seek treatment.

Possibly there is a way to legalise euthanasia, maybe we could have special locations where it happens so that protocols could not be abused. It is such an issue fraught with dangers, abuses and problems.

It is a difficult problem requiring a great understanding of human nature, we are getting closer to a solution but I would need to be convinced that the solution is the right one.

 

[Julia]

Knobby,

The short lived legislation in the Northern Territory some years ago was working well until the fundamentalist Christians in the Federal Government over-rode the Territory's laws.

Re my grandmother: She could tolerate the pain. What she could not tolerate was the loss of her dignity with every minute function having to be assisted. She had been an active, capable person all her life, and found her complete dependence intolerable. There was nothing wrong with her mind or her capacity to make rational decisions.

Other than religious convictions, I simply don't see why anyone would want to deny a person of this age, a peaceful, assisted death.

Julia

 

[Knobby22]

Julia

I have no religous convictions and maybe the NT leglislation was the answer.
In any case, even if I did have religous convictions, I do not see why they should be forced on to other people.

Maybe the way forward is a trial such that occurred in the NT where the results could be analysed and peoples fears (such as mine) could be shown to be false.

This to me would be a great way for a political party to go forward on this issue rather than an out an out allowing euthanasia to occur and uninteded consequences occurring.

Governments often get it wrong before they get it right.

 

[nioka]

Governments often get it wrong before they get it right.

That should be "governments get it wrong more often that thay get it right"????????

 

[Julia]

Julia

I have no religous convictions and maybe the NT leglislation was the answer.
In any case, even if I did have religous convictions, I do not see why they should be forced on to other people.

Maybe the way forward is a trial such that occurred in the NT where the results could be analysed and peoples fears (such as mine) could be shown to be false.

This to me would be a great way for a political party to go forward on this issue rather than an out an out allowing euthanasia to occur and uninteded consequences occurring.

Governments often get it wrong before they get it right.

Knobby

Agree entirely. If the NT legislation and practice had been allowed to continue for a few years, then a reasonable determination could have been made as to how ethically it was working.

Julia

 

[Dink]

The only benefit to legalisation (or decriminalisation) is that it promotes greater consultation between treatment teams (and possibly families) without the risk of legal action. From memory I believe studies have shown that the rate of euthanasia in the Netherlands decreased following decriminalisation and may in fact be less than in countries in which euthanasia is not decriminalised. However I reiterate that doctors in Australia have enough legal protection to act humanely and in the best interests of their patients.

In response to Nioka's post I am sorry to hear that her grandmother sufferred as she did. Every case must be treated on an individual basis. I will not comment on your grandmothers situation as I simply do not know enough.

Essentially all cases are very complex. I would like to think in this day we would treat any persons pain effectively and keep them comfortable. Manage any psychological problems. Have infrastructure and services in place to care for them without giving her any suggestion that she is a burden on society. If they still wished to bring upon their death quicker they could request life sustaining measures etc. be ceased (which includes nutrition).

Our understanding of pain and acknowledgment of it has improved greatly over the last 1 to 2 decades. Gone are the days when pain was expected and to be endured until it subsides. Pain is treated promptly and often without question (unless drug seeking is possibly). Studies have shown that if acute pain is treated effectively the development of chronic pain (and the psychological component that makes it much worse) is much less.

Another point that is often overlooked is who will perform the act of euthanasia if it is legalised? Would there be specialists (maybe euthanologists). You must remember that while some doctors are more altruistic than others, all (well I hope all) entered medicine with the aim to help people. The hippocratic oath itself states "I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect". I for one did not get into this profession to perform such acts or have it expected of me to do so.

 

[chops_a_must]

Essentially all cases are very complex. I would like to think in this day we would treat any persons pain effectively and keep them comfortable. Manage any psychological problems. Have infrastructure and services in place to care for them without giving her any suggestion that she is a burden on society. If they still wished to bring upon their death quicker they could request life sustaining measures etc. be ceased (which includes nutrition).

So anorexia patients are allowed to refuse food are they? I didn't know that.

 

[Dink]

No unfortunately. I forgot to add the competent part. A competent patient can refuse anything they want. Anorexia nervosa is an extremely complex condition which is primarily a psychological illness with severe physical manifestations. They are not aware of the risks/benefits and consequences of their actions. Their beliefs about their own self worth and physical appearance are erroneous. If their psychological issues are corrected their aversion to food resolves.

 

[Dink]

Just as we would not simple allow someone who is depressed to commit suicide if we could prevent it. We would treat the depression...

 

[chops_a_must]

I knew that. But really, when it comes down to it, doctors can pretty much put a treatment order on anyone if they are doing harm to themselves. Technically, they should even if someone is dying.

 

[coyotte]

Hi Julia

My reasons, logic and arguments supporting pro-life are more that adequately covered in the RU486 thread.

For me, nothing changes in this thread.......sure there will be people who disagree with my views just as there will be people that agree with me....and I don't have a problem with that.....I'm not trying to change anybodys' views but just giving food for thought to those who might be undecided one way or the other.

But a sobering background thought I pose to those who might be considering supporting suicide and/or euthenasia is that I bet they hope they are right and that I and those who support my views are wrong because eternity is a very, very, very long time to be suffering in hell or whatever for getting it wrong for the relatively miniscule 80 odd years on average we spend in this life

Anyway, just my food for thought and if anyone would like to discuss my views any further then all I can do is refer them to the RU486 thread because I cannot add anymore here than what I posted there.

cheers

bullmarket

Well my answer to the question you pose is YES !
By the very description you offer , I must be AWARE to be suffering -- hence I must be alive ! --- hence ETERNAL LIFE , compared to the opposite which by your argument must be obliviation .

Cheers

 

[Happy]

Setting bait to find out who BullM is now?

 

[Julia]

The only benefit to legalisation (or decriminalisation) is that it promotes greater consultation between treatment teams (and possibly families) without the risk of legal action. From memory I believe studies have shown that the rate of euthanasia in the Netherlands decreased following decriminalisation and may in fact be less than in countries in which euthanasia is not decriminalised. However I reiterate that doctors in Australia have enough legal protection to act humanely and in the best interests of their patients.

In response to Nioka's post I am sorry to hear that her grandmother sufferred as she did. Every case must be treated on an individual basis. I will not comment on your grandmothers situation as I simply do not know enough.

Essentially all cases are very complex. I would like to think in this day we would treat any persons pain effectively and keep them comfortable. Manage any psychological problems. Have infrastructure and services in place to care for them without giving her any suggestion that she is a burden on society. If they still wished to bring upon their death quicker they could request life sustaining measures etc. be ceased (which includes nutrition).

Our understanding of pain and acknowledgment of it has improved greatly over the last 1 to 2 decades. Gone are the days when pain was expected and to be endured until it subsides. Pain is treated promptly and often without question (unless drug seeking is possibly). Studies have shown that if acute pain is treated effectively the development of chronic pain (and the psychological component that makes it much worse) is much less.

Another point that is often overlooked is who will perform the act of euthanasia if it is legalised? Would there be specialists (maybe euthanologists). You must remember that while some doctors are more altruistic than others, all (well I hope all) entered medicine with the aim to help people. The hippocratic oath itself states "I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect". I for one did not get into this profession to perform such acts or have it expected of me to do so.

Dink

It was my grandmother, not Nioka's.

I appreciate your point of view as a doctor. However, I'd sincerely suggest that your quoting of the hippocratic oath is somewhat of a "cop-out" for your own personal stand on this question. And you are absolutely entitled to such a stand.

You have previously said that a form of euthanasia is commonly carried out by means of increasing doses of pain relief which as a side effect only may cause death, presumably largely because of respiratory failure.
The fact that you are completely happy with this, because it can be seen to be "justified" seems to me to be somewhat unfair to the patient who is suffering from a condition for which narcotics would not normally be prescribed. So effectively you are deciding which category of patient may be assisted to die (and yes, that's what is happening) and which may not.
Is that really fair? Did you become a doctor in order to have this sort of power over who may suffer and who may not?

And, underneath all of this quasi symptomatic treatment there is the fundamental question of a perfectly rational person simply deciding that they have made their contribution to this life, have nothing more to offer, are old and will never get better, and would just like a dignified and peaceful end.
If someone is determined to die, they will do so. I simply don't feel they should have to resort to such dreadful means as I described with my grandmother. And for you to suggest that starvation is an acceptable alternative is astonishing to me. (Remember the fiasco with the Terry Shiavo case in the USA?)

Your point about "who will be the "euthanologist" is well made. Where a patient is past the point of being able to swallow tablets or liquid, the involvement of a physician would seem necessary.

How do you feel about the Northern Territory legislation? Was that, with all its referrals and safeguards, acceptable to you.

Julia

 

[Bobby]

Well Dink,

Whats you thoughts to Julias post, many are waiting your responce.

Times are going to change we hope , don't let yourself fall into the hystere'sis area

Bob.

 

[2020hindsight]

Maybe Dink - (in addition to Julia's questions) - your opinion of Nitschke - who to me comes across as a very ethical and empathetic person.

......http://www.smh.com.au/articles/2002/12/03/1038712920730.html This ffrom Dec 2002:-
"The commonest way people over 75 die in our society is by hanging themselves," Dr Nitschke told ABC Radio today.

Machines such as the COGEN would not be necessary if governments changed laws on euthanasia.

"They won't bring in a law," he said.

"They make the access to the best of the drugs, nembutal (a barbiturate), impossible and then they carry on about this being a gruesome death," Dr Nitschke said.

"They are such hypocrites."

In July, Dr Nitschke announced the production of plastic bags with drawstrings which people could put over their heads to euthanase themselves.

Dr Nitschke has been conducting a series of workshops in north Queensland over the past few days.

Discussions at the meetings have covered palliative care, psychiatric illness and depression, drugs and the ramifications for friends and family members present when people take their own lives.

Last month, a Northern Territory court ordered the return of Dr Nitschke's records seized by Queensland police investigating the death on May 22 of Gold Coast grandmother and cancer sufferer Nancy Crick.

Dr Nitschke had been facing charges over the death of Mrs Crick, whose death was witnessed by 21 people. etc etc

 

[Dink]

Hi Julia,

First I would like to apologise for the mix-up and hope this did not offend.

I do not think euthanasia (or assisted suicide) laws need to be changed in Australia. I am not against decriminalization/legalisation of euthanasia or assisted suicide and I am not ethical opposed to euthanasia. My indifference is more from a practical standpoint. Prior to studying medicine I was definitely in favour of the NT laws. But I believe this was largely due to ignorance despite writing a couple of essays on the topic. However as you move through the profession you start to see the various options available and the various other ways in which you help people that does not involve active euthanasia. I think people are scared about dying in pain and dying without dignity. This is understandable. I believe Dr Nitschke plays on these fears. Legalized euthanasia gives people the sense that their wishes are more taken into account but this is not the case and people should be made aware of this. I worry that some doctors, families, and patients will take the course of action that is easiest and not the one that is necessarily the most appropriate. Despite this view I believe it is only a matter of time before legislation legalizing euthanasia gets enacted and I will change my practices accordingly.

Active euthanasia does occur (not that I have been involved) but very few doctors have been charged and I do not believe any have ever been found guilty of murder in Australia (in other countries it has occurred but these have been in cases of gross malpractice). So rest assured that there are doctors willing to put their careers on the line for their patients even if not as openly as Nitschke (hence they can keep doing it with less scrutiny).

I believe if, as you called it, “quasi symptomatic treatment” is effective there would be very few cases in which a patient would want to end their lives. Your grandmother’s case may very well have been one of these. People with motor neurone disease are another example. In such cases mental faculties are maintained but patients are physically incapacitated. These are the most difficult cases to deal with. I believe in this day your grandmother’s case would be much better managed (including dealing with depression which would have most certainly have been a confounding factor). I do not believe euthanasia was the only other option for your grandmother and the fact that she so tragically took her own life shows that society and the health system failed her in numerous other ways.

In terms of the starvation issue it is a widely practiced method of hastening ones death. If you ever fill out an advanced health directive it explicitly asks whether you would like artificial feeding if you were not capable of feeding yourself. This is predominantly employed in the terminal phase of an illness. Some doctors will even cease fluids but maintain enough to keep the patient comfortable. The main issue from recollection about the Terry Schiavo fiasco was who made the decision to cease life-sustaining therapy and the motives behind the decision not the method. If she had an advanced health directive there would not have been the uproar. The issue of starvation was not at question within the medical fraternity and I believe was more likely propaganda put forward by pro-life advocates to try to swing public opinion in their favour. It was terrible to see what would have been a very distressing situation for the family and friends played out in the media.

Julia, I did not quite understand the questioning on my power to decide who suffers and who doesn’t. I do not want any of my patients to suffer. If someone is in suffering I will relieve the symptom and attempt to correct the cause. This is regardless of what the symptom or cause is. If you could give me examples of the suffering (i.e. other than pain requiring narcotics) that you had in mind I would be happy to comment further.

Dink

PS. Sensationalist comments like the one in 2020hindsights post supposedly said by Nitschke “The commonest way people over 75 die in our society is by hanging themselves” are an example on how he plays on peoples fears. I strongly reject such a statement until someone can give me evidence to the contrary.

 

[2020hindsight]

PS. Sensationalist comments like the one in 2020hindsights post supposedly said by Nitschke “The commonest way people over 75 die in our society is by hanging themselves” are an example on how he plays on peoples fears. I strongly reject such a statement until someone can give me evidence to the contrary.

ahhh - yes - obviously in the context of euthanasia - clearly people who qualify for the discussion he was on about - and the sort of people who approach him for help.

The more important point was that he'd been to court defending his principles, - and the rights of others to a merciful release - and close to being put in jail for it. Splitting hairs between exact techiques of hanging vs others - (or drowning as in Julia's grandparents case ) wont advance the argument far ..

I'm sure EXIT could give you stats of how many people approach them, how many die this way or that. Then again - they have to be careful that they're not dobbed in to the authorities.
http://www.exitinternational.net/director.htm

PS it's probably easier to get those stats than the number of people who die by ... negligence ( I'll be polite) .. in our hospitals. Bundaberg is just a tip of the iceberg Dink.

 

[Dink]

Obviously in the context of euthanasia - I still strongly disagree. Never once seen someone older than 75 who has attempted to hang themselves. Not that this means it doesn't occur. Maybe it means they have a high sucess rate. Overdoses and refusal to eat and take medications I certainly have seen... and more difficult to get good statistics on. Less shock value as well. I would imagine hanging oneself would be quite a tricky thing to do when a 75 year old who is so physically ill they think they have nothing to offer. Unfortunately these are probably those who are depressed but still physically capable. I'm not sure if I've made myself clear yet... major depression is not a justified reason for euthanasia (or suicide) on the background of organic disease or not. That is why when someone has suicidal ideation we treat them against their wishes if need be because they are deemed not of sound mind to make decisions for themselves and depression is treatable.

PS. Had a look at EXIT. Couldn't find the statistics. Interesting the references to Nancy Crick. People do realise that she didn't actually have cancer don't they.