Monday, 22 June 2009

Assisted Suicide vote in Parliament

We are starting with a series of postings by relevant academics and end-of-life activitsts who will present their own persoanl viewpoints on the ethical issues around the end of life debate. Our first panelist is Phillipa Taylor Senior Researcher, Bioethics and Family, CARE.

In late June/ early July Peers in Westminster will have a free vote on whether it should become legal to assist someone who wants to commit suicide. The Bill is the Coroners and Justice Bill which includes welcome provisions to make it an offence to encourage suicide via the web. However, attempts are being made to use this bill to change the law on assisted suicide.When the BiIl was in the Commons amendments were put down at Committee stage removing the offence of assisting someone to commit suicide but these were not put to a vote. An amendment was put down at Report Stage to allow people to help others (such as relatives) travel abroad to a country like Switzerland where they can access a suicide clinic. This amendment was not considered because parliament ran out of time, so the Bill emerged from the Commons without any change in the law. Now the Bill is in Committee Stage in the Lords and three amendments seeking to liberalise the law have been put down. Unlike in the Commons, the Lords will not run out of time so these amendments will be debated and quite possibly voted on unless the tabling peers withdraw them.

I, along with many others, believe that weakening the law on assisted suicide is unethical, unnecessary and dangerous.

1. It is unethical because the long held society-wide prohibition on intentional killing would be weakened by these amendments. Those who are tempted to commit suicide are highly vulnerable and need protection and counselling, not help in killing themselves. As the Prime Minister recently said: “It is necessary to ensure that there is never a case in which a sick or elderly person feels under pressure to agree to an assisted death or that it is the expected thing to do.” This is in stark contrast to euthanasia campaigner, Baroness Warnock, who has described dementia sufferers as “wasting people’s lives” and “wasting the resources of the National Health Service”. We should not value someone because of their “usefulness” but should recognise their inherent dignity in being human and, with compassion, seek to improve their quality of life, whilst not sacrificing the principle of the sanctity of human life.

2. It is unnecessary because, as it stands, the present law is clear, right and protects the vulnerable. Society already accepts many limits on an individual’s autonomy and personal choice for the greater good, recognising that we are not entitled to make choices which endanger the reasonable freedoms of others. For example an individual’s freedom to drive at whatever speed they like is limited in order to provide safety to others and themselves. Overturning the agreed principle of no intentional killing would have a wider impact on society, especially the vulnerable. Moreover, in most cases, good palliative care provides sufficient physical pain relief. Every patient is different, but using present techniques it is estimated that 90% of pain can be treated successfully.

It is dangerous because if Parliament accepts that people can travel abroad to assist a suicide, there will be more calls to allow assisted suicide here. Oregon, where physician assisted suicide (PAS) is legal, shows the difficulties of establishing fool proof safeguards to prevent abuse and ensure all acts of assisted suicide are truly voluntary. There is a reported lack of transparency over the practice of PAS there, minimal oversight and ineffective safeguards. In 2008, 50 per cent of patients requesting suicide were assisted to die by a doctor who had been their physician for eight weeks or less.

It is vital that the message society sends to vulnerable people should not, however subtly, encourage them to seek death, but should assure them of our care and support in life. The truly compassionate (although not always easy) and holistic response to demands for assisted dying lies in good medical treatment and in meeting patients’ physical, social, psychological and spiritual needs.

The photograph of actors around a death-bed was taken by Littlelovemonster. the picture of the house of Lords was taken by UK Parliament


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Wednesday, 3 June 2009

Compassion should never lead us to kill

Lord Falconer's article in The Times entitled "A more civilised approach to suicide" argues in favour of decriminalising relatives who escort a loved on to a suicide clinic abroad. He then makes an appeal for compassion for the families of the terminally ill, who are already under tremendous pressure. Compassion should never be equated with facilitation of a medically assisted death.

Compassion need not kill
The treatment of illness and the relief of suffering have advanced very considerably in the past decades. Symptom control has also made major advances. Our understanding of the nature of pain and human responses to it are increasing steadily. Pharmacological and physical methods for its relief are available and effective for conditions and circumstances which would have been previously resistant. Drug delivery systems, special formulation, chemotherapeutic agents, physical techniques such as TENS (Transcutaneous Electrical Nerve Stimulation) are pushing back the thresholds of pain and bringing relief to those who are appropriately assessed and treated.

The Ethos of Medical Practice
It is no part of the doctor's tradition or ethos to kill. This option was open in pre-Hippocratic Medicine, but Hippocratic tradition, and later, Judeo-Christian teaching set out to change this and to oblige the doctor to preserve and sustain life by every means possible. It has always been accepted that death could not be postponed indefinitely, but the duty of the doctor as expressed by Ambroise Pare 'to cure sometimes, to alleviate often, to comfort always', has stopped short of death as a treatment option. There is still in most doctors an abhorrence of killing, even accidentally, and a deeper abhorrence of doing so intentionally.

Doctors who have to deal with the very ill and terminally ill will admit to having been tempted at some time to bring a patient's life to an end. Doctors, with a few exceptions are not in the forefront of the demand for eithanasia or medically assisted suicide. They are however involved in the ethical, moral and practical issues (Lack of information, or equipment or resources) around terminal care. There is a basic need is for better clinical awareness of the principles of good management of troublesome symptoms and, as a consequence, better education and training of health-care professionals in these principles. Good clinical judgment is based on knowledge, compassion and integrity.

Ian Galloway, convener of the Church & Society Council recently presented the views of the church of Scotland in an articpublished an article on Interfaith Matters. In there he states
Pain management is a significant component within palliative care. Since its inception, palliative care education has used the model of multidisciplinary education. Palliative care is synonymous with holistic care which includes physical, psychological, social and spiritual needs. It is an approach which seeks to maximise the quality of life of patients and their families facing problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems. In recent years the provision of spiritual and religious care has benefitted greatly from multi-faith and multicultural approaches to healthcare and the move towards professionalisation of healthcare chaplaincy. If palliative care includes good spiritual care and a managed approach to pain, then some of the issues leading to calls for physician assisted suicide may be resolved.
Rvd. Galloway's views have been picked up by other bloggers.

The irreducible minimum of care has been defined as -fuid and nutrition, analgesia and tender loving care. The phrase 'compassion mingled with respect' attributed to Mother Teresa, perhaps sums up a more constructive attitude towards end-or-life issues. If a community is to claim to be civilised and compassionate it must care for those facing the last moments of their lives withou hastening that end.


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