A most flawed process indeed

[aeolium]

"choice" is a minefield

Well, speaking personally, I'd rather have choice than no choice. Being able to make moral choices is part of being adult, having choices made for you is part of being a child.

It's quite "normal" at some point in ones life to want to commit suicide , thankfully most people don't go through with it

We're not talking about that kind of decision, but about the decisions of seriously ill people who can foresee a life with a worsening prospect leading to a painful death without any dignity.

Here is imo a sensible view on the 'slippery slope' argument (from the Simon Jenkins article I linked to earlier):

"In her dispassionate analysis of the law on dying, the LSE law professor Emily Jackson has challenged the "slippery slope" argument that any benign reform should be opposed as possibly leading to a malign outcome. She points out that "the grey area problem exists whenever we attempt to regulate anything". Merely banning a benefit that could possibly become a disbenefit is stupid and possibly counter-productive, as with the law on so-called recreational drugs. A crude society allows itself to be ruled by imaginary fears. A civilised one rolls up its sleeves and tries to draw lines."

[MrGongGong]

Well, speaking personally, I'd rather have choice than no choice. Being able to make moral choices is part of being adult, having choices made for you is part of being a child.

I'll bear that in mind next time I have to have surgery then !
sometimes (and I mean SOMETIMES ) choosing something doesn't mean that the choice is a good one
we all choose things that are bad for us
and some choices have to be not available for us to live in a society ! (I might want the choice and freedom to walk about the place with a loaded gun for example )
and

We're not talking about that kind of decision, but about the decisions of seriously ill people who can foresee a life with a worsening prospect leading to a painful death without any dignity.

thats exactly what we are talking about

the folks in Switzerland are more than happy to assist people who are "tired of life" with NO physical illness

I'm not saying that its a "slippery slope" BUT that we are unable to provide safeguards

[Lateralthinking1]

Eight problems.

1. GPs are intended to alleviate pain for the living rather than putting an end to life. By rights the "ending of life" service, if introduced, should be in the hands of specialists at Swiss type centres. The fact that it is not being proposed to have a separate building in the High Street for it indicates that people feel uneasy about it deep down.

2. The fact that a friend could get years in jail for providing the dose but it would be seen as entirely normal if provided by a doctor suggests that the state is somehow more trustworthy than a friend. I doubt that this is the case.

3. Would private doctors also have the power? If so, how would they be publicly accountable?

4. If you see what is being proposed as a good thing, how can you morally justify providing the service to those strong enough to have all their mental faculties intact but not to those in pain who can't decide for themselves. I'm not advocating decisions being taken on behalf of people with dementia or mental illness but in terms of alleviation of pain it would discriminate against the mentally ill.

5. Wouldn't an honest presentation of the procedure fully accept that it would mean savings to taxpayers as well as being supposedly in the interests of the patient? The fact that this isn't being said again shows that people can't advocate
it honestly.

6. Some people who would be very good GPs wouldn't go into the profession if this were a part of their role.

7. Mistakes are frequently made by the NHS. Operations are often undertaken on the wrong person. As soon as a mistake happened in regard to ending life, what would it do to public confidence in the NHS?

8. One of the strongest arguments against the death penalty is that the wrong person could be killed. Wouldn't the start of this procedure break down that argument by accepting risk and lead to greater possibility of the death penalty returning?

[aeolium]

sometimes (and I mean SOMETIMES ) choosing something doesn't mean that the choice is a good one

That's not the point - the point is whether society has the right to deny someone the choice to end their life without having to throw themselves off a cliff, or under a train, or by hanging, gas or carbon monoxide.

and some choices have to be not available for us to live in a society ! (I might want the choice and freedom to walk about the place with a loaded gun for example )

There is nothing in the choice to seek an assisted death that poses a threat to society. A car can be as dangerous as a loaded gun if it is driven recklessly, or under the influence of drink or drugs, yet though we have laws against those things there are still many accidents arising from those causes. By your argument of total protection we would never allow cars on the road at all.

thats exactly what we are talking about

No, it's not. The report by the Assisted Dying Commission only recommended it in cases where someone was certified as having less than 12 months to live, and prospective legislation in the form of private members bills have only ever suggested its use for terminal cases.

we are unable to provide safeguards

Why? What is uniquely complicated about the issue that makes it impossible to legislate for? The main question is mental competence and whether a person is freely making a decision. Yet all kinds of legal cases depend upon judicial and medical assessment of mental states - are you saying that, although people seem to be qualified to make those assessments in other cases they could not in this? A time-period of several months could be built in to allow people to reconsider (and to withdraw from the process at any time).

[aeolium]

1. GPs are intended to alleviate pain for the living rather than putting an end to life. By rights the "ending of life" service, if introduced, should be in the hands of specialists at Swiss type centres. The fact that it is not being proposed to have a separate building in the High Street for it indicates that people feel uneasy about it deep down.

I would imagine that this service would be provided as a specialist one and not through GPs but that would be a matter to be resolved after consultation, though if people feel uneasy about it why do polls regularly show a strong majority in favour of a change in the law?

2. The fact that a friend could get years in jail for providing the dose but it would be seen as entirely normal if provided by a doctor suggests that the state is somehow more trustworthy than a friend. I doubt that this is the case.

For a medical service, which is what is involved, a doctor or suitably qualified medical professional is needed, and also because the process would have to be thoroughly regulated at every level to satisfy concerns about possible abuse.

3. Would private doctors also have the power? If so, how would they be publicly accountable?

If any private doctor were to be included in the register of authorised professionals, then they would have to be subject to the regulatory procedures and to oversight by the relevant NHS body set up to monitor the service.

4. If you see what is being proposed as a good thing, how can you morally justify providing the service to those strong enough to have all their mental faculties intact but not to those in pain who can't decide for themselves. I'm not advocating decisions being taken on behalf of people with dementia or mental illness but in terms of alleviation of pain it would discriminate against the mentally ill.

I imagine that the service would not necessarily be denied to those suffering pain, only those judged not mentally competent to decide freely for themselves. Some would inevitably be excluded from the service because they could not satisfy this condition, but this is hardly discriminatory so much as one of those safeguards to protect against abuse of the vulnerable.

5. Wouldn't an honest presentation of the procedure fully accept that it would mean savings to taxpayers as well as being supposedly in the interests of the patient? The fact that this isn't being said again shows that people can't advocate
it honestly.

Well, the proposal from the Assisted Dying Commission only advocated the service for those with a terminal condition certified to have no more than 12 months to live, so it would hardly be a great saving for the taxpayer, particularly given the extra costs of providing the service. But do you really think that the pressure for a change in the law has come mainly from die-hard Benthamites concerned to save the taxpayer money by ending the lives of the terminally ill prematurely, or from people appalled at the prospect of their descent into a deeply unpleasant degenerative condition leading to a painful death?

6. Some people who would be very good GPs wouldn't go into the profession if this were a part of their role.

I would very much hope that there would be an opt-out on grounds of conscience for those doctors unwilling to participate in this service.

7. Mistakes are frequently made by the NHS. Operations are often undertaken on the wrong person. As soon as a mistake happened in regard to ending life, what would it do to public confidence in the NHS?

Mistakes do end life already in the NHS and have done ever since it was set up. Have they eroded public confidence? Do you think that this particular operation might take place on the wrong person? That would surely equate to the wrong person having a heart transplant or something as catastrophic. There don't seem to have been any problems with the Dignitas service in its 13 years of operation, apart from an alleged case of slow-operating poison in 2004.

8. One of the strongest arguments against the death penalty is that the wrong person could be killed. Wouldn't the start of this procedure break down that argument by accepting risk and lead to greater possibility of the death penalty returning?

No, because that argument about the death penalty was based on known miscarriages of justice, and the likelihood of future ones. There is, I suggest, not the slightest chance of the wrong person being assisted to die under this proposed service. Some might argue that the person petitioning to be allowed assisted dying may not be mentally competent or may be too vulnerable, but the force of that argument would depend on the strength of the safeguards put in place to prevent that (especially re medical and judicial assessments of mental competence). Again, had there been any major problems with the operation of the Dignitas service, would we not have heard them widely publicised?

[MrGongGong]

T
There is nothing in the choice to seek an assisted death that poses a threat to society.

I fundamentally disagree about this
IMV it is a great threat to many in society
and to society as a whole

this so called "commission" consisted of a group of people who were in favour of this
and Its disingenuous of the BBC and media to regard it as anything but a bit of publicity from a pressure group

[Serial_Apologist]

I fundamentally disagree about this
IMV it is a great threat to many in society
and to society as a whole

this so called "commission" consisted of a group of people who were in favour of this
and Its disingenuous of the BBC and media to regard it as anything but a bit of publicity from a pressure group

Do you really think that those in favour of this are against the kinds of safeguards which aeolium has outlined?

[MrGongGong]

Do you really think that those in favour of this are against the kinds of safeguards which aeolium has outlined?

no not at all
why would you think that ?
I think they believe in them and think that they would work
but I don't agree

[Lateralthinking1]

aeolium - Thank you for your comments which I have reproduced here in bold. My comments are added below.

I would imagine that this service would be provided as a specialist one and not through GPs but that would be a matter to be resolved after consultation, though if people feel uneasy about it why do polls regularly show a strong majority in favour of a change in the law?

We were advised in the news that it would be for GPs to provide the lethal dose. I suggest that many of those who support this proposed reform genuinely believe that they hold views which are unequivocal. However, if you were to put it to them that there should be special buildings next to Tesco, opposite a pub or on a factory estate, and then ask them what those buildings should be called, some would feel rather more awkward. In truth, having the disposal located in a surgery softens the associations for all.

For a medical service, which is what is involved, a doctor or suitably qualified medical professional is needed, and also because the process would have to be thoroughly regulated at every level to satisfy concerns about possible abuse.

My feeling is that GPs could acquire the necessary expertise but will vary considerably in moral judgement. GP practice is wide-ranging in many areas including abortion and the provision of medication to address depression. We are also talking about human beings with individual foibles. For example, one Christian doctor, the brother of a friend, told me on a group night out that he took a really dim view of people who had one night stands. He said that he tended to send them to a clinic before addressing any other conditions because they made him angry. And he brought that subject up out of the blue. We had all been talking about holidays at the time. Furthermore, it is reported in the news that people would have to take the dose themselves. This means that the expertise of a doctor would be compromised by the legal requirement of not having any direct involvement. They could not intervene if a patient bungled, not that a doctor would even be there in the patient's home if the stuff was taken there.

If any private doctor were to be included in the register of authorised professionals, then they would have to be subject to the regulatory procedures and to oversight by the relevant NHS body set up to monitor the service.

My concern is that money talks, particularly in the private sector, although not exclusively. We have seen how in the NHS certain drugs are favoured, possibly because of arrangements with specific companies. This partially accounts for the fashions in treatment that come and go. I am not saying that there are such arrangements in respect of cholesterol but this is one example of an aspect of health that meant nothing 20 years ago. Now it is regarded as a prime indicator and frankly I find it deeply questionable. Breast implants are an example of money being made without sufficient care for adequate research. The regulatory body there was arguably lacking and the same applies to others. NICE is one case of seemingly never-ending controversy.

I imagine that the service would not necessarily be denied to those suffering pain, only those judged not mentally competent to decide freely for themselves. Some would inevitably be excluded from the service because they could not satisfy this condition, but this is hardly discriminatory so much as one of those safeguards to protect against abuse of the vulnerable.

I accept that denial to the mentally impaired is an important safeguard to protect the vulnerable. However, the hard truth of it is that this inevitably means that by virtue of that protection such people will be discriminated against in the alleviation of pain. Unfortunately life isn't as straightforward as the supporters of the procedure would like to believe and I do think that they will find it hard to argue rationally through this conundrum. Insisting that the mentally impaired suffer greater pain just isn't acceptable.

Well, the proposal from the Assisted Dying Commission only advocated the service for those with a terminal condition certified to have no more than 12 months to live, so it would hardly be a great saving for the taxpayer, particularly given the extra costs of providing the service. But do you really think that the pressure for a change in the law has come mainly from die-hard Benthamites concerned to save the taxpayer money by ending the lives of the terminally ill prematurely, or from people appalled at the prospect of their descent into a deeply unpleasant degenerative condition leading to a painful death?

I don't think that the advocates are ardent supporters of Jeremy Bentham. However, it would be disingenuous to ignore the economics involved. I would find it hard to think of any weapon used in war during my lifetime that has been manufactured with the stated intention of helping the taxpayer. We are always told that evil dictators must be removed or it is a question of human rights. Many recognise that the purpose that no one dares ever to mention is financial interest, even where that may be a secondary factor. I am reminded of such things by this proposed reform for there is an element to this too of especially selecting the palatable information. Money will be saved, however small, just as money is saved by the use of the electric chair.

I would very much hope that there would be an opt-out on grounds of conscience for those doctors unwilling to participate in this service.

Noted.

Mistakes do end life already in the NHS and have done ever since it was set up. Have they eroded public confidence? Do you think that this particular operation might take place on the wrong person? That would surely equate to the wrong person having a heart transplant or something as catastrophic. There don't seem to have been any problems with the Dignitas service in its 13 years of operation, apart from an alleged case of slow-operating poison in 2004.

No, because that argument about the death penalty was based on known miscarriages of justice, and the likelihood of future ones. There is, I suggest, not the slightest chance of the wrong person being assisted to die under this proposed service. Some might argue that the person petitioning to be allowed assisted dying may not be mentally competent or may be too vulnerable, but the force of that argument would depend on the strength of the safeguards put in place to prevent that (especially re medical and judicial assessments of mental competence). Again, had there been any major problems with the operation of the Dignitas service, would we not have heard them widely publicised?

Mistakes in the NHS do dent public confidence. This happens even in the area of record keeping and is more acute in terms of erroneous patient care. Members of my family and neighbours have been given the wrong medication just in the past year. Your use of the word "operation" to describe the ending of life takes the meaning of that medical term into a new area. Some might regard it rightly or wrongly as Orwellian. In any case, there is the potential for greater public concern where the medicine for dying is given to the wrong person. It is less easy to accommodate than a procedure for survival which goes badly wrong. I am not sure that Dignitas is so fully open to scrutiny for any of us to know what has happened there. An individual's right to privacy is a useful, if necessary, smokescreen just as the need for security at nuclear power stations means that full transparency is never possible.

[aeolium]

Lat1, those are good points and reflect a proper concern about the safety and general workability of any change to the law to allow assisted dying. I will not reply in detail (some probably think I have already spent too much of the board's space on this subject), but will confine myself to one point which seems to run through your view of this, that it seems to be a sinister - Orwellian even - example of state involvement in ending life. That is certainly not what it is - the state has opposed changes to the law and arguably by making assisted suicide (but not suicide) illegal is already intervening in people's ownership of their own lives. The pressure for change has come from private individuals, particularly those in an extremely distressed state as you have no doubt seen. The British answer to any difficult question about individual choice - whether on recreational drugs, or this matter of assisted dying - is to ban it, even though banning it will not make the issue go away or the demand go away. It will force the individuals concerned into arguably even more undesirable actions to obtain relief, such as going to a Swiss clinic to end their lives (as the conductor Edward Downes and his wife did recently) or committing suicide in unpleasant ways, or asking their partners to 'help' them to end their life. All of these are much worse solutions imo to having a regulated assisted dying procedure in this country. You and many others may well find this a step too far, but in that case you must contemplate that the logic of that is requiring an increasingly elderly population to go right through to the natural term of their lives irrespective of the quality of that life and the suffering and indignity it may involve. It is a dilemma that may well at some stage affect you or me or any of our closest relatives or friends. If you are confident that you would be able to cope with that situation should it arise, then good for you.

[MrGongGong]

One important point in this age of "with us or against us"

To say that one is opposed to doctors killing people (which is what it amounts to really ! call a spade a spade ) is NOT to say that one is in favour of people enduring endless suffering.
It's a far to often used "argument" that one encounters all to often ......... another familiar example is that if one expresses concern at the way in which prisoners are treated at Guantanamo is not to say that one is in favour of terrorism.
Most of the cases that folk seem to be citing here (like the people on the Terry Pratchet film last year ) would NOT be covered by these proposals anyway.

[aeolium]

To say that one is opposed to doctors killing people (which is what it amounts to really ! call a spade a spade ) is NOT to say that one is in favour of people enduring endless suffering.

1) It is not 'doctors killing people', which suggests that the doctors are the ones taking the decisions. It is doctors providing medical assistance to enable those who make their own decisions to end their own life to do so. Surely you must appreciate the difference.

2) I am sure you are not in favour of people enduring endless suffering. Yet the logic of your position is that that is just what you are requiring people to do - at least, not endless suffering for it will eventually end but great suffering for a considerable period of time, something that the people themselves wish to avoid. Rather than rubbishing proposals for trying to improve the unsatisfactory situation that the current law creates, you could try to suggest constructive proposals that might assist people in the very distressing conditions that lead them to take those extreme decisions.

[MrGongGong]

1) It is not 'doctors killing people', which suggests that the doctors are the ones taking the decisions. It is doctors providing medical assistance to enable those who make their own decisions to end their own life to do so. Surely you must appreciate the difference.

2) I am sure you are not in favour of people enduring endless suffering. Yet the logic of your position is that that is just what you are requiring people to do - at least, not endless suffering for it will eventually end but great suffering for a considerable period of time, something that the people themselves wish to avoid. Rather than rubbishing proposals for trying to improve the unsatisfactory situation that the current law creates, you could try to suggest constructive proposals that might assist people in the very distressing conditions that lead them to take those extreme decisions.

1) Whether a doctor actively administers a drug that will kill you or whether (as the Swiss folk do) the doctor puts it in your hand and you take it ........ it amounts to the same thing.

2) Suffering is unavoidable in life. Palliative care has moved on immensely in recent years so that no one HAS to endure constant pain. This is more about judgements of "quality of life", I have considerable personal experience of working with people who you might imaging have a "quality of life" that you would find unacceptable. Some in life are easy to imagine, not being able to walk, not being able to hear etc BUT some are almost impossible, it's almost impossible to imagine what it is like to have a radically different perception of the world so that ones emotional responses seem to be (to an outside observer ) irrational and illogical, i've met people who are terrified of paper or fascinated by door handles etc etc
The point is that one can't really make an informed choice about something that is so outside ones cognitive framework.
Given this I maintain that one needs to err firmly on the side of caution and not permit this kind of thing even though I might think that it would be totally intolerable to live without being able to hear (for example).
Having read much about this and heard and seen examples of people who have chosen to die in this way I remain unconvinced that it is something that we should contemplate.
What we should be doing is spending MORE resources on the most vulnerable rather than less as is the governments plan, a government that plans to force cancer patients to work hardly inspires confidence in their ability to protect the vulnerable.

[aeolium]

1) It is still not killing on the part of the doctor, as the person taking the fatal dose is taking the decision him/herself. That same person could of course get a prescription of paracetamol or other painkiller and take a fatal overdose. Much more painful and messy but the important thing seems to be that the doctor is not knowingly involved.

2) Pain is a matter of degree - people have very different thresholds. In some cases the pain is not merely physical, which can indeed be to some extent controlled by medication, but mental:the sense of helplessness, the indignity, the removal of all possibility of enjoyment in life. I think it really comes down to opinions about death and whether you feel that under all circumstances death will always be the worst possible outcome, and that life should be preserved at all costs. For some that will be the case, for others not - I think that is a matter for people to make up their own minds about. It is not about judging that a particular quality of life is simply too low, because what would be intolerable for some will not be for others, but that ultimately the destiny of a person's life is not for society, for the state to determine, but for that person. We allow citizens every form of autonomy that does not damage others, except that one, the ability to end a life that has become intolerable.

[vinteuil]

I think it really comes down to opinions about death and whether you feel that under all circumstances death will always be the worst possible outcome, and that life should be preserved at all costs. For some that will be the case, for others not - I think that is a matter for people to make up their own minds about. It is not about judging that a particular quality of life is simply too low, because what would be intolerable for some will not be for others, but that ultimately the destiny of a person's life is not for society, for the state to determine, but for that person. We allow citizens every form of autonomy that does not damage others, except that one, the ability to end a life that has become intolerable.

Thank you, aeolium - beautifully put. For many of us it is intolerable that we are not 'allowed' that choice.