Sunday, November 25, 2012

Voluntary Euthanasia

This is a controversial subject I know and it tends to provoke knee jerk responses but I think it deserves to be considered rationally - and, more often than not, it isn't.

There's been a heated discussion going on in Australia on the subject for some years. For some the prospect that someone might believe they have good reasons for wanting to end their life is always over-ruled by the belief that human life is sacred and must run its course. For others there is a real fear that eugenics might rear its ugly head again with those deemed of no use to society or a drain on it being killed. They talk about life being devalued and people - usually elderly people for some reason because apparently all elderly people are confused, suffering from dementia and/or easily manipulated - being talked into ending their lives.  Finally there's the question of who would actually perform this act.

These are largely straw man arguments. It's called voluntary for a reason. No-one is suggesting that anyone other than the person wishing to die would make the decision and, while it would be wise to ensure that the person seeking death was mentally competent and not just suffering from a temporary mental illness or had been pressured into it, in the end the decision would be that person's alone. Given this eugenics could never have a part in it. The hardest part would be in how it would be carried out. It would hardly be fair to ask a doctor who has sworn a solemn oath to preserve life to actively kill another person. This is why there would have to be a mechanism which permitted the person to take their own life and protecting anyone who helped them procure the drugs or whatever else they required.

Two things started me thinking about this now. The first was the recent documentary with Sir Terry Prachett on the subject, the second was a court case where a man, who killed his severely disabled wife at her request as part of murder suicide pact, was found guilty of murder and, while out on bail before being sentenced, killed himself.

In Sir Terry  Prachett's case, he has been diagnosed with a form of Alzheimer's disease. It's progressive and eventually will take away his mental capacity. Anyone who has watched a loved one disappear into dementia will understand why he, an articulate, intelligent man, does not want to travel this path.

If you haven't seen it first hand you might think it's a slow fading with forgetfulness and confusion followed at its worst into being comatose. It is not. It is a terrible disease. Its sufferers do forget things like words or put things in the wrong place like a kettle into the fridge and it embarrasses and humiliates them - but that is in the early stages. Later the hallucinations begin, then the lack of understanding of what is happening around them that leaves them terrified. Imagine you are an old woman in a nursing home and a male carer has the job of showering you or taking you to the toilet. How would you feel when this man starts taking off your clothes and you have no idea who he is or why he is doing it? (Please note I am in no way criticising the male carer. He is no doubt professional and doing his job. The problem is that his patient can't understand this.) Then people you don't know come in and kiss you on the lips or hug you. It is frightening because you don't remember that this man is your husband or that woman is your daughter. It's no better if you are a man. It's just that the experiences are different.

Having watched a family member suffer in this way I can understand exactly why Sir Terry is investigating the possibilities. In the documentary, because even helping him to procure the necessary drugs would be a criminal offence in the UK, he went to Dignitas in Switzerland to see how their system works. It's not cheap and so is not open to many. They were permitted to film a death and while it was very sad to watch, it was done with great dignity. The person has to be assessed by a doctor for mental competence and has to be capable of actually taking the drugs by themselves which means, of course, the decision has to be made earlier than perhaps some might like. The problem is that under UK law anyone helping a severely disabled person to get to Switzerland could be considered as aiding a suicide. I have no idea what choice Sir Terry Pratchett will make but I could see that this is an option I might consider in his situation.

The case of the old man, who killed his wife at her request and has now himself suicided, highlights the difficulty of the present laws. I have to wonder if something like the Dignitas solution is more appropriate. It is a personal choice, there is no pressure to do this (in fact in the medical interview the doctor was at pains to do nothing to encourage it) and maybe we have no right to force people to live on in agony whether it is mental or physical. There is a lot of talk about how medicine can make suffering manageable but for some managed pain means still being in pain and the side effects are sometimes almost as bad.

Having seen people die very slowly in pain, I can't help wondering if we need to accept that, as long as the person is mentally competent, they have a right to decide how much they can bear and not place obstacles in their way. I am not saying that doctors or government officials or family members or anyone else should make this decision or carry it out. I'm saying that if someone makes this decision with valid grounds like those on the Pratchett documentary, they should be allowed this option and maybe we should make it accessible so they can die in their own homes with certainty and dignity instead of forcing them to go across the world.

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