Friday, 2 January 2015

Euthanasia and Assisted Suicide

Whilst this is not very upbeat for the new year, there has been some debate of the issue of assisted suicide in the past few days. This is taken from NHS England website

Euthanasia is the act of deliberately ending a person's life to relieve suffering.
For example, a doctor who gives a patient with terminal cancer an overdose of muscle relaxants to end their life would be considered to have carried out euthanasia.
Assisted suicide is the act of deliberately assisting or encouraging another person to kill themselves.
If a relative of a person with a terminal illness were to obtain powerful sedatives, knowing that the person intended to take an overdose of sedatives to kill themselves, they may be considered to be assisting suicide.

Legal position

Both euthanasia and assisted suicide are illegal under English law.
Depending on the circumstances, euthanasia is regarded as either manslaughter or murder and is punishable by law, with a maximum penalty of up to life imprisonment. 
Assisted suicide is illegal under the terms of the Suicide Act (1961) and is punishable by up to 14 years' imprisonment. Attempting to kill yourself is not a criminal act in itself. 

Types of euthanasia

Euthanasia can be classified in different ways, including:
  • active euthanasia  where a person deliberately intervenes to end someone’s life – for example, by injecting them with a large dose of sedatives  
  • passive euthanasia  where a person causes death by withholding or withdrawing treatment that is necessary to maintain life, such as withholding antibiotics from someone withpneumonia  
Euthanasia can also be classified as:
  • voluntary euthanasia  where a person makes a conscious decision to die and asks for help to do this
  • non-voluntary euthanasia  where a person is unable to give their consent (for example, because they are in a coma or are severely brain damaged) and another person takes the decision on their behalf, often because the ill person previously expressed a wish for their life to be ended in such circumstances
  • involuntary euthanasia  where a person is killed against their expressed wishes
Depending on the circumstances, voluntary and non-voluntary euthanasia could be regarded as either voluntary manslaughter (where someone kills another person, but circumstances can partly justify their actions) or murder. 
Involuntary euthanasia is almost always regarded as murder.
There are arguments used by both supporters and opponents of euthanasia and assisted suicide. Read more about the arguments for and against euthanasia and assisted suicide.

End of life care

If you are approaching the end of life, you have a right to good palliative care – to control pain and other symptoms – as well as psychological, social and spiritual support.
You're also entitled to have a say in the treatments you receive at this stage.
For example, under English law, all adults have the right to refuse medical treatment, as long as they have sufficient capacity (the ability to use and understand information to make a decision).
If you know that your capacity to consent may be affected in the future, you can arrange a legally binding advance decision (previously known as an advance directive).
An advance decision sets out the procedures and treatments that you consent to and those that you do not consent to. This means that the healthcare professionals treating you cannot perform certain procedures or treatments against your wishes.

Other countries

Active euthanasia is currently only legal in Belgium, Holland and Luxembourg. Under the laws in these countries, a person’s life can be deliberately ended by their doctor or other healthcare professional.

The person is usually given an overdose of muscle relaxants or sedatives. This causes a coma and then death.
However, euthanasia is only legal if the following three criteria are met:
  • The person has made an active and voluntary request to end their life.
  • It is thought that they have sufficient mental capacity to make an informed decision regarding their care.
  • It is agreed that the person is suffering unbearably and there is no prospect for an improvement in their condition.
Capacity is the ability to use and understand information to make a decision. Read more about the capacity to consent to treatment.
In some countries the law is less clear, with some forms of assisted suicide and passive euthanasia legal, but active euthanasia illegal.
For example, some types of assisted suicide and passive euthanasia are legal in Switzerland, Germany, Mexico and five American states. 
Page last reviewed: 11/08/2014

Will this position change? Quite Possibly.This is taken from Dignity in Dying Website.


Lord Falconer’s Assisted Dying Bill

Dignity in Dying advocates a change in the law on assisted dying. They believe that, subject to strict upfront safeguards, the law should allow terminally ill, mentally competent adults to request life-ending medication from a doctor. The dying patient would then have the choice to self-administer that medication at a time that was right for them.

Lord Falconer’s Assisted Dying Bill was tabled in the House of Lords in June 2014.

Second Reading – the first time the Bill was debated

The Bill received its Second Reading on Friday 18 July 2014. During a debate lasting over nine hours the Bill was debated in detail but not voted on, as no wrecking amendment was tabled, meaning law change moved one step closer as the Bill progressed to the committee stage.

Committee Stage – the whole house debates the Bill clause by clause

The Bill had its first day of Committee Stage on Friday 7 November 2014. This was an important step forward because the House of Lords accepted the principle of law-change and voted in unanimous support for an amendment to the Bill, put down by Lord Pannick, which set out a model for judicial oversight of assisted dying. This requires a judge in the family division of the High Court to confirm that a terminally ill patient, with less than six months to live, has reached “a voluntary, clear, settled and informed” decision to control the time and manner of their death. This amendment was preferred to a more onerous model of judicial oversight, which would have required a judge to reach a decision on whether a patient’s request was in breach of the European Convention on Human Rights

A recent YouGov poll (pdf) found 73% of adults in England and Wales support the proposals in this Bill.

Assisted Dying Bill - What's Next
The Assisted Dying Bill: What’s next?

Summary of the Assisted Dying Bill
The Assisted Dying Bill is a specific, focused piece of legislation based on a recognition – repeatedly expressed by the courts – that the issue is one for Parliament to address. A change in the law that every opinion poll has shown is supported by an overwhelming majority of the public.

You can view the Bill in full and track its progress on Parliament’s website here.

If enacted it would:

Result in fewer adults facing unnecessary suffering at the end of their lives, subject to strict upfront safeguards, as assessed by two doctors.
Bring clarity to an area of the law that is currently opaque and thereby provide safety and security for the terminally ill and for medical professionals.
Neither legalise voluntary euthanasia, where a doctor directly administers life-ending medication nor act as a slippery slope to do so.
Protects anyone who doesn’t have a terminal illness, including elderly and disabled people, by not in any way affecting the law that makes it a criminal offence to assist ending their lives.
Above all it will give dying adults peace of mind that the choice of assisted dying is available if their suffering becomes too great for them in their final months of life.

Without a change in the law, terminally ill patients will continue to take decisions without adequate safeguards, whether by travelling to Dignitas to die, ending their lives themselves or being illegally helped to die by doctors.

Impact of the Assisted Dying Bill

The Bill draws on the experience of Oregon’s Death with Dignity Act.

This law has been in force for 17 years and has enabled a small number of people who were terminally ill to request the choice of an assisted death. In practice only a very small number of patients have an assisted death – less than 80 in total in 2013 out of the annual 30,000 deaths in Oregon. There has been no evidence of abuse since its inception.

The Assisted Dying Bill would:

Provide safeguarded choice and control to terminally ill adults and prevent prolonged suffering among these dying adults who want to have choice over how and when they die.
Ensure that terminally ill adults who have assistance to die do so having met clear pre-determined criteria and have explored all their alternatives; rather than as at present, in secret, when checks are only made after someone dies (as set out in the prosecuting policy on assisted suicide).

The Assisted Dying Bill would not:
Legalise assisted suicide for people who are not dying (for example disabled people or older people).
Legalise voluntary euthanasia where a doctor administers the life-ending medication. Under the Assisted Dying Bill the person choosing an assistance to die would self-administer the prescribed life-ending medication.
Legalise a system where the person being directly helped to die is no longer competent to make that choice for themselves. This Assisted Dying Bill would only apply to adults with mental capacity both at the time of their request and at the time of their death.
This is an emotive subject on which we have varying views

3 comments:

  1. I was 100% in favour of this - always have been - until last year when a close relation became terminally ill with liver failure (and a host of other problems). She was bed-ridden, doubly incontinent, losing sight, had to be fed, was declining mentally and losing her speech. When the hospital could do no more for her, she was put in a care home where she needed 24-hour care. After six weeks or so, her husband was told that henceforth her care would be chargeable, because under the NHS guidelines, her condition was not severe enough for 'continuing (i.e NHS-funded) care' . We couldn't believe it - the woman was clearly going to die within weeks. I did some research and discovered how unbelievably stringent the criteria for continuing care are. I was also shocked at the multiple processes, committees etc. involved to get this money. I further discovered that PCTs are adept at applying the guidelines in a way which I can only describe as jesuitical. There are even (no surprises here!) lawyers who will 'help you through the system'. My brother was facing costs of more than £1000 a week but we had an amazing stroke of luck. Completely by chance, an NHS inspector did an unannounced visit to the home and looked at their paperwork. He saw my sister-in-law's medical notes and on the spot reversed the 'no' decision. She died three weeks later.

    Now that I know how truly cash-strapped the system is, I cannot see how the proposed reforms would be safe. We clearly do not have the cash needed to care adequately for the dying. Any decisions on ending life should surely be taken independently of financial aspects. In countries with a bigger health spend, e.g. in Scandinavia, I can see this happening and a good thing it would be. Here in 21st century Britain, we are simply not able to remove money from the equation.

    ReplyDelete
    Replies
    1. I wouldn't be so sure about Scandinavia; please read this article in the latest NEJM. It is clear that socialism is too expensive even for the wealthiest of countries. We need an alternative solution.

      http://www.nejm.org/doi/full/10.1056/NEJMp1411430

      Delete
  2. If England is like the U.S., over half of all medical expenses occur in the last 6 months of life. It is an incredible economic burden to leave behind with often so little to gain, and much of what is gained is unwanted. If my dog is in pain with no hope for recovery, I cry as I put her to sleep. I do so because I would not ask her to live a life of pain for my personal gain. Yet in much of the U.S., I would not have the options for end of life treatment afforded my dog. Why do I deserve less?

    ReplyDelete

Please note that all comments are moderated and any personal or marketing-related submissions will not be shown.