Tuesday, September 23, 2008

A Duty Too Far?

One of the most difficult topics ever broached is the "end of life" question, which has recently been projected back into the headlines by Dame Mary Warnock with her perhaps ill-judged comment that dementia sufferers ought to be assisted to commit suicide.

It is unfortunate but not surprising that comment has focused around the phrases with the most shock value, effectively preventing a balanced debate on what is a delicate ethical question.

"Right to life" and "Right to die" advocates are equally passionate, and both cases have merit. It is hard to argue the case against assisting somebody with an incurable degenerative disease to have a painless and dignified death at a time of their choosing, rather than forcing them to suffer weeks, months or years of pain and dependence while their disease runs its course. Yet at the same time, every human life has a value, and nobody except the person living that life can/should be able to decide whether or not it is worth living. It is very easy to see that the possibility of being assisted to die could metamorphose into the duty to take this route.

Society is excellent at being judgmental. Consider how smoking cigarettes has moved from normal, mainstream behaviour, to being discouraged, to being outlawed except in the privacy of the home. Now anyone brazen enough to continue enjoying a smoke is made to feel like a pariah. The same is beginning to happen with diet. Food packaging regales us with details of fat, calories, salt, and every advertisement urges us to take more exercise and stop eating so much of the fun stuff. I fully expect to wake up one day and find that the government has decided to ban chips, or put a 'health tax' on the price of a cream cake. And the propaganda is working. Everybody now knows that they should be eating a lot more fruit and vegetables, far fewer biccies - and we are beginning to look askance at those who don't follow the rules. One of my oldest friends - very fit and slim - actually apologised for taking sugar in her coffee; an automatic defence, she told me, because so many people take the opportunity of voicing their disapproval when she asks for the sugar bowl.

Now imagine that we manage to pass legislation allowing us the right to die. Initially, of course, we will be ultra-cautious. Individuals who want to pursue this right will no doubt have to jump through many hoops to demonstrate the hopelessness of their position and their fixed determination to end their life. Then gradually, as we become more at ease with the idea that mortality can be quite easily controlled - and as society strains to cope with the needs of many more elderly people - there will be a shift towards perceiving euthanasia first as a sensible decision for anyone with poor quality of life, then as a positively good way of easing the burden of caring for the frail, confused and disabled.

We may then find ourselves casting the same look of disapproval at an elderly citizen inching their painful way along with their walking frame, as we now do when we see a huddled smoker in an office doorway, or a fat shopper with a trolley full of carbohydrates.

Although I started by believing myself to be in favour of the right to assisted suicide, I find that I have now come full circle. The risk of abuse is just too great, and I for one would not care to live in a society where a single person was made to feel that they had a duty to die, for the greater benefit of the state.

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8 Comments:

At September 23, 2008 5:00 PM , Blogger Mary Emma Allen said...

Thanks for sending this blog post to the All About Alzheimer's Carnival at Alzheimer's Notes (www.alzheimersnotes.com). I saw the news article about Dame Mary Warnock's statement and thought, "I must write my thoughts about this." I have the same fears you do...that what starts out as possibly humane and respecting an individual's choice will become abused and carried to the extreme.

 
At September 24, 2008 9:49 AM , Anonymous Anonymous said...

I agree completely.

Whilst it is difficult to even pass opinion unless you are someone who is in the actual situation, the possibility that the choice will be made not to benefit the actual person in question, and rather those who may be affected by their actual requirements, is too great a risk to chance.

 
At September 24, 2008 10:55 AM , Anonymous Brian Young said...

This is a real difficult issue however I have strong views about the subject. We do not allow educated adults to make informed and well thought out decisions that effect them. We are so concerned with political correctness that we will allow humans to suffer in a way that we would never allow an animal. If somebody decides that they want to end their suffering, then as long as procedures are carried out to ensure outside pressures are not being applied, assisted dying should be allowed. The problem is that governments want to control even the most basic of human rights, in effect you do not even have the right to end your own suffering - but hey if it makes the decision makers feel righteous then that's fine!

 
At September 24, 2008 11:58 AM , Anonymous Liam Braddell said...

This is one of the few subjects that I can honestly say I have no general fixed opinion on other than if I were in the situation myself. I see many people with degenerative conditions and my point of contact is usually when they are positive and require help from caring companies like Theraposture to find ways of living with their conditions and remaining positive about the challenges they are faced with. Sometimes however, this point has passed and we are involved in their situations when loved ones and carers are making decisions for these people and this often makes me think about how I would feel if that were me. M.N. is a terrible condition that leaves the person usually fully aware of their condition and difficulties but with a body that simply wont work.

This is the condition that I personally fear the most and if I were in that situation, I would be in favour of someone helping me to commit suicide. That said, I think that the instruction could only be followed if make clear at a point of being able to give it myself.

I don't think we will ever see this right legally granted as there are too many possible scenarios that would make it difficult to legislate about. My personal wish is that should this wish be followed through by loved ones, a sympathetic view should be taken by the authorities.

 
At September 24, 2008 3:31 PM , Anonymous Colin Davies said...

Assisted suicide could/should be available on the NHS/Gov as in the film Soylent Green, that would relieve the onus on the abetter and make the decision autonomous. Modern drugs/medicine can extend life but not necessarily improve quality of life - surely a subjective judgement anyway.

Bear in mind the 'catch 22' of being of sound mind, it could be argued that if you wish to take your life you are not of 'sound mind'!

As you can probably tell I'm not really sure which way to go on this subject, I'm not against it, but then again abuse or foul play could be present - either way it's a risk.

 
At September 25, 2008 10:10 PM , Anonymous Katharine Shaw said...

cfqxcUnfortunately, many people with dementia do die before their time, because of the poor quality of care in residential homes. My own mother died of peritonitis following a ruptured gallbladder. Before she was admitted to the home, I made all her meals and froze them in advance leaving a list for the care staff to follow. I also gave them specific instructions on what my mother did and did not like to eat. When my mother was admitted to a residential home after the care package broke down, I passed on all this information to them as well. On the day in question, the home did not even tell me she had been complaining of pain after eating or seek to find out if there was any history in the family. She died, in agony, alone in the middle of the following night, having fallen out of bed, not 12 hours after a doctor had pronounced her to be suffering no more than indigestion. She was otherwise in good health and enjoying a good quality of life with regular visits from me and my brother, trips to stately homes and gardens and meals out. We respected her wish not to eat fatty food, which, as it turns out was her way of managing the pain. The home provided no alternatives to sandwiches and cake, which she did not usually eat. No explanation of the lack of discussion with us was given, and the senior staff in the home were conspicuous by their absence when we visited to pack up her belongings. The thought of how she died still haunts me and I wish I had done more to keep her at home even at the expense of my own health and career, just to have the satisfaction of knowing she had the best care possible until the day she would have died of a natural death.

 
At September 26, 2008 12:21 PM , Blogger Independent Living Editor said...

Katherine, I am so sorry to hear of your mother's distressing final hours. With such a high proportion of care home residents suffering from dementia, it is obviously vital that both managers and their staff receive good training in how to care for their clients properly and take account of their individual needs.

 
At October 19, 2008 4:07 PM , Blogger Judith said...

I have little experience in this field, so I would like to know if it is even possible for carers to judge, or to find out from patients with dementia themseves, whether they consider they have a good quality of life or not.

 

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