In Tony Nicklinson's heroic suffering, I can't help but see the case for life

[ljtaylor]

It is harrowing to watch the anguish of a man who wants to end his life but cannot - yet his message somehow backfires

Comments

[metatrix]

I'm so conflicted about euthanasia. I used to be firmly pro-euthanasia until I read an article written by a patient who had previously battled for the right to be euthanized, and lost. Years later she was thankful that she had lost, thankful she was alive, and she was arguing against legal euthanasia. I wish I remembered her name or the name of the article.

From what I do remember of the article, the main points were something like:

- it is extremely difficult to sort out what is a true wish to die from what is treatable depression speaking. This is because almost everyone in such a situation will be depressed, so the psychiatrist needs to figure out if the degree of depression is permanent/untreatable, or if can get better with treatment, and if the desire to die will change with treatment for the depression.

- it is common and normal to want to die after a life-changing disability or diagnosis, and it can take years to adjust/accept the new reality. For some people (but not all), after the period of adjustment is over, they find a new will to live.

- people in these situations often feel like a huge burden to friends, family, and society, so by making euthanasia an option, they may feel guilty for wanting to live. they may feel like they 'should' choose euthanasia in order to unburden their loved ones.

- people in this situation are some of the most vulnerable and disenfranchised members of society, and legalizing euthanasia is simply too risky. There is too much of a risk that all the proper precautions (thorough mental health evaluations, etc.) won't be followed. Too much risk that caregivers may pressure patients into choosing euthanasia, or that depressed patients will choose euthanasia prematurely. Ideally, euthanasia should be the 'treatment of last resort' when all other options have been exhausted and life is truly unbearable, but the fear is that there will be too much room for abuse if such a law were to pass.

- physician-assisted suicide is already practised quietly and routinely, with the help of a famous loophole (principle of double effect). This is working fine, so we don't need to legalize euthanasia.

[darth_eldritch]

Likewise I knew a man who went through severe chronic pain, had wanted to die. He came out of it a firm proponent of assisted suicide.

No doubt he enjoys life today, he states that you have no idea what it is like until you have been there.

[rex_dart]

This is working fine, so we don't need to legalize euthanasia

Did you in fact read the article at all?

[metatrix]

I wasn't actually stating my own opinion. I was merely summarizing the main arguments stated in an article I read a long time ago.

Personally, I'm undecided on the subject of euthanasia. I stated so at the beginning of my comment.

[herongale]

physician-assisted suicide is already practised quietly and routinely, with the help of a famous loophole (principle of double effect). This is working fine, so we don't need to legalize euthanasia.

What that's referring to is the fact that if you're treating someone with intense, terminal pain, the very medications that are used to treat the pain can also help usher in death.

But the man in this story is not someone with terminal cancer. He has locked-in syndrome, and I would bet that his physical pain is never to the degree where he needs heavy pain medications which could mercifully help end his life. This "option" isn't really an option at all, it only works in select cases... usually the sort of select cases where even if you do nothing, and let someone writhe in their moving, transcendent pain (/rolling my eyes here), they'll probably die sooner rather than later anyway, because the illness that is paining them is also the illness that will kill them.

Locked-in syndrome is often a non-progressive illness, meaning that the event that causes it could be something like trauma, or a stroke... once the original inciting event is over, it's not going to automatically get worse, nor is it going to bring on death on its own.

The issues that you raise are all important, but that doesn't mean they necessarily should be a bar to assisted suicide as an option... all it means is that it's a really difficult medical decision that should require the input of several different types of doctors, to make sure that depression or coercion are not factors, to make sure that the patient is in a proper mental state to be making such a decision. Where assisted-assisted suicide is legal, there are usually very stringent criteria in place to screen for these factors before it would even be considered: so, for instance, a patient with depression would need to be treated for their depression first, and then see if the will to die still holds true. The patient in the story cited above doesn't sound depressed to me: the very passion with which he argues for his right to die seems to counter that possibility quite nicely. And it really doesn't look like a case of coercion either. So although the cautions you raise are important, they don't really seem to apply in this case. There is no reason to argue in generalities about a specific case.

[metatrix]

First, I want to re-iterate that I wasn't actually stating my own opinion on euthanasia. I was just summarizing the main points that were brought up in an article that I read on euthanasia a long time ago. Personally, I'm undecided on the subject of euthanasia.

One thing my prof said in my medical ethics class which I think I agree with is that you can argue for legalizing physician-assisted suicide, but legalizing euthanasia is a wholly unnecessary legal risk, and going too far. If you legalize physician-assisted suicide, patients are still able to end their own life in a safe and dignified manner with medical help. But you have the added precaution of the patient being the one to 'pull the trigger'. This precaution is may seem insignificant on the surface, but it's actual hugely significant because:

- it avoids lawsuits from family members who will sue the doctor for wrongful death, saying the patient didn't really want to die
- it avoids the mental distress of the doctor needing to end the life
- it protects the doctor from criminal prosecution
- extra insurance that the patient really wants to die

In almost any circumstance, some kind of system can be rigged whereby the patient, no matter how disabled, can perform the final action that ends their life. Even if the patient is locked in and can't move, a system can be set-up whereby a morphine drip hooked up to a computer will be activated by the patient blinking his eyes in a specific pattern.

So, in that sense, I believe that between physician-assisted suicide and euthanasia, it is physician-assisted suicide that ultimately retains patient autonomy best (all the way until the very end), whereas euthanasia follows more in the old tradition of paternalism/beneficience ('it's too emotionally painful for the patient to pull the trigger, so as physicians we will take on the burden instead')

IDK if that made sense.

[wrestlingdog]

Thank you for this.

[kyra_neko_rei]

To address some of these arguments, I don't think the phenomenon of some people changing their minds later is a relevant argument for denying it. To force people to remain alive because they might change their minds later is someone else choosing to gamble with their well-being as the stakes, or rather forcing them to gamble their chance at relief for a change of heart that might never come.

In any other situation, the threat "I'm going to force you to keep doing this until you tell me you like it, and then I'm going to use that statement as justification that I was right all along," is monstrously creepy.

Yes, sometimes people change their minds, and they will always have the option to step back and wait if they think that likely to be the case. But I don't think protecting people from themselves ought to go this far, to the point that it fails to protect them from other things they can't escape.

As for the risk to people of legalizing euthanasia, a solid series of thorough but achievable failsafes to make consent clear and recognized should be required. If it is more burdensome to fake the person's consent than to simply kill them and make it look like an accident, then this will not be the method of choice for murder to be committed.