Assisted Suicide

[matty-hodgson]

What if the cure comes out the day after you died?

then it's probably already too late to cure it.

[cleaverlch]

Waiting months is nothing compared what the cure might give you. If you know that there is a cure in clinical trials, would you still choose to die instead of waiting for it?

[matty-hodgson]

Waiting months is nothing compared what the cure might give you. If you know that there is a cure in clinical trials, would you still choose to die instead of waiting for it?

personally, if i knew i didn't have long left and there was an experimental drug out, i'd apply to test the drug out and help those in the future that might have the same disease.

and just for the record, i'm neither for nor against the whole 'assisted suicide' thing.

[b0redom]

Looking at the bigger picture. Good luck getting a life insurance payout if you do go for euthenasia. I'd bet pounds to pence that it excludes suicide.

[Saracen]

Waiting months is nothing compared what the cure might give you. If you know that there is a cure in clinical trials, would you still choose to die instead of waiting for it?

For me, it would obviously depend on the situation. But either way, as far as I'm concerned, it's MY decision, based on my assessment of that situation.

[TeePee]

The issue in the states with depression is the product of a recent study which showed that about 60% of the terminally ill patients who chose the legal assisted suicide also had symptoms of depression.

Why 40% weren't depressed at their pending inhumation is more of a mystery.

What this shows is that there should be a doctor involved in the process, to ensure that there really is a terminal illness, as well as assist with the mechanics of the process, and as a checks and balances issue.

[Saracen]

Which study is that, TeePee. The most recent one I'm aware of is Ganzini's study (BMJ) of the situation in Oregon, and it didn't reach that conclusion.

But, you also need to be very cautious of how criteria are defined, especially in situations like this.

One problem .... how do you decide if a given patient is "depressed"?

It isn't like, oh, cancer or plague. With those, you can run blood tests or analyse tissue samples and determine that a given cancer does or doesn't exist, or that a particular disease is or isn't present. But with psychiatric issues, it's a LOT more vague than that. There's generally going to be a series of evaluations, and the caseness decided. Simplistically put, if you score above a certain level on those tests, you qualify as "depressed". But different people react differently, and it's not an exact science. Depression isn't a "you do or you don't" thing. It's a spectrum, with no clear delineation.

So ..... if you're interviewing 100 people that qualify for an assisted suicide program like the Oregon one, you've pre-selected a group that by definition have a terminal illness. Are you justified in being depressed about that? Is it a surprise if you are? And even if you are, is that a reason for denying a clearly expressed wish for an assisted end?

I mean, I can't imagine anyone exactly being happy about having a terminal illness, like cancer or Lou Gehrig's disease. So, quite where does unhappiness with your current lot end and depression start? Factor into that that a proportion of those in that study were already sufficiently advanced in their illness that they were suffering considerable pain. Many terminal conditions do involve intense pain. So you either have to put up with constant and substantial pain, or you have to take ever-increasing levels of painkillers. And, sooner or later, those painkillers reach the point where you're so doped up that you don't recognise your own family, that you don't know day from night, that you are catheterised because you can't control your bladder, and so on. Anyone knowing they face that has reason to be a bit depressed, and eminently good reason to decide that there will come a point where they have had enough, and that the price of a continued existence (because, in my opinion, it reaches the point where quality of life is zero and it is existing rather than living) is higher than it's worth.

And that's been my point all along. It's MY decision when the price is too high and not justified by the benefits, if there are any at that point.

So, given that there's no categoric definition of when a given patient is depressed, and it relies on that "caseness" assessment, and given the sheer facts of some terminal illnesses, it's hardly surprising if some terminal patients at advanced stages aren't exactly abounding with gaiety. The first line of the conclusion if the Ganzini study is interesting ....

Our study suggests that most patients who request aid in dying do not have a depressive disorder.

But you have to be VERY careful what you're looking at. For instance, you get different results from studies that looked different underlying situations. One study (Emanuel, Fairclough and Emanuel) of patients with a terminal cancer showed that 59% of those with a serious and pervasive desire to die had depressive symptoms, but only 8% of patients without such a desire had similar symptoms. Maybe that's where you're 60% came from? So ..... are those people depressed because they're suicidal, or suicidal because they're depressed?

But that study was in an area where physician-assisted suicide was not legal. It's one thing expressing an interest in something that you know you can't legally get, and quite another actually asking for it when you can get it. Again in Oregon, where it is legal (with a lot of conditions) 17% of similar patient groups expressed an "interest" in assisted suicide, but less than 2% actually request it. As you can see, the picture on depression and it's relation to assisted suicide is very far from clear.

[TeePee]

This was my point, in rather more words.

[TheAnimus]

I thought we had a system in place for assisting suicide? Glasgow?

But in all seriousness, dosen't the moral quagmire of this come down to a case by case basis? There will always be some that seam questionable? A 23 year old taking his life because he's wheelchair bound for instance. But there will always be the other cases, situations where painkillers fail to help someone who's terminally ill, has no living relatives, and their only friend, tiddles, was hit by a delivery truck.

The danager is once you slip into helping people top themselfs (with means other than living north obviously) then you might find the situations aren't so black and white.

[Saracen]

.....

But in all seriousness, dosen't the moral quagmire of this come down to a case by case basis? There will always be some that seam questionable? A 23 year old taking his life because he's wheelchair bound for instance. But there will always be the other cases, situations where painkillers fail to help someone who's terminally ill, has no living relatives, and their only friend, tiddles, was hit by a delivery truck.

The danager is once you slip into helping people top themselfs (with means other than living north obviously) then you might find the situations aren't so black and white.

Well, yes and no.

It seems to me that there's two aspects to this. The first is whether you are going to have a system that permits assisted suicide at all, or not. There are people that just believe, for varied reasons, that it's wrong. While we're all entitled to our opinions, one thing that gets right up my snoot is when people say it's wrong for religious reasons. If they think it's wrong because God (or Allah, or whatever) tells them it is, then that's fine with me. So don't do it yourself then. Where I get right peeved is when they say can't have the option because their God says it's wrong. Then just try to get them to prove that their God actually even exists, let alone that he/she/it said that.

So, to my mind the first issue is whether we have a system at all. And that's got nothing to do with a case-by-case basis.

Only if we establish that we aren't going to totally rule out any sort of a system is it worth getting to case-by-case issues. Then, there's a series of issues and yes, some of them are case-by-case, but some aren't. For instance, if you have a system, you need to define what general eligibility criteria are. The Oregon system, as I understand it, has a lengthy set of criteria which includes that it's only available to terminally ill patients, that you have to be able to demonstrate legal competence, must be of legal age, and must be an Oregon resident. Unlike the Swiss Veritas clinic, there's no dropping in from out of State or out of country .... though I understand there's a debate in Switzerland about whether they should restrict it to Swiss nationals from the current situation.

Only then after establishing that you're going to have a system at all, and establishing the general criteria for eligibility, does the circumstances of individual cases come into it. Then, you'd have to determine when a given case might or might not be suitable, and i certainly wouldn't object to that.

But the moral quagmire cuts both ways. Suppose for a moment that I'm determined to off myself, and you don't believe I should. Providing I'm adult, sane and not suffering from some treatable temporary metal condition, like severe depression, what gives you the right to decide I can't make that decision for myself? What gives anyone that right?

And, on a pragmatic level, what would make you think you can stop me? If someone is physically able, and that includes 23-year-olds in wheelchairs (and I know the case you refer to), and is determined to top themselves, then they will. It's not exactly rocket science, and there are countless ways of achieving that, many of which are pretty-much foolproof, and short of locking me up in a padded cell, you can't stop me.

So, if you have a pleasant, legal and dignified option, not only do you avoid the unpleasantness of having to scrape my remains off the front of a train, but you have a clinic environment and a legal framework which gives you a decent shot at talking me out of it, or talking me into trying other options first.

On the other hand, if you preclude that option, you drive the whole thing underground and the first you're likely to know of my plans is when I disrupt the mainline train services out of wherever I lived.

A lot of suicide attempts aren't serious attempts, in my opinion. Many are calls for help. Some of those certainly go wrong and end up being successful, which is really sad if they were just a call for help. But there are so many easy and obvious ways of getting the job done that if you've got someone that really wants to do it, they WILL find a way, if they're physically able enough to do it. There are studies that show that where there is a legal system that permits it, few people that actually apply for a prescription under that system don't actually use it. And if you know that you have a prescription that, if ingested, will kill you, then you don't take it as a call for help.

At the end of it all, though, it comes back to a simple question, in my view. If I am adult and of sound mind, then it's my business if I want to end it, and nobody has a right to deny me that because they don't believe in it, whatever the basis for that belief is and I don't limit that to religious belief. Deny it to themselves if they wish, but don't make my decisions for me, because the decision to live or not, subject to being adult and of sound mind, is the ultimate in personal responsibility. I'm not responsible for anybody else, and nobody else is responsible for me.