Right to die gives right to kill

When proponents of euthanasia talk about the right to die they omit to explain that it involves other people and would also give the right to kill.

Would health professionals who are bound by the Hippocratic oath to do no harm want to do that?  Is it fair to ask them to? Even if the answers to those questions were affirmative, how could we be sure decisions would always be based on medical and humanitarian grounds?

Macdoctor points out the dangers of a financial incentive to hasten the end of dying patients.

This brings me to the central problem I have with human euthanasia.

It is a cheap cop-out.

Least I be called insensitive in the face of Dr Pollock’s eloquent and  emotional letter, let me say that I say this entirely in the context of medical practice. I do not consider Dr. Pollock’s desire to die rather than suffer a “cop-out”, I consider the legalisation of euthanasia to be a cheap (and nasty) alternative to adequate palliative care. And therein lies the chief dilemma.

Governments being what they are, as soon as euthanasia is legalised, there will immediately be a subtle drive to euthanase dying people.

 Would it be possible to have safe guards that ensure that those who wanted to opt for voluntary euthanasia  could without the danger that others would feel pressured into it?  They may feel they have to opt for an early death, not for their own sakes but that of their family and friends or even because they felt they were using scarce resources and wasting the time of the people caring for them.

Most of us think if we were severely disabled we would opt to forgo treatment, but would we?

Theodore Dalrymple writes of a man whose life support was about to be turned off until he blinked:

Mr Rudd, 43, was injured in a motor accident. He was paralysed and thought to be severely brain damaged. . .

However, taken to the neuro-intensive care unit at Addenbrooke’s Hospital in Cambridge, he was kept alive by the miracle of modern technology, without which he would undoubtedly have died.

His close relatives and doctors thought that the life he now had was not worth living. They prepared to turn off the machines keeping him alive. They thought this is what he would have wanted. It is also what most of us probably would have thought too.

At the last hour it was noticed he was able to move his eyes and that by doing so he could communicate a little. And what he communicated to everyone’s surprise was that he wanted to continue to live, even the life that he was now living. In other words his relatives and the doctors, with the best intentions in the world, had been mistaken. . .

That would have been a fatal mistake.

Dalrymple goes on to explain about Quality Adjusted Life Years (QALY) and how that measure could influence treatment.

Health policies are often decided on the basis of QALYs. Interestingly and alarmingly the QALY assumes that the life of a quadriplegic (someone paralysed from the neck down) not only has no value for the person who lives it but has a negative value for him: that is to say such a person would rather be dead and in fact would be better off if he were dead.

Whatever they thought before they were paralysed, however, most quadriplegics think their lives are worth living.

With a few exceptions, such as the young rugby player who was accompanied by his parents to Switzerland to be able to be given assistance in suicide, they don’t want to die. The fact that before they were paralysed most quadriplegics thought (as most people, including health economists think) that life as a quadriplegic would not be worth living but change their minds once they are quadriplegic, has very important implications for the idea of living wills.

In fact it invalidates the very idea. It is impossible to decide in advance what would be intolerable for you until you experience it.

When discussing this situation most of us think we would choose death rather than a life with severe impairments, but how can we know how great the desire for life, or death, would be until we are faced with making a choice?

When euthanasia is spoken of, it’s usually described as providing a merciful end, but would we feel the need to hasten our deaths if we could have a painless and natural one instead?

Dalrymple raises another problem. If we did legalise the right to kill, where would we draw the line and how would we stop it moving?

One of the problems with assisted suicide and euthanasia is what the Americans call mission creep. We live in non-discriminatory times: why should only certain categories of patients have the benefit of what Keats called “easeful death”? Indeed, when euthanasia was legalised in Holland it was not long before a psychiatrist killed a patient with supposedly intractable depression.

Why should only the terminally ill and the quadriplegic have the right to assisted suicide or euthanasia? Do other people not suffer equally, at least in their own estimation?  An old saying goes that hard cases make bad law and it is also true that there are pitiful cases in which a quick death would seem a merciful release.

Unfortunately it is well within the capacity of carers to make suffering unbearable and therefore death seem the preferable, quick and merciful option. And if people have a right to death on demand then someone has a duty to provide it, otherwise the right is worthless, a dead letter.

Who is this person who has such a duty? Will we strike off doctors for refusing to kill their patients? This is something that the indomitable Mr Rudd would not approve of and I think he deserves to be heard.

Euthanasia is not the same as choosing to forgo treatment. It is not passively letting someone die or even giving pain relief which might have the side effect of hastening death. It is actively killing and if we give the right to do that how can we be sure it wouldn’t be misused?

Rather than agitating for the right to die we should be agitating for the right to live with dignity and without pain.

The right to die sounds like control is in the hands of the patient and I struggle to see any difference between that and suicide.  But euthanasia is much more than that. In legalising the right to die we’d also be legalising the right to kill.

UPDATE:

Lucia Maria aat NZ Conservative has similar concerns in  euthanasia raises it’s ugly head again.

Dim Post is cautiously in favour of legalising euthanasie but also sees the dangers in death panels.

goNZo Freakpower supports legalisation in any last requests,

So do Brian Edwards in the doctor and the right to die and Richard McGrath at Not PC in Cancers – personal and parliamentary.

Lindsay Mitchell asks what happend to the death with dignity bill?

4 Responses to Right to die gives right to kill

  1. Linda Reid says:

    Great post.

    I think we need to look at the ‘dignity’ issue as well. There is an assumption that if we have ’embarrassing’ physical responses to illness, or we need our personal care done by someone else, that this is somehow a loss of dignity. From my point of view, with a fully functioning body, I understand why people would assume that.

    However, I believe that dignity is self-generated, and cannot be taken away by our circumstances.

  2. Fredinthegrass says:

    Thankyou Hp for a timely and well constructed post.
    Let me say now I am pro euthanasia, and I am not afraid of the likelihood there will be “mistakes” made.
    Lets look at ‘life’ – with a compromised legal system, a struggling health system, not to mention an education system that seems unable to keep up with the ever increasing pace of change; all of which exposes innocent people to risk that often leads to death.
    Why is it when this issue is raised it becomes so complicated?

  3. Gravedodger says:

    Whilst I accept the ramifications and obligations of the Hippocratic oath on the medical profession I am deeply troubled by the enormous resources we as a society invest in a patient who sometimes just by good fortune accesses the constrained services in the treatment system with no prospect of recovery while a patient with very good prognosis dies waiting just to access the very expensive and rationed services. All too often the “in” patient referred to above may well have contributed to their situation by poor life choices, reckless behavior or other contributory factors while the unlucky,”out” patient may simply be a victim of very bad luck. The medical profession already condemn patients to premature death by accepting the very necessary rationing of medical services due to budgetary constraints, the difference being this permitting of premature death is by omission rather than conscious action.
    My comments are just an opinion of what actually happens and in no way aimed at the Drs and their oath. I arrived at my position through my life with animals, some very treasured by me and having to take a very final action at their life termination. Sadly Dr Pollocks request for a debate on his view of assisted death made by a person in full control of their mental, emotional and rational view of their mortality and what I will call euthanasia as an active procedure to possibly solve the dilemma I outlined above. IMHO and very poorly expressed opinion we have two very different subjects that I admit are linked when measured against the “mission creep” included in Macdoctor’s thoughtful analysis.
    Good post HP we must at least debate it from time to time as the reality of treatment with the amazing ability to keep a body alive is a very expensive exercise and can be very capricious in its delivery and all to often seen as unfair.

  4. macdoctor01 says:

    You mention QALYs, HP. As I have mentioned in other posts, QALYs are a good way to compare the value of two similar procedures, to determine which is the most cost-effective to use. They are very bad at comparing two dissimilar procedures because the subjective measures used in calculating one set of QALYs does not correspond to the other.

    They are an utterly dreadful way of determining whether a person should live or be offered euthanasia. You, yourself, have pointed out why. The subjective measures used to determine a QALY bear no relation to the entirely subjective desire of the patient concerned. They are as dissimilar as tastes in music or food.

    The excessive reliance of MoH bean counters on QALYs fills me with dread. Using a dangerously opinion-based measure as an immutable yardstick hides the seriously unethic and uncompassionate nature of resource allocation decisions and can seriously distort the provision of health care.

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