“Should We Control Death?”

G’day mate,

Euthanasia.  Suicide.  Topics we often avoid because they can be uncomfortable.

This week I watched a television program where euthanasia popped up, and I had to admit to myself that I didn’t know where I stood on the issue.  So I got thinking about whether or not people should be allowed to control death…

Firstly, I had to clarify the difference between “assisted suicide” and “euthanasia” – last week, I didn’t know there was a difference.

Assisted suicide is when someone kills themselves with the help of someone else, but importantly they are still the ones who actively take their own life.  When people talk about euthanasia, they are usually talking about the situation where a person leaves a wish to have themselves killed by another person under a predefined circumstance.

So, I wanted to explore these two different questions:

1) Should people have the right to suicide?

2) Should people have the choice to be killed under predefined circumstances?

 

1) Should People Have The Right To Suicide?

Some people say no.  They argue that life is precious and is always worth fighting for.

Some have religious reasons for saying no.  For example, they may believe that God created them and gave them free-will to live their life, but only He should decide when they die.  Personally, I find that this sounds as though we are all like robots.  Robots that can be switched “on” and programmed to make their own choices, except there is a key element of the coding that means they cannot destroy themselves so they can only be switched “off” by their creator.  That doesn’t sit right with me.

Other people argue that if we value “freedom”, then we should honour a person’s desire to control their death.

As a society, we have learnt to control many things…

For example, we have considerable control over birth.  We can control conception and offer artificial pregnancy to couples (including same-sex couples), which would have been preposterous only a few generations ago.  We offer abortion to mothers (i.e. allow the killing of a human life due to a mother’s wish).  We offer termination of pregnancy to couples if the unborn baby has a genetic disorder (i.e. allow the killing of a human life if that person will have an “undesirable disability”).

In the above situations, it seems that letting nature run its course or valuing the survival of a human life are not considered the top priorities.

Another example of not valuing the survival of a human life is the contradictory laws of drug use.  We disallow the use of some drugs that “damage” the body or can alter the mind to the extent that a person can be a danger to themselves or others.  Yet we allow the use of tobacco that damages the body and can reduce life-span.  We allow the use of alcohol that damages the body and can alter the mind to the extent that a person can be a danger to themselves or others.

Society allows someone to choose to refuse medical assistance and “let life run its course”, even if it means, for example, that they die a slow death due to starvation and dehydration.

Thinking of the above circumstances, it seems obvious that there is not a clear, number one, value that applies to all situations.

I appreciate that decisions can be complex, but I would think a society should base its laws on some hierarchal set of values.  Should survival be a top priority in all cases?  Or should freedom?

I’m reminded of several comments I’ve read this week…

If someone is suffering and wants to die, why should we ask them to suffer more?

My country’s law decree, death by 1000 cuts to me.” (from a terminally ill woman who starved herself to death in a hospital)

What sort of God lets someone suffer to the point of wishing for death?

To my knowledge, it is currently legal in Australia to suicide, but it is illegal to help someone else suicide.  In other words,

It’s ok to kill yourself, as long as you do it alone.  Please don’t involve your loved ones; if you do then they may be prosecuted because they failed to intervene with your death.

This doesn’t sit right with me because it encourages suicidal people to have a lonely and violent death.

In some parts of the world, it is legal for doctors to prescribe lethal medication in some situations.  But bureaucracy dictates when and when not to allow assisted suicide.

So let’s explore the question…

Under what circumstances would you grant a person’s wish for assisted suicide?

Some say you should never grant a person’s wish to die – let life run its course.

Some say that if you have an incurable and painful disease, then it is ok.

Other people would avoid using the term painful and go further and say that as long as you have a terminal illness it is ok.

Many people agree in principle that people should be allowed to relieve their suffering by committing suicide in the above cases, but argue that allowing this would be the start of a slippery slope.  The concern is that society would go further and allow non-terminal patients to access assisted suicide.

At first thought, this seemed understandable to me.

But further thought had me questioning the notion that a society’s values should be fixed.  In other words, our society’s values have changed over time.  For example, I wouldn’t want people being executed for questioning whether the world is flat or round, and I wouldn’t want a woman prohibited from working and voting because she is “a man’s possession”.

It also had me thinking whether it would be such a bad idea to allow non-terminal patients to access assisted suicide?

I don’t feel anyone should judge the degree of another person’s suffering.  If someone is suffering to the point that they wish to die, then surely that is the highest degree of suffering?

The only thing worse would be to wish to be dead but have that option taken away from you.

Now, some people would say that if a suicidal person is mentally incompetent, then they should not be allowed to make their own health choices.  Defining mental incompetence is a grey area, but I think we deal with this greyness in other areas of law.  It seems logical to me that someone who is deemed mentally incompetent should not be allowed to access assisted suicide.  And I wouldn’t consider this to be discrimination.

Another grey area is the area of mental illness.  Some would say that if you are mentally ill you should not be allowed to make your own choices.  And some would argue that if you are suicidal then obviously you are mentally ill!

And what about the person who has tried medical treatment and can’t get relief for their suffering?

Whatever the reason, if someone wants to commit suicide, then they are obviously ill.  The question is: how long should they suffer for?

If they have a terminal illness, then do we want to keep them alive for their benefit or for our benefit?

If they do not have a terminal illness, then do we think we can always “fix” their suicidal thinking?  Should we force them to keep taking our “medicine”, even when it is not working?

I’ve heard the argument that suicidal thinking is like choking – do you sit back and let nature take its course or do you do everything you can to keep them alive?  The argument is: you never surrender to the illness.

So should we take away an individual’s freedom of choice when they are a danger to themselves?

In other words, it comes down to values: do we value survival over freedom?

If survival was our number one value, we would not allow abortion.  We would not screen for genetic disorders such as Down syndrome and kill an unborn baby because of the potential “inconvenience” to society or because we are acting “in the child’s best interests”.  We would ban cigarettes and alcohol “in the best interests of the individual”.  We would not allow a patient to refuse medical treatment for an illness.

If freedom was our number one value, we would have “death clinics” available for suicidal people.  This may seem ridiculous, but let’s entertain that thought and see where it takes us…

If a person has suicidal thoughts but believe they can be healed of their suffering, they could go to a hospital for treatment.  But if they do not believe they can be healed, or do not want to be healed, they could go to a death clinic to die peacefully.

I believe there is something like this in Switzerland, but I think their assisted suicide program is restricted to people with terminal illnesses.

If someone went to a death clinic, there would have to be a procedure.  You would have to be interviewed and assessed by more than one professional to try to get to the root of the problem.  You would have to be offered other forms of help.

If you were deemed mentally incompetent, then next-of-kin would be contacted and a management plan would be devised and implemented.  Perhaps substance abuse would need to be dealt with.

If you were assessed as having a mental illness, then every effort would need to be made to give treatment to alleviate the suicidal thoughts.  A certain cooling-off time would undoubtedly be necessary.

If you were not mentally ill but suffering physical pain, then cooling-off time would still be necessary and sedation could be offered in the meantime.

If the patient wanted, family and loved ones could be present.  If the patient didn’t, then perhaps it would be a requirement that next-of-kin be at least notified and be allowed to respond in some way before patients are allowed to commit suicide.

If a patient changed their mind and wanted to leave the clinic, then there would be a procedure for that.  Next-of-kin would be involved and a management and follow-up plan would be put in place.

Would this be a terrible idea?

Could death clinics decrease the number of violent suicides?

If suicidal people knew that they would leave the clinic either dead or feeling better, then would it not encourage them to the clinic?  Wouldn’t this be a good thing?  Surely getting people to a clinic would give them every chance of surviving and getting better.

Even if the worst did happen, perhaps it would make it easier on a patient’s loved ones, as opposed to a sudden and violent suicide.

One of the hardest things about suicide is the unanswered question of “why?”  Having death clinics might provide loved ones with answers and could give them an opportunity to intervene or at least say goodbye.

This would probably be an improvement to the current situation in Australia.  Too many people take their own lives violently and all alone.  Their loved ones are left with too many unanswered questions and never had the chance to intervene or say goodbye.

I haven’t spent much time thinking about it, but I think death clinics are worth serious consideration.

 

2) Should people have the choice to be killed under predefined circumstances?

I think that if assisted suicide is available, then voluntary euthanasia should also be available.

The key is to make the conditions under which a patient wants it to occur as clear as possible.  Just because there would be greyness in some situations, this shouldn’t preclude others from having their wishes come true.

Perhaps there needs to be a very detailed application process.  If you can have a detailed will for your assets, and a detailed funeral plan for disposing of your body, then I think you should be able to have a detailed plan for your death.

In fact, I think it should be compulsory to have a detailed health care plan.  If people don’t want to be euthanized, then their desired palliative care arrangements should be documented.

Yes, we currently have advanced care directives in Australia, but to my knowledge these are not strictly followed and instead someone is appointed to make decisions on the patient’s behalf.  I think advanced care directives should be more detailed, compulsory, and be strictly followed.

Surely how someone dies is more important than what happens to their assets or what happens to their body after they’re gone?

The main argument against voluntary euthanasia is similar to the main argument against assisted suicide – life is sacred and should be let to run its course.

The other common argument is the “slippery slope” argument that says that opening the door to voluntary euthanasia will inevitably open the door to non-voluntary and involuntary euthanasia.

I think this is a very important consideration.  I think it strengthens my view that everyone needs a detailed advanced care directive that needs to be followed.

The important thing for me is the reason why I would be in favour of voluntary euthanasia.  I think it should be about personal choice.

Many arguments for voluntary euthanasia are focussed on a patient’s best interests.  But I think under this reasoning, it could open the door to non-voluntary and involuntary euthanasia.

I don’t believe anyone should have the power to euthanize a patient when they think it is in the best interests of the patient.

I believe that someone should have the power to euthanize a patient ONLY when the patient’s prior wishes are clearly met.

 

Conclusion

When I started writing this, I didn’t have any strong opinions.  After exploring these issues, it seems to me that arguments against assisted suicide and euthanasia are based on fear.  People fear the misuse of power.  People fear living with the knowledge that a life was ended with their permission.

But to me it comes down to this question:

“What do you value more: your freedom or your survival?”

Throughout history, people have been forced into war when their survival is on the line.  But, more importantly, many people have chosen to go to war when their freedom has been challenged.  In other words, they decided that their life was worth sacrificing for the freedom of their loved ones.

Over time, people have stood up against the status quo of the time and have gained more liberties over their rulers.  Arguably, this gradual shift towards more freedom hasn’t stopped yet.  Regardless of what I think in 2017, I think it is inevitable that humans will fight for freedom of how to die.   With advancements in medicine, I predict a distant future where death by assisted suicide or voluntary euthanasia is the norm.

My prediction may be wrong, and you might hope that it’s wrong, but something tells me that the human desire to be free will overpower the desire for survival.

I think our desire to be free is what distinguishes us from other life forms.

The question is:

“How much freedom do you really want?”

 

Cheers,

Bazza

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