"assisted suicide bill" (may trig due to topic? not sure)

shadow-light · 21-01-2010, 02:34 PM

http://news.bbc.co.uk/1/hi/scotland/8471553.stm

What do people think?

The One Who · 21-01-2010, 02:46 PM

I think the security measures need to be tightened and lengthened. For example, instead of being registered at a Scottish GP for 18 months, make it 36 months. Only a fifteen-day 'cooling off' period?! Has to be increased to something more like three-six months.

I think it's a dangerous road to go down, personally.

Heidi Tiger · 21-01-2010, 05:10 PM

See I think legislating for it is a positive thing as it draws the clear lines between Diane Pretty for example and Tom Inglis. It also makes sure that a doctor only administers the drug, which I feel is a much safer option than simply not prosecuting a relative who aids in the suicide.

As for how to protect the vulnerable from pressure I feel that maybe aswell as a GP and a psychiatrist being involved, perhaps a social worker should be aswell. That way all the family dynamics can be assessed to try and ensure that the circumstances are legitimate.

As for the fifteen days, it does seem short if we are talking about a long term degenerative condition such as Huntington's or Parkinson's, however there are situations where I can see a need for a shorter time limit such as those where death is likely to only be a few weeks away, but would be extremely painful and distressing if nature was left to take it's course. So I think perhaps there could be a couple of time limits dependant on the likely progession of the condition. Because in the situation I just outlined, we effectively already have assissted suicide, doctors do prescribe massive amounts of opiates for pain-relief but also to hasten death and I think clarifying the law in that situation is more satisfactory than the situation we have now where such law-breaking is technically illegal,but has a blind eye turned to it.

sajhfuahuefghaeg · 21-01-2010, 05:36 PM

What Heidi said/

Imaginary_friend · 21-01-2010, 06:06 PM

I agree with Heidi too. I think that in theory it's a really good idea. Having seen the effects that watching people dying with terminal cancer has had on both my parents, i would say that yes, it's a good idea. My mum watched her sister die at 26 in agony from cancer, and the dose of painkillers that the doctors would have had to give her to stop the pain would have killed her - so they didn't. The same thing happened to my dad's mum, although i think in the end they did give the morphine to her. She didn't want to be here anymore, she wasn't going to get better, and it was heartbreaking for the entire family to watch her.
Having said that, i think with degenerative disorders it gets a bit more tricky...at what stage do the patient, doctor, family and psychiatrist is the right time? It'll be interesting to see the reaction and decision on this one...

22-01-2010, 02:01 AM

This is legal in one state here in the U.S. I did a study on it and as long as the right measures are in place I think it's ok. My uncle just committed suicide about a month ago cause he had cancer and a lot of pain. Had assisted suicide been in place in Arizona, our family would have been better prepared and he probably would have gone through less distress than doing it himself.

However I had also studied what has happened in the Netherlands. Most of them are completely legit, however one case happened where a psychiatrist did an assisted suicide for a continuously depressed patient. Not only was it illegal if I remember correctly, but he didn't ask for a 2nd opinion like the law stated, and there were some other shady stuff, aside from the fact that this person was depressed, not dying. I understand the guy was depressed for a long time, but then we might as well not even admit anyone to the hospital for suicide. And then when the psych went to trial, the jury just dismissed it even though it was illegal. They basically just said they understood the circumstances! I thought it was outrageous. Not to mention he did that to a mentally ill patient who most people would say is probably not in the right state of mind to make a decision like that.

So I think we have to be careful to say NEVER in the case of only mental illness, only terminal stuff. It could be abused so quickly if we are not careful. I understand the need for people who are dying of cancer, but I really feel it must stop there, and it's obvious from the case I mentioned that in the places its legal there are not enough safeguards in place as the dr never had any punishment. It could quickly turn from euthanasia to genocide targeting the mentally ill. So I think there are some positives and it may be doable, but I think it has to be super regulated and any breaches of the law with euthanasia need to be seriously dealt with no matter what.

Liar. · 22-01-2010, 02:19 AM

I don't see anything wrong with it to be honest.
They've made it so anyone who chooses to use this method has all the options of backing out and that they will be thinking clearly (15 day cooling off period etc.)

Frozenfairytale: it says quite clearly, 'Bill does not apply to those with dementia or other degenerative mental condition' so i dont see why you think the mentally ill are going to be targeted.
Why should it JUST apply to those dying of cancer? There are plenty of other terminal illnesses which cause people to be in a lot of pain, should it not apply to them also?

22-01-2010, 04:26 AM

Okay here's the article. The link may not work as I had to register to get back into it. (it was for a project back in 2007 so I just reread it for the first time in three years) It's several years old, but it's still what happened and it's the only reason I worry about the mentally ill being targeted. When I was in classes and had debates about euthanasia I never even heard of this case, and at the time it had happened quite a while back. It's a case you'd think would be brought up a lot. Even from those who are against euthanasia never knew of it, which is worrying that it never got attention after something so much in violation of the terms of euthanasia happened. It took extensive research for me to find it. Also notice it comes from a medical journal, so it is legit.

I want to quote it to make sure I have my facts straight. as you will notice, the court found him GUILTY of not following the euthanasia rules, yet he was not punished. What's to stop him or others from doing it again if there are no punishments in place? That's why I say even though I agree it should be for nearly all terminal illnesses (not just cancer), we have to be extremely careful to uphold the laws and safeguards put in place. If these safeguards can be ignored in the Netherlands, then there's nothing to say that won't happen in other countries. The fact that this was fairly ignored in the media is a bit scary. I have always heard that this doesn't happen and to find a legitimate medical journal saying it did is disturbing to say the least. That doesn't mean there isn't good cause for certain euthanasia, but cases like these need to be made known so people can be aware of the dangers and prevent them. Notice the patient had never even tried anti-depressants, he had always refused them as well.

Quote:

BMJ 1994;309:492-493 (20 August)
Editorials

Assisted suicide for depression: the slippery slope in action?

In June this year the Dutch supreme court convicted but declined to punish a psychiatrist, Dr Boudewijn Chabot, for assisting the suicide of a physically healthy patient who was stated by the court to have "a depressive disorder in the narrow sense."1,2 This judgment has been interpreted as "a historic ruling,"3 but outside the Netherlands it has received scant attention.4,5 Although the prosecutor general thought "that help in assistance with suicide to a patient where there is no physical suffering and who is not dying can never be justified," the supreme court rejected this contention. It explicitly accepted that euthanasia or assisted suicide might be justifiable for a patient with severe psychic suffering due to a depressive illness and in the absence of a physical disorder or a terminal condition. 
The court did, however, find Chabot guilty because he had not obtained a second opinion examination of the patient by another psychiatrist and there was no independent expert evidence that "an emergency situation"6 existed - the normal mitigating defence in such cases. Although the guilty verdict could have brought with it a custodial sentence, the court elected not to punish him, on the vague grounds of "the personality of the accused, as well as the circumstances in which what has been proved to have happened took place."1 
It is difficult to reconcile some of the details in the case, such as Dr Chabot's reported claim that the patient was unlikely to respond to antidepressant drugs,5 with standard practice in the management of what the court ruling stated was a depressive disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised.7,8 This is particularly so as antidepressant treatment had not apparently been shown to be ineffective - it had been offered to the patient but refused. 
Hopelessness, along with suicidal thoughts and morbid preoccupation, are core features of depression. Nevertheless, it is the perception of the patient's subjective hopelessness that is one of the main determinants of doctors' assessments about the appropriateness and urgency of euthanasia and assisted suicide.9 
The implication of the court's reference to the disorder being "without psychotic features" also raises concern in view of the heavy burden this places on the distinction between "psychotic" and "non-psychotic." The fact that the court mentions this distinction seems to imply that had the patient been deemed to be psychotic then Dutch mental health legislation might have been invoked to enforce compulsory treatment. An oversimplified view of the distinction between psychotic and non- psychotic depression may lead to failure to recognise that distortions of thinking and judgment falling short of delusions commonly occur in depression, with consequent underestimation of their effect. It is also important to emphasise that many apparently intractable depressions are associated with inadequate exploration of available treatment options rather than absolute refractoriness.10 
The importance of psychiatric factors in the assessment of patients requesting euthanasia for physical suffering has also increasingly been recognised. In view of the evidence that unrecognised depressive illness can be an important factor in requests for euthanasia and that sometimes its treatment can lead to the retraction of the initial request for euthanasia, it is of particular concern that in one anonymous survey in the Netherlands a second opinion had not been sought in up to a quarter of cases of euthanasia.9,11 
Nevertheless, the intensity of psychic pain suffered by some patients with severe affective disorder must be acknowledged. In moments of candour some professionals may admit sympathy for the view that in severe and persistent depressive illness, when all appropriate physical treatments, including polypharmacy, electroconvulsive therapy, and psychosurgery,12,13 have apparently been exhausted, voluntary euthanasia may sometimes seem to be as justifiable an option as it does in intractable physical illness. This, however, is not necessarily to condone it for either. 
The particular problem that is raised by "psychiatric euthanasia" is the dubious boundary between psychiatric illness and understandable unhappiness. Now that this judgment apparently accepts the precedent of assisted suicide for depressed patients as being morally justifiable if not actually lawful, it is difficult to imagine how the progression to a test case regarding psychic suffering in a person who is not mentally ill can be avoided. 
However psychiatrists respond to this dilemma, campaigners against euthanasia will point, perhaps with good reason, to cases such as Chabot's as evidence that the slippery slope they feared already exists. It has long been argued that if euthanasia and assisted suicide become acceptable, as they now have in some countries, for "core cases" - people who are terminally ill with physical symptoms, especially pain, which cannot be relieved by other measures but who remain psychiatrically well and fully competent - then it may be impossible to restrict the scope of these new medical interventions.14,15 However well any legislation is hedged about with guidelines and protections against abuse, the slippery slope predicts an inevitable extension of these practices to other, more vulnerable, groups, such as those who are demented, mentally ill, chronically disabled, frail, dependent, and elderly - and perhaps even simply unhappy. 
We hope that the implications of this judgment will be carefully considered in the Netherlands, Britain, and elsewhere. Finally, we are left with a quotation from George Annas, professor of health law at Boston University: "If you're worried about the slippery slope, this case is as far down as you can get."4 We are not so sure.16 
A D Ogilvie, S G Potts

<hr align="left" width="30%">

Supreme Court of the Netherlands. Arrest-Chabot, HR 21 juni 1994, nr 96 972. Nederlands Juristen Blad 1994;26:893-5.
Chabot B. Zelf beshikt [Chosen fate]. Amsterdam: Ballans, 1993.
Sheldon T. Judges make historic ruling on euthanasia. BMJ 1994;309:7-8. [Free Full Text]
Toufexis A. Killing the psychic pain. Time 1994 July 4:71.
Sheldon T. The doctor who prescribed suicide: was the Dutch psychiatrist Dr Boudewijn Chabot right to help a sane, healthy woman take her own life? Independent 1994 June 30:27.
Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst. Hulp bij zelfdoding bij psychiatrische patienten [Assisted suicide for psychiatric patients]. In: Koninklijke Nederlandsche maatschappij tot bevordering der geneeskunst. Utrecht: KNMG, 1993.
Practice guideline for major depressive disorder in adults. Am J Psychiatry 1993; 150(4):(suppl).
World Health Organisation Mental Health Collaborating Centres. Pharmacotherapy of depressive disorders - a consensus statement. J Affect Disorders 1989;17:197-8. [Medline]
Van der Wal G, van Eljk M, Leenen HJJ, Spreeuwengerg C. Euthanasia and assisted suicide. 1. How often is it practised by family doctors in the Netherlands? Fam Pract 1992;9:130-4.
Quitkin FM. The importance of dosage in prescribing antidepressants. Br J Psychiatry 1985;147:593-7. [Abstract/Free Full Text]
Bajle WF, DiMaggio JR, Schapira DV, Janofsky JS. The request for assistance in dying. The need for psychiatric consultation. Cancer 1993;72:2786-91. [Medline]
Poynton A, Bridges PK, Bartlett JR. Psychosurgery in Britain now. Br J Neurosurg 1988;2:297-306. [Medline]
Goodwin G. Drug treatment of depression: what if tricyclics don't work? In: Hawton K, Cowen P, eds. Dilemmas and difficulties in the management of psychiatric patients. Oxford: Oxford University Press, 1990:1-15.
Gunning KF. Euthanasia. Lancet 1991;338:1010-1. [Medline]
Hendin MD, Klerman G. Physician assisted suicide: the dangers of legislation. Am J Psychiatry 1993;150:143-5. [Abstract/Free Full Text]
Weindling P. Psychiatry and the holocaust. Psychol Med 1992;22:1-3. [Medline]

http://www.bmj.com/cgi/content/full/309/6953/492

Buttercup. · 22-01-2010, 06:50 AM

for the terminally ill, i think it is alright..
but for the mentally ill?? that is scary. i probably wouldn't be alive..and that is scary thinking that somebody would want to help me die..would make me even more suicidal.

sajhfuahuefghaeg · 22-01-2010, 09:22 AM

I highly doubt they'd let the mentally ill do it, because if you're mentally ill you're nearly almost suicidal. They'd be like 'uh, no, get better.'

shadow-light · 22-01-2010, 11:03 AM

As far as I am aware it is ONLY for the terminally ill. And the person has to be mentally stable enough to make the decition as well as having the concent of 2 doctors. There was talk of there being psychological evaluation too, but I'm not sure if that is staying.

The main argument people have against it currently is people feeling pressured into it by family, for finacial reason or due to feeling a burden

The One Who · 22-01-2010, 03:31 PM

The mentally ill are not 'being targeted' with this bill. It is not intended for them. Only for those with terminal and/or physically degenerative illness.

I think that this is a Bill which shouldn't be enacted unless the rest of the UK are going to with it too. Although Scotland has control over its own NHS services, I think this is just too different for only one part of the UK to have.

Heidi Tiger · 22-01-2010, 05:02 PM

Quote:

Originally Posted by The One Who

The mentally ill are not 'being targeted' with this bill. It is not intended for them. Only for those with terminal and/or physically degenerative illness.

I think that this is a Bill which shouldn't be enacted unless the rest of the UK are going to with it too. Although Scotland has control over its own NHS services, I think this is just too different for only one part of the UK to have.

I think that's a good point, otherwise instead of eloping lovers heading off to Gretna Green it'll be those who are dying. It also just seems so wrong that you could have two identical cases 1 mile away from each other across the border and one person would be allowed a peaceful and dignified death whilst the other would be forced to suffer. That said though I disagree with all forms of "postcode lottery" within the NHS.

The One Who · 22-01-2010, 05:10 PM

Quote:

Originally Posted by Heidi Tiger

I think that's a good point, otherwise instead of eloping lovers heading off to Gretna Green it'll be those who are dying. It also just seems so wrong that you could have two identical cases 1 mile away from each other across the border and one person would be allowed a peaceful and dignified death whilst the other would be forced to suffer. That said though I disagree with all forms of "postcode lottery" within the NHS.

Exactly. Although there probably won't be many who come north for the purpose of it because of the time you need be registered for, it is a bit of an extreme lottery.

I'd be happier if the money was spent on hospices.

tamobhuuta · 01-02-2010, 08:08 PM

i agree with 'The One Who'. here's a quote i found (have taken out a slightly religous bit):

Quote:

What a sick person needs, besides medical care, is love, the human ... warmth with which the sick person can and ought to be surrounded by all those close to him or her, parents and children, doctors and nurses.

Heidi Tiger · 02-02-2010, 12:51 PM

Did anyone see the lecture on BBC 2 last night with Terry Pratchett and Tony Robinson?
It was very powerful and moving aswell as being interesting and raising some thoughtful points. I'd reccommend people to watch it on iplayer if they're interested.