In June this year The Sunday Times reported the death of Cari Loder who, rendered housebound by the progression of her Multiple Sclerosis and fearing that she would be sent to a care home, took her own life using a method she had researched via the internet. She put a hood over her head and inhaled pure helium until she fell unconscious before suffocating in what is known as asphyxial suicide.

A former lecturer at London University’s Institute of Education, Ms Loder lived alone and had previously purchased both the hood and helium online; she also had in her possession a book entitled Final Exit in which information is offered which may help a person end their life more peacefully than if they attempted to jump in front of an unsuspecting train-driver or hurl themselves from the top floor of a multi-storey car-park onto bag-laden shoppers below.

No one can possibly know when Cari Loder first contemplated the idea of suicide: perhaps at the onset of her disease when first confronted with the chilling facts of her a debilitating illness; perhaps not.

In the years before her suicide she was known for her chance discovery in 1994 that a combination of an antidepressant, an amino acid and vitamin B-12 reduced her own symptoms and the treatment became known as the “Cari Loder Regime”. She is quoted as saying at the time “One day I had been hardly able to walk without crutches; the next I was able to dance to Top of the Pops.” Fifteen years later her disease had limited her physical capability to the extent that she chose suicide rather than put herself into full-time nursing care.

The article revealed that before her death Ms Loder had also been in telephone contact with Friends At The End (FATE), an organisation the paper described as ‘a pressure group in favour of assisted suicide’ and subsequently asserted that her death would ‘reignite the debate over euthanasia’, the tacit suggestion being that these conversations may have influenced Ms Loder’s decision to take her life.

Dr Libby Wilson, a retired GP and spokesperson for FATE said of Ms Loder: “Cari was determined to take her life, and she did, without any help from anyone. She didn’t want to confide in anyone because she was afraid she might make them complicit in her decision, and that they would come under criminal investigation. She thought it was monstrous that she had to do all this herself when she should have much preferred to have been able to just swallow something that would put her into a sleep from which she would never wake up.”

Just to be on the safe side, police arrested an elderly neighbour who is thought to have walked Ms Loder’s dog while she died.

Debbie Purdy’s persistent attempts to obtain a bottom-line ruling on assisted suicide have resulted in the Law Lords instructing the Director of Public Prosecutions to issue a policy clarifying the circumstances under which it would be in the public interest to prosecute the relatives of people travelling abroad to obtain a medically assisted suicide. The DPP, Kier Starmer, QC, is expected to announce the policy later this month.

In the meantime we hear from finger-wagging organisations warning that a change in the existing law would allow money-grabbing and heartless relatives to put thousands of old, disabled, demented or otherwise vulnerable people on the next flight to Switzerland and get their hands on the cash/house/family jewels etc.

It is absolutely right that the law should protect the vulnerable, young or old, from fear or hurt at the hands of those on whose care they rely: statistics published by the NSPCC show that in 2008 35,828 children were subject to Child Protection Plans in England (29,200), Scotland (2,437), Wales (2,320) and Northern Ireland (2,071). Yet for every baby who dies from violence and abuse, thousands more are cared for with tender love; for every shaken baby, thousands more are held in safe arms. And though it is vital to consider the vulnerable who may be put under pressure to die from unscrupulous relatives it is also vital to accept that there are other terminally-ill people who are under no such pressure whatsoever and for whom the decision to take their own life is a courageous and entirely independent choice.

Anna’s piece entitled The Gold Standard for an Obscene Death was triggered by a letter published in the Telegraph regarding the Liverpool Care Pathway which informed us that “…in 2007-2008 16.5% of deaths came about after terminal sedation…” Given that all of us can expect to require some medical treatment towards the end of our natural lives, with the current population of the UK at over 60million 16.5% of deaths suggests that 9,900,000 UK citizens might find themselves with enough boxes ticked by medical staff to expect to die under terminal sedation.

Within the forum discussion a junior doctor, Ben M, was good enough to share his knowledge of the Liverpool Care Pathway and was keen to point out: “A patient must fulfil stringent criteria to be placed on the LCP. The idea is that we do everything we can to give a patient a peaceful and dignified death. It is only used when the clinical prognosis is very poor ie less than a couple of days usually, and that they are unable to eat/drink safely or are unconscious (there are other inclusion criteria these are examples).”

Since 2002, in the region of 115 Britons are known to have travelled abroad to secure a peaceful and dignified medically-assisted death at the time of their choice, having also had to meet stringent criteria before being granted the go-ahead and agreeing a date on which they would like to end their lives. Many more are known to have joined the Dignitas organisation but, having obtained the equivalent of a ‘green light’, chose not to travel abroad but to die less controversially within the standard care provided by hospitals and hospices. Some of those who chose to stay at home may even have met the stringent criteria allowing them to be placed on the LCP; we will never know.

Anna is right when she says that none of us wants to think of death or to discuss it. The inescapable and shocking truth of terminal illness is ugly, as is the obliteration of one’s physical independence by a creeping and incurable disease. Assisted suicide is also an uneasy and unpleasant topic for discussion. Yet with the DPP’s policy announcement expected shortly, discussions-aplenty we are sure to have.

What our society should now properly debate is that, for some, the prospect of humiliating physical helplessness is an emotional ordeal more terrifying than the fearful option of planning and competently achieving one’s own death; any debate should not insult the intelligence of those people who make the huge and difficult effort to secure for themselves an assisted suicide abroad in the face of such a prospect; any debate should credit those people with having made a considered and preferred choice; any debate should not assume that the relatives of those determined to take control of the circumstances of their death are gleefully rubbing their greedy hands together; any debate should concede that they may just as easily be devastated by the fact and grieving doubly at the prospect that, unless they are prepared to risk 14 years’ imprisonment, they will not be with their loved one when they die.

For those terminally-ill people determined to die on their own terms, many may be unable to secure a medically-supervised suicide at an overseas clinic, prevented either by physical disability or by financial constraints, and those are the people who will attempt suicide by other means, facing sickening fear and risking failure.

Any debate should at least consider whether a documented discussion between a doctor and a terminally-ill patient at the patient’s request could be the first step in an official application to the Coroner to obtain a medically-assisted suicide, providing that ‘stringent criteria’ are met openly at every stage of the process.

The harsh facts of debilitating disease and terminal illness are stark and frightening, but so too are the practical options of suicide. Ms Loder researched her subject and contacted an organisation which was prepared to talk with her on the taboo subject of suicide as a response to the acceleration of her disease. In this regard the internet has made such advice as exists on the subject at least readily available to anyone with a computer, yet there is a sense of disapproval that any such practical advice should be shared with those who have made the excruciatingly difficult decision that suicide is the last independent but hugely symbolic statement of choice they will make.

Goria Smudd

Discuss.

1
Old Holborn September 4, 2009 at 17:20

A man who gave his father a gun in hospital so that he could shoot himself has been jailed for three years.

LINK

2
Anna Raccoon September 4, 2009 at 17:29

I don’t usually swear Old Holborn…

But….

Bastards!

3
Ted September 4, 2009 at 18:01

Thomas Szasz’s writing on the subject always struck me as entirely sensible and accurate.

4
Bodwyn Wook September 4, 2009 at 19:06

This posting of Gloria Smudd’s is even more germane, if anything, for my Yanks because of the truly incomprehensible medical rat maze in this fragmentrary neither/nor ‘health’ ‘care’ ’system’ that these poor souls have inflicted on themselves, here.

Basically, from the objective libertarian viewpoint, ‘government’ and the ‘insurance industry’ and ‘medical management’, altogether have bureaucratised, over-priced and otherwise put themselves wholly out of the individual picture.

And, of course, no more is this so than at the hour of ones death.

So much is this now the case that, in fact, no one in America ‘has ‘ health insurance any longer here, not really; and, for any Yanks who ‘do’, it is but a matter of time before this is yanked and one-by-one all surviving are bound over to a bankrupt state. We, here, individually /must/ therefore figure our own ways out, and that’s that.

Accordingly, I shall link & circularise this (what the Rabbi said to the Baby Boy, hehe!) to my friends here, via the pp of /Bodwyn Wook/.

Many thanks to you both, for so calmly & devotedly passionate a contribution.

5
JuliaM September 4, 2009 at 19:13

“Just to be on the safe side, police arrested an elderly neighbour who is thought to have walked Ms Loder’s dog while she died.”

*sigh*

Why is this nearly the saddest thing about the whole story?

6
miss mink September 4, 2009 at 22:44

I just don’t understand why a terminally ill person, who has to endue
incredible pain every day or rely on another person for help with every simple task in life, can’t request an assisted suicide.
Is this really a ‘humane’ society ?, where the morals and sensitivities
of the healthy are put before the sick and dying’s wishes.

7
Liz Robillard September 4, 2009 at 22:52

Poor, poor lady. I so wish I’d known her. Another sad example of health and social care provided by this unspeakably lousy adminsitration, and yes the man with dog being arrested is almost surreal in it’s evil

8
Châtelaine September 5, 2009 at 00:04

Strangely enough it was in Switzerland that I had a neighbour whose father was terminally ill with cancer, yet didn’t get “too much” painkillers as it was bad for his health … !

As a Dutch person I know of many people, who’ve had an assisted death. Who have chosen the date and the way when they were ready to leave – have been able to say goodbye to loved-ones – have left this world without or less suffering – have also left their loved ones with less pain and sorrow as ”it was good”.

If we can put our dog or cat down, because he/she is suffering too much to no end, why would we deny that right to a human being?

9
Gloria Smudd September 5, 2009 at 00:45

miss mink – Simples! Assisted suicide is a prickly legal issue because of a change to the law (in the 1960s?) which ruled that suicide itself would no longer be illegal so that a person who had tried to commit suicide but had failed wasn’t then also slammed in jail because they’d botched the job. However, I believe it was and still is against the same law to aid, abet, encourage, assist, pressure, coerce, listen to or even tickle under the chin anyone who may confide to you that they are considering suicide if they then go ahead with their plan.

If you ever are told by anyone, including your neighbour, that they plan to commit suicide, my advice is also seemples …. don’t walk their dog on a regular basis! Get your own dog if you’re that keen on walks.

It just goes to show you can’t be too careful.

10
Bodwyn Wook September 5, 2009 at 00:51

Here in Minnesota, now, there have been several cases over this past year, of nursinghome employees suspended in different parts of the state, for pantomiming sex with demented and helpless patients, young women parading nude in front of old men, the fondling by leering young males (hardly /men/) of elderly ladies’ breasts and crooning obscenities, telling Alzheimer’s patients their spouses have died, and other horrors.

In just the same way, there will be abuses of euthanasia.

But the majority of care home workers are decent if underpaud people, and likewise euthanasia mostly will not be mis-used.

11
Gloria Smudd September 5, 2009 at 01:38

Châtelaine September 5, 2009 at 12:04 am
………………

What you say and what I have bothered to find out for myself of the system in the Netherlands convinces me that there is an alternative to the British tight-arsed, po-faced, sanctimonious, two-faced and out-dated law which shakes a warning flag in pretend defence of the vulnerable yet which rubber-stamps the ‘nil-by-mouth’ treatment of LCP patients.

The UK legal system is fighting tooth and claw (again, why????) to ensure that terminally-ill patients do not have the option to end their lives when they choose, at home among their families, rather than be mangled through the tedious, exhausting, expensive and pointless ‘end-stage’ treatment to which they are entitled within the NHS guidelines. I could spit. But I won’t.

12
Sabot September 14, 2009 at 18:03

Sorry, I am late to the discussion, But I just can’t hack it. I will never advocate assisted suicide.

I refuse to believe that any doctor in any country would deny a pain killer to any terminally ill and suffering person that might result in their premature death. Think about it. Doctors have been doing this for centuries.

To legislate is just the thin end of the wedge. I don’t understand why people can’t see that assisted suicide deprives people of their dignity.
And, No, I don’t have any God motivated opinions on this, but to take a life, even one’s own, is to diminish life. Life is a gift, you can’t just take it away when it no longer suits you.

13
Gloria Smudd September 16, 2009 at 14:37

I think you’ve pinpointed one of my main concerns here Sabot; namely that we almost expect to be medically ‘helped’ at the end of our lives in hospital. Indeed it was Anna’s article on The Gold Standard for An Obscene Death which triggered me to contrast the vast numbers of people who might expect to experience ‘terminal sedation’ with the few terminally-ill who would prefer to take their own lives rather than to die under the end-stage circumstances dictated by their disease.

Yesterday (14.09.09) The Daily Mail published figures following an audit of almost 4,000 patients ‘treated’ on the scheme during 2007/2008: the report states that 39% of patients on the LCP suffered from cancer but others had conditions such as PNEUMONIA, DEMENTIA or STROKE; more than a third were given sedatives; 76% of relatives of LCP patients were told that their loved one had “entered the dying phase” but 28% of relatives were not told that the patient had been placed on the LCP.

Many of us have had operations under general anaesthesia and know the surprise with which we ‘go-under’ and find ourselves being ‘brought-to’ with no sense of time passing; my concern here is that general anaesthesia is very, very different from sedation. I think it is important to establish whether patients under sedation in hospital are sedated to a degree where they are unaware, free from pain, free from hunger and thirst or whether the sedation may allow some degree of dreamlike consciousness, with patients able to hear, to feel pain or thirst but unable to communicate. I have certainly watched at a hospice bedside for the weeks it took for the healthy heart in a cancer-ravaged body to stop beating. I have no way of knowing whether the patient was conscious of my presence but unable to show it or deeply unconscious during what was unmistakeably the “dying phase”.

I have long quarrelled with the habit of coupling the topic of Euthanasia with the question of medically-assisted suicide. Any such argument is often greeted with cries against ‘Euthanasia by the back door’. I think the back door’s been open to euthanasia for a long time but it’s called ‘entering the dying phase’ and ‘terminal sedation’.

I feel that all end-of-life care should be up for vigorous discussion and debate and that includes an honest recognition that what society claims to abhor is already going on and that we can all expect to be part of it without our knowledge or consent. I only suggest that it should be legal for a terminally ill patient to speak officially with their GP on the subject of assisted death, that their conversation should be properly documented and passed on to the Coroner under whose examination the facts of each individual case should be established and an outcome legally agreed.

14
Gloria Smudd September 28, 2009 at 19:46

Interesting take on things here from by Tony Delamothe, deputy editor, BMJ
http://www.bmj.com/cgi/content/full/339/aug26_1/b3446

and today 83-year old retired GP Libby Wilson (see original post) was arrested in Guildford, having travelled from her home in Glasgow, in connection with the death of Cari Loder. Kier Starmer, DPP, has said of his recently issued guidelines that there was an argument for prosecution if the suspect was unknown to the victim and assisted by providing information via a website to help them end their life.

15
The Real Brenda February 15, 2010 at 00:52

Doctors appear to have been bitten by the power and corruption bug usually reserved for Family Lawyers. Thanks for sharing ‘today 83-year old retired GP Libby Wilson (see original post) was arrested in Guildford’ Police may be slow at times but eventually they do get the job done whatever happens. Overworked I expect.

Read more: https://www.annaraccoon.com/internet/suicide-the-uneasy-option/#ixzz0fYrlq99h

16
Plain Jane February 18, 2010 at 16:22

The LCP worries me too, not because it is some kind of sinister plot by government, but because it is another protocol that will be viewed as a replacement for knowledge, skill, judgement and compassion. It is written I understand by the Marie Curie organisation and has recently been revised to emphasis that deep sedation should not be the norm and neither should withdrawal of food and fluids. There does come a time when forcing fluids into people does not help them in any way and can cause the lungs to fill up i.e. because the heart is failing and the body cannot process the fluids. I am not medically qualified but I think you will find this is well known medical fact. However the prospect of having food and even worse fluids withdrawn for an extended period just to hurry up death and free up a hospital bed is worrying – there needs to be far more detailed information made available so that the debate can be a useful one and not as now, one fuelled by fear, suspicion and guesswork. I would suggest someone who took part in writing this protocol goes on tv and radio with sufficient time to explain it in detail.