I make no apologies for keeping the corpse of the euthanasia/assisted suicide argument hanging around the bar today; if the stench is unpleasant and disagreeable to you, so be it. It’ll be your stench one day, you can’t live for ever – take some smelling salts or something.

I don’t often get ‘stung’ by comments; I’ve developed a thick skin over the past couple of years, but there have been a couple of comments that really got to me in respect of this debate. The temptation to fire up the arthritic fingers and bash out a reply was nearly overwhelming – but it is too sensitive a subject to take that approach, and I don’t want to single anyone out when I say that many people, too many people, ably abetted by the determined conflation of issues in the media, do not understand that there are two debates here, not one.

Let me make two things abundantly clear. I haven’t changed my mind on legalised euthanasia, nor do I have any wish to see your Aunty Gilda dying a long and lingering death out of some religious respect for the notion of ‘life’.

I also fully respect your right to take your own life if you wish, as you wish, when you wish.

The grey area is when you involve other people.

At present, it is illegal for a Doctor to kill you in any short, painless, or humane manner. He is required to judge the amount of barbiturates and morphine that will ensure that you suffer no pain, and possibly are completely unaware of your surroundings – but he must not increase the dose even fractionally if that would effectively kill you.

If he wants to kill you – then he requires a court order to do so. That court order will demand that all medical treatment is ‘refused’ on your behalf – the so called extension of autonomy to refuse treatment that we all hold.

No longer will he be juggling pain relief; in fact no longer will he be giving you food or water, because that can be classed as ‘medical treatment’. You will merely be left to expire at your own pace, unaided by the medical team. No more friendly morphine, in fact you might as well crawl away under a bush – not a lot of point in being in hospital. No wonder they give it the euphemism ‘Liverpool Pathway’. It is a horrendous way to die, a million miles away from the outcome most people expect from a Doctor or euthanasia.

What I suspect most people want from legalised Euthanasia, is that the Doctor be permitted to increase the dose of morphine, to a level that he knows will kill you. End of pain, end of suffering, no lingering death, just swallow these tablets and we can all go home?

That is fine by me – given that we already have legally sanctioned killing of patients. I would prefer that it was done in a humane and dignified way. The Doctor dealing out Dignitas. I wouldn’t be so keen to support euthanasia if we hadn’t already brought in our half cocked version. But I haven’t changed my mind from previous articles.

Next up in the long queue of ways to beat nature, is Assisted Suicide. That is an entirely different beastie. That is not, and never will be, in the category of ‘I don’t know how you can want anyone to suffer in the way my Aunty Gilda did, Anna’.

Assisted suicide is not about the last few weeks of Uncle Fred or Aunty Gilda’s miserable life. Assisted suicide is about extending your autonomy to kill yourself, at a time, place, and for a reason of your choosing, to grant someone else the right – or should I say, duty – to do it for you.

Assisted suicide is carefully promoted by situations that we can scarcely argue with – the man with Motor Neurone disease, for instance. The little most of us know about that disease is culled from the papers – a ‘terrifying death’ ‘suffocation’ ‘gradual total paralysis’ – and we all respond like lemmings – ‘ooh, er, I wouldn’t fancy that’. Well who would? It doesn’t become a reason to support Assisted Suicide.

Truly, there is no one going into the Dignitas clinic for any of the reasons that have been quoted to me – ‘Fred’, incontinent, unable to move, unable to see, in terrible agony, nor immobile and about to suffocate – as reasons for euthanasia. There is one very simple reason for this.

You have to fly to Zurich. You have to be fit enough to fly to Zurich. British Airways don’t yet have intensive care flying hospitals, and they are not keen on upsetting their other customers.

The carefully crafted scene the BBC showed was of someone fit enough to fly, surrounded by his loving family, who was perfectly able to lift a cupful of barbiturates to his lip – who had chosen to die at that moment, in that manner. He could equally well have saved up his barbiturates and done the same thing quietly at home. Wouldn’t have improved the viewing figures though. They might just as well have filmed someone hurling themselves off the top floor of Broadcasting House. It was supported by Debbie Purdy, who is campaigning for the right to ask her husband, without fear of prosecution, to ‘dispatch’ her, at a time and manner of her choosing.

It was a perfect conflation of three issues – the caring Doctor over-dispensing barbiturates, suicide, and the non-prosecution of your family for ‘helping you’.

I am not, and never will be, in favour of ‘assisted suicide’. As I have said before, we have enough trouble deciding on the truth of what goes on in the bedroom when both parties are alive and able to speak for themselves. We will never be able to decide on the truth of the situation when one party in is the morgue having the plastic bag dislodged from their head.

You cannot say ‘yes’ to assisted suicide and then say ‘but only by a Doctor at the end of life’.  Suicide is the right to kill yourself, whenever, however, you wish.

To the people who have said – ‘I’d be proud to do the honours for my friend/parent/child’. Quite possibly so. That is your voluntary choice. What I object to is the present situation where a parent can say ‘I want to go to Dignitas – and I expect you to arrange it’. That is a quite unfair emotional burden.

I have seen the reality of arranging such a trip, and it is debilitating, life changing. It makes no difference whether it is Zurich or a porta-cabin at the rear of your local Tesco’s. It will make no difference whether it is some heart string tugging terminal disease or depression.

Having someone you love say to you – ‘please make arrangements to kill me, if you don’t I will suffer unimaginable pain/ live an unbearable life, and it will all be your fault’, is grotesque.

Now, if someone would change the barrel for me – drinks all round?

Edited to add: I’ve just been sent a link to Mummylonglegs excellent – and characteristically blunt – post on the subject. We are almost in agreement on something for a change! More than worth reading.

Mummy x June 17,
2011 at 09:13

To anyone that has never had to make these kind of decisions I would offer
this advice. On paper it sounds easy, no one wants to see a loved one suffer
any more than they want to suffer them selves. The idea of a swift end appeals
to us all, but dying is the easy bit, it’s the living on afterwards that is so
very hard. I don’t know about other people but in my case not a day goes by
when I don’t wonder if I did the right thing. My head says it was what my Mum
wanted, she would have died with in a couple of days anyway, at least it was
pain free etc. My heart, well, it never did listen to common sense. I hate to
use the term traumatised but it’s the only one that fits. In the 2 years since
this happened I have been left with a profound inability to fill in forms.
Silly I know but there it is. I receive a form and my heart sinks. I will do
anything rather than just sit down and commit an agreement to paper. The other
thing I struggle with is making decisions that involve others. Be it what to
have for tea, or what car to buy I struggle. I doubt my own judgement and I
obsess over what could go wrong. I only managed to buy the car because I was
put on the spot and I had someone with me that convinced me it would be a good
idea. Every morning I go out and I am convinced the car won’t start and my
decision would have been the wrong one. I take no satisfaction from the
decisions that go my way by the ones that don’t, well they just knock me on my
arse.
I know, deep down, this desire of mine to be proven wrong, time and
again when it comes to decisions I have to make is simply because deep down,
no matter how right it was for my mum, it was wrong for me.

So there you have it. there are many words that could be used to describe
assisted suicide but simple, quick and painless are not ones I would choose. I
respect anyones thoughts on this subject but really, until you have been there
you cannot know for sure what it is like to end the life of another.

Mummy x

John B June 16, 2011 at 15:50

Electro-kev, you cannot say that for definite, that there is no God. In
fact if one looks at the logical implications that arise from available data
they would tend to indicate there is. Just depends which bits you look at and
the conclusions you allow yourself.
However.
Mercy is the important
factor. He says that He would rather have mercy than sacrifice.
And the
merciful option would seem to be to allow the patient to choose their own pain
management.

Zaphod June 17, 2011 at 22:04

You can believe illogically if it suits you, but logically, there is no
god, and no need for one.

John B June 16, 2011 at 14:10

Eleanor, I think you are correct, except that there does need to be very
careful and compassionate oversight. Which, agreed, there mainly has
been.
Increasing a drug dose to overcome pain, while it may indeed become
lethal, is the choice a patient can make and hopefully communicate it to the
doctor.
It would seem that Pratchett has a political agenda and this is
part of it.
It this the thin end of the wedge of authorities being
empowered to terminate people?

Eleanor June 16, 2011 at 11:08

I would really rather not think about this. Doctors have been bumping off
terminally ill and suffering patients for many a long year. Nobody much
discussed it beyond thinking that it might be happening. What was wrong with
that?

Zaphod June 17, 2011 at 22:01

The problem with that is that it exposes the doctor to a real danger of
prosecution for murder. It’s not a sustainable solution.

electro-kevin
June 16, 2011 at 01:54

Further to my last comment:

If we’d left our dog to die howling in pain over the course of a week, as
did my grandmother, he would have been taken off us and put down humanely –
most likely we would have been prosecuted for neglect or cruelty too.

Neither dogs nor humans appear to have souls – according to empirical
scientific evidence there is no proof other than that we are are biologically
evolved machines.

There is not one shred of scientific evidence which points to a god and nor
is there any which says we shall suffer pergutory for killing ourselves.

Perhaps it’s not so much a case of proving to you why euthenasia should be
allowed as it is an issue of stripping down your belief that it shouldn’t.

Such over-intellectualising and dithering. Such suffering caused in the
name of humanity.

carol42 June 15, 2011 at 23:21

Trouble with committing suicide yourself is not knowing exactly what to
take, how to get it and how much do you need to be sure. I can’t imagine
anything worse than trying and waking up still alive. My family are well aware
of my views and agree with them but I would not ask them to help although if
the situation arises it may mean I would have to do it sooner than I want
while I am still able. I have watched two friends die horribly, one with COPD
and one with cancer which had spread to the brain. My own husband died after a
terrible accident, I was glad he only survived for 22 hours as he had terrible
brain damage and he would have hated to survive and be helpless. You agree it
is a right to take your own life but will the family feel any less guilty that
you died alone, I don’t know. I can only speak for myself but I am adamant
that if it comes to it I will not hesitate, my son feels exactly the same, we
witnessed my mother’s experience in a nursing home after a stroke and I would
never go into one where I would merely be waiting to die anyway. It is not
that I don’t want to be a burden, though I don’t, just that when my quality of
life fails to that extent I simply don’t see any point in dragging it out. I
am far more afraid of end of life in a nursing home or even worse an NHS
hospial than I am of dying.

Lerxst June 15, 2011 at 22:15

“‘please make arrangements to kill me, if you don’t I will suffer
unimaginable pain/ live an unbearable life, and it will all be your fault’, is
grotesque.”

But of course, someone can ask that regardless of whether ‘assisted
suicide’ is legal or not, and they can still make you feel just as guilty.
That’s not about the law, it’s about the willingness of a person to use
emotional manipulation.

It’s also perfectly possible to have a rational conversation and come to a
conclusion that “if this happens… kill me”. My brother and I both have a
genetic condition, which if we live long enough could affect the brain. We’ve
both seen enough to know that neither of us have any desire to live out our
days as gibbering wrecks, drooling in a chair all day. The result is a pact,
that if one of us heads down that route and is unable to end things
themselves, the other will step in. It’s not about guilt or fault, it’s very
much about love (and admittedly a degree of insurance).

Westerlyman June 15, 2011 at 18:46

In the Terry Pratchett programme it was quite clear that Dignitas do not
administer the fatal dose. Only the person committing suicide was permitted to
do that. They simply ensure that the suicidee has a pleasant environment and
is not going to bungle the attempt. Terry Pratchett made the point that as a
journalist he had seen the results of many DIY suicides. Whether successful or
not DIY suicides often involve innocent parties. I can think of little more
selfish than to throw oneself under a train or lorry for example.

The debate then comes down to should someone who is unable to kill
themselves have the right to ask someone else to do it for them. I do
understand Anna’s point that this is placing a burden on the person being
asked. Not just the possibility of legal action but also sheer emotional
stress of carrying out the act, or indeed being unable to help and having the
guilt of letting their loved one suffer.

Like the Dignitas procedure of assessments and interviews I do not see any
reason why someone should not be able to arrange to have their life terminated
at a certain point in the future. Obviously the instruction should be able to
be rescinded at any time. It just needs a system of checks and that the
professional administering the fatal injection, or whatever, is truly
impartial and legally absolved from all blame.

One of the saddest issues related in the Dignitas programme was that both
people who suicided said that they were actually doing it before they wanted
to but that if they delayed and became unable to travel to Switzerland they
would miss their opportunity and that was more frightening to them.

Engineer June 15, 2011 at 16:37

The only reason that anybody has to ask a loved one to assist them to end
their suffering is because they cannot ask the medical profession for such
help. Yes, I know that doctors must ‘do no harm’ – but what constitutes harm?
Does the prolonged extension of life, even though agonising and with little
dignity, and possibly against the wishes of a patient, do harm?

It’s a difficult thing, but perhaps there should be a means by which
someone can request that their demise be hastened by medical intervention.
Yes, there would have to be proper safeguards; a legal mechanism by which the
doctors (plural – no single doctor should ever be asked to undertake such a
service without the independent checking by at least one other) could be
exempted from any charges, and the request would have to come from the
patient. Of course, that leaves some who have extreme difficulty communicating
suffering in a limbo, but at least it gives a chance to others to avoid a long
and agonising decline.

Too many of us have witnessed the decline and suffering of relatives to
have to go there ourselves.

There would then be no need to impose such a burden on loved ones.

Last Man Jack
June 15, 2011 at 13:39

Hi Anna,

I am glad that this topic is being discussed and I am pleased to see your
second article on the matter to clarify your position. I am a long time reader
of your threads and this, first post, was one of the first I didn’t agree
with.

As it is such an emotive subject there will never be a ‘catch all’ answer.

That said there is a clear difference to make between what we could call
suicide and the Dignitas version of voluntary self inflicted euthanasia. Where
a terminal and debilitating is confirmed by medical experts and whilst the
patient is still in a fit mental and physical state to follow their choice
through, I believe it should be just that – their choice.

I am fortunate that to this time I have never had to deal with suicide of a
beloved friend or family member. I have, however, had friends who have lost
parents and sibling to depression induced suicide.

If I had experience first hand I don’t doubt that I would have a more
rounded opinion with more consideration for those left behind, however, in the
scenario of terminal illness noone is being stripped of a loved one rather
spared the unpleasant decline of that person into pain and indignity.

The final point I’d make is that in the past I have, to my shame, often
seen suicide as a cowards option. Considering the option of Dignitas or
equivalent I’d say there is a great messure of bravery involved to take
control of a situation over which you normally would have none. I am not sure
I would be made of stern enough stuff.

Last Man Jack

electro-kevin
June 15, 2011 at 13:38

‘please make arrangements to kill me, if you don’t I will suffer
unimaginable pain/ live an unbearable life, and it will all be your fault’, is
grotesque.

A lot of things are grotesque. Especially my Gran’s last few days when she
was literally howling in agony.

Either way you carry appalling guilt.

permanentexpat
June 15, 2011 at 13:09

Together with Abortion, this is a subject on which there will never be
consensus…far, far too complicated & complex and it would be impossible to
choose two themes so very personal.
As far as the Love factor goes, if it
is real love, then the question of mutual help in an unbearable/terminal
situation needs no qualification.
A problem is having the necessary means
personally at hand for an exit with dignity to be successfully achieved…it is
not sensible to be unprepared for an event which, though inevitable, need not
be in painful degradation.

PT June 15, 2011 at 12:56

“‘please make arrangements to kill me, if you don’t I will suffer
unimaginable pain/ live an unbearable life, and it will all be your fault’, is
grotesque.”
Indeed it is grotesque. Not everybody could deal with that.
Equally, not everybody can bear to see a loved one suffering terrible agony,
or even lesser, but constant grinding pain, day after day, with no hope of
improvement; quite the opposite in fact. There is also the argument that one
would be prosecuted if one did NOT euthanise a dog in such pain. And let’s
face it, pain relief, while better than in Nelson’s day, is far even from
adequate in most cases, whatever interested parties may say.
Within every
argument on this topic there are two or more equally valid viewpoints. There
is no right or wrong answer. We just have to accept that often, humans are not
permitted an easy death.