[dr2005]

Originally Posted by Adam the Fish

My dad has Multiple Sclerosis, and I've seen him suffer with it for a good few years. I've worked hard to empathise with that, because I think it's important when considering this sort of proposal. I am personally in favour of a safeguarded way for the painfully and terminally ill to die sooner and more peacefully than they otherwise would. One reason for this is my personal wish to give everyone as much freedom as is possible, obviously within reason ie. not impacting in a hugely negative way upon others. Personally, I would like to have the option of assisted dying available in case I develop anything similar to what my dad is going through. I'm not saying he should choose assisted dying, or at what point if he did, because that's entirely up to him. I'm just saying that I'd want to be able to make such a choice if I could.

Much as I understand, and sympathise with, the position you are coming from, I would caution against basing any thought process about the acceptability or otherwise of a course of action such as doctor-assisted suicide on personal circumstances.There is an inherent conflict of interest at play.

Originally Posted by Adam the Fish

I don't know whether it would be appropriate to call it a right, since safeguarding would prevent everyone from accessing it at all times, which is kind of what a universal right needs to be.
Even so, I don't think that means we shouldn't have the option. There are many options to which we don't have a "right" per se, but they're available because they improve quality, including quality of life.
So, even if we did not provide assisted dying as a universal "right to a dignified death", I don't see a reason why the option of active euthanasia shouldn't be allowed. I can think of reasons why that would make people happier - peace of mind, reducing suffering, etc.

This takes us into the rather thorny topic of "quality of life", and I think this is where we are going to end up agreeing to disagree. I suspect the issue is, in my mind, "quality of life" becomes rather redundant when you're talking about ending it. The act of assisted suicide does not in itself improve quality of life, as the act does not provide for life continuing and so quality cannot conceivably improve (or worsen as the case may be). What it offers instead is a semblance of control over the situation, and I can see how in certain circumstances that may offer someone a sense of feeling their quality of life has improved. But at the same time, it is reliant upon someone retaining their agency until the time comes, and life seldom plays by those rules. A person who has made a decision to end their own life could be struck by a brain stem stroke, for example, rendering them completely incapable of doing anything. Thereafter, their decision becomes somewhat redundant. It may be a rather extreme example, but I guess I just question the wisdom of depicting it as improving quality of life when that doesn't add up. Is it in fact bordering on the territory of a noble lie?

Originally Posted by Adam the Fish

I also don't think we need a universal definition of what a "dignified" death is; the point in giving the option is that an individual thinks assisted dying would be more dignified, they can choose it. If you don't think it's dignified, there are other options (ie. palliative care) available to you.
The use of "dignity" in the campaigning is simply because those who are part of those organisations are campaigning for the option to die in a way that they collectively see as dignified (or moreso than options currently available).

But is there not also the inherent flipside that certain types of death are viewed as "undignified"? Does that not entail that persons facing such end of life scenarios may be compelled to view it as "undignified" not because it actually is by any objective standard, but because society views it as such? Is there not then the risk that such people will seek out assisted suicide, or feel compelled to agree to such courses of action if suggested, as a result? That to me seems a very real possibility once you start deeming certain types of death as "dignified" or otherwise.

Originally Posted by Adam the Fish

I've already said that I'd want the option available were I to develop a condition similar to MS, and I can assure you that I've thought that through as rationally as ever. I don't see why one shouldn't consider the wish to end interminable pain early as rational, anyway. In the sort of situations you're talking about where people should be talked out of suicidal wishes, that is because the pain can be, for want of a better phrase, made to "go away" (albeit through a lot of hard work) and life be returning (roughly) to a normal standard. The difference, obviously, is that the sort of painkilling techniques (ie. very strong painkillers) required for the situations I'd suggest assisted dying for are really quite seriously detrimental to one's ability to live life anyway. They just prolong things with not a lot of responsiveness from the individual being treated, especially towards the end of life.

This may be a somewhat controversial suggestion, but one I feel obliged to make anyway for purely academic reasons: how can you in fact be sure that your decision is a rational one? In the mind of the beholder, any thought can be deemed rational even if on closer examination it is far from being. In addition, your comments in respect of suicidal wishes fall down when confronted with people who, despite the best efforts of those around them, simply cannot be persuaded that living is better than dying and for whom life will never return to normal. There is something of a contradiction going on where we have one situation where the wish to end one's life prematurely is deemed irrational and so hindered and prevented at every opportunity, and another where the wish to end one's life prematurely is deemed rational and facilitated. Either wishing to end one's life prematurely is rational, or it isn't. Based on the common impulse to avoid meeting one's maker early if at all possible, and our attitudes towards self-killing in general, I would suggest it's more likely to be the latter. I imagine the response would be that in assisted suicide and euthanasia situations death is looming in any event - although that could equally be said for someone crossing the road if they're unfortunate enough. The only difference appears to be in knowing it, and I sense it's more a question of trying to have some semblance of control over the situation rather than because the wish to die is seemingly rational.

Originally Posted by Adam the Fish

So, definitely have safeguards, but actually, the wish to end pain is a perfectly acceptable reason to want to end life, in my opinion. I'm no psychologist, but your example of choosing to give false confession after mental breakdown from torture would perhaps demonstrate a basic animalistic urge to end pain (eg. that inflicted by torture).

It's interesting you say that, because from my understanding of the literature (admittedly not in-depth by any means) it's actually the urge to survive which motivates people to make false confessions. They use the false confession as a means of seeking to preserve their own life, on the basis that it gets them out of danger at least for that situation. Pain motivates the urge, but it is not the motivation for the action itself. Otherwise, one would just as readily expect such persons to actively pursue death as that would be the most surefire way of ending their pain.

Originally Posted by Adam the Fish

As far as we know, in countries where assisted dying is already legalised, this has not been a problem with their safeguards. There's no reason to my mind why their safeguards could not be reproduced satisfactorily in the UK (etc.), with any extra thought put into this. I can't claim that it would be entirely effective, because I haven't tried coercing every single individual ever into assisted dying and then watched to see if the safeguards caught it. As far as anyone can tell, current systems have worked well to prevent this.

Additionally (and this responds to your second point as well), organisations like [the campaign for] Dignity in Dying already recommend "Advance Decisions". I've already demonstrated that it's possible to rationally decide that death would be preferable to treatment for some individuals (including me!) in some circumstances, so more people making these sorts of instructive documents (as would presumably happen if assisted dying were legalised) would act as a way of safeguarding in the first place. It would be easy for those judging the mental states of those people, because the decision would already have been made (of course, changing their mind would be possible!) - the difficulties you specify would only be for those who hadn't made a decision beforehand.
As I've said, there's no evidence to suggest that safeguarding for those people is ineffective in countries where assisted dying is legal.

With respect, I beg to differ. Professor Theo Boer, a Dutch ethicist who sat on a Regional Review Committee for euthanasia decisions for many years, has expressed concerns about the safeguards and the regular increase in euthanasia rates since the law was introduced in 2002 (up 15% annually on average). Likewise, while Swiss law does not in fact legalise euthanasia (a loophole is instead exploited relating to the law on suicide), Dignitas made great efforts to strengthen its screening processes in light of concerns that its facilities were being abused. I haven't been able to locate anything conclusive on the Oregon laws, but I think to suggest there is no evidence whatsoever is perhaps being a touch selective.

As for advance decisions, I fear that is not a particularly good comparison. A refusal to accept treatment (which, admittedly, stems from the right to personal integrity and autonomy that euthanasia proponents rely upon) is based on a notion of "letting nature take its course" - no one is intervening to hasten their demise, it's just happening through an omission. Assisted suicide and euthanasia, by contrast, require a conscious decision to end life prematurely for one reason or another. Refusal is exercising the right to autonomy over oneself; assisted suicide and euthanasia impose said autonomy upon the will of another person (e.g. the physician). That's a different ethical and legal ballpark.

Originally Posted by Adam the Fish

I would suggest an increase in investment for palliative care facilities, as a safeguard for assisted dying, to ensure people don't choose euthanasia just because specific palliative care facilities are too expensive or deemed unpleasant. I believe that there would be a positive impact on such facilities as a result of the legalisation of assisted dying (as I would, naturally...).

I suppose the question I'd ask would be: what guarantees are there that funding for such facilities would be maintained? The palliative care movement is, ultimately, underpinned by a belief that maintaining a decent standard of life until a person's life runs its natural course is the right approach to end-of-life care. Doctor-assisted suicide and euthanasia are in direct conflict with such a belief. In circumstances where greater demands are placed on end-of-life care facilities and resources, it wouldn't take much for a more economically-led approach to determine that palliative care isn't such great value compared with doctor-assisted suicide and euthanasia, and as such reduce resources for palliative care facilities. That is already starting to occur in the Netherlands in respect of terminal cancers, according to statements last year by Professor Boer, and as a logical development it's a pretty straightforward transition from euthanasia being a fringe option to euthanasia becoming the default. Particularly when resources are only going to become more stretched in the coming years.

Originally Posted by Adam the Fish

I'm in favour of it, as you may have noticed - but I suspect the things I've said might have been suggested to you before, so I'd be interested to see why you haven't deemed them sufficient responses in the past.

See above. But in simple terms I think the problem I have is a lack of rigorous, empirical evidence supportive of doctor-assisted suicide and a lot of rhetoric instead. I deal in a field which puts little weight in rhetoric, and I've stumbled across enough articles and studies questioning the popular wisdom behind assisted suicide and euthanasia to introduce doubt. Once a lawyer gets doubt, it's very hard to shift.