Euthanasia linked to Organ Donation

The Daily Mail 5/9/16 reports on a paper published in a medical journal which calls for allowing euthanasia to enable organ donation in the case ‘where it has been argued through the courts that a patient in a permanent vegetative state is going to have clinically assisted nutrition and hydration withdrawn, with the inevitable consequence of death, and causing dessication of the organs such that they are no longer able to be donated.’

This is actually a very narrow condition, however, it raises alarm bells for some people, perhaps because they fear that the principle might be easily extended. The involvement of a court decision is paramount. The court would have a much easier decision to make if the patient had previously completed both an organ donor card, and an Advance Decision – in particular one which requests assisted dying in hopeless circumstances such as this. MDMD strongly recommend everyone to complete an Advance Decision.

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What is “Unbearable”?

The Economist 6/8/16 reports research done in USA which interviewed patients aged over 60 who were admitted to hospital suffering from serious illness. They were asked to compare various symptoms to death to say how it compared to death. Half or more thought incontinence, being unable to get out of bed, or relying on a breathing machine were all “fates worse than death”. Over 30% thought living in a nursing home was worse than death.

Although a small scale study, MDMD agrees with the Economist that this type of research is really important as it begins to show real attitudes towards living and dying for those who are close to that point themselves. None of the conditions tested were necessarily “terminal” illnesses.

The Economist article is available here. Though you will need to apply for a free subscription.

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Two BMJ Blog posts on assisted dying in Dementia and Psychiatric cases.

Richard Smith, former editor of the British Medical Journal (BMJ) writes a moving personal story of his mother who suffers from dementia, arguing the case for assisted suicide for early stage dementia patients – as he and his mother did 10 years before.

Colin Brewer, former psychiatrist and current associate coordinator of MDMD, follows this up with another BMJ blog expanding and clarifying the case for Medically Assisted Rational Suicide (MARS) for dementia cases. He expands the arguments to include severe incurable psychiatric cases. Among many important issues he raises, he usefully points out the illogical and cruel limitations of any “terminally ill” time constraint on permitting legal MARS.

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Lord Rix changes his mind in support of legalised euthanasia

In 2006 Lord Rix, who was president of Mencap, voted against an assisted dying bill in the House of Lords. Now, aged 92, and terminally ill himself, he has changed his mind, and has called on the speaker of the House of Lords to open the debate again: “I can only ask that once again the House of Lords brings the UK up to date by allowing legal euthanasia after all other avenues have been pursued. Please raise the question again in the House of Lords so that people like me do not continue to suffer untold misery for want of a kind alternative.”

What changed his mind? “As a dying man, who has been dying now for several weeks, I am only too conscious that the laws of this country make it impossible for people like me to be helped on their way, even though the family is supportive of this position and everything that needs to be done has been dealt with. Unhappily, my body seems to be constructed in such a way that it keeps me alive in great discomfort when all I want is to be allowed to slip into a sleep, peacefully, legally and without any threat to the medical or nursing profession. I am sure there are many others like me who having finished with life wish their life to finish.”

Daily Telegraph Report

Daily Mail Report

His phrase referring to people like him “who having finished with life wish their life to finish” is a clear example of the MDMD description of a completed life.

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New Scientist reports on assisted suicide for psychiatric cases

New Scientist 23 July 2016 published an article discussing assisted suicide for psychiatric patients – which is legal in some countries such as the Netherlands and Belgium. The article gives an interesting account of the issues around providing medically assisted suicide to people with only psychiatric problems, such as a Dutch woman in her ‘30s.

Unfortunately, in referring to assisted suicide for people who are “not terminally ill”, the article does not distinguish between these very difficult, purely psychiatric cases of younger people, and the far more common case of people who are elderly and are suffering from a number of incurable “non-terminal” conditions, which permanently and incurably reduce their quality of life below the level they can tolerate. This latter category includes people suffering from dementia and other degenerative diseases. The article does not clarify that the term “terminally ill” is usually defined as having a life expectancy of less than 6 months. MDMD strongly reject the idea of restricting medically assisted dying to the terminally ill in this sense, as it would be denied to many people who quite rationally request it, and instead would have to suffer for a long time.

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Man shot wife with dementia in care home ‘to end suffering’ – BBC News

An elderly man told care home staff his dementia patient wife “had suffered enough” after shooting her at point blank range, a court hears.

Source: Man shot wife with dementia in care home ‘to end suffering’ – BBC News

This story is a challenge to the DPP guidelines. From the details available it appears that the man was acting out of compassion. Did his wife previously ask him to help end her life? Unless she left a written statement there may be no evidence. The moral is surely that if you want someone to help end your life in the future when you feel your quality of life is permanently below the level you wish to accept you should leave a written statement to that effect. It may help a compassionate relative who helps you to die, defend themselves against laws which may otherwise punish them for their compassion.

A more humane legal system, as available in some European countries, would permit someone with dementia to request assisted suicide or euthanasia in the earlier stages of dementia, before mental competence has been lost. That way there is no doubt of the person’s intentions, and they are not dependent on someone else carrying out their instructions to end their life to relieve their suffering.

An assisted dying law which is restricted to those who are terminally ill with a prognosis of 6 months or less (as proposed by Dignity in Dying and rejected by MPs) would not help in situations like this. That’s one reason why it is the wrong approach for this country.

Update: The Hereford Times reports that at the trial it transpired that Mr King was himself suffering from dementia. He was sentenced to 6 years for manslaughter to be served in a psychiatric hospital. The judge said “As you will know, there’s no evidence that she was in pain or suffering any more than anyone else who has succumbed to dementia. This was not a mercy killing. Rather, it was a killing that occurred at a time when the experts agree that you were suffering from dementia causing an abnormality of your mental functions.”

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Couple in joint suicide pact to avoid going into care

The Daily Telegraph reports the case of a Devon couple in their ’80s who successfully carried out a joint suicide. From the article it appears that this was a rational, well thought out, end of life choice. However, it is unfortunate that this couple needed to end their lives in this way. Perhaps, with more compassionate and flexible legislation they might have been able to have a better death. In particular:

  • Saying goodbye to their relatives and friends.
  • Avoiding the secrecy and risk of failure of their plans.
  • Delaying their death in the knowledge that there would be medical help to assist in safely and painlessly ending their lives when they felt their quality of life was permanently below the level they wished to accept.
  • Avoiding the shock and distress they undoubtedly caused to their cleaner who discovered their dead bodies, and their family who were unprepared for their action.
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Euthanasia 2016

Euthanasia 2016 took place in Amsterdam in May 2016. Slides from the presentations can be found in the following link, including the presentation on ‘When is a Life Complete?’ by MDMD Coordinator, Phil Cheatle

Source: Presentations | Euthanasia 2016

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Helping my Father Go To DIGNITAS

MDMD supporter Penny Hall’s father suffered from dementia. He chose to end his life in Switzerland while he was still sufficiently mentally competent to do so. The story is reported in this Cambridge News article.

Why should he have to travel to Switzerland?
Why should his family suffer a police investigation for accompanying him?

The end of the article talks about Dignity in Dying‘s campaign and points out that their proposed Assisted Dying law would not help people like Penny’s Father. While MDMD supports Dignity in Dying as far as they go, we think their approach is too limited precisely because of cases like this.

MDMD campaigns for a more compassionate law in this country – so that people like Penny’s father can have what they see as a good death without traveling abroad… a law the helps people in early stage dementia – not one limited to the 6-month terminally ill.

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