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Suspended sentence for failed mercy killer

The BBC and the Guardian report the particularly tragic story of 95 year old Denver Beddows who admitted battering his 88-year-old wife Olive with a pan and a hammer at their home in Warrington. Mrs Beddows survived the attempted murder. Mr Beddows received a two year suspended sentence.

Apparently Mrs Beddows had pleaded with her husband to end her life so that she would not die in a care home. This is given credibility by the fact that Mrs Beddows has now forgiven her husband and wished to be reunited with him.

The story is complicated by the fact that according to psychiatric reports Mr Beddows had a history of depression dating back to 1962 and was “clearly under a great degree of mental strain and was not thinking straight”.

Without a compassionate right-to-die law, it is hard to see how tragedies like this can be avoided. With an appropriate law, Mrs Beddows would be able to formally request medical assistance to die. Before being granted, the request would be assessed by multiple independent professionals who would evaluate, amongst other things:

  • Did Mrs Beddow have the mental capacity to make a life ending decision?
  • The medical situation leading to Mrs Beddows request – presumably an 88 year-old, in need of a care home had a serious illness. What were the prospects of a recovery that Mrs Beddows would find meaningful?
  • Whether Mrs Beddows was being coerced into making her request. Was there evidence of a long held view that she would want an assisted death if she was so ill as to require permanently living in a care home – something that she foresaw that she would find intolerable. In its best form such a view would be documented in a signed and witnessed advance statement. This would help doctors and others assessing the case to be confident that it was her own choice. MDMD advocate such advance statements to be made at the same time as an Advance Decision.
  • Whether all other possible solutions have been properly examined.
  • Was she suffering from a curable depression?
  • Might she adapt, given time, to a changed situation following some life-changing change in circumstances.

If, following careful evaluation by multiple independent professionals, the conclusion was that her wish to end her life was safe and persistent, then with appropriate medical assistance, she could have the good death she wished for. If the request was found to be unsafe and rejected it would not be defensible for someone to attempt murder or assist suicide – so vulnerable people would be better protected than at present.

For some people, even the best nursing or palliative care is not the type of end of life they want. Instead of fighting on against inevitably worsening illness, they would prefer to peacefully go to sleep and not wake up, often in their own home, possibly in the company of those closest to them. Why should they be denied this rational choice?

In the absence of an appropriate right-to-die law, cases like this will persist. Untrained, emotionally involved people will take the law into their own hands. They will try to assist in suicide, or even attempt murder. It may go horribly wrong, as in this case. It could be very traumatic. The person may not die but be left with serious injuries. Worse, once the life has been ended there is no way of knowing whether the action really was at the deceased’s request. Where are the safeguards in that? Yet that is what parliament decided was a “safer” option than really tackling the issue of what right-to-die legislation this country should have. The result: people who would like an assisted death have to continue to suffer, against their will, and be denied the good death they seek. And in addition, people, like Olive Beddows, have to beg apparently well-meaning people to assist suicide or murder. They risk themselves ending up in a worse situation. The person assisting them will be subjected to, at best, a police interrogation, and at worst, criminal charges and a custodial sentence. The parallel with backstreet abortions before abortion was legalised is chilling.

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MS Sufferer heading to Switzerland while he still can

The Scottish Sun reports the case of Colin Campbell.

Colin suffers from the Primary Progressive form of MS. He intends to go to Lifecircle in Basle to end his life on 15th June while he still can. He told MDMD “I qualify everything I say with ‘intend’ as my health could fail totally at any time.” He has lived with the gradually worsening condition since 1995, but his quality of life is now deteriorating below the limit he can tolerate, and he needs to take action now, while he is still physically able to.

Colin has bravely chosen to make his decision public in advance, to help demonstrate why a change in the law is necessary. Why should people like him have to go to Switzerland to find compassionate doctors who are legally able to help him have the good death he wishes? We need to provide this in the UK, for mentally competent adults who have made their own, settled choice in the face of incurable, unacceptably low quality of life.

Cameras will record Colin on his journey. Andi Reiss is the independent documentary film maker who is following Colin’s case as part of a larger project looking in detail at the issues around assisted dying.

Colin has told MDMD that his doctors have not discussed his life expectancy with him. The Multiple Sclerosis Trust clearly points out that MS is not a terminal illness. There appears to be no prognosis of six months or less. Given this, it is interesting that Ally Thomson, director for Dignity in Dying Scotland is quoted in the Scottish Sun article as saying “It is a tragic and unacceptable reality that seriously ill people like Colin Campbell feel they have no other choice but to spend their final days traveling hundreds of miles to Switzerland in order to have the dignified death they desire.” MDMD fully agree with her on this. Unfortunately she doesn’t go on to say what option she would like to see for people like Colin. The legislation Dignity in Dying have been proposing would not help him, as his life expectancy is not less than 6 months.  Perhaps this case will help Dignity in Dying see the need to broaden their policy to show more compassion to people like Colin (and Omid), instead of denying them the help they need and thereby prolonging their suffering unacceptably. MDMD certainly hopes so.

MDMD commend Colin for his bravery in being so public at this difficult time. We respect his choice and wish him well in the course he is choosing.

Update October 2017: Colin deferred his decision to end his life in Switzerland. See the story here.

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Avoiding Prolonged Dementia

Dementia is now the leading cause of death in England and Wales. How can we ensure we don’t suffer from it for longer than we wish?

Medically Assisted Suicide is one option chosen by a few. In the UK those choosing this option need to arrange appropriate help in Switzerland, as it is not legal here. This has to be done prior to the point where mental capacity has been lost. MDMD campaigns for this to be a legal possibility in the UK, avoiding the additional bureaucracy, journey, and expense at the end of life to obtain a good death.

Another option is to rely on an advance decision to refuse all treatment once a particular mental capability is lost. This is possible in UK. The option is discussed in an essay by Norman L. Cantor, Emeritus Professor of Law, Rutgers Law School. He has been widely published in legal and medical journals on the topic of the legal handling of dying medical patients. His areas of expertise include Advanced Directives and medical decision making for the mentally disabled.

The essay relates specifically to the law in the USA, but the issues it discusses are much more widely applicable – in particular the issue of whether those caring for a patient who is suffering from dementia but apparently not in distress, might decide that the patient may have changed their mind regarding their end of life care wishes, or may not be suffering sufficiently to refuse some simpler treatments. These questions are very difficult for carers and health care proxies, who may “play safe” by agreeing to life prolonging treatments such as antibiotics, perhaps accepting life-sustaining treatments, when alternative painkillers, without life-sustaining properties, might be more appropriate.

Prof Cantor includes his own Advance Directive which is very instructive on how one might make a clear statement of one’s wishes in this regard. In particular he explains the following:

  • At what point in mental decline his decision applies – “..mental deterioration to a point when I can no longer read and understand written material such as a newspaper or financial records such as a checkbook.“
  • Why he refuses treatment -“…intolerable indignity and degradation associated with cognitive dysfunction…“. But also to allow his loved ones to remember him “…as a vital, critically thinking individual…“. And “… to avoid being an emotional, physical, or financial burden on my family and friends, even if they would willingly assume such burdens.“
  • He is clear to maintain his request “… even though I might appear content in my debilitated condition.“
  • The scope of treatment being rejected is clear: “… rejection of any and all life-sustaining means.  This includes simplistic medical interventions such as antibiotics, blood transfusions,…” In the UK, where preventative treatments such as flu jabs are given routinely to the elderly, someone with similar views might wish to explicitly reject these too.
  • In addition to refusing artificial nutrition and hydration he clarifies his wishes regarding assisted feeding – “If I am indifferent or resistant to hand feeding, I do not want to be cajoled, harassed, or in any way impelled to eat or drink.“
  • Finally he considers the possibility that people may think he has changed his mind: “The question may arise as to whether I have had a change of mind and revoked my advance directive.  My wish is that no revocation be found unless I do so while still capable of a considered choice, …“

MDMD thank Prof Cantor for sharing his advance directive publicly – a document that is obviously based on careful informed consideration of the relevant issues. The issues he addresses are important to many of us. Although in the UK an Advance Decision can only be used to refuse medical treatment, an associated advance statement allows a wider description of a person’s views and end of life wishes.

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New Legal Challenge on Assisted Dying

Today a new legal case to challenge the law on assisted dying is seeking financial backing. Please can you help!

The law firm Bindmans are representing ‘Omid’ who was diagnosed with the incurable illness, Multiple System Atrophy (MSA), in 2014. He is now largely confined to bed, has to wear a catheter bag and needs help with all personal care. He has difficulty speaking, and has lost much control in his arms and hands – making him unable to attempt suicide unaided. (A previous attempt failed.)

Omid is not terminally ill, in the sense of having a life expectancy of 6 months or less. For MDMD this is an important distinction as we do not believe the 6 month criterion can be anything more than a first step in our campaign. MDMD encourage supporters to help fund this action by Omid. We note that another legal case being brought by Noel Conway is limited to helping those with a life expectancy of six months or less – something doctors say they cannot accurately predict. Omid’s case is much more representative of MDMD’s objectives.

The Bindmans legal team are experienced as they also worked on the cases of Tony Nicklinson and Debbie Purdy. The last case ended in 2014 . In that case Lord Neuberger said “There seems to me to be significantly more justification in assisting people to die if they have the prospect of living for many years a life that they regarded as valueless, miserable and often painful, than if they have only a few months left to live“. (Lord Neuberger is President of the Supreme Court, the final court of appeal in the UK for civil cases, and for criminal cases from England, Wales and Northern Ireland.) MDMD strongly agree with his opinion that assisted dying should not be restricted on a life expectancy basis.

The BBC reported the outcome of the 2014 case saying:

“The Supreme Court … right-to-die judgement boils down to a single phrase directed at Parliament: Sort it out, or we will.

“It argues that MPs have ducked the issue for too long – and it is time they, as our democratically-elected representatives, find the political backbone to amend the law on assisted suicide.

In 2015 the House of Commons failed to do so. We await with interest the outcome of this case. The issue will not go away until people like Omid are allowed a peaceful, medically assisted death if that is their persistent, well-considered wish. Why should people be forced to continue a life suffering against their will, (often having to pay for their own care), and be denied access to the drugs which can give them the good death they crave?

If social and medical care is serious about being “patient-centred” they need to be legally able to give people like Omid the end of life help they so desperately want. For example, NICE, the National Institute for Clinical Excellence, state in their guidelines to improve care for people at the end of life:

“… put the dying person at the heart of decisions about their care, so that they can be supported in their final days in accordance with their wishes.”

Omid’s wishes can not be put at the heart of decisions about his care, with the law as it is at present. MDMD wishes him every success in his legal challenge to allow what to him is a good death.

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House Of Lords Debate on Assisted Dying

On 6th March 2017 the House of Lords held a short debate on Assisted Dying “To ask Her Majesty’s Government what assessment they have made of recent legislation on assisted dying in North America; and whether those laws provide an appropriate basis for legislation in England and Wales.”

The transcript reveals the continuing debate along well-worn lines. Those in favour of a change in the law in the UK describe the recent changes in legislation in Canada, California and Colorado as indicating a “tide of history” which will sooner or later reach the UK.  Those opposed were concerned about inadequate safeguards and the possibility of future extensions of an initial law permitting assisted dying.

In his summing up, the Advocate-General for Scotland (Lord Keen of Elie) makes some helpful observations. Importantly he points out something that is often overlooked in media headlines: the two sides of the debate have much in common. We all want to ensure people have access to high quality compassionate care at the end of their lives. Further, we all want to protect those who are vulnerable from coercion. He identifies the central question as “whether a blanket ban on assisting suicide is a necessary and proportionate way of achieving this.” MDMD clearly think not. True compassion, for some people, in some situations, means medical assistance to end their life at a time of their choosing, when their quality of life is incurably below the level they can accept. To deny people this opportunity is a cruelty that vulnerable people should be protected from as much as from any coercion to request it.

Regarding a change in the law, Lord Keen cautions that there are cultural differences between countries which mean that we cannot simply adopt a law from elsewhere. He also echoes concerns about the possibility of laws being modified in future. He points out the need for very carefully crafted safeguards, while accepting that no safeguards could eliminate risk completely. “The real question is: how much risk to the vulnerable is acceptable in order not to deny those who would genuinely wish to be assisted to commit suicide the opportunity of an assisted death?”

How do we move the debate forward? MDMD believes that some new thinking and proposals are necessary. Some important suggestions we offer are:

  • The six month criterion has serious problems both of diagnosis, but also for people with incurable, often slowly degenerative, diseases who suffer intolerable conditions for much longer. Dementia is an important example. It is now the most common cause of death in England and Wales. People with a dementia diagnosis are faced with horrible alternatives before they lose their mental capacity: ending their life in Switzerland like Ron Hall; ending their life themselves like senior judge Sir Nicholas Wall, the former President of the Family Division; or being subjected, like Joan Cheatle, to the living nightmare of one’s self withering away uncontrollably with loss of all shreds of dignity, even though she had excellent specialist care.Despite these concerns, the six-month criterion may turn out to be an important initial safeguard – but it should be recognised for what it is, the first step in a cautious, incremental approach towards more compassionate, but still safe, solutions. Many changes in law have been introduced step-by-step – our right to the vote being the most obvious example.
  • Currently proposed safeguards are not considered adequate by many opponents. We should work actively to improve this. MDMD’s suggestion of extending the concept of an advance decision could be an important contribution here. Under our proposal, vulnerable people who had not previously made a formal statement of their wish for the option of an assisted death, made at a time when there were no questions about their “vulnerability”, would have precisely the same protection as at present. Yet those who could point to evidence of their long held wish, or who were very clearly not vulnerable even if they had recently changed their mind (like Lord Rix), would be allowed assistance to have the good death they desire.
  • More detailed proposals are needed of how exactly doctors and courts could establish that someone was making their request freely. There are already many healthcare professionals experienced in interviewing people, especially vulnerable people, to ascertain their wishes, to test the reasons for those wishes, and their consistency. Perhaps such an expert interview should be compulsory and recorded on video for consideration by others involved in the authorisation process.
  • The question of “how much risk to the vulnerable is acceptable” needs to be balanced by the question “how much suffering should be inflicted on the incurably ill by refusing their well considered requests for an assisted death?”. The best estimates, from those jurisdictions where assisted dying is legal, suggest that the risk to vulnerable people is very small indeed – there is very little evidence of coercion – though admittedly it could be hard to trace. We should perhaps do more work to quantify the amount of incurable suffering being experienced by those who are refused the life ending assistance they desire – but it is very difficult to do so. We have estimates of how many people choose to end their life in Switzerland (47 people went to Dignitas in 2016 from Great Britain). We can only estimate how many people take their own lives due to incurable suffering. Dignity in Dying estimate 300 per year. This is a helpful statistic, but it is likely to be a significant underestimate as they only include those suicides where “terminal illness” is mentioned, and their data will exclude many situations where someone has voluntarily stopped eating and drinking to hasten their death, as this is unlikely to be recorded as suicide. Anecdotally we hear of many more cases of people suffering against their will at the end of life, where death eventually comes as a relief.

MDMD encourages and participates in constructive discussion between all parties. There is clearly much more work to be done to produce a more acceptable proposal for how the law should change in this country.

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Senior judge ends his life after being diagnosed with dementia

Several news sources report the suicide of Sir Nicholas Wall, the former President of the Family Division, Britain’s most senior family law judge. The Daily Mail has some particularly interesting quotes.

Daily Mail

The Guardian

Daily Telegraph

BBC

MDMD are not aware of the full circumstances of Sir Nicholas Wall’s death, but the case highlights the following issues:

  • Faced with an illness that permanently reduces one’s quality of life below the level one can accept, a decision to end one’s life is a rational and understandable choice for some people.
  • If the law were changed to provide legal medically assisted suicide, then people like Sir Nicholas would be likely to seek professional support, in the knowledge that a legal medically assisted suicide would be available when necessary. Evidence from countries where this is available demonstrates that in some cases this can help people delay the point at which they chose to end their lives.
  • Dementia, and other conditions which can be intolerable for well over 6 months, highlight the problematic limitations of legalising assisted suicide only for those with a life expectancy of 6 months or less.
  • This is particularly poignant for dementia, as by the time a sufferer has a life expectancy of 6 months or less, they are unlikely to have sufficient mental capacity to safely permit a medically assisted suicide.
  • Dementia is an increasing concern for many people. It is now the most common cause of death in England and Wales.
  • Without a change in the law permitting medically assisted suicide, some people feel forced to take action to end their life themselves. Without controlled legal access to appropriate lethal drugs, alternative methods of suicide are uncertain and prone to failure, possibly leaving the person in a worse state. Some methods are very unpleasant and traumatic for both the person involved and their families.

We need a more compassionate law that allows people like Sir Nicholas Wall to have a good death at a time of their choosing, with appropriate counselling, assistance and company.

UPDATE 7th June 2017

The inquest into Sir Nicholas Wall’s suicide is reported in a piece in the Guardian. He died by hanging in his care home, leaving letters to his wife. The piece does not say whether he was considered to have lost mental capacity, but his actions, letters and planning suggest that his decision was rational. The coroner who examined the note he left said it was clear that he intended to take his own life. Similarly it is unclear whether he had been diagnosed as suffering from a potentially curable depression, as opposed to understandable sadness due to his incurable illness, which for him was intolerable. His nurse, the last person who saw him alive, described how he joked and smiled during her visit. We can reasonably speculate that this is not the behaviour of someone acting out of severe depression.

How much better his death could have been with appropriate legalised assisted dying. He could have had professional counselling – possibly delaying his choice to end his life; he needn’t have died alone; he could have explained to his family, saving them the shock and unpleasantness of a violent suicide …

The tragedy of this case is that Sir Nicholas was not allowed the compassion and medical assistance which would have enabled him to have a good death at the time of his choosing.

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Book Review: Rational Suicide in the Elderly

Rational Suicide in the Elderly: Clinical, Ethical, and Sociocultural Aspects

by Robert E. McCue (Editor), Meera Balasubramaniam (Editor)

Springer 2017 (8th Oct 2016)

An entire book devoted to the better understanding of Rational Suicide in the Elderly was essential reading for MDMD (Our name was formerly SOARS: Society for Old Age Rational Suicide). We were pleased to see that SOARS gets mentioned on the first page of the introduction and the SOARS website is extensively quoted in Chapter 6 – an indication of the influence of our campaign.

The book is a collection of 15 papers written mostly by psychiatric academics working in the USA who discuss the notion of rational suicide in the elderly and what they see as the best practices for treating patients exhibiting a rational wish to die. The psychiatric viewpoint is broadened a little with contributions from those in departments of psychology, philosophy and oncology. Two of the 18 contributors come from the UK and two from New Zealand. Surprisingly and unfortunately there are no contributions from medical professionals in the Netherlands, Belgium or Switzerland, where much practical knowledge and understanding of rational suicide is developing as those countries have the most far reaching assisted dying legislation in the world.

Many of the authors carefully question the notion of “rational suicide in the elderly”. How old is elderly? What is a “rational” decision? Can suicide ever be rational? But the book’s prevailing view is that, despite the ethical and philosophical considerations, there do exist people who are suffering from an incurable medical complaint, which renders their life no longer worth living in their opinion, who are not terminally ill, nor mentally ill, are not suffering from a curable depression, but have a desire to hasten their death. This is perhaps best demonstrated in a quote from the book’s final paragraph (in a chapter that carefully unpicks and rejects a lot of the standard justifications for “rational suicide”): “It seems to me obvious that it is sometimes better – kinder, more decent, dignified, compassionate – to bring an end to human suffering than to let it continue.”

Many of the issues considered by the authors in developing an understanding of “rational suicide in the elderly” are the same as those raised by SOARS supporters in the discussions that led to the organisation both changing its name from SOARS to MDMD, and broadening its objectives beyond “Old Age”. (And prior to that, in our consultation on the “When is a Life Complete?” document.)

Given that people exist who rationally believe suicide is their “best” option, the book attempts to give guidance to psychiatrists who encounter such people as “patients”. It is here that the book seems to get into several difficulties.

It is implied that the issue of rational suicide in the elderly is only about those who end up as psychiatric “patients”. The presumption is that a true rational suicide would successfully have done the job him or her self, without ending up in the psychiatrist’s consulting room. The fact that they have instead become a patient leads to the possibility that they may be seeking “help” to overcome their suicidal thoughts. Although this may be true in some cases, there are much wider issues, most notably the case of people who “successfully” choose rational suicide without any counselling.  Is it the correct attitude for psychiatry, or the wider medical profession to take – to accept people rationally ending their life, without professional counselling; alone; without assistance; and often in tragic circumstances? MDMD think not, we would like to see two forms of help available to all potential rational suicides: first, independent counselling to ensure that they are making the correct decision for them, at the right time; and second, legal medical assistance to die within agreed safeguards. It is only in the knowledge that medical assistance to die is a possible outcome, that people will intentionally seek medical help with their rational suicide decision. Without that possibility, the rational person, wishing to hasten their own death, would avoid discussing their plans with their doctors for fear of either being “treated” until they gave up their desire to end their life, or worse, being physically prevented from doing so, possibly including enforced hospitalisation, as a form of “safety planning”. A third risk for those in the UK considering going to Switzerland for medical help to die, is that a full discussion with their doctor may result in the doctor refusing access to medical records needed by the Swiss organisations who help foreigners. In these areas, the doctor patient relationship appears to be broken.

There is an irony here. Only with the option of legalised medically assisted suicide will potential rational suicides wish to consult their doctor. But once they do, it is likely that their suicide can be delayed and in some cases prevented, while ensuring that more people have the “good death” they should be entitled to. Much better a peaceful medically assisted suicide at a carefully considered “right” time, than a traumatic, lonely unassisted suicide, done too early while the person still can. The book does not consider these benefits of assisted suicide and therefore misses many of the issues that need to be discussed in a full coverage of rational suicide.

One important observation it does make is that the reasons given by people seeking rational suicide who are not considered “terminally ill”, as their life expectation exceeds six months, are identical to those who are terminally ill and receive assisted suicide in US states where it is legal. This usefully highlights why the 6 month criterion is so inappropriate.

Once a potential rational suicide is accepted as a “patient”, psychiatrists are in a very awkward position. On the one hand it can be very difficult for a medical professional to accept that an assisted death or worse, an unassisted suicide, is actually the best option for the patient. There is a tendency to see this outcome as a failure. This attitude is something that MDMD thinks needs to be overcome as society better understands the true nature of rational suicide as being the best outcome for some patients. A more pressing concern, especially in the USA where the book is focused, is on possible legal repercussions from relatives of a suicide who might claim that a psychiatrist involved had been negligent. An entire chapter is devoted to “Rational Suicide and the Law”, and several other chapters stress the importance of “risk assessment”, “safety planning” and “preventing impulsive behaviour”. For both these reasons it seems clear that professionals helping those who wish to actively hasten their death need some form of emotional and legal protection to do this difficult work effectively.

The main approaches suggested for working with people seeking a rational suicide are various talking therapies such as “Motivational Interviewing” to help the person understand the motivations behind the desire to end their lives and to expose and build on any uncertainties and desire for change the patient may have. Authors recommend applying these techniques non-judgementally, with respect for the patient’s views. While these approaches may be successful in preventing suicides, they run the risk of undermining a patient’s choice, possibly making them feel guilty in wanting a hastened death. It seems essential to ensure that the person has properly considered all options, including that they may be able to adapt to changed capabilities, but where should this dialogue stop? At what point should the psychiatrist stop challenging the patient and simply accept their view, even if they disagree with the patient’s conclusion? Many of the authors appear to have an attitude that suicide should be prevented if at all possible. The realisation that a hastened death may actually be the best option for some patients sits uncomfortably with what they are legally and ethically bound to do. A re-evaluation of these legal and ethical limitations seems necessary, but the book does not explore this.

Several authors refer to spiritual or religious belief as helping people come to terms with their dependency and changed circumstances. A full chapter is devoted to Christian objections to suicide. This may be appropriate for a USA audience, but in the UK only 59% of the population consider themselves to be Christian, with 25% of the population claiming no religion – a proportion that has grown by 10% over the preceding 10 years, growing in all age categories. (ONS report based on 2011 census data.) The reducing significance of religion is hinted at in a chapter about the attitudes of the “baby boomer” generation which concludes: “… a significant minority will consider suicide to be an intelligent and rational act in the face on an irreversible worsening in the quality of life.”

The penultimate chapter suggests that one or two doses of psychedelic drugs such as psilocybin might be an effective “treatment” for those who have lost meaning in life, possibly to the degree that suicide could be prevented. While this may suit some people, and may indeed reduce suicidal ideation, we must question the extent to which rational suicide is an illness to be treated with drugs that alter the person’s personality, as opposed to respecting the person and their personality as they are, and accepting rational suicide as it purports to be – a rational evaluation of one’s likely future quality of life leading to a decision that the person would be better off dead.

While several authors acknowledge that in some cases a hastened death would be best for the patient, the practical advice is all about attempting to alleviate symptoms, especially in cases where the patient can be helped to find some new reason for living. An important issue that is not tackled is how to help someone decide that their death should be hastened – or rather to corroborate the decision that the person has already reached. Of course, without the necessary law, the decision is irrelevant as the psychiatrist cannot assist. But advice from the psychiatric community is necessary in order to draft appropriate, safe and workable laws. A good law would enable more appropriate action in cases where, after full consideration with professional help, the patient is convinced that a hastened death is in their best interests.

Although the book has the serious limitations noted above, it is a step in the right direction. Many difficult issues are carefully analysed in commendable depth. Psychiatry (and the law) has a long way to go before it can be said to fully support the real needs of people whose quality of life is permanently, unacceptably low, to the point that they consider hastening their death. But at least the issue of rational suicide for people with intolerable quality of life, due to incurable medical conditions, is now firmly placed on the psychiatrist’s couch.

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Dementia sufferers ending their lives in Switzerland

Today the Mail on Sunday published an article about the father of an MDMD supporter who ended his life at Dignitas. Penny’s father Ron Hall suffered from early stage dementia. The psychiatric assessment to ensure he still had mental capacity to make the life ending decision was done by MDMD’s associate coordinator, Colin Brewer. Interestingly, the article goes on to point out that Colin regularly has to refuse an assessment of adequate mental capacity when, in his professional opinion, the person is no longer lucid enough to make the decision to take their life.

Dementia is a particular concern for MDMD. It is now the leading cause of death in England and Wales. Many more people die with dementia rather than of it. The issue of dementia highlights the reason why MDMD does not want assisted dying to be restricted to those who are expected to die within six months. By this stage, terminally ill dementia sufferers are very unlikely to have sufficient mental capacity to safely make the decision, and they will have already suffered for far too long.

Opponents to a change in the law warn that dementia sufferers who choose to end their lives while they still have mental capacity may be shortening their lives unnecessarily, as they may die of something else first. This is true, but some of us would prefer to sacrifice a period of diminishing life quality rather than run the risk of having to suffer the living nightmare that the later stages of dementia can become. It is a difficult choice for anyone – but one that we should be allowed to make for ourselves, provided we are well informed, but before it is too late, we no longer have capacity, and we end up like Joan Cheatle.

A spokesman for the group Care Not Killing commented that “a lot of people fear that when there is a care crisis within the NHS there will be more pressure on people who are elderly and frail to think about ending their lives.” MDMD understands this concern. We propose the idea of an extended advance decision – which allows people to record their wish for the option of a medically assisted death, long before they are elderly and frail. Such an advance statement would ensure that their choice was not the result of pressure, should they be considered vulnerable at the time they make their choice.

MDMD are pleased that articles like the one in today’s Mail on Sunday keep the issues in the public eye. We call on those with concerns over the safety of assisted dying legislation to work with us constructively to find a safe proposal to allow people a “good death” when, for them, that requires medical assistance to die.

UPDATE 24th January 2017

Following the Mail on Sunday article, Radio 5 live contacted MDMD. This resulted in the radio interview with Penny Hall. A reduced podcast of the interview is available here. For the next few weeks the original full interview is here.

Penny’s interview was followed an hour later by an interview with Baroness Ilora Finlay, chair of National Council for Palliative Care and co-chair of Living and Dying Well. MDMD agrees with Baroness Finlay’s comments that everything possible should be done to enhance the final phase of people’s lives. Where we differ is how to deal with the the situation when a person’s quality of life falls permanently below the level the person is able to tolerate, despite having the best care available. Only the person themselves can judge where that point is for them.

The knowledge that medically assisted suicide is available when things get unbearable can help people enjoy that final phase of life for as long as possible. Without it some people feel that the better option is to end their lives themselves, one way or another, while they still can. The irony is that a carefully designed assisted suicide law, working in partnership with the best palliative care, could actually prolong people’s lives and increase it’s quality by removing the fear that the dying process may at some stage become intolerable and they will be trapped.

Until the palliative care community work with groups like MDMD to find a safe, workable way forward which includes the possibility of a medically assisted death in this country, there will be far too many bad deaths, and people like Penny Hall’s father, who decide that the best death possible for them is an assisted one in Switzerland.

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PRESS RELEASE: MDMD Response to Noel Conway’s legal challenge on Assisted Dying

Today MDMD issued the following press release:

My Death, My Decision is pleased that, with support from Dignity in Dying, (DiD), Noel Conway, who is most unfortunately terminally ill with motor neurone disease, has begun judicial review proceedings, claiming that the failure of Parliament to amend the present Suicide Act, to permit him to have a medically-assisted rational suicide, unlawfully interferes with his rights.

While welcoming Mr Conway’s appeal, MDMD regards his attempt to change the law only as a “first step”.  By focusing on someone who is terminally ill, we are forgetting that very many other individuals (especially the elderly) may also be suffering severely, and for much longer periods than six months, from various medical conditions. These people may also hope, for the possibility of a legalized medically-assisted rational suicide.  Whenever our Parliament considers legalizing “assisted dying” again, it must then consider changing the law to include all competent, incurably suffering adults – as is fortunately possible today in Belgium, Luxembourg, The Netherlands and Switzerland.

The six-month criterion proposed by DiD is a particular problem for those suffering from early stage dementia. By the time a sufferer is within six months of dying they will have lost their mental capacity to choose an assisted death, should that be available. By then they are likely to have experienced extensive suffering and loss of dignity. Dementia is now the single largest cause of death in England and Wales. [Office of National Statistics:  Deaths registered in England and Wales (Series DR): 2015]

MDMD also wants to comment on part of the extensive statement by Mr. Conway which appears on the DiD website, www.dignityindying.org.uk/news/noel-conway-seeks-change-law .  In this, he notes that, regarding the possibility of going to DIGNITAS in Switzerland, “I do not wish to die in a faceless clinic, away from home and without my loved ones around me”.  Since MDMD was founded in 2009, at least nine of its supporters have travelled to Switzerland to end their lives there. Most of them have gone to DIGNITAS.  Our patron, Dr. Michael Irwin, has personally witnessed five such assisted suicides.  While we strongly agree with the need for assisted dying without travelling abroad, it is a great distortion of the truth to describe DIGNITAS – To live with dignity – To die with dignity, near Zurich, as “faceless”. In fact, The Guardian, on November 18, 2009, noted that it “is sunny, clean and neutral, not unlike a holiday rental apartment”.  Furthermore, everyone can see photos on the DIGNITAS-website. The word “clinic” is inappropriate as there is no medical staff or equipment present (although an individual is interviewed by a Swiss physician, independent of DIGNITAS, upon their arrival in Zurich, who writes the necessary prescription).  Furthermore, family members and friends are encouraged by DIGNITAS to be present when someone dies, and this happens with almost all assisted dying cases.

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My Death, My Decision is a company limited by guarantee, registered in England company number 11758121 and located at Unit A 39 Moreland Street, London, EC1V 8BB.