Right to die

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Is it? I have never heard of any lobbying from the medical industry towards keeping assisted suicide illegal. And I don't really think it is a big deal for them. The number of cases of people that decide to end their lives seems a little low (so much that they make global news when they do) for the medics to really reap that much benefit.

Where the medical establishment really reaps the financial gains is when people start resorting to "heroic measures" to gain a few months extra of compromised living. I think they gain more to capitalize on a patient's fear of death rather than fighting the wish to die.

the way i see it is, if somebody is of reasonable mind - by which i mean capable of making their own decisions then they should have the right to do with their life as they choose.

it gets me annoyed when i see people on the news debating the issue like they have some sort of say over what somebody else does with their life.

if i was terminal or was in some way unable to live my life as i chose then i would want to die. absolutely nobody else on this entire planet will ever tell me that i cannot choose to die - it is not and never will be their decision to make.

unfortunately there will be people queuing up to make money from this but that is the way of the world. as long as it is never encouraged through advertising or persuasion then i dont see the problem with somebody makingmoney from it. at the end of the day there is always going to be costs involved and people need to be paid.

[puts on doctor hat]

In twenty years of medical practice, I have never seen this type of calculus. In fact, the calculus that I have seen is precisely the opposite. The truth is that there is a steady stream of patients--we never lack for work, and waiting times attest to that. And every terminal patient for whom there is no hope of recovery is taking up a bed that could be available to someone else.

[does a few stretches, warms up, and dives in]

So let's get into the medico-legal ethics. First, we need to distinguish between some different circumstances.

There are patients who are terminal--that is to say they are suffering from a disorder which is progressive and which will inevitably be fatal. Late stage cancers, organ failures and the like are all examples. Then there are patients who are chronic, but not terminal. They are suffering from a disorder which is stable, but from which they will never recover. Neurological damage is a prime example in these cases. Within these two broad categories there are potential special circumstances: risk of impairment of mental capacity is an obvious one, and incapacity to undertake actions is another.

Now, a physician can be confronted by several different possible actions, each of which is subject to very different legal and ethical analysis.

1) treat and preserve the life of a patient

In theory this is a default state, but in fact it is not, because treatment is always predicated on consent--whether express, in the case of a patient who says clearly, "yes, that is the treatment that I want you to administer," or implied such as the case where a patient is unconcious, but there is no reason to believe that the patient would refuse treatment.

The moment that a physician has reason to believe that consent has been or would be withheld, the physician much turn attention to the question of whether the administration of treatment is ethical. This must be contrasted with a legal obligation to treat in the face of withheld consent (for example a parent refusing to a child's treatment on religious grounds, or a patient whose competence is in question who refuses treatment).

2) withhold treatment

From my perspective (though this is not a universal view) this is closer the default position. Until there is an ethical reason or a legal obligation to act, the default action is to take no action. "Allowing nature to take its course," is not an unreasonable medical approach when confronted with terminal illness. The ethical and legal quandaries arise where a patient (or more problematically, a patient's guardian) insists on heroic efforts.

3) withhold alimentation or hydration

In contrast to withholding treatment, withholding alimentation or hydration is an action that will hasten death, and the cause of death is likely to be dehydration or starvation. This is still, however, a passive action. The patient, left alone, would be free to forego food and water, and if in an unconscious state would be unable to eat and drink, in any event.

Cruel as this may sound, there are circumstances in which this can, in fact, be the most humane approach. Hydration and nutrition require expulsion, which likely means a urinary catheter or incontinence garments. The former is painful, and the changing the latter can be very painful, too. Patients who are incapable of swallowing require an NG tube. In contrast, terminal patients rarely report or demonstrate discomfort from withholding nutrition and hydration, other than dry mouth. The discomfort of a dry mouth can be relieved without significantly hydrating the patient.

4) provide therapeutic means that can be misused by the patient to commit suicide

The most obvious mechanism is the morphine pump. In practice, however, devices such as these are dose limited and a patient is unlikely to be able to make a conscious, rational decision to overdose and to simultaneously have the means to do so.

5) provide means with the express intention that they will be used by the patient to commit suicide

Now we start to walk into more difficult areas. We are crossing over the line from passive measures into taking active steps that we know, or ought to know, will be used for the purposes of suicide. The principal restriction here is legal. In most jurisdictions, counselling suicide is a criminal act. In many, so too is aiding or assisting a suicide. There is a significant question of law as to whether a physician providing the means to commit suicide is counselling, aiding or assisting, and one that will not be answered the same way in every jurisdiction.

The ethical question is not clear cut, either. For my part, I firmly believe that a competent person is free to make the decision to commit suicide at any time--not merely in the face of terminal illness. However, competence cannot be in question, and the person must make the decision in full awareness of the consequences for others. There are others, however, who take a much more restrictive view about when a patient can make a competent decision.

6) administer a lethal dose

This is, of course, the end state of any debate about assisted suicide. It is also the place that makes many physicians uncomfortable. I have no hesitation about withholding treatment or signing a DNR. I am quite prepared to discuss the benefits and consequences of withholding nutrition and hydration. I can even contemplate circumstances in which I would be prepared to provide a patient with the means to self-administer an overdose.

But even if the legal prohibitions were to be swept away, I am not at all certain that I would be prepared to do the deed myself.

Pain doesn't necessarily have to be physical in nature. Taken from the article the OP linked to:

I understand that point, but then look at Steven Hawking. I just hate to see someone stop fighting for meaning and dignity in whatever life they have. His choice is his to make.

I do too... But as Puddingmouse said, he's being kept alive against his will which can arguably be construed as a form of mental torture.

Well, you're in CANADA....And you must remember that here in the USofA our healthcare system works differently and is more easily swayed by free market influence. Terminally ill patients are usually transferred from the clinic/hospital where they've been receiving treatment to a hospice where they're given palliative care. This kind of care still costs money. And if their insurance company lets them go they or their families still have to pay for this care . In the case of people with chronic medical conditions(like permanent neurological injury), such people can survive for years, and sometimes decades, to which there's even more of an incentive to keep these people living so that healthcare providers can continue to bill them! It seems that in the US, the law is more willing to give terminal patients the right to doctor assisted suicide than chronically ill patients; since they're going to be dying very soon anyway and there's less money to be made from them.

With regard to the specific case here, I can certainly support this man's right to end his life, so long as it is of his own free will & not under duress.

But with regard to euthanasia in general, I'm not so inclined to jump on the bandwagon. I tend to be pro-choice & all in favor of individual rights on almost everything. But in the case of euthanasia, I can envision a right to die quickly evolving into a DUTY to die. Specifically in the U.S.A., the ability to prolong life comes hand-in-hand with enormous medical bills that can bring financial ruin on families & care-givers. In our country, with its exaltation of private profits & free markets & its relentless focus on the bottom line, I can see how a person in such a situation might feel obligated to die just to relieve family members of the burdens & financial strain of providing care & maintaining a life that may not have much quality or independence left to it. Or to put it another way, the time to go would be when the insurance company decides to stop paying.

Why? What right do you have to decide that someone MUST live, no matter what they want? Are you god?

The right to die is one of those things that is entirely in that persons hands. No one else can make that decision for them.

If a person wants to end their life, I think they should be allowed under some guidelines.

Hawking has two loves in his life that keeps him going.

Stephen Hawking Loves Strip Clubs…And The Universe