People with a low quality of life, who cannot look after themselves should not be kept alive. The majority of people with Alzheimer's should be terminated - just keep a few alive for research.
Etc etc etc.
That's what was being said in the early 90s.
'Doctors should decide when a patient should die - without reference to the patient's wishes, the wishes of the family, the opinion of other doctors, or any interference from the law'
'Young schizophrenics who are in good physical health should be terminated and their organs used for transplants'
Those were crazy times ...
On May 9th 1994 the Lords Select Committee On Medical Ethics came out TOTALLY against any form of euthanasia in the UK ... and that's how things should be.
Under NO circumstances should anyone in the medical profession be involved in actively ending the lives of patients.
People who do not wish to experience the unpleasantness of advanced old age, extreme disability, etc., should not demand that other people who are in such states be terminated by the medical profession ... or be given the right to kill themselves with medical assistance.
39 comments
I don't remember any of this being an issue in the 90s. There has always been a debate surrounding euthanasia and there was some discussion on the Netherlands' position on the matter, but that was it.
No one was taking the position of mandatory euthanasia for anyone.
Having said that, it's no one's decision but mine if I choose to terminate my life because of extreme illness or pain, and doctors should be able to help if I and they so choose.
I'm not sure that anyone outside of a select few nutjob groups would have seriously considered this, much less doctors. That's what I said about evolution denial back when I first heard about it. How naïve I was.
Denying people the right to end their own life is grossly inhumane. Depends entirely on the scenario. There are nutcases out there who want euthanasia for just about everything. For example, a scenario in which a person repeatedly states he wants to kill himself.
Letting suicidal people who can't think clearly terminate their lives is as idiotic as letting anorectic people starve themselves to death because it's what they 'want'.
Life is to be preserved, not taken away. Doctors are to heal, not kill. If a patient wants to die, it's the doctor's job to convince him or her to want to live on. Plain and simple.
Come to think of it, I remember being asked about this on the forum some time ago. Guess I'll have to get in there and actually address the reply I got in the near future:o.
<< Life is to be preserved, not taken away. Doctors are to heal, not kill. If a patient wants to die, it's the doctor's job to convince him or her to want to live on. >>
Øyvind: Yes -- up to a point. Many people head for such a choice rashly and irrationally because of being mentally ill. However, there is such a thing as a perfectly rational motivation for euthanasia; if someone is examined and judged to be entirely sane and competent but still wishes to end his/her life, I think it can only be considered cruelty to deny that choice.
My father, now about to go into assisted living, made out a living will years ago to cover the issue of keeping him alive artificially after Alzheimer's disease turns his mind to mush. It boils down to one word: "Don't." And I think that is an entirely rational decision.
~David D.G.
Øyvind : What if, for example, a woman with terminal cancer who is in a state of constant pain wishes to end her life?
Are you advocating that she should just be drugged up with painkillers of limited effectiveness for the rest of her days?
I'd call that cruel.
David D.G. : I completely agree. People deserve to die with dignity, and when they choose to.
Firthy2002: Actually, I have heard one. I remember one anti-euthanasia speaker saying something like, "For people in a bad financial situations, for people who are afraid that they will be a burden on their family, I'm horribly afraid that the right to die may become the duty to die."
I'm still in favor of the right to die, but I recognize it's something to be very careful with.
Irene
"People who wish to experience the unpleasantness of advanced old age, extreme disability, etc., should not demand that other people who are in such states be kept alive against their wishes ... or be denied the right to kill themselves with medical assistance."
Fixed it for you...
@David D.G.
Øyvind: Yes -- up to a point. Many people head for such a choice rashly and irrationally because of being mentally ill. However, there is such a thing as a perfectly rational motivation for euthanasia; if someone is examined and judged to be entirely sane and competent but still wishes to end his/her life, I think it can only be considered cruelty to deny that choice.
There's a huge problem with that argument. Many people who decide to do something because it's what they really want later realize that the decision was foolish.
People who decide that they want death don't get the chance to reconsider or even just try to fix the consequences of their actions after the fact, consequences that often range well beyond the person's own wishes.
Newton's Cat -- how about you come down with a terminal cancer -- a particularly painful one, at that -- and get back to us on how you feel about people having the right to kill themselves, with or without medical assistance? OK?
Actually, it´s only IF the patient and only if the patient wants it, what we call euthanasia. One thing is that you´re not in favour, another fairly different is LYING.
I'd say forcing something to remain alive when quality of life has gone to "terminal and constant pain" is a direct offense to "do no harm". Ending someone's life with a little dignity when they ask for it shouldn't be done unquestioningly of course, but once you're sure they know what they're asking?
Its their wish, and their right.
<<Life is to be preserved, not taken away. Doctors are to heal, not kill. If a patient wants to die, it's the doctor's job to convince him or her to want to live on. Plain and simple.>>
Thank you! I'm a doctor and i wouldn't like to decide whether a life is worth to be lived or not. I totally agree with therapeutic limitation, but not with active killing...I didn't study for hurting people intentionally.
Sure, we could limit ourselves to follow patient's wishes...but how are we to know if the patient is "sane enough" to make that kind of decision?(how can we define that?) how can we be sure that the patient isn't misinformed?...or that (s)he isn't being influenced by others? (ex: family members who want insurance money)
<<I'd say forcing something to remain alive when quality of life has gone to "terminal and constant pain" is a direct offense to "do no harm".>>
Doctors usually don't force anyone to remain alive. The only exception that comes to mind, are the procedures to prevent suicides at psychiatric wards. Everyone else can reject a theraphy or kill themselves if they want to.
But MadSerena, all doctors ALREADY have access to assisted suicide in the form of Nembutal and other peaceful drugs.
Why should everyone else be forced to resort to hanging, shooting, jumping off buildings or in front of trains, or worse in order to die?
You are heartless, and I hope that you are never my doctor. Doctor Death has compassion. Doctor Pain is paternalistic.
Have you managed to convince any cancer patients without depression that they should hang on until the bitter end rather than killing themselves? Don't forget that quite a few of them commit suicide BEFORE they have to go into a hospice.
<<But MadSerena, all doctors ALREADY have access to assisted suicide in the form of Nembutal and other peaceful drugs.
Why should everyone else be forced to resort to hanging, shooting, jumping off buildings or in front of trains, or worse in order to die?
You are heartless, and I hope that you are never my doctor. Doctor Death has compassion. Doctor Pain is paternalistic.>>
So i'm heartless because i wouldn't like to kill you? O_o
I'm not being paternalistic (or maternalistic?), i'm not making decisions for anyone...on the contrary, i'm abstaining from that.
Sure, you have the freedom to choose your doctor; i wouldn't like to have a patient like you either...a patient who expects me to do something that is against my obligations (in my opinion and according to my country's constitution).
There are forms to kill oneself in a painless way, without medical assistance; i won't be specific, i'm not here to promote suicide...is not an information that hard to find, anyway.
Stop twisting my words. You're heartless because you are forcing me to die violently AND PREMATURELY while I am still able to. If I could get help to die anytime I wanted, I'd be calmer and I wouldn't jump off a bridge the minute I was diagnosed with cancer. What's your proposed treatment for quadraplegics? Sedate them into a coma for 40 years so they don't get any suicidal thoughts? So your anti-choice beliefs are actually INCREASING the suicide rate, especially among those over 75.
Yes, I can choose a doctor, but it's incredibly difficult to find one willing to risk prosecution.
Without medical assistance. Right, you probably mean the plastic bag and helium methods. They still require some degree of physical strength.
Edit: Why do you believe that assisted suicide is unconstitutional? Is it because you want all "free" will that disagrees with your own to be outlawed, hmmm?
<<Stop twisting my words. You're heartless because you are forcing me to die violently AND PREMATURELY while I am still able to. If I could get help to die anytime I wanted, I'd be calmer and I wouldn't jump off a bridge the minute I was diagnosed with cancer. What's your proposed treatment for quadraplegics? Sedate them into a coma for 40 years so they don't get any suicidal thoughts? So your anti-choice beliefs are actually INCREASING the suicide rate, especially among those over 75.
Yes, I can choose a doctor, but it's incredibly difficult to find one willing to risk prosecution.
Without medical assistance. Right, you probably mean the plastic bag and helium methods. They still require some degree of physical strength.>>
If you jump off a bridge the minute you're diagnosed with cancer, is still YOUR decision...nobody is pointing you with a gun or something.
Don't make others deal with guilty consciences (or a prosecution), just because you aren't brave enough to deal with you life. That's childish and selfish.
A quadriplegic -like every other patient- is free to reject any therapeutic procedure and that sure will shorten his/her life considerably...in the meanwhile, we can offer him/her pain relief.
<<Edit: Why do you believe that assisted suicide is unconstitutional? Is it because you want all "free" will that disagrees with your own to be outlawed, hmmm?>>
Assisted suicide is illegal in most countries, because is considered murder...and is considered unethical in most medical societies. It also goes against Hippocratic oath.
Nobody is denying your right to plan your own death...but we also have the right to deny you help. To assist suicides isn't a part of our job (at least in most countries)...and i wouldn't like to have that kind of job, i didn't study medicine for that.
This isn't fundie. It's a bit of an exaggeration, but I do think there are a few good ethical arguments against euthanasia/assisted suicide.
I'm not saying I totally oppose it, but it is a system which could easily be abused.
I think it's more childish and selfish to impose a death on someone that they do not want.
If I get cancer, I may or may not commit suicide immediately, but I can guarantee you this - if voluntary euthanasia were legal, I would live longer.
Take patients with MND. By and large, they do NOT want to suffer the indignities and pain of suffocation and risk the failures of palliative care.
With VE illegal, they are forced to kill themselves while they can still move their arms. Therefore, your views encourage suicide. There are no two ways about it.
BTW, if assisted suicide is OK when you remove life support such as a feeding tube or a respirator, why is a lethal injection not OK?
Both result in and intend death. One is more humane than the other, however.
The Hippocratic oath also forbids women practising medicine and surgery. "Do no harm" would prohibit any treatment with a harmful side effect. Oh noez! Every single doctor in the world has broken the oath!
--I remember one anti-euthanasia speaker saying something like, "For people in a bad financial situations, for people who are afraid that they will be a burden on their family, I'm horribly afraid that the right to die may become the duty to die."--
That really isn't a euthanasia issue, IMO. That whole scenario can be averted easily enough with a health care system that isn't so damned worthless for anyone making under 100K a year. If simple meds didn't cost two-grand a month or more, I think we'd see the issue of people choosing euthanasia to avoid ruining their families disappear.
But of course, alot of the anti-euthanasia crowd is composed of the same people who scream that they shouldn't have to pay for Jimmy's lung cancer because he smoked a cigarette 10 years prior and nonsense like that.
What he may mean is that euthanasia, by tolerating it now under the guise of "the patient wants", may become compulsory in a future little by little. However, take for granted that it´s happening right now is a strawman, and it´s deeply dishonest.
<<BTW, if assisted suicide is OK when you remove life support such as a feeding tube or a respirator, why is a lethal injection not OK? Both result in and intend death. One is more humane than the other, however.>>
When you remove life support, you're aren't shortening a life...you're stopping prolonging a life by artificial means. They are different things, even if both cause death.
<<The Hippocratic oath also forbids women practising medicine and surgery.>>
It doesn't forbid it. But, yeah, that oath does have some outdated concepts (forbids abortion), so that's why that oath isn't a central part of my argument... i just mentioned it as a "plus". Anyway, the "do not harm" thing is still pretty much important to us.
<<"Do no harm" would prohibit any treatment with a harmful side effect.>>
No it wouldn't prohibit them, because harm isn't intentional in this case, it's an undesired effect. We only recommend a treatment, when the potentional benefits are greater than the potential negative effects.
Anyway, ALL medical treatments are potentially harmful.
<<That whole scenario can be averted easily enough with a health care system that isn't so damned worthless for anyone making under 100K a year. If simple meds didn't cost two-grand a month or more, I think we'd see the issue of people choosing euthanasia to avoid ruining their families disappear.>>
That's not going to happen, health is going to be more and more expensive. Don't blame us (the doctors), we aren't getting any richer, money goes elsewhere.
<<But of course, alot of the anti-euthanasia crowd is composed of the same people who scream that they shouldn't have to pay for Jimmy's lung cancer because he smoked a cigarette 10 years prior and nonsense like that.>>
I'm not one of them...I wouldn't oppose to Jimmy's treatment, he deserves medical care like any other human being. All of us do things that could harm ourselves...like eating food rich in sugar, salt or fat.
When you remove life support, you're aren't shortening a life...you're stopping prolonging a life by artificial means. They are different things, even if both cause death.
That's just a way of avoiding responsibility for one's actions.
Why is consent necessary for removing life support? Because, unless one is operating under the principle of futile care theory, removing wanted life support is akin to murder.
And it does involve shortening a life, even though most of the machines didn't exist a few decades ago. You're arguing semantics.
It doesn't forbid it. But, yeah, that oath does have some outdated concepts (forbids abortion), so that's why that oath isn't a central part of my argument... i just mentioned it as a "plus". Anyway, the "do not harm" thing is still pretty much important to us.
Yes it does: I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
No it wouldn't prohibit them, because harm isn't intentional in this case, it's an undesired effect. We only recommend a treatment, when the potentional benefits are greater than the potential negative effects.
Anyway, ALL medical treatments are potentially harmful.
Why should the fact that it is "undesired" make a difference? It's still harm, and IT'S STILL FORSEEN.
Sometimes treatment WILL be harmful - take chemotherapy for instance. Sometimes the treatment is worse than the cancer itself.
That's just a way of avoiding responsibility for one's actions.
Why is consent necessary for removing life support? Because, unless one is operating under the principle of futile care theory, removing wanted life support is akin to murder.
And it does involve shortening a life, even though most of the machines didn't exist a few decades ago. You're arguing semantics.
Consent is necessary when you start/finish ANY treatment...life support isn't different. Emergencies are the only exceptions.
Again, the patient (or the family in his/her name) has the right to stop or reject any treatment, even if that decision will cause his/her death. And to let someone die is very different than to kill, it's not a thing of semantics...when you let an illness follow its natural curse, you are not shortening a life.
So yes, people do have responsabilities in their own health. We diagnose and recommend treatments, but the patients are the ones who make the choice and are responsible of their choice...they can't force us to do things we aren't obliged to do, though (like assisted suicide), we have rights too.
We are doctors, not babysitters, deal with it. And you were the one complaining about paternalism...hypocrisy much?
Yes it does:
I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
Women aren't even mentioned. And Internists (whatever sex) shouldn't perform surgery if a Surgeon (whatever sex) is available, so it kinda applies.
Why should the fact that it is "undesired" make a difference? It's still harm, and IT'S STILL FORSEEN.
Sometimes treatment WILL be harmful - take chemotherapy for instance. Sometimes the treatment is worse than the cancer itself.
Intentions ARE important, you fail at Medical Ethics.
If to treat is significantly better than not to treat, and benefits of the treatment are greater than its negative side effects, you're helping NOT hurting. Period. Everything has a price.
This applies to chemotherapy too...we will only offer chemo to a patient if the treatment will improve his/life in a significant way, so it will be worth the side effects. BTW, the patient can reject chemo anytime.
OK this is the last time i'll answer you. This discussion is getting off-topic and repetitive.
Consent is necessary when you start/finish ANY treatment...life support isn't different. Emergencies are the only exceptions.
Again, the patient (or the family in his/her name) has the right to stop or reject any treatment, even if that decision will cause his/her death. And to let someone die is very different than to kill, it's not a thing of semantics...when you let an illness follow its natural curse, you are not shortening a life.
But if a patient chooses to stop treatment, doesn't that mean that they've given up on life? Shouldn't you "convince him or her to live on", as another poster said?
So yes, people do have responsibilities in their own health. We diagnose and recommend treatments, but the patients are the ones who make the choice and are responsible of their choice...they can't force us to do things we aren't obliged to do, though (like assisted suicide), we have rights too.
Unplugging a respirator IS assisted suicide. There's nothing "passive" about it. The "difference" is just something that makes you feel better.
We are doctors, not babysitters, deal with it. And you were the one complaining about paternalism...hypocrisy much?
You wouldn't be forced to assist suicides if it were legal.
Why do you have to campaign so vigorously against it? You're just increasing suffering. Why is self-starvation OK, but a lethal injection not OK?
Women aren't even mentioned. And Internists (whatever sex) shouldn't perform surgery if a Surgeon (whatever sex) is available, so it kinda applies.
Yes, I concede this point. It does defer surgery to those trained in it. I'm quite certain I saw a line in the oath forbidding women to practice medicine, though.
Intentions ARE important, you fail at Medical Ethics.
If to treat is significantly better than not to treat, and benefits of the treatment are greater than its negative side effects, you're helping NOT hurting. Period. Everything has a price.
But forcing patients to die slowly through terminal sedation could be construed as harm. The oath NEVER mentions weighing the pros and cons and then making a decision.
All it says is "do no harm".
Consent is important, but so is the outcome. Doctors frequently increase morphine dosages in terminally ill patients without telling them that "this next dose might be the last".
This applies to chemotherapy too...we will only offer chemo to a patient if the treatment will improve his/life in a significant way, so it will be worth the side effects. BTW, the patient can reject chemo anytime.
OK this is the last time i'll answer you. This discussion is getting off-topic and repetitive.
I think you're skirting the issue of "causing harm". Just because one form of harm is being traded for another doesn't make it any less of a "harm".
@Jen:
How do you change your mind if a new treatment surfaces after you've gone and killed yourself?
You can't, and therefore suicide, assisted or otherwise, is never the best course of action.
You and I, and I'd wager even most doctors out there, have no idea what new medications and procedures are ready to come down the pike. We don't have that sort of access and the doctors don't have the time to be looking them all up if they're out doing their job the way they should be.
Assisted suicide...this is a tricky one. On one hand, if a patient is in chronic pain, and no chance of recovery, it should be his/her right to choose death. However, the physician should still have the right to abstain on moral grounds--I know I wouldn't sleep well knowing I assisted someone's death, even if they did want it. There really is no easy answer on this one. And definitely not one that no one gets hurt with.
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