Thoughts and opinion from the wards
End of life choices
I am writing this as a separate blog because the post I wanted to make in response to tnolan's blog - Are our views about euthansia in a muddle - was too big to be allowed as a response post.
As some of you will know this has been an issue of hot debate here in Scotland over the last 12 months. A bill has been introduced to the Scottish Parliament and has recently been going through the committee stages. It's called the End of Life Choices (Scotland) Bill and it seeks to offer some legal protection around those who seek to end their lives actively if faced with a terminal condition. It was introduced by Margo MacDonald, MSP, who suffers from Parkinson's disease.
Sadly at times the debate has become very polarised with some quite extraordinary claims being made, even from within the medical profession (such as the right to autonomy should somehow not matter so much when it comes to this issue). I think there has been an unduly heavy influence at times from those who wish to push their own religious or moral agendas. Sometimes there has also been the use of ill-judged and intemperate language such as "murder".
Suffice to say I take a somewhat different (and, hopefully, more pragmatic) view.
When I was with my mother when she died from metastatic carcinoma of unknown origin I began to wonder about this issue. When I lost my wife to cholangiocarcinoma my views started to solidify. It was clear to me that despite them both having the best possible palliative care, palliative care did not have all the answers.
I have always been uneasy with what I perceived as a degree of hypocrisy in our cultural and political attitudes here in Scotland to this "thorny" issue.
There are those who advocate not just physician-assisted suicide but out and out euthanasia. For me this is far more than just a subtle semantic difference and I cannot support the latter. PAS tries to protect autonomy; euthanasia removes it.
Both my mother and my wife went through a traumatic terminal phase. If either had asked me to help end their distress I would have wanted to be in a position where I or a colleague could have acted with care, kindness, compassion and humanity without the threat of losing our livelihoods and going to prison. Fortunately I was never asked to make that choice.
There are those that say the desire of some to end their own life reflects inadequate palliative care but to me this is just a smoke screen. Both my wife and mother had outstanding palliative care. But with my wife palliative care couldn't stop the hair loss and the intractable vomiting caused by her chemotherapy; it couldn't stop the bloatedness, facial swelling and debilitating muscle weakness caused by her steroids; it couldn't stop the personality changes caused by her brain radiotherapy; it couldn't stop her overwhelming loss of dignity which distressed her so much; and it couldn't stop her young children witnessing all of this. And all these things caused her great distress at the end of her life.
Now I come to what I see as the hypocrisy of the whole debate. At present, of course, we actually DO allow people the right to die. But, as has been pointed out by tnolan, this is a passive choice in the form of refusing to have treatment. That right to refuse, even in the face of overwhelming evidence that refusal will result in death, is protected in law and also regarded as unchallengeable by doctors, politicians and society as a whole (taking into account all the safe guards around mental health issues). We demand far fewer hurdles or safeguards for that decision than were being proposed for the Scottish End of Life Bill.
So if you can have autonomy and chose to end your life by refusing treatment knowing that that will kill you why can't you chose to end your life in an active way? If someone has reached the end of the road of toleration when suffering a terminal disease why are we so averse to giving them the means to end their own life peacefully, painlessly and in a planned time and place of their choosing with their family, friends and loved ones around them? Why at their greatest time of need do we deny them that most fundamental of human rights - autonomy?
I only hope that if I am ever in that position we will live in a society which has become sufficiently grown-up, humane and kind to allow me the right to choose because, although it's a cliche, that is what it all boils down to in the end.