Should Mr Nicklinson be allowed to kill himself?
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Should Mr Nicklinson be allowed to kill himself?
Chat about radiology with radiologists and those who want to get into the speciality
Tony Nicklinson has won the right to have his right to die case heard before the courts. This is the result of a hearing in which the Ministry of Justice’s contention was that any such case wou
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Forums » Open clinical » Radiology » Should Mr Nicklinson be allowed to kill himself?
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Should Mr Nicklinson be allowed to kill himself?
posted at 16/3/2012 12:10 AM GMT
on bmj.com
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Posts: 958
First: 15/7/2011 Last: 15/5/2013 |
Tony Nicklinson has won the right to have his right to die case heard before the courts. This is the result of a hearing in which the Ministry of Justice’s contention was that any such case would potentially re-write the murder laws, and that this is a matter for Parliament, rather than the courts. Mr Nicklinson has had “locked-in syndrome” since a stroke in 2005: he’s capable of communication, but little else. What makes his case different from that of, say, Diane Pretty is that his argument rests on an appeal to necessity: his wife claims that ”the only way to relieve Tony’s suffering will be to kill him. There’s absolutely nothing else that can be done for him”. He cannot kill himself. I strongly suspect that although he has gained the right to a hearing I seriously doubt that the next step will be successful. Interestingly the case represented that a Doctor should be able to terminate his life but does it automatically follow that it must be a Doctor to hold a lethal drink for Mr Nickinson to suck through a straw. Granted a Doctor would need to prescribe the lethal cocktail. |
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Re: Should Mr Nicklinson be allowed to kill himself?
posted at 16/3/2012 10:16 AM GMT
on bmj.com
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Posts: 1263
First: 13/4/2010 Last: 20/5/2013 |
To my mind it's not enough just to reconsider the way we think of and deal with death. I think we also need to change the way we allow people to deal with their own death. When I was with my mother when she died in 1998 from metastatic carcinoma of unknown origin aged 61 I began to wonder about this issue. When I lost my wife to cholangiocarcinoma (cancer of the bile duct) in 2005 aged 41 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 perceive as a degree of hypocrisy in our cultural and political attitudes 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. 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 could act with care, kindness, compassion and humanity without the threat of losing my livelihood and going to prison. Fortunately I was never asked to make that choice. But I feel I would have done anything for my wife... 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, the faecal incontinence 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 my 3 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 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 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. So if you can have autonomy and chose to end your life by refusing treatment 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 their most fundamental human right - autonomy? Why do we allow them fewer rights than a pet dog? I am not some kind of evangelist or fundamentalist who thinks "I am right and everyone else is wrong". I love living in a democracy where speech is free and we are mature enough to have different views over sensitive subjects without blowing each other up because of those differences. I think everyone involved in this debate needs to move away from and, ideally, avoid using anecdotes. We can all quote distressing individual cases that help support our view (as I have done above) but I am not convinced that helps lead to constructive debate. Rather, I fear, it entrenches things. All too often the discussions around physician-assisted suicide are often lumped in with issues such as the rights of the disabled and capital punishment but this is not helpful either. I disagree that the concept of a competent individual wishing to chose the timing and circumstances of their death in a terminal situation is linked to saying that a disabled life is not worth living. I find the former position completely understandable whilst the latter view is abhorrent to me. As for capital punishment, the real issue there is that it is anti-justice and all about retribution. The mark of any good legal system is that any punishment can be reveresed or pardoned if the conviction is subsequently found to be unsafe. Capital punishment by definition precludes such reversal and is therefore wrong. I have to emphasise again that I am in favour of some kind of change in the law as I do not find the current situation acceptable or desirable - for me the staus quo is not an option. Although the numbers may be small the current legislation does, in my view, cause some people unnecessary distress and suffering and I find that inhumane. In my ideal world physician assisted suicide would be a rare event. Indeed, some of the evidence suggests that when such an option is legally available people are less likely to avail themselves of it. In other words, because they have the safety net of that option they tend to persevere longer with other options. I know this is controversial but I can see the logic in it. I was at a talk about 18 months ago where the speaker, who was opposed to any change in the law, basically said there was no place for autonomy in this discussion. I disagree with that quite profoundly. I do not think autonomy is the be all and end all of course. Sometimes we over-rule individual autonomy for the sake of a greater public health good - we have compulsory seat belts or we have bans on smoking in public places for example. But not all autonomy is the same. When it comes to end of life decisions where a person of sound mind has made a decision to end their life and that decision is supported by the other people directly affected by the decision - family and friends - then, in those circumstances, I do believe autonomy trumps all and I don't see how such a supported decision can have a negative effect on others. I am clear in my own mind that if I have a terminal condition and I am suffering intolerably either physically or emotionally I should be free to end my life at a time and place of my choosing with the people I love around me should they wish to be so. And I think that a civilised society should be prepared to supply me with the means and mechanisms to do so. So I think physician-assisted suicide should be allowed under very strict circumstances. In the end of the day no doctor would be forced to participate which would immediately put quite marked limitations on the availability of PAS. However, if the person themselves is incapable of carrying out the final act then that would automatically disqualify them from PAS in my view and Mr Nicklinson would perhaps come under that category unfortuantely. |
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Re: Should Mr Nicklinson be allowed to kill himself?
posted at 16/3/2012 12:01 PM GMT
on bmj.com
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Posts: 958
First: 15/7/2011 Last: 15/5/2013 |
skysteve I agree very much with your thoughtful analysis. Having been unfortunate to encounter the deaths of very close loved ones I believe that you can express views from a very real perspective. I am not sure if we will ever advance the issue of assisted death in this country very far, but I feel tremendous sadness at Mr Nicklinsons situation. I cannot for one minute imagine how I would cope in his circumstances. |
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Re: Should Mr Nicklinson be allowed to kill himself?
posted at 16/3/2012 2:11 PM GMT
on bmj.com
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Posts: 2042
First: 12/3/2010 Last: 20/5/2013 |
Remarkably, for a country often seen as reactionary and illiberal, the USA has three states in which assisted dying is allowed, Oregon, Washinton and Montana. In Oregon, the Death with Dignity Act came in in 2008, and since then four hundred people (0.2% of all deaths in Oregon) have used its provisons, that are for a doctor to prescribe the medication which the person must take. I can find no figures for the similar Wsahinston State Act. These Acts were wholly politically led, but in Montana the policy is driven by case law, Baxter v. Montana, and again, I can find no figures on useage. The last is obviously more relevant to the Nicklinson case, and you may read about it on the Wiki: http://en.wikipedia.org/wiki/Baxter_v._Montana with many references and hyperlinks to follow up. But in any of these, the requirement is still that the patient must actively take their own life, and that is Nicklinson's problem. It could be yours or mine. As doctors, we are well able to DiY, if we want to, but if that is long after retirement, will we have the means? Or the physical ability, as in this case or worst of all to my mind, the mental ability. My own father went long before his body died, and that went through several episodes of chest and urinary infection that could have, but didn't end his suffering. If he was suffering - his body did. John |
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Re: Should Mr Nicklinson be allowed to kill himself?
posted at 16/3/2012 2:35 PM GMT
on bmj.com
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*Moderator*
Posts: 682
First: 17/11/2008 Last: 19/5/2013 |
I had put my poll answer as my heart is willing but my ethics won't let me and then I read Skysteve's post which was increibly moving but also well reasoned and thought maybe I should have gone for yes the indignity is appalling. But I disagree with Skysteve limiting PAs to someone who is capable of taking their own life because this seems unrealistic- it would deny those who need it most from having assistance to die. |
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Re: Should Mr Nicklinson be allowed to kill himself?
posted at 16/3/2012 2:56 PM GMT
on bmj.com
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Posts: 1281
First: 9/12/2011 Last: 20/5/2013 |
Tough call, but as dignity is losing ground, one wonders if life is worth living if you cannot eat, breather well, or ar in severe pain! There comes a point where this must be considered. DuaneF |
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Re: Should Mr Nicklinson be allowed to kill himself?
posted at 16/3/2012 3:17 PM GMT
on bmj.com
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Posts: 25
First: 9/8/2011 Last: 22/3/2012 |
Is this about quality of life? Does he think the current 'quality' of his life is worth clinging on to? Probably not, if he wants to die. This case presents a conflict between the individual's right over what we are told about life being sacred and everyone being equal. Unfortunately, the assertion of his rights will impinge on someone else's rights (his family?). |
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Re: Should Mr Nicklinson be allowed to kill himself?
posted at 16/3/2012 4:31 PM GMT
on bmj.com
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Posts: 166
First: 25/2/2010 Last: 17/3/2012 |
Mr Nicklinson has 'locked in syndrome' following a stroke in 2005. Prior to that sudden catastrophic event I believe he was an active professional man. I think it is hard for anyone to imagine what it would be like to undergo that transition; to lose virtually all bodily movement, including the ability to speak and communicate ones despair and fear. It must be so hard to wake every morning, feeling trapped inside a body that no longer functions, knowing that only death will bring an end to suffering. It would be hard not to long for that death to come sooner. |
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Re: Should Mr Nicklinson be allowed to kill himself?
posted at 16/3/2012 4:36 PM GMT
on bmj.com
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Posts: 9
First: 10/6/2011 Last: 16/5/2013 |
That doctors' duty of care to their patients is to maximise their QALYs (Quality adjusted life years) not only by treating disease but also by preventing it is not controversial. It would seem to follow logically that this duty of care also extends to minimizing "zeroQALYs" - years (or months) where the patient has no quality of life. Where there is no remedy for the zero quality then I can see no plausible ethical objection to assisting a patient who so wishes to procure a painless and peaceful death. The distinction between doing so witholding treatment or nourishment (which is legal) and doing so by active intervention (which is illegal) is usually based on the total misinterpretation of the couplet from AE Clough's deeply ironic rendering of the Ten Commandments - "The Latest Decalogue" - : Thou shalt not kill but needs not strive officiously to keep alive" . The ethical distinction between handing a patient a lethal cocktail of drugs and administering them to a patient incapable of taking them is hard to fathom. Both equally require rigorous regulation to prevent abuse; and so does all the rest of medical treatment and most of the other aspects of our existence. An entirely plausible ethical case could be argued that keeping Mr Nicklinson alive when he has expressed the wish to die and to escape from his intolerable existence amounts to torture by his medical attendants and should be treated as such. |
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Re: Should Mr Nicklinson be allowed to kill himself?
posted at 16/3/2012 5:30 PM GMT
on bmj.com
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Posts: 134
First: 25/5/2011 Last: 17/5/2013 |
I take that the view that our individual existence can be likened to that of a driver in a car. The driver a representation of the soul, for want of a better word or concept, but the car very much representing the human body. If you have ever had the misfortune to attempt a long journey in a failing vehicle which keeps breaking down, you will know only too well the incredible frustration and misery that this brings, particularly as you see others speed past you along the road, as you had once hoped to do when setting out earlier in the day. Once immobile and prevented from further progress, the fear and uncertainty of not knowing what the day holds while you await a mechanic is a torment of frustration, mind-numbing boredom and humiliation and can easily give rise to feelings of just not wanting to bother with going on. Instead, ideas of simply wishing to turn around, return home and cease all future attempts at travel in the future become more and more appealing. As doctors we are both the mechanics of the car and counsellor to the driver. We have been trained to repair the car and to help the driver travel as far as they may. We do not like to abandon a vehicle by the side of the road without at least trying to gain an extra mile or so for the driver. It seems such a terrible waste just to give up and we are by nature optimistic, industrious, clever and resourceful. In this case however there is no hope for the car and the doors have locked themselves and imprisoned the driver within. The driver is just asking us to help him to get out so that he can walk home. We know that without his car, he will never travel again and we fear for the uncertainty of leaving him to walk off alone and leave us with a car to dispose of that we could not repair and have had to destroy. It is not our usual outcome and I suppose that we worry about what other passing motorists will make of us should they see a mechanic smashing a window and levering a door off before setting fire to a car by the side of the road. This, we know, will leave a blackened patch on the verge to remind everybody passing in the future of both an imperfect car design and the capacity for failure by mechanics. In my view, having tried everything I know, rung colleagues for advice and re-read the handbook twice, I cannot just leave the driver in there once I realise the situation is hopeless. It is not enough just to pass sandwiches through the sunroof, for the driver remains trapped within and is suffering the frustrations and uncertainties that we all well know. I take the view that it is both cruel and cowardly to then just drive off having given him a meal and congratulate myself for this, rather than facing up to the realities of his situation. I equally despise other mechanics, especially experienced ones, who can see only too well what is going on yet just drive past and try to ignore and forget about the stranded and trapped man. For too long a crowd of concerned bystanders have talked incessantly, distracted, threatened and hampered any mechanic who does stop to assist this man and so prevented them from doing anything more than just standing and staring at the distressed driver within the doomed and immobile vehicle. At least now a judge has cleared them away from the scene and told them to be on their way. I now ask if a mechanic, standing by the car, who is about to do a very ugly, but necessary task is to be hampered by his fellow mechanics? Are we to convene a meeting? Are we to ring Head Office? Are we to wrestle the tools from the mechanic's hands and have a very public roadside dispute in front of passing motorists? Are we to be distracted from the truth and horror of this man's distress once more by clever words? I believe that the time for action is upon us. Too much suffering has already been endured by this man. This is no longer purely a question of mechanical engineering, this is about our individual humanity. I, for one, will fetch my tools. I would hope that one day somebody would do this for me under these dreadful circumstances. Most especially, if they had heard me repeatedly ask them to do me this one final service. |
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