Assisted suicide, should someone be allowed to plan their own death (16 June 2011)

Assisted suicide.  I was thinking about this subject in the last couple of days and tonight it came up as a question on BBC’s Question Time.  

I didn’t see the programme Terry Pratchett: Choosing to Die because I was doing something else, and watching something else but my intention is to watch it this weekend on the iPlayer.  
However, it’s something that I have listened to in debate several times.  It’s also a topic that I can’t say that I am wholly for or wholly against.

What I believe is this, people should have the right to plan their lives out right to the end and currently they can, they just can’t choose how to die.  I speak frequently with elderly people about how they want the last days of their life to be.  They get to choose whether they are hospitalised or whether they remain at home or in their care home.  This doesn’t mean that they get to choose when they die but it’s a plan that’s there to be put into place when it’s evident that they have reached the final days of their lives.

Done properly and sensitively they can choose what interventions they would have when they were no longer able to consent to something.  For example they may choose to not have antibiotics or equally they may choose to have them if it’s thought that by taking them they will make that person’s end of life less distressing.  They choose whether they want a Do Not Attempt Cardio-Pulmonary Resuscitation (DNA-CPR) or not, or whether, in the event of losing their swallow they would have a PEG tube inserted, or not.  Part of this discussion about an end of life care plan will include who they want by their bedside, whether they want religion to be a part of it, whether they want certain music played, or something read to them.

What they cannot choose is when they will die or how.  No one can unless they choose to commit suicide.  I have heard many good arguments about why assisted suicide should be made legal.  It’s very difficult to say that assisted suicide should not be considered when people talk about the pain they have, the lack of life they have and that they have absolutely no desire to live.  People who know how their disease will progress, how their bodies will degenerate and how absolutely horrific their death will be if allowed to die naturally.  People who have suffered horrifically through their lives with disease and illness and who cannot be guaranteed that a natural death will be without horrific pain.

Yet I see the other side.  I see that it would be exceptionally difficult to regulate.  Who decides a person should be allowed to die? The person decides ultimately but who OK’s the procedure? A doctor? Just one? No.  There would have to be rounds of assessments before the event of assisted suicide could take place.  The person should be of sound mind, they would have to be assessed by more than one doctor and more than one psychiatrist.  They should be counselled.  They would have to be declared of sound mind.  And who decides whether someone is eligible to be considered? Is it limited to people with life-limiting illness? Or should an elderly person who might be fairly fit an healthy be allowed to be considered for assisted suicide because they don’t want to become victim to one of the many dementias and other illnesses associated with old age.

It’s an extremely sensitive subject.  I cannot openly say that assisted suicide should be allowed because if it were and it wasn’t regulated properly it would be open to a lot of abuse.  A doctor who thinks people should be allowed to live beyond 70 and drain society when they do slowly convinces his elderly patients to end it all.  A nasty relative desperate to get their hands on the contents of a will slowly convinces that person they should end it either because they are old of have an illness.

I don’t believe that anyone can say they are definitely for assisted suicide or definitely against it.  I believe that as advances are made with palliative care that options for care at the end of life are opening up.  I believe that good palliative care means that a pain and distress free death is possible, even now.  On the other hand I can see where people are coming from when they don’t want to risk getting to the stage where they have no control and may die a horrific and painful death.  Do we really have the right to tell people they can’t choose how and when they die?