[stone]

This morning at 08:15am BBC R4 had a thought provoking item with Esther Rantzen and Amy Proffitt talking for and against the assisted dying bill being debated in UK Parliament today.

I was uncomfortable with Esther Rantzen's comment that she thought her dog's death was better than her mother or husband's had been. I know she means well and also that it was a light hearted comment. It made me reflect though that my fish at work are one stage further along than her dog in terms of luxury/"dignity". Her dog had to endure old age. My fish all get euthanised before they become elderly and that is (rightly) insisted on by animal welfare officers etc for lab animals.

Perhaps what is messed up is people seeing it as somehow being undignified to be demented and incontinent or whatever. When we are new born babies, we are like that and everyone is fine with that.

I'm throwing this out there because I've got very limited experience, knowledge or insight on this and am keen to hear others' perspectives.

[Oldmanmatt]

This morning at 08:15am BBC R4 had a thought provoking item with Esther Rantzen and Amy Proffitt talking for and against the assisted dying bill being debated in UK Parliament today.

I was uncomfortable with Esther Rantzen's comment that she thought her dog's death was better than her mother or husband's had been. I know she means well and also that it was a light hearted comment. It made me reflect though that my fish at work are one stage further along than her dog in terms of luxury/"dignity". Her dog had to endure old age. My fish all get euthanised before they become elderly and that is (rightly) insisted on by animal welfare officers etc for lab animals.

Perhaps what is messed up is people seeing it as somehow being undignified to be demented and incontinent or whatever. When we are new born babies, we are like that and everyone is fine with that.

I'm throwing this out there because I've got very limited experience, knowledge or insight on this and am keen to hear others' perspectives.

It’s not as simple as indignity, it’s often pain and suffering. I know my wife would have taken the option, many months before she died and I would have carried out myself.
The whole thing is a nightmare though and far from simple, unless we want a “Logan’s run” world.

[Aussiegav]

Wow Stone, another  heavy topic thread.
Like your style! 

Having more than 2 decades of working in elderly care, complex dementia & intensive care, including the first two waves of COVID, I’ve seen a lot of death. Much of it quite drawn out and horrible for both the person and their loved ones.
So from a professional perspective I’m a strong believer that the approach to care and its delivery can be a lot better.

From a personal perspective, having had a family member have a prolonged painful and mentally painful end stage of life due to cancer, my feelings are the same.

[remus]

Perhaps what is messed up is people seeing it as somehow being undignified to be demented and incontinent or whatever. When we are new born babies, we are like that and everyone is fine with that.

One significant difference is that a new born child has ~75 years of quality living ahead of them, whereas a dementia patient is unlikely to have lots of quality living ahead of them.

Personally I hope assisted dying is legal by the time Im at risk. It seems to work well in other countries, and forcing people to suffer through poor-quality of life with little hope of enjoyment seems unusually cruel.

[chriss]

Wow heavy indeed, possibly deserving of a woke 'trigger warning '

My older brother died of cancer about 25 years ago when he was only 23. Sitting watching him die slowly with my parents and younger brother is the most freeing, but horrific experience I've ever had.

The only save grace was that they pumped him so full of morphine he wasn't in pain. Given the choice he & we as a family would of ended his life earlier and with more dignity.

[MischaHY]

Having witnessed the effect on my close family of my grandmothers slow descent into alzheimers over a five year period I agree that it would be better for everyone with a similar diagnosis to be able to go gently into the good night. There's no grace in losing your mind and memories.

[mrjonathanr]

Perhaps what is messed up is people seeing it as somehow being undignified to be demented and incontinent or whatever. When we are new born babies, we are like that and everyone is fine with that.

When I get very old, I do hope the people around me recognise that I have more agency than a newborn baby.

[stone]

Perhaps what is messed up is people seeing it as somehow being undignified to be demented and incontinent or whatever. When we are new born babies, we are like that and everyone is fine with that.

When I get very old, I do hope the people around me recognise that I have more agency than a newborn baby.

My impression (happy to be corrected) is that when people say they want to "die with dignity", what they mean is minimising the period when they lack agency. Sometimes disease does cause us to lose all agency doesn't it?

I haven't really got a coherant view about all of this myself. That is why I was asking everyone on here. I was struck by what Amy Proffitt was saying. She was wanting better resourced palliative end-of-life care, but very much not wanting this assisted dying bill to go through. 

Coronation Street (the TV soap) currently has a storyline about a character with MND and wishing to have assisted dying. I thought they did a good job showing all kinds of consequent strains in the relationships with those around him. The situation seemed similar in a Louis Theroux episode interviewing families where it was legal in the USA.

[stone]

I just googled and saw that Amy Proffitt also wrote something about this subject when the RCP was choosing what position to take: https://www.rcplondon.ac.uk/news/assisted-dying-why-rcp-should-be-opposed

[mrjonathanr]

My impression (happy to be corrected) is that when people say they want to "die with dignity", what they mean is minimising the period when they lack agency. Sometimes disease does cause us to lose all agency doesn't it?

Depends rather on your understanding of the term, but it’s not just loss of mental capacity that people want to avoid. The end stage of life with illness can result in miserable loss of bodily control, although the mind may be still sharp.  I’ve known people who have lost either physical or mental capacity. It’s grim. I won’t elaborate.

The issue is an individual’s right to choose rather than be told. It’s an important topic, but feel you might be oversimplifying the reasons for making that choice tbh.  Whatever the simplicity of the moral issue - control of your own destiny- fashioning good law around that will be tricky.

[stone]

The whole thing is a nightmare though and far from simple, unless we want a “Logan’s run” world.

I was unaware of "Logan's run" and just Googled. Thanks! -that is exactly what I was thinking of when I drew comparison to my fish at work which are kept in a "Logan's run" style.

I was thinking that Esther Rantzen wouldn't want that for her dog, and instead herself makes a judgement as to where to draw the line. But that is simple for her dog because the dog doesn't get a say. With a person, there is a fraught dynamic, where the patient is thinking of those around them and the family/society have conflicting emotions and social pressures -not to mention financial stresses -or a wish to have no perception of being influenced by such considerations etc etc.

My impression, from both the Coronation Street story line and the Louis Theroux documentary, was that having to deal with such dilemmas was another raft of anguish and the last thing we'd want to saddle patients and families with.

[SamT]

Have a listen to Will Selfs point of View - October 2023

https://www.bbc.co.uk/programmes/m001d5rq

My dad (85) took his own life later that day.

Stroke that took away his ability to drive due to a problem with his vision (otherwise un-affected) and then Alzheimers diagnosis.

Luckily for him, he still had agency along with physical ability and above all, the bravery to do what he did.  For which I respect him enormously.

Myself and my sister joked about writing to Will... You killed our dad. 

[Oldmanmatt]

Have a listen to Will Selfs point of View - October 2023

https://www.bbc.co.uk/programmes/m001d5rq

My dad (85) took his own life later that day.

Stroke that took away his ability to drive due to a problem with his vision (otherwise un-affected) and then Alzheimers diagnosis.

Luckily for him, he still had agency along with physical ability and above all, the bravery to do what he did.  For which I respect him enormously.

Myself and my sister joked about writing to Will... You killed our dad. 

BZ for the strength that took to write.

[SamT]

Had to look that up, but cheers.

Its not that bad, for so many reasons its was a good albeit bold/traumatic option.

He was good friends with Mark Vallence of Wild Country if that means anything, just not as weathy 

[Falling Down]

Sorry for your loss Sam and thanks for sharing on the forum.

For anyone interested, here's a long, very good (IMHO) article by philosopher Duncan Reyburn that he published about a month ago. Not that I'm agreeing with what he's written but I found it very thought provoking.

https://open.substack.com/pub/duncanreyburn/p/citizen-disposal?r=4n4mm&utm_medium=ios

[seankenny]

I am completely torn on this question. I totally agree with many posters in their support - a close relative is currently undergoing an undignified and degrading end to life, and naturally that’s deeply upsetting.

But… in the last few years I’ve had a peek into the world of chronic illness and disability, and it’s been fairly shocking. It brings out people’s inhumanity, to the point that losing friends and relations is an absolutely standard experience that almost everyone endures. The post-2010 austerity programme hit disabled people particularly hard, and really, who cared? Do I trust our society to treat disabled people with compassion if we have the tool of state sponsored suicide to hand? I’m afraid I don’t. Our society thoughtlessly throws people inside stinking deadly jails, or lets them rot in tent cities on the streets. It’s not hard to imagine us being pretty casual about assisted dying too.

As an aside, or perhaps something in tandem with Ben’s article above, I can recommend Tolstoy’s Death of Ivan Illyich which touches on similar themes.

[remus]

Sorry for your loss Sam and thanks for sharing on the forum.

For anyone interested, here's a long, very good (IMHO) article by philosopher Duncan Reyburn that he published about a month ago. Not that I'm agreeing with what he's written but I found it very thought provoking.

https://open.substack.com/pub/duncanreyburn/p/citizen-disposal?r=4n4mm&utm_medium=ios

An interesting piece, but I found it hard to get past the constant hyperbole. For example calling the doctors involved murderers, calling MAiD a "state-approved murder", a "nazi dystopia" and "the modern equivalent of the gas chamber".

Ultimately I don't think they make much of an attempt to balance the opposing sides: is being able to optionally end your life e.g. in cases of great suffering worth the risk of people being coerced in to ending their lives.

Imagine a child handing the relevant lethal dose to a parent to administer, if indeed that is the process followed. Imagine a friend handing a gun to another friend. Imagine a little girl watching the substance of that lethal injection being deployed into the arm of her mother. Can we honestly reconcile ourselves to what would be required of us to make such acts palatable? Nature may be cruel at times, and life hands very difficult endings to many of us. But to emulate that which opposes life is precisely to side with death. It is to side with the poison, the car crash, and the natural disaster.

I think this quote makes my point. It is certainly unpalatable helping someone kill themselves (I would certainly find it very hard, and of the doctors I know I think they would find it difficult too). But equally forcing someone who has expressed a clear wish to die to live against their will, while they descend into madness, or suffer in great pain for months or years, is obscene.

[Will Hunt]

Sorry for your loss Sam and thanks for sharing on the forum.

For anyone interested, here's a long, very good (IMHO) article by philosopher Duncan Reyburn that he published about a month ago. Not that I'm agreeing with what he's written but I found it very thought provoking.

https://open.substack.com/pub/duncanreyburn/p/citizen-disposal?r=4n4mm&utm_medium=ios

I couldn't really get on with this for the same reason as Remus. It's unnecessarily belligerent and reads a bit like something Dan C might have posted on here at one time.

Which is a shame because there's not really been much counter-argument presented, yet there are really important things to consider from the case against. Personally I'm in favour of some form of assisted dying, not least to avoid having circumstances where somebody dies prematurely because they feel pressure to take the action themselves before they're unable to do so. However, I'd favour a very limiting set of criteria for people to be eligible, and it would be really really hard to legislate and implement properly because of the variety in the individual circumstances in question.

In terms of agency, people who are physically well might want to die, and might make a rational decision to do so, but we don't view this sort of suicide as "acceptable" (if one of your mates told you that they were planning suicide and described their reasons to you then you'd presumably try and stop them) and nor should we.

Illnesses aren't binary. For many people living with dementia it is possible to live well for many years. A life at <100% is not necessarily not worth living. Having said that, I totally understand that for many people the disease may progress to a point where that person isn't living well - in that case I would choose assisted dying.
It's worth bearing in mind that there are already procedures in place whereby people with mental capacity can choose to refuse certain treatments, which may mean that they don't survive when doctors might otherwise be able to keep them alive. e.g. https://www.resus.org.uk/respect/respect-healthcare-professionals

If anybody wants a brutal read you can check out this blog:
https://substack.com/@diaryofapunter
Paul describes his climbing accident here: https://diaryofapunter.substack.com/p/on-breaking-my-neck-doing-what-i?utm_source=profile&utm_medium=reader2

Later on in the blog he describes his wish to die and says that he has applied to Dignitas, though maybe just to feel some sort of control. I've been wondering whether I think that assisted dying would be acceptable (under my own criteria) in his circumstances and this comment made me think that no, I don't think it is:
https://open.substack.com/pub/diaryofapunter/p/the-baying?utm_campaign=comment-list-share-cta&utm_medium=web&comments=true&commentId=54971209

[spidermonkey09]

I dip into that blog occasionally and its absolutely brutal. Very hard to read.

[stone]

[ But equally forcing someone who has expressed a clear wish to die to live against their will, while they descend into madness, or suffer in great pain for months or years, is obscene.

I thought though he made a good point about how much our feelings get directed by people we interact with.
 The comment Will linked to offered solidarity and good humour to help counter even the most challenging circumstances. It's great to champion that approach IMO.

[remus]

For sure. But after that, if someone still wants to end their life, then I think they should be allowed to do so.