Death Without Dignity? E-Book

John Wyatt

• Herausgeber: Quo Vadis Institute
• Kategorie: Geisteswissenschaft
• Sprache: Englisch
• Veröffentlichungsjahr: 2023

Seitenzahl: 141

Beschreibung

In this engaging and timely book, John Wyatt analyses the arguments in favour of euthanasia and physician assisted suicide and shows how unstable their foundations are. Instead, Wyatt suggests a more humane path forward: one that is both achievable and more honouring to the patient.

Leseprobe

I M P R E S S U MDeath Without Dignity? Euthanasia and Assisted Suicide in Europe

John Wyatt

© 2023 John Wyatt/Quo Vadis Institute.All rights reserved.ISBN: 978-3-9505365-3-9

Author: John Wyatt (www.johnwyatt.com)

Quo Vadis Institute, Reiterweg 28, 5020 Salzburg, Austria (https://qvi.eu, [email protected])

This Ebook is also available in German under the title “Sterben ohne Würde? Euthanasie und assistierter Suizid in Europa” (2023, ISBN 978-3-9505365-4-6).

Table of Contents

Introduction

Chapter 1 – Tragic Narratives

An Assisted Death in Linz

Andrea Mielke

Alzheimer’s Disease in the Netherlands

Daniel James

Chapter 2 – Setting the Scene

Euthanasia

Rational Suicide

A Lethal Chamber

The Nazi Euthanasia Programme

Euthanasia in the Netherlands

Euthanasia in Belgium

Assisted Suicide in Switzerland

Germany

Austria

Spain

United Kingdom

Finland

Summary

Chapter 3 - The Beginning of Wisdom is to Call Things by Their Proper Names

Defining Euthanasia and Assisted Suicide

Assisted Suicide

Chapter 4 – Compassion

Stopping the Suffering

Chapter 5 – Autonomy - the Right to Choose

Choice is Not as Simple as It Sounds

A Settled and “Uncoerced” Will to Kill Oneself

Mental Illness and Depression

Chapter 6 – Real World Problems

Having a Terminal Illness

Wrong Diagnosis

Risks from the Prescription and Supply of Lethal Medications

Ensuring a Clean Death

Abuse by Relatives

Gradual and Incremental Extension of the Grounds for Assisted Suicide

Chapter 7 – Medicine and the Role of Doctors

Psychological and Emotional Consequences for Doctors

Why the Medical Profession?

Chapter 8 - Social Forces and Trends

Suicide and Society

Societal and Economic Context

Health Consequences of an Ageing Population

Disability Rights

How Do These Societal and Economic Factors Influence the Assisted Dying Debate?

Chapter 9 – Lessons from Oregon and Canada

Chapter 10 – A Better Way: Expert Palliative Care

Dealing with “Total Pain”

Being There

Dying Well

Cicely Saunders and the Euthanasia Debate in the UK

Can We Afford to Provide Expert Palliative Care for Everyone Who Needs It?

Chapter 11 – Christian Responses to Assisted Dying

The Meaning behind Suffering

Chapter 12 – Summary and Conclusion

Resources and Organisations

Resources and Further Reading

About the author: Prof John Wyatt

Endnotes

Introduction

“Death, like the sun, should not be stared at.” So wrote the philosopher François de La Rochefoucauld. But that’s exactly what we shall be doing in this short book. Staring at the reality of death in our society, and at the arguments and controversies that surround the topic. What does it mean to die well? Is it best to die in control? To choose your own way out? Is it best to make a deliberate choice to end it all at the time and in the manner that you decide? Is suicide always an act of despair and hopelessness or could it be a responsible way to die? Or is there a better way to die? Does modern palliative care provide a better, a richer, a more humane option?

These are not easy questions to confront. Writing this book has made me think about my own death and those of my loved-ones. What will happen in my last hours, days and weeks?

Death and dying are not comfortable topics. They raise uneasy questions and anxieties, reminders of our own frailty and vulnerability, and fears about the impending loss of loved-ones. I have found writing this book emotionally challenging but I am absolutely convinced we cannot avoid these vital topics.

Just as we can’t escape being confronted with death and dying in our personal lives, so also these topics have taken on growing importance in the public arena. Scarcely a week goes by without another high profile media story highlighting the inadequacies of end of life care in our health services, or the tragic story of an individual who committed suicide to escape the suffering and indignity of a terminal illness. Some of the real-life stories feature in the subsequent chapters.

Sophisticated lobbying campaigns around the world are using these personal tragedies as the driving force to change the law to allow different forms of medically assistance in ending life. Interestingly there is no agreement on the best form of legislation or even on terminology. As we will see, the different forms of legislation around the world are mutually contradictory. In the Netherlands and Canada, you need to have unbearable and intolerable suffering but there is no requirement to have a terminal illness. In Austria, legislation introduced in January 2022 allows medically assisted suicide for individuals with a terminal illness or a “permanent debilitating condition”. In many US states you need to have less than 6 months to live but there is no requirement to have any degree of suffering. In the UK “assisted dying” bills are being debated in both English and Scottish Parliaments.

So what are the forces that are driving this demand for a change in the law? Is it about individual choice and control over our lives – what philosophers refer to as personal “autonomy”? Or is it about controlling unbearable physical suffering? And is it possible to construct a law which has an internal logical consistency and is robust and safe in practice?

Of course these are much more than philosophical, political or legal issues. We must never forget the personal tragedies and fears that lie behind the public debates. If we wish to understand the full human reality of what is going on, then our first responsibility is to empathise, to try to comprehend the suffering, fear and desperation which many people face at the end of life.

This is not an easy discussion and the public debate is often emotive, confused and confusing. I have tried to make this book as up-to-date as possible but the target is continually moving and, to my frustration as an author, fresh developments are occurring almost weekly. The book is intended for lay people and does not presume any medical knowledge, but I hope some health professionals will find it instructive as well.

I’m very grateful to many friends and colleagues who have contributed to the development of this book and who have read earlier versions of the manuscript. I’m especially grateful to Verena Schnitzhofer who provided invaluable research assistance, to Jasper Knecht for detailed editorial input, and to Morten Magelssen, Rick Paul and Peter Saunders who reviewed the manuscript. However, of course, I remain responsible for any errors that remain.

My aim is to examine the arguments for and against euthanasia and assisted suicide, particularly as they have developed in continental Europe.

In Chapter 1, we look at four real-live tragic stories of individuals who chose to end their lives for medical reasons.

In Chapter 2, we shall look briefly at the strange history of mercy killing, and then at current euthanasia and assisted suicide practice in countries that allow various forms of medical assistance in dying, especially in the Netherlands, Austria, Belgium, Switzerland, USA and Canada.

In Chapter 3, we look briefly at the language that is used and why clarity of language is important.

In Chapters 4 and 5, we focus particularly on the two main arguments put forward in favour of assisted dying – the argument from compassion and the argument from choice - the right to direct one’s own life.

In Chapter 6, we look at real world problems in how legislation works in practice and the difficulties that are encountered.

In Chapter 7, we look at the medical role in the legislation and what the consequences might be for doctors and health professionals.

In Chapter 8, we look at some of the wider societal context in which various forms of medical assistance in ending life is being sought and of the longer term consequences to society if euthanasia and assisted suicide becomes common in Europe and elsewhere.

In Chapter 9, we turn our attention to Oregon which has had a form of medically assisted suicide since 1998 and to Canada which legalised “Medical Aid in Dying” in 2016 and the remarkable developments that have taken place since then.

Then in Chapter 10, we look at the development of palliative care and ask what are the arguments for and against palliative care. Is this a better way to die?

In Chapter 11, we look at specifically Christian responses to the proposed legislation on assisted dying.

Finally in Chapter 12, we summarise and conclude the discussion with suggestions for further reading and study and ways of getting involved personally in this vital debate.

But first, we turn to a few of the personal stories that lie at the heart of this debate.

Chapter 1 – Tragic Narratives

An Assisted Death in Linz

In September 2020, a 36-year-old man came to the police station in Linz and reported that he had helped his friend to die.1 Police immediately went to his apartment and found the body of a 29-year-old man. The dead man had suffered from musculoskeletal pain for many years. He was known to have mental health issues and had made several suicide attempts in the past. His friend had promised to help him on this occasion and had obtained sedative medication at his request. He had taken an overdose late on Friday evening and had become comatose shortly afterwards. But on Saturday lunchtime he still showed signs of life. In order to keep his promise, the older man had placed a pillow against his friend’s face and suffocated him. The 36-year-old was charged with assisting a suicide and detained in prison.

Andrea Mielke

Assisted suicide was formally legalised in Austria in January 2022 and 57-year-old Andrea Mielke was the first person in Salzburg to opt for assisted suicide.2 She had been born with a rare genetic condition and had been a wheelchair user all her life. She had been a strong campaigner for the rights of disabled people and despite her physical limitations had many remarkable accomplishments. But she had decided that she could carry on no further. “I want the right to decide for myself when I end my life, when living is no longer possible.” The battle to achieve this right had not been easy, “If you're not tough and brave enough, then you've lost anyway; because fighting the authorities is the worst thing and almost nobody can stand it." Following her request, the Austrian law insisted on a 12-week cooling off period, before her request could be carried out, but eventually in April 2022, in the presence of her partner Adi and two doctors, she took lethal medication and ended her life.

Alzheimer’s Disease in the Netherlands

In September 2012, a 70-year-old woman living in the Netherlands was diagnosed with Alzheimer’s Disease.3 On the following month she signed a formal declaration. “When I shall be in a state in which my suffering is unbearable and hopeless or when there is no reasonable prospect to return to a state of life dignified for me or further loss of dignity for me is to be expected, I explicitly request my physician to administer to me or to provide me with the substances to terminate my life.” Over the following four years her mental condition deteriorated and in March 2016 she was confused and agitated. However, when asked by her physician whether she wishes to continue living she said “Yes, I do not want to die.” She repeated this several times. Still, at other times she appeared distressed and confused. In April 2016, her physician, supported by her relatives, administered a lethal injection, even though she appeared to be resisting the injection and needed to be restrained. The case caused considerable controversy and the physician was accused of violating the euthanasia legislation.4 Nevertheless, following a detailed investigation, the actions of the physician were supported in a 2019 judgement from the Criminal Court in The Hague5 and subsequently confirmed by the Supreme Court in 2020.6

Daniel James

Daniel James was a promising young rugby player who had played for the England youth squad. In 2007, at the age of 22, he suffered a spinal cord injury while playing rugby and became permanently paralysed from the chest downwards.7 Daniel made an attempt on his life by swallowing an overdose of tablets whilst in the spinal injuries unit at Stoke Mandeville Hospital in England, seven months after his injury. Six weeks later he was discharged home and took a second overdose a few months later.

On that occasion, he was taken to hospital where a psychiatrist noted he was "very angry and extremely hopeless." He was also despondent that he had again failed in his suicide bid. He refused any medical treatment but two days later was "calm, rational and co-operative." He still maintained that he wanted to die and if he did not do so from his physical problems he would continue to attempt suicide.

His parents, who up until then had done everything they could to dissuade him, told the psychiatrist they had come to accept his wish to die. They had bought thousands of pounds worth of equipment for their home to help with his rehabilitation but he had shown no interest in using it. In March 2008, Daniel applied to go to the Dignitas centre in Switzerland telling his mother that if he were rejected, he intended to move out of the family home into assisted accommodation and starve himself, as "that was the only means of ending his life in a way that he was able to control."

In September 2008, accompanied by his parents, he travelled to the Dignitas centre in Zurich where he took a lethal dose of barbiturates. His parents were quoted as saying, “His death was no doubt a welcome relief from the 'prison' he felt his body had become and the day-to-day fear and loathing of his living existence... This is the last way that the family wanted Dan's life to end but he was, as those who know him are aware, an intelligent, strong-willed and some say determined young man.”

So here are four tragic true-life stories of people who desperately wanted to kill themselves because of severe illness, disability, suffering and despair. Surely it is time for a civilised society to provide a legal and medically assisted way for people faced with such terrible circumstances to choose to end their own lives?

We should always remember that the debate about euthanasia and assisted suicide is not only about complex legal, medical, ethical and societal issues. Above all, it is about individuals, desperate, suffering people who feel that their lives have become valueless because of serious medical conditions and who want to end their suffering by killing themselves. Why on earth should we not change the law to help people like these?

In the next chapter we look briefly at the wider historical context of debates about the ending of life.

Chapter 2 – Setting the Scene

When it comes to euthanasia and assisted suicide, it seems as though we all suffer from historical amnesia. The implication is that suffering at the end of life is a new problem which requires new solutions. Yet the reality is that euthanasia has been actively discussed in the United Kingdom and many European countries for almost 150 years. The following chapter tells the story of attempts to legalise mercy killing over the last 150 years and I think it provides essential background for understanding the current legislation battles. However, if you want to fast forward to the present debate, please turn to Chapter 3.

Euthanasia

In 1870 Samuel Williams, an English schoolmaster, published an essay entitled “Euthanasia”. He proposed that “in all cases of hopeless and painful illness, it should be the recognised duty of the medical attendant, whenever so desired by the patient, to administer chloroform, or such other anaesthetic as may by and by supersede chloroform, so as to destroy consciousness at once, and put the sufferer to a quick and painless death; all needful precautions being adopted to prevent any possible abuse of such duty, and means taking to establish, beyond the possibility of doubt or question, that the remedy was applied at the express wish of the patient.”8 His essay was reprinted several times. But it’s remarkable that right from the beginning the idea of mercy killing carried out by a doctor was christened with a euphemistic title, for euthanasia means, of course, “good death”: eu-thanatos. As we will see controversies about appropriate use of language has been a feature of the debate right up to the current time.

It’s pretty clear that it was advances in medical anaesthesia in the 19th