Jul 20 2010
Locked-In Syndrome and the Right to Die
Tony Nicklison, 56, had a stroke in 2005 that left him in a locked-in syndrome. This means he is fully conscious but mostly paralyzed. He is able to move his eyes and, unlike some people with locked-in syndrome, he is also able to nod his head. But he cannot speak. He is able to communicate by blinking or by nodding his head when someone indicates the proper letter on a letter board.
Mr. Nicklison says that he wants to die, and is raising the issue of assisted suicide in the UK. Legally he can refuse food and water and would die of dehydration, but he and his wife do not want to use that option. He would rather die quickly at a time of his choosing. But he fears that his wife would face prosecution for murder if she gave him a lethal injection.
Mr. Nicklison says of his own condition:
“I have no privacy or dignity left. I am washed, dressed and put to bed by carers who are, after all, still strangers.
“I am fed up with my life and don’t want to spend the next 20 years or so like this. Am I grateful that the Athens doctors saved my life?
“No, I am not. If I had my time again, and knew then what I know now, I would have not called the ambulance but let nature take its course.”
It is easy for most people to sympathize with the horrible state of being locked-in. If we try to imagine ourselves in such a condition (even though we probably cannot fully imagine how it would be) we can understand why someone might rather die than continue in such a state. Put another way – it is difficult to imagine any quality of life in such a state.
However, a survey conducted by the Association du Locked-in Syndrome (ALIS) in France:
based on a survey of 70 to 78 individuals with LIS by ALIS in France: 71% never thought of suicide, 26% thought of it occasionally and only 3% often; 53% had never considered euthanasia, 39% had considered it at some stage but not anymore and 8% would demand it now.
That only 8% of those in a locked-in syndrome would demand euthanasia if offered is surprisingly low. Some researchers believe this is partly due to modern technology which allows locked-in patients to communicate and to use computers and the internet. It is often surprising how resilient people can be and that some people can find value in life even in terrible conditions.
This brings us back to the issue of assisted suicide or euthanasia. While we might admire people who can persevere even in a locked-in syndrome, we are in no position to judge those who find such a life unacceptable. I face this decision with patients frequently – in ALS patients who are slowly losing their muscles and are essentially progressing toward a locked-in syndrome. Without heroic measures, they will die before they get to this state, but patients need to decide for themselves if they wish such measures to be taken (mainly tracheostomy and being connected to a respirator) or if they wish to die comfortably. Here there is no question of euthanasia because such patients will die without an intervention that they have the right to refuse.
What we have found over the years is that this is a very personal decision. Some people can find value in a purely intellectual existence, even if they have no physical quality of life. Others cannot imagine such an existence.
With those who become locked-in suddenly, and who do not require a ventilator, like Mr. Nicklison, the choice is between starvation/dehydration, euthanasia, or continued life locked-in. This is tricky from an ethical point of view, and very controversial. There are those who assert an individual’s right to take their own life, or request another to assist them in taking their life as a fundamental right to privacy. This is a perfectly legitimate argument.
But it also has to be weighed against some very practical concerns – concerns which have caused most countries to make euthanasia illegal. One concern is that the person requesting euthanasia is certain about their choice, and that their choice is settled after long deliberation. As the survey indicates above, while 39% of those locked-in have contemplated euthanasia, only 8% would accept it now. This suggests that there are many individuals who change their mind. How long does it take, therefore, for such a decision to be considered settled.
There are also concerns about the caretakers decision-making. How much is the burden being placed on caretakers affecting the decision to accept euthanasia? Does the option of euthanasia compromise the dedication toward doing everything possible to maximize quality of life of the affected person? Maybe, for example, if they were treated for depression (a common complication of stroke) they would no longer request euthanasia.
It seems we are heading towards more nuanced laws regarding the right to die and balancing it with protection for the therapeutic and caregiver relationships and the rights of individuals to proper care and treatment. The Nicklison case is sparking this debate anew in the UK and will test their existing laws.
58 Responses to “Locked-In Syndrome and the Right to Die”
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The right to die is a necessary corollary to the right to life, if you ask me. As long as we make sure the decision is (1) thoughtful and considered, (2) the person’s condition is indeed incurable given current and immediately foreseeable technology, people have a right to die.
I fully support people’s right to die. As Michael Meadon stated above, I think its the corollary to life. If I have any natural choices, one of them is my right to die.
The problems associated with this right are very complex, as Steve noted. But I don’t like the position of black and white- make it illegal because there are so many nuances and possibilities of intentional and unintentional corruption. We too often want to make a distinct line and stop thinking when things get complicated.
On a different aspect of Steve’s commentary, I was wondering about the French survey. I have struggled with severe depression on and off most of my adult life. In all of that time, I have never considered suicide. I have concluded that its not in my “nature”, for lack of a better explanation. But many people, who’s life/depression would appear to be better than mine do commit suicide. If we look at the French statistics, I wonder how much a person’s natural predilection for suicide effects the decision even in extreme circumstances like LIS.
The question as to weather or not euthanasia should be legal, to me, is an easy one. Yes, it should be. The difficulty is determining when and how it can be carried out. If someone is depressed because of their situation, how much effort must be made before relenting to their wishes? How do you determine if the person involved is depressed? You can’t ethically force a patient to take medication. What do you do if someone is determined to be depressed, yet they refuse to take medication that could alleviate the depression and their significant other, or family claims if they were not depressed they wouldn’t want euthanasia? What if they have no significant other, or family? It gets very muddled very quickly. At such a point who would actually administer the drug(s)? Would you be able to find someone who knew the situation and would be comfortable with administering a lethal dose while in the back of their head thinking maybe this patient would change their mind if they had agreed to taking other medication? It’s a mess, but I would not want to prevent someone who definitely does NOT want to continue to exist in such a state and their significant other and family concur. To me preventing that would amount to torture.
I don’t have the answers. I wish I did. But I am certain that the current situation is not a good one. I think we could come up with some kind of “regulation” (for lack of a better word) that would allow for euthanasia under certain circumstances.
@Sara is a much better writer than I am.
I have to say from the outset that people, once born, have a right to conduct their lives as they will. They also have the right to terminate their lives if they so desire.
It is not a matter for others (of some ‘standing’ or ‘authority’) to assess anyone, stroke a beard and say that he/she will grow out of it, will respond to drugs, will be taken care of in a hospice, will be all right. In other words, ‘no, we will not grant you the right to die on your own terms by your own methods – and by the way we can help you live’.
I have known several suicides (successful ones) who have expressed the desire to die. All the do-gooders in their world, all their friends, their partners, their medical practitioners demurred and tried to talk these people out of taking their own lives.
As a result, some of the only methods available were horrendous. I have known two men shoot themselves; another three males hang themselves; two who used barbiturates and one who used heroin.
Now the barbiturate and heroin users had a much better time of it than the others.
What always niggles at me is that trying to talk people out of suicide is just such an arrogance.
Sure, some potential suicides are talked down and then often they try again later and succeed.
The point is that in a community, we should be focussed on helping each other and that means also helping people to die when they want help.
It doesn’t mean that we have some obligation to deny them for whatever misguided reason. I think this stance comes from an old religious imperative and latterly from some sociological imperative geared to supplant religion.
It seems to me that people are trying to apply amorphous moralistic ideals (or ideas) where none is needed.
Either way, let people be and help them do what they want.
It is and should be a fundamental right, and as has been said above, the corollary to life. There is nothing magic about living or dying. Other species do it every minute of every day and they don’t have a cortex to fret with. It is just part of their life.
I suppose it wouldn’t be too hard to rig up a little electronic device controlled by the patient where they could initiate the actual administering of the drug. You could even have them select the dosage. The context might be to set up the system to allow them to control “chronic pain” in this way. That way, it is officially not a “suicide machine”, overdoses are “accidental” and there is no “assistance”.
Is the impulse to preserve life more important than the patient’s wishes? The answer both legally and medically in almost every case is “yes.” I think this is wrong, but natural. Doctors swear an oath to do no harm and a patient’s death is seen, incorrectly in my opinion, as the ultimate harm. Most religions view suicide as a sin. Culturally suicide is seen as a cop out or a sign of mental illness. There is enormous back-pressure against ending a life as ever being a logical and compassionate choice.
Mental illness is the ultimate catch-22. If you talk of ending your life your are presumed mentally ill and therefore incapable of making the choice. Proof of mental health means changing your mind about suicide. I know it is not this absolute, but the bar is always raised so high to convince the law the medicine that your suicide is a rational choice. And depression. “You don’t really want to commit suicide if you’re depressed.” Really? I hear depression sucks. Chronic depression sounds like a perfectly good reason to check out. Maybe it can be treated and maybe it can’t, but shouldn’t this be the patient’s choice?
The last part of Steve’s essay chapped me the most. Who cares if the person might change their mind the next day, or next year, or in five years? So many decisions in life are irrevocable: making a baby for one. We don’t have three doctors attest to the mental health of both parties before coitus. And this is worse because you are playing with the fate of a third party.
It is high time that a patient’s wishes took precedence over the “in loco parentis” attitude of both our government and the medical profession. The fact that this decision is serious and permanent is all the more reason to defer to the patient’s wishes.
Steve, you write that there is a concern whether or not the decision to die by euthanasia is made after long consideration and the patient would not change his mind if he had the chance, but isn’t that a concern about every kind of suicide? Is non-assisted suicide legal only because it is not possible to enforce due deliberation?
It seems to me (ignoring the larger issue of the implications of having another person performing the act) that the standards for euthanasia regarding personal choice should be the same as the ones for regular suicide – just because in the case of euthanasia the law can actually force people to give suicide due deliberation does not mean that that is ethically justifiable.
However I think the issue of whether a medical provider can ethically do it or not is more pertinent for the reasons you listed.
Dmitry – in many states suicide is also illegal. (Of course this is only relevant in cases of attempted suicide.)
There is certainly an issue of consistency within the law. But with suicide there is no opportunity to deliberate. When the medical profession is involved, there is an opportunity to have guidelines, rules, and laws to regulate or ban the process.
Mr. Nicklison talks about his wife taking action to end his life. But his complaint about privacy is that strangers groom him. What if his wife was encouraged to become involved with his daily living skills, instead of something lethal. He says he is fed up with his life. How could his family assist in making his life less frustrating?
There are some thorny issues with this case.
Should we allow major depression cases decide their right to die? Given the limitations of this syndrome can an accurate psychiatric diagnosis be made to exclude major depression or other mental illness. I would see mental illness as a barrier to an informed decision. I am concerned that the tendency in this situation is to personalize what this condition would be like for us. I agree with right to die. I think opponents may have a justified argument against right to die, in this case, given the facts as presented. I think this case is good for public sentiment but lacks the clarity to settle a legal issue.
locutusbrg – might I point out that people who commit suicide are rarely enamoured of living. Most are depressed. That is the point, is it not? If you aren’t depressed it is unlikely that you will want to exit your life unless there was an excellent reason like unending pain and an inevitable death anyway.
Major depression cases commit suicide every day. Do you realise that somewhere around 1 million people (mainly men) commit suicide each year? That is more than die in wars/skirmishes or whatever you want to call today’s warfare annually.
Bipolar sufferers commit suicide as do schizophrenics. Arthur Koestler and his wife committed suicide when he was diagnosed with cancer. They made the decision and put it into operation. In their London flat as I recall.
I don’t know how you would define an ‘informed decision’. Nor how you would define ‘mental illness’. These are phrases that are fraught with different meanings for different people.
I can tell you that I wouldn’t go near a psychiatrist if I were feeling depressed. I would just feel worse.
But at 66 my joie de vivre is alive and well although some would call me deranged! Hahaha. Let’s hope it lasts.
Check out the exit sites and Dr Philip Nitschke. These oldies are hilarious as they try to circumvent the law and manufacture Nembutal in secret locations for their exit from this vale of tears (joke!!!).
Does your heart good. Seriously.
@ locutusbrg
“Should we allow major depression cases decide their right to die?”
Yes. If he wasn’t depressed he wouldn’t want to die. His life seems unbearable and to him it is not worth living in these circumstances. Under the usual diagnosis criteria for depression anyone who wants to die is depressed. You can’t really take depression into account when considering the issue. The life circumstances that are causing his depression are not going to change, why should his depression change?
Being depressed doesn’t impact your intelligence, it skews your view of life. But so do lots of other things. If you believe in a particular religion your view of life is entirely different than mine. If you are a conservative, your view of life is different than mine. But your perspective or my perspective does not make either of our personal decisions invalid or wrong for us. Nor does it mean that we will feel the same way about life or those decisions 5 years from now. That’s just part of the equation.
A depressed person views life from a belief that none of it is worth doing. Sometimes that means laying in bed and not moving, and sometimes it means getting up and hanging yourself. Its not a socially functioning view of life, but it is also not an illegitimate one. A depressed person can rationally decide whether or not to die but if they have LIS they can’t act on it.
I think we need to distinguish someone who has a mental illness – “major depression”, and someone who may be experiencing an appropriate emotional response to life circumstances they percieve to be unbearable.
If someone has been diagnosed as sufffering from major depression they have an illness that is causing them to believe their life to be unbearable, and this illness should be treated before decisions about right to die are contemplated.
In practice, it may be difficult to distinguish a depressive illness from what we might consider an understandable response to appalling life circumstances, but there is no underlying reason why someone in the latter circumstance should be automatically assumed to have a mental illness. Often, though a trial of antidepressive medication is given.
I have been involved in these discussions in a couple of these cases. Some patients have been adamant about wishing to continue living, and have expressed that view through blinking or other means. In others we have withdrawn support after discussions with the patient and family. Ruling out mental illness is not usually neccessary.
While not directly on topic, I think Mr. Nicklison’s quality of life could be greatly improved with minimal application of technology. He can move his eyes sufficient to use a letter board, and he can move his head. I’ve seen electronic, “automatic” letter board technology for people who could only reliably control their eyes. They are presented with a screen of letters, lasers track where the eyes are focused, and a nod of the head to trigger a “select” switch. This was pretty mature technology several years ago.
I believe there was a Scientific American (Alan Alda) episode on this.
While Mr. Nicklison certainly should have the right to make decisions about his life, I wonder how much his quality of life could be improved with the capability of independent communication.
Another very interesting and well-balanced post.
My observation would be that debate about legislation and medical practice in this area needs to start with a discussion of the basic principles we should seek to apply.
My suggestion would be that we start from the principle that individual autonomy should be respected as far as possible. In other words, we should allow people the freedom to govern their own lives, including at the end of their lives.
We should provide assistance to help make this freedom real, when circumstances prevent people from putting their desired choices into effect. We should only intervene to stop someone from exercising free choices if those choices do harm to others, or if we have strong reasons to conclude that they are not capable of rational decisions.
There are multiple issues about how to legislate this in respect of ending life, including the possibility of pressure placed on subjects by relatives and of course the overall fact that the decision to end a life cannot be reversed. These need very careful thought before proceeding with legislation or changes to medical practice.
However, I would suggest most of those who argue that these issues are insuperable actually have more fundamental objections – they disagree with the principle of autonomy, often from religious movtives. That is why the discussion should start with the principles and proceed to the practice, rather than the other way around.
HHC – do you really expect that Mrs Nicklinson isn’t already involved with her husband’s ablutions and day to day living problems?
This cerebral accident happened in 2005, not yesterday. She must need physical help in looking after her husband; it isn’t that strangers do it all while she twiddles her thumbs and looks the other way. Get real, for pity’s sake.
Let me tell you that people who have had enough of living know that they have had enough of living. They don’t need to be molly coddled along for any reason. This couple strikes me as the sort of partnership (and their daughters) who knows exactly what they are doing and are about as supportive of each other as they could be.
Pity the others HHC – there is a suicide every 40 seconds. Every 40 seconds of every day of every week, every month, every year!! Most of them haven’t the kind of supportive loving family that the Nicklinsons appear to be. Most of them don’t tell anyone what they are contemplating because they don’t want to be talked out of it.
Some of them change their minds at the wrong time and the trajectory can’t be changed. They are few. Over 20 times the number of successful suicides try it on and fail. Most of them are not looking to suicide, the psychs will say they are looking for help.
This is not, repeat NOT, the Nicklinsons’ stance.
In defence of assisted suicide:
As someone mentioned, the right to control yourself (your life) is the fundamental and natural right of all humans. If you take this away, you have a slave of the system basically. And prohibiting suicide is not only stupid, but also unenforceable. How you can punish a dead person? Maybe he hurt someone??? All these laws are complete bunk and should be abolished. But I have no atomic bombs in my basement, so I can’t expect to conquer the state with violence, haha.
I agree with Novella, that maybe if we treated patients from depression they would change their mind etc… But how is it possible to properly treat a locked-in patient?
And why did it matter if he changed his mind in some ambiguous future? He can’t escape from pain or/and from desperation NOW, not tomorrow or after few years.
So I think it’s a duty of the very same doctors to treat their patients as individuals, not some statistical numbers. At least I would like to be treated that way and I wouldn’t pay to a doctor who just ignored my wishes and acted in his OWN preference (though, that is not always black and white and there is few exceptions). But of course, we can not choose doctors most at the time because we are forced to pay for medical care with taxation. But that’s another story.
So yes, I am aware, that person can change his mind, but he can’t complain if he is dead either.
By the way, when I buy some service from the someone for example, I can also change my mind after some time, but I wouldn’t expect to bring my money back just because I don’t need a service anymore. I know, in America everything is possible (no offence, it just has so many stupid and absurd laws).
p.s. sorry for any grammatical/spelling error.
Veronique, Sounds like the story Dr. Novella discussed really upset you. Remember, Mr. Nicklison and Mrs. Nicklison have a right to stop food and drink according to UK law. What they are requesting is that the UK change their laws to accomodate their lethal request. We cannot counsel suicide in the UK or US without legal actions being taken against us.
We don’t know the extent of family involvement. In most cases, families assume the paid caregivers will provide the necessary life treatment, and familiies prefer to quietly visit the patient.
Death is a permanent solution to life’s indignities.
HHC what the Nicklison’s are asking is that Mr. Nicklison’s right to choose the manner of his death be respected, and that he not be forced by the state to suffer a prolonged, painful death by starvation while his wife and family watch. All the state has to do is not prosecute those who assist him. We are not debating whether assisted suicide is currently a crime, we are debating whether it should continue to be a crime.
If a jailer for years on end encased a man in a cast so he could not move, and muzzled him so he could not speak, would that not be torture? If a jailer deprived a man of food and water until he was almost dead, would that not be torture? So is it not state-sanctioned torture to make this man choose between an insufferable existence and a painful death? Can there really be no other option? What is wrong with a permanent humane solution to life’s ‘indignities’ (as you so minimize Mr. Nicklison’s condition) when they are insufferable?
HHC – see this that you wrote “Sounds like the story Dr. Novella discussed really upset you.“?
Don’t ever try this mealy mouthed attempt at diminishing by personalising. At least don’t try it on with me; it doesn’t wash and makes you look like the incompetent debater that you are.
There – how’s that? Wait – there’s more coming!
But first – I noticed an entry by John Smeaton, who is the Director of an organisation called the Society for the Protection of Unborn Children (SPUC), getting in a gratuitous comment on his blog. I won’t link to him because I don’t like this sort of pious, ill-thought-out rubbish that passes for discussion.
Anyway, Smeaton spruiks that Mr Nicklinson’s push for special legal dispensation from prosecution for his wife in order to effect his death, somehow ‘undermines security of us all’ – his words, not mine. My words are – Clap trap and utter tommyrot.
As I say, Smeaton is being gratuitous and pushing a barrow for his own benefit.
The story of Nicklinson’s plight is one that needs to be addressed in a far different way from the likes of HHC and Smeaton.
Nicklinson has put up living like this since 2005. That’s 5 years, people. He knows (he’s described as being strong-willed) that he has had enough and wants to die.
Stop food and drink, you say HHC? Cruel, aren’t you? You must be driven by some form of religious dogma. I don’t know of any humanist who would see the cessation of nutrient a compassionate way to deal with such a plight as the Nicklinsons find themselves in.
No, we don’t know the extent of family involvement; you are correct HHC. Guess what? It doesn’t matter a scrap what we know about the family ‘involvement’; none of our business.
We DO know that he wants to die. That is enough. Let’s deal with ensuring that he can do what he wants to do.
He can’t effect his own death. He needs help and is asking that his wife be protected from prosecution under legislation that was never intended to capture people in this situation. This does not pose much of a problem.
If the legal opinion is that Mrs Nicklinson should be offered protection from a cover-all piece of criminal law never intended to include her, then good. This means that other people can apply in similar situations for legal protection. Quite right and as it should be; each application will be treated on its merit and as applying to the current law.
Maybe the law will be changed to accommodate the sort of modern situations that people find themselves in given our facility with modern medicine and life-extending practices. That is a very different process from this particular case that asks for a compassionate look at the compassionate act of a woman for her husband.
Give me pip anytime. He/she is someone who, at least, can see the humane position, unlike you HHC.
“Death is a permanent solution to life’s indignities.” You know, you really do sound like a sanctimonious religite type. The holier-than-thou argument is so passé as to be ridiculed in this century and so it should.
Of course death is a permanent solution. That’s the point of it. This is exactly why Nicklinson is seeking it – as a solution to the unbearable life he is forced to live at the moment. Sheesh.
I twice wanted to stick it to HHC for his inconsiderate, patronising, and condescending posts. I’m glad I held off (though that was mainly through lack of time).
That was outstanding Veronique!
Bravo, Veronique! It is dirty work cutting through bullcrap, but someone has to do it.
HCCs smug cruelty disgusted me so much it left me speechless. Thanks for finding the words that his/her bizarre inanity left me without.
Just because it is difficult to confront the right to die does not mean we have to leave our humanity aside, like HCC who adores festering in a impasse, whitewashing his/her ignorance with so-called caring. Yuck. Bigtime.
And may I add Veronique does have a blog, click on her name if you are so inclined.
Wow, you guys think that this is a reasonable tone to use in a debate? You seem really pissed and not exactly open to arguments from the other side (so I shan’t make any at this time)
One suggestion: before you accuse everyone who disagrees with you of being irrational and religious, take a step back and look at what you are saying (or rather, in what way you are saying it)
*bracing for impact*
Why is this a debate, mazeedt? There is nothing to discuss. This man clearly has the right to die and to die in the best possible way, and not by starving. If you think there is something to discuss, then what can I say? You and others like you are the reason for this man’s suffering.
Then how come you are arguing so fervently? And you make allot of good points.
But if you do not want a debate but an in club for admiring each other then you have it
Mazeedt – there are no arguments from the ‘other’ side that do not make a mockery of the intolerable position that Nicklinson is in.
Unless, of course, you would all like him to suffer while you all play nursie and attempt to reduce his suffering to a level that YOU can manage in the way that YOU dictate.
That’s why I can’t stand the holier-than-thou trollish posts that say, for some reason, Nicklinson, his wife and his daughters must ‘put up’ with inconceivable and unbearable pain and anguish just to satisfy the selfishness of a people who can’t see outside their religite square. To say there isn’t some form of superstition involved in this selfish stance is to blind yourself.
HHC and Smeaton and others like them have points of view that have to do with them not Nicklinson.
Even if HHC were to come back as declare he wasn’t a woo woo of some sort, I would have difficulty placing him anywhere except on the edge of the continuum of human compassion.
So don’t bother bracing. I am not going to bother with arguments either from HHC or you that purport to come from the ‘other side’. I am not pissed off at all. I don’t like cant and I don’t put up with irrationality. HHC displays both. I am outspoken and clear – no need for me to defend that.
I am firmly and irrevocably on the side of Nicklinson and what he is trying to achieve. I applaud the public stance he and his family have taken and I hope there is a win situation for them. I have no doubt that Nicklinson will die; it is just that no one wants to be a martyr, convicted and gaoled or even receiving a suspended sentence or facing a manslaughter charge.
That is the issue here. Don’t be deflected by your perceived reasonable or unreasonable tones of debate.
Besides, all I did was give HHC a taste of his own medicine – he deserved it in spades – hahaha. Sorry if you aren’t used to commenters returning the serve. Maybe you need a thicker skin for the internet.
Hahahaha, don’t worry about me
you know I don’t even disagree with you on the basic question of whether or not this guy had the right to die or not. I just can’t stand for the way you guys are arguing. You know what it reminds me off? I’m sure I don’t have to paint the picture
Besides, from a neuroscientific standpoint there is a real issue with the extent to wich people can express “free will”. Would you also say that a drug addict has a free choice to take the drug? All I want to say with that is that there are legitimate reasons for concern on this issue and those are worthy of discussion.
Then discuss.
By the way, ever heard of the term ad-hominem
Thanks but I don’t need your approval to do so and right now I am out of time
Smell ya’ laters
/
Mazeedt – ad-hom that is exactly what HHC got back in spades. Can’t you read??
I haven’t given you any approval – all I said was ‘discuss’. That’s what you said was worthy.
So come to the table and discuss. Don’t be a crab and scuttle off sidesways.
Hahaha, it so happens my cell isn’t quite dead yet so sure, you want my opinion all of a sudden…
Just promise you’ll try to get rid of the ad-hominem and straw men from here on.
Hmmm…. I think that you fail to see the dark side of the coin of people having the right to die, namely that you would then make it an obligation for someone else to kill that person. There may be ways around that but assume that no one of the people who can do it wants to. Should they be forced to kill the guy?
As a physician in training I do not feel comfortable with the idea of having the obligation to kill someone. On the other hand, if someone suffers from above mentioned complications then I think that “ending it” should be an option provided: 1 a through mental examination 2 that someone is prepared to do it 3 that there is thorough and unequivocal documentation that the person wants to do it 4 that it can be ascertained that the person was not pressured into doing it
And probably other restrictions should apply also
Simply speaking I think that the issue of society killing someone is always a sensitive subject
Mazeedt – I think you must be young. No one is looking for your opinion as you call it. You are either ready to discuss something worth discussing or not.
I, frankly, fail to really understand why there should be a discussion at all. It is unnecessary. There is a man who wants to die. Let him do it and help him if he can’t help himself. That’s it.
You seem to want to raise issues that are so tangential and, frankly, of little relevance to the topic under discussion, that I wonder what your issues are.
You say you are a physician in training. What does that mean? Have you finished the academic years of your degree and are you now involved in clinical experience within a teaching hospital under the direction and tutelage of practical teaching medical and surgical clinicians in their own hospital departments? Or have you finished your degree and are now involved in a residency in a teaching hospital. You don’t really make it clear.
In any case, there is no sniff of any potential obligation for anyone to kill anyone else. Where on earth did that come from? You can’t oblige someone to kill another – unless you are the government and send your country’s troops to war. Or you have a job as an executioner in a country that still executes prisoners.
What is being discussed is the right of someone to kill himself using a third party because he is unable to carry out the act himself. There will be a method that can be rigged up if necessary to allow people like Mr Nicklinson to activate a death switch (for want of a better word). That isn’t a problem – we are a highly inventive species.
So let’s not use emotive words like ‘forced’. That isn’t necessary.
What Mr Nicklinson is doing is forcing a legal issue and that’s what I applaud in him. He is in an untenable position (for him) and he is attempting to do something about it for both him and to set a precedent that can be drawn upon by others in similar situations.
In my first comment I mentioned that in our modern society we seem over-absorbed with ethical questions that need not even arise. Let’s put some arguments to your points:
1.I disagree that Mr Nicklinson needs to undergo a through (sic) examination. From information available to us, as observers, Mr Nicklinson displays no mental aberration and, apparently, from his wife’s and children’s perspective he is sane enough to make a rational decision regarding the (not)quality of his life and hence his desire to end it.
2.His wife is willing to undertake the task of administering a lethal injection and the family appears to concur with the decision.
3.Mr Nicklinson has stated unequivocally, directly in a manner that can be verified that he wishes to end his life.
4.The fact that Mr Nicklinson has made his statement obviates this point of yours.
What other restrictions would you apply and why?
Society is not killing Mr Nicklinson; the medical staff will supply a lethal injection and the legal opinion will deliver its ‘guidance’. All that is about to happen (I hope) is that the way for Mr Nicklinson to kill himself will be facilitated by a compassionate ‘society’ if you like.
I think you are confused person who needs to think about the issue and not throw up unnecessary red herrings. This is a very specific case. The playing around with medical ethics on maybes and what ifs can be best left to those who enjoy such philosophising. Mr Nicklinson just wants to die.
You conflate basic human rights with the ideological issues.
(-:
You like to belittle people, don’t you?
I might point out that, with the extremely aggressive way that you are arguing I do not want to be a part of this discussion
oh but wait, then I suppose that I am, how was it now?
“…a crab [that scuttles] off sidesways.”
well, go figure
mazeedt.
“…a crab [that scuttles] off sidesways.”
How is that not a totally appropriate characterisation of your appearance here?
(-:
Charming to be talking with ya’
It is oh so nice to see that you folks are capable of a civilized debate without needlessly ostracizing people who dear to in any way question your dogma
dare I mean…
mazeedt – I don’t usually try to belittle people; unless they make totally inappropriate and personal attacks on me. Then they can expect no quarter from me. And I am sure they don’t expect any quarter to be given:-).
Be that as it may – that is not what is happening with your presence here.
You came on here and made a comment that had nothing to do with the discussion and everything to do with how you wanted commenters to behave and how you ‘believed’ a debate should develop.
Since then, any response to you and your arguments has been met by incomplete (and I may add somewhat incoherent) sentences spread over many comments.
You have submitted opinions with no evidence as though they were facts and when those opinions have been addressed your further response is to complain that you are being belittled.
Let me make it plain to you – your ideas and opinions are being called into discussion, question and yes, you are being asked to back up, or otherwise, your statements. No one is (was) attacking you personally.
You have yet to make a defence or explanation of your statements. You are not being attacked although you seem unable to divorce yourself from your comments. Your ideas (not you) are being attacked – that is what debate is about.
It is no good your writing meaningless three word comments with …. after them or resorting to feeling hurt.
If you feel ostracised then that is your feeling – nothing to do with this discussion. And certainly nothing to do with commenters (me) who query your statements and then ask for some robust defence of same.
If and when you learn to construct a germane argument then I will attempt to engage with you again. As it stands now, I have nothing further to say to you.
And please don’t misconstrue this as my running away. Born of frustration, I am merely disengaging from a fruitless exchange.
Besides, I have made the points I wanted to make and that’s enough.
Mazeedt – one last try.
This link is to Jerry Coyne’s web site. You will find quite a discussion of free will.
Enjoy.
http://whyevolutionistrue.wordpress.com/2010/07/21/free-will-and-biology/
Aha
I have to admit, yes I do expect more of skeptics. I expect the currency of a debate not to be fallacies and antagonism but a reasoned, cogent debate. All I wanted to point out was that you guys needed to take a deep breath and look at the way you were arguing. Because to me it seemed very much like some fanatics trying to beat the crap out of the opponent with insults and moralizing. Perhaps I was over reacting? At least I was trying to be civil.
“I don’t usually try to belittle people; unless they make totally inappropriate and personal attacks on me.”
uhm, show me where such an attack was made on you
You have submitted opinions with no evidence
Yeah, that is why it is called opinions
as though they were facts
how exactly have I tried to pull of an opinion as fact?
“And please don’t misconstrue this as my running away. Born of frustration, I am merely disengaging from a fruitless exchange.”
Okay so what was I trying to do just recently?
your ideas and opinions are being called into discussion
Oh really? because I got a completely different picture
My original problem was with the way your treated HHC’s comments
# HHCon 20 Jul 2010 at 3:24 pm
Mr. Nicklison talks about his wife taking action to end his life. But his complaint about privacy is that strangers groom him. What if his wife was encouraged to become involved with his daily living skills, instead of something lethal. He says he is fed up with his life. How could his family assist in making his life less frustrating?
Veronique, Sounds like the story Dr. Novella discussed really upset you. Remember, Mr. Nicklison and Mrs. Nicklison have a right to stop food and drink according to UK law. What they are requesting is that the UK change their laws to accomodate their lethal request. We cannot counsel suicide in the UK or US without legal actions being taken against us.
We don’t know the extent of family involvement. In most cases, families assume the paid caregivers will provide the necessary life treatment, and familiies prefer to quietly visit the patient.
Death is a permanent solution to life’s indignities.
Where exactly in these statements is there cause to respond with personal insults such as:
“the incompetent debater that you are.”
and
“there’s more coming!”
and
“Cruel, aren’t you? You must be driven by some form of religious dogma”
and
“can see the humane position, unlike you HHC.”
and
“You know, you really do sound like a sanctimonious religite type. The holier-than-thou argument is so passé as to be ridiculed in this century and so it should.”
(I included this one since I do not think that it is a fair representation of what he said. The way I understood it he was simply pointing out that there was reason to be cautious with the “permanent solution” because it is, exactly that, permanent.)
and (though this one is not yours)
“I twice wanted to stick it to HHC for his inconsiderate, patronising, and condescending posts”
and (same here)
“Bravo, Veronique! It is dirty work cutting through bullcrap, but someone has to do it.”
and (ditto)
“HCCs smug cruelty disgusted me so much it left me speechless.”
and (ditto)
” like HCC who adores festering in a impasse, whitewashing his/her ignorance with so-called caring. Yuck. Bigtime.”
and
“on the edge of the continuum of human compassion.”
and
“I don’t like cant and I don’t put up with irrationality.”
I’m sure I do not need to continue
In other words you have already characterized anyone who would oppose you as: on the edge of the continuum of human compassion, irrational etc.
How do you expect that anyone would seriously enter a debate like that, I mean it is not like there is only one person doing this.
and besides, apparently when I am trying to pull out of a discussion that doesn’t lead anywhere I am, and I quote:
“…a crab [that scuttles] off sidesways.”
but when you do it I should not
“misconstrue this as my running away.”
So yes, I do have a problem with the way that you are acting on this forum. A little civility please.
HHC is not Hitler, he is just trying to express some caution regarding this issue
Thanks for the article on free will… uninteresting but thanks anyway
My take on that is that we punish people so that the expectation of the punishment is factored into the decision of committing the crime… no need for a pure, physics defying, free will for that to be effective
By the way, how is
“If you think there is something to discuss, then what can I say? You and others like you are the reason for this man’s suffering.”
not an attack on me?
Debate? Argument? Why?
No need for either in my opinion, this is the world’s most simply answered question!
The most important thing any free person has from the moment they’re born is the right to self-determination, the right to choose life or death being paramount. Anyone who can’t see that is clearly attempting to control the rights of others.
End of story.
mazeedt,
This is the sum total of HHC’s contribution to this “discussion” which you suggest we accept as a reasonable alternative view:
——————
“Mr. Nicklison talks about his wife taking action to end his life. But his complaint about privacy is that strangers groom him. What if his wife was encouraged to become involved with his daily living skills, instead of something lethal. He says he is fed up with his life. How could his family assist in making his life less frustrating?”
The unmitigated gall of this paragraph is beyond belief.
HHC makes the unwarranted assumptions that the only reason Mr. Nicklison wishes to die is because strangers groom him, that he would not feel like dying if only his wife would take care of him, that he would want his wife to devote her life to his personal care, that his wife is in fact not involved in his personal care, and that she should be able to do so 24 hours a day. Then he suggests that if she and the rest of his family but take over his personal care for the rest of his or their lives he would not feel the need to kill himself.
As I said, the unmitigated gall.
“Veronique, Sounds like the story Dr. Novella discussed really upset you.”
Patronising or what. Smug or what?
Veronique’s opinion is different form HHC’s so she must be too emotional to think straight. Right? Calm down, woman, and think calmly and rationally and you will see that I am right.
“Remember, Mr. Nicklison and Mrs. Nicklison have a right to stop food and drink according to UK law.”
Yes, just starve him to death – a very reasonable alternative to dying quickly and painlessly, don’t you think?
How very considerate.
“What they are requesting is that the UK change their laws to accomodate their lethal request.”
Yes how inconsiderate of him. He wants to change the UK law just so he can escape his own miserable life. Bugger everyone else who wants those laws to stand for some reason that has nothing to do with theor own circumstances.
Well, maybe he just wants the law to consider his case on its own merits. It is his life that he wants to end, not anyone elses, but apparently he cannot have he wish fulfilled because other people want their own idealisation of what is right and wrong to prevail over his personal suffering.
“We cannot counsel suicide in the UK or US without legal actions being taken against us.”
Just try to take action against a dead man.
But if you mean Mr. Nicklison’s wife. Well, good on you, HHC, a big victory for your particlar brand of morality against the suffering of this particular family.
“We don’t know the extent of family involvement. In most cases, families assume the paid caregivers will provide the necessary life treatment, and familiies prefer to quietly visit the patient.”
This is reasonable comment?
“paid caregivers” “families quietly visit the patient”!
Thank you for the characterisation of those less fortunate than yourself. You just know what these people do to their loved ones don’t you. And we just know what you would do in similar circumstances don’t we, holier than thou, HHC?
“Death is a permanent solution to life’s indignities.”
Yes, that’s right, if he has decided to end his life, so he can’t have thought it through clearly could he, HHC?
———————
These are the comments you defend, mazeedt.
Congratulations.
You make a good point but to be honest I think that you are reading too much between the lines
And even so there was no reason for the commentors to try to beat him at his own game.
I do not care much for what he is saying but I do care for his right to express his opinion without being ridiculed and severely insulted beyond reason
Besides, many of those comments were not directed at what he was saying but at his person
I would comment in depth why I think that you are reading too much into what he is saying but typing on the phone is annoying pfuh
I have a brother who is 17 months older than me. He has ALS.
He avoided talking about what he wanted for a long time. When he was pushed by his doctor for an answer, he was very definitive. I happened to be there. At that time, he was having trouble using a CPAP mask. He said he wanted to go on a respirator. I got the sense that the staff didn’t think he knew what he was getting himself into.
Since then, he’s had a feeding tube put in. And that was ok for a couple of months. Then he ended up in hospital for other problems and was in the ICU. Now the CPAP (even worn all the time) didn’t work. So quite suddenly he was given the choice to go on the respirator or not. So he’s now on a respirator.
And he’s still in the ICU, months later. Because of a mixture of economics and other factors, he can’t go home. There are some facilities that would be better for him and a lot cheaper where he would be better off, but there is a waiting list.
———————————-
One of the attacks on Obama was that Ezekiel Emanuel was some sort of Dr. Death because of his writings. That was and is bizarre because Emanuel is an opponent of doctor assisted suicide. I recommend anyone interested in the topic read
“America should think again before pressing ahead with
the legalization of physician-assisted suicide
and voluntary euthanasia” by Ezekiel Emanuel http://www.theatlantic.com/past/docs/issues/97mar/emanuel/emanuel.htm
I will offer a comment from the perspective of someone who is a bit closer to being the subject of the debate and Dr. Novella’s interesting post. I’m 57. Multiple sclerosis, diagnosis in 1976. I can talk, move my head and have some control over my right hand. Eyesight a bit less than perfect. This must be written by voice.
First off, I absolutely assert my right to choose. In everything. Right now life is still interesting and very worth living. I hope it stays that way. If not, I’ve had a pretty good run.
One of my first online posts was in the early days of FidoNet, well before the Web. Someone brought up the topic of euthanasia or assisted suicide. I attempted a thoughtful reply. I learned that such discussion will get you savaged by someone who thinks that they have the right to determine your fate (often hyper-religious). Same thing today I guess.
I very much wish that anyone concerned about the “right to life” direct their energies to preventing and stopping wars, educating those confused about vaccines, reducing the slaughter on our roads or any of the very many ways we can prevent needless deaths. That would be time well spent.
Those of us who may one day find our quality of life such that we would choose an earlier death is our concern. And hey, we all lose consciousness some final time in any case. Kindness would be assuring that we can have that decision and not be forced to endure a life no longer worth living.
Now I shall get back to my various interests. There will never be enough time to learn all I wish to learn, listen to all the books I wish to hear but I always make time for the SGU and I try to keep up with some of what Dr. Novella writes. And an occasional scotch.
Simply the choice should be his own, or really anyone who desires to end what they view to be an unsatisfactory life. I can understand the hesitation due to the unwanted legal ramifications for his wife, or whomever commits the final act.
In cases like this, where there is a demonstrated physical “issue” for lack of a better word, it is clearly black and white. However, the issue of able bodied people with no faults other than a depression disorder is a tricky one.
I’m not going to say that depression is something that is not an impact in someone’s life, because it most certainly is. It is going to the depths of despair and helplessness, hopelessness, that encourages the idea to end it all. Yes it is a skewed view of reality, but the question is whose reality? If reality is something we all share, then people with depressive disorders are not living in reality, but rather in their own world. When one blames oneself for a multitude of things far out of their control, that is not reality, that is a sickness.
Feeling worthless, or generally not wanting to live life are two different things, in my opinion, and it could be one in the same for many, but having dealt with depression for many years, and teetering on the brink quite often, having the fortitude to say it’s not always going to be like this is a major hurdle to leap. If I was in a situation where I had consciousness, and not much else, I don’t think I could cope, but then again that is a hypothetical.
I wish we could evolve to a society that did not take into consideration the implications of acts when only a handful of people are personally affected. It is wrong for society to take a precedent over the personal in all cases, because society does not know exactly what is going on, in spite of best efforts to do so. We cannot see inside his mind, or his wife’s, so to sit and debate on whether it is right or just is mind-boggling.
But I seem to have contradicted myself, which is par for the course. I want the world, but don’t want it at the same time.
If Everyone dies by Teatime, to whom do I send the congratulation cards?