Death provides liberally for all men

Thoughts on suicide and assisted dying.

When you think about it since the beginning of time human beings have been solving their problems with death. Cane and able two brothers cannot get along, death provides a solution. Two nations can’t stand each other. Well they can kill each other until everyone who cares about it enough to go to war is dead and then the problem is solved. death brings peace. Are your old people too ill, too dysfunctional? too many mouths to feed for someone who isn’t pulling their weight? Put them out exposed to the elements and death will solve the problem. Are your people so miserable that they can’t stand to get out of bed in the morning, well leave them in bed until they starve or until they kill themselves in despair. Death solves the problem.

As human beings we frequently resort to death to solve societies problems. To solve individuals problems that they cannot tackle on their own. Resorting to death to solve our problems is just human laziness.

Because collectively we have the power to really do something about most of these problems. We have the technology to feed the world, we have the technology to house the world. Our medical technology has greatly increased peoples lifespans because we’ve poured a lot of energy and effort into acute diseases. But the problem is sometimes we work so hard on extending peoples lives we forget that chronic illness can rob them of a reason for living. It might be long-term disability, painful conditions, long-term mental health issues, either way the resources to address this sort of thing simply aren’t there. It’s not because we don’t have the technology. I can tell you for a fact what’s been achieved on the lab bench even decades ago, often doesn’t make it into clinical practice. Sometimes it’s because of life threatening side-effects. More often it’s because the process of commercialising the technology is too expensive. many of these experimental lab techniques are developed under the assumption that shortcuts can be found later on to avoid some of the more complicated and resource intensive steps. When that proves not to be true, when you discover you can’t avoid time-consuming tissue engineering or substitute simple compounds for gene therapy, then interest tends to wane. Governments aren’t willing to shell out huge amounts of money to resolve chronic illnesses unless they’re life-threatening or hugely expensive in terms of maintenance treatment. By the same token there are only so many individuals with the kind of money to buy such things privately.

Something similar could be said for mental health. So often it’s not as simple as just giving people therapy. Therapy is a good start but long-term mental ill health is often driven by situations. Disability, addiction, social isolation, The hopelessness of having limited options in life. Feelings of being trapped which are validated by real life circumstances. It’s not enough just to give people therapy sometimes you have to change peoples situations and that tends to cost money, time and effort.

So when people commit suicide we tend to blame them. we tend to suggest it’s a form of weakness on their part. But I think just as often the weakness that is highlighted is societies weakness. Or even worse societies laziness. That we are perfectly prepared to use death as a solution to the problems that drive people to a state of hopelessness in which they would contemplate taking their own lives.

This is I think what makes the philosophy of assisted dying so abhorrent to me. Don’t get me wrong I don’t look down upon those who feel compelled to end their own lives. I look down on the society that has chosen to leave them in a place where they feel they have no other option. We wouldn’t have to consider assisted dying if there was more support for assisted-living. It’s not particularly difficult to jump off a cliff or swallow a lot of pills. Even Stephen Hawking, I assume, if he had felt suitably inclined could’ve programmed his wheelchair to drive him off the edge of a cliff. If we maintain peoples independence until the very last moment they always have the option to end it for themselves.

Even someone in the early stages of dementia could before the effects became severe acquire poison and keep it in a safe place so that if they ever get to a point where they can no longer tolerate their situation, they can in a lucid moment dig out that bottle of poison.

When we talk about assisted dying what we typically mean is painless dying. I don’t think it’s in peoples interest or the public interest for suicide to be painless. I think if the thought of a painful death troubles you enough that it would prevent you from doing it then maybe it’s a good thing. because clearly your situation isn’t that dreadful if that is enough to stop you.

I somewhat feel the same way about hospice care, I can’t imagine wanting to spend my last days in a place that would remind me of the fact that I am imminently about to die. I’d rather have my body patched up and proped up and pumped full of whatever drugs were necessary to keep it moving so that I continue to experience life on my own terms until the very last moment. Maybe we can never outrun death but we can give it a damn good try. By living our lives instead of waiting for the end.

People seem to have this fake sense of moral superiority in this notion of accepting death. I personally think it is more noble to live one’s life to the full in spite of imminent death and in defiance of it.

Call me cynical but it is far easier to dump someone in a bed and faun over them than it is to perform extensive medical procedures upon them knowing that all it’s going to do is to improve their quality of life for a few weeks or months after which they will inevitably die.

If we spent more time trying to make life worth living and less time trying to stop people dying I think people would probably live longer.

People say war is a failure of states craft. Famine a failure to plan for the future. I consider assisted dying to be a failure of medicine. And suicide in general I considered to be a failure of society to look after its most desperate and vulnerable members.

  • Again I don't think thats true. Phase 0 trials are very useful. One person case studies do get published. But when it happens its usually bleeding edge tech that's being applied. But I'm a big fan of bleeding edge tech.

  • If the alternative is euthanasia surely any level of medical risk is acceptable?

    Yes, I think that is fair.....but unfortunately, the medical establishment do not want to experiment on people who are too far gone (as it were.). These unfortunate souls are simply left to die in my experience.  It is not that there are rules stopping it (although they are), it's the fact that the value of experimental subjects of this grade are not useful.  I think these people should be allowed the dignity of choice (personally.)

  • In reality, your ideal does not exist.  This patient has no scientific use to science.  He is too far gone.  Guinea pigs need to be healthy(ish).  Drug trials don't exist for patients who are beyond the pale.

    Who said anything about drug trials. Ok I don't want to talk about your friend specifically because I think it's going to make things needlessly emotionally charged. But suppose you have a bed bound patient who's lost their sight. Well researchers have been working on brain implants to restore vision. No reason you can't try a brain implant. Work like this is often called a phase 0 trial. Really early experimental work carried out with just a few patients as a proof of concept. To try and get a handle on the basics of how the technology works in practice when you move from animal to human. It's more about proving that you can get a therapeutic effect than whether its safe which is why generally you need patients who's medical situation is absolutely desperate. Its a misconception that you need hundreds of participants in a double blind system to do useful medical research. If the metric you care about is 'can this person read an eye chart' and if there was basically 0 probability of that happening with out intervention even a single case can be instructive.

    There is always some crazy thing you can try. Jabbing electrodes into the brain, gene therapy, replacing body parts with cybernetics, tissue engineering. I once heard of a person who had their leukaemia cured by being given HIV. Or a person who had their cancer cured by being injected with flesh eating bacteria that ate the tumours from the inside out. If the alternative is euthanasia surely any level of medical risk is acceptable?

  • In reality, your ideal does not exist.  This patient has no scientific use to science.  He is too far gone.  Guinea pigs need to be healthy(ish).  Drug trials don't exist for patients who are beyond the pale.

    Accordingly, I respectfully ask you again Peter..in the case of my friend, do you think assisted dying should be available to him?

    Disambiguation - Peter, I do not ask this with anything other than interest in the answer.  I'm most certainly not trying to change nor judge your opinions.  I thank you for raising an interesting and important topic area of discussion.

  • I can only speak for myself but if I was in that situation Id want to be experimented on. I’d say to the doctors find your finest Frankenstein and let him experiment on me until he restores my senses or kills me in the process.

    effect may be the same as simple euthanasia but the intent is totally different. And there’s always a small chance one of the crazy things we try might work.

  • If you’re mentally competent enough to beg doctors to die and the only thing you’re in hospital for is palliative care then there is absolutely no reason for you to be in hospital at all. you could be in your own home where you can do what you like including commit suicide if you so choose. When I’m talking about transitory pain I’m talking about the transitory pain and sticking a fork into the electrical socket or something like that.

  • To the point where they have to start making a choice between whether or not they tolerate a certain degree of pain or exist in a state of delirium.

    The consequences of a cancer mestastacising and causing multiple additional growths in and around the body can lead to situations where the level of morphine needed to control the pain would kill the patient.

    So you have your patient lying there, covered in bed sores because their skil is paper thin and their bones are rubbing on the sheets, they are incontinent, immobile and in excrutiating pain, beggin to be allowed to die as medical science can keep them going in this condition for months more.

    Try using the arguemnt that the pain is transitory for the person who has been in pain for weeks and has months more ahead of them.

    How can you possibly think making them suffer is a morally acceptable thing to do? If you can fulfil their heartfelt wishes to alleviate the pain and let them die in peace with what dignity remains then how cruel would you be to deny this to them if it was an option.

    At the moment this is illegal but thankfully the vast majority of doctors will turn a blind eye to the situation when it is clearly in the patients best interests.

    My main beef here is with the law that does not allow for suitable mercy to be permitted when the situation merits it.

  • Peter,

    People seem to have this fake sense of moral superiority in this notion of accepting death. I personally think it is more noble to live one’s life to the full in spite of imminent death and in defiance of it.

    Do you think it is "noble" for my friend to live out his "life" to the full, in defiance of death ?     To what end?

    He cannot breathe, eat, speak, see, hear, communicate (in ANY way) nor move (in ANY way.)

    His final window on this world was an eye-gaze unit...........which he stopped being able to use in 2019.

    His organs are fine.  He could live on for many, many years yet.  The NHS provide him with 24-7 care.

    There is ABSOLUTELY NO HOPE of ANY improvement in his situation.

    He breathes through a pipe in his neck, and is fed through a pipe into his stomach.

    Do you think it is "noble" for him to "live" out his "life" in this way?

    Is is "noble" for his wife and children to be locked in to the same reality - unable to move on with their own interactive lives?

    I am interested in your perspective on these particulars Peter.

    For the record, my friend sits in your camp of opinion - or at least he did, the last time I was able to discuss it with him = when he knew (or thought he knew/understood) what the rest of his life was going to be like.

    Philosophical defiance of death is fine in word form.......but a straw man on fire, when facing the reality of my friends life AND that of his lovely family.

    Number.

  • I don’t know about your specific situation. I do know that in the past individuals with dementia have sometimes been given sedatives and other drugs intended to modify mood and behaviour not because it was combating their dementia, but because it curbed disruptive behaviour that their dementia caused.

    of course it won’t surprise you to learn that I view using medication in this way as unethical.

  • medicine is a failure though, in the future we will look back on this time and see all our medical knowledge as a joke and all these pills and chems we put into our body as not working and a very scary thing to do as they cause most of the issues we are suffering from.

    my nan had dementia and alzheimers but i swear once she forgot to take her meds she was more coherant and almost back to normal... it was all the different 100s of pills they had her on that screwed her up. dementia is not natural, i swear its caused by these pills the doctors give you..

  • Having spent time with close family as they died a slow and gruellingly painful death from cancer, they were in a wretched state near the end and both wanted it to just stop

    Death is never pretty. I’m under no illusions as to how bad things can get. People can become emaciated and unable to move without assistance. Dependent on huge amounts of morphine in order to manage pain. To the point where they have to start making a choice between whether or not they tolerate a certain degree of pain or exist in a state of delirium.

    now suppose you strap them into an exoskeleton so it no longer matters how weak or uncoordinated they become. The Computer can manage their movement for them. Supposed we build a morphine pump into that exoskeleton that can control their pain precisely minute to minute. All of this technology already exists. It’s not available because society has decided it’s not a priority. This is what I’m talking about when I talk about society letting death solve its problems.

  • A degree of suffering is part of life. Why shouldn’t it be part of death. I don’t believe most people kill themselves because of physical suffering in the moment. People kill themselves because they lose hope that their physical, mental spiritual and social condition will not get better.

    whether or not everyone does have the option of throwing them selves over a cliff. In my opinion if we concentrate on helping people live instead of helping people die, by which I mean helping the chronically ill retain their independence then everyone would have the option of  throwing  themselves off a cliff.

    all death  is horrible. There is no way to protect people from a horrible death. Pain is transitory and we have many drugs to help people control that. I certainly have no problem with the Doctor Who decides his patient is a better judge of the trade-off between the risk of death and alleviating pain when it comes to pain medication. But that’s not assisted dying that’s pain management.

    it’s too easy to watch someone float away in a hazy morphine bliss and call it a good death. Sometimes people need reminding there are no good deaths only good lives. Ethically it is not a doctors place to decide how long a patient should fight against inevitable death. But in my view it is a doctor’s duty to provide them with the option for as long as possible. And a large part of that is helping them retain their ability to control their own lives in the midst of illness. l

    Even if a human being becomes a brain in a jar on life-support The moment you give them the independence to go where they want to go and do what they want to do without having to ask someone’s permission, say by hooking them up to some kind of robot, you have given them the freedom to end their own lives. and ethically the great thing about that approach to medicine is that by that point maybe they no longer need to.

    assisted dying, and for that matter hospices, exists because it’s easier than making heroic efforts to keep people independent in their final days and in the face of chronic illness.

  • The amount of suffering willfully inflicted upon people who would benefit from assisted dying is a stain upon our supposed human decency. 

    I agree.

    Having spent time with close family as they died a slow and gruellingly painful death from cancer, they were in a wretched state near the end and both wanted it to just stop.

    There are still some doctors who will listen to the patients wishes and when there is no alternative to help the suffering will let the patient or caregiver have more control over the morphine doses and will not ask for an autopsy when they do die.

    I find it shameful that our society will crimilise people for this - there needs to be a means to assess if it is a reasonable request to stop us making the people live on in extreme pain.

    Just my view of course.

  • but then we take a situation like canada where the government is actually pushing people to be euthanized for being simply depressed, have PTSD after serving or are homeless.

  • I disagree strongly that the responsibility rests entirely on someone who doesn't want a slow and horrible end to use whatever limited means are available to them to cut it short, potentially pushed into taking that step much earlier in case they might not be able to if they put if off. And the idea that most people who would benefit from assisted dying are fully capable of travelling to a cliff and getting off it is nonsense. The kinds of pills and poisons available to the average person would result in a horrible death and the fact that you seem almost to favour that as it shows they really wanted to die is disturbing. 

    The amount of suffering willfully inflicted upon people who would benefit from assisted dying is a stain upon our supposed human decency. 

  • I consider assisted dying to be a failure of medicine. And suicide in general I considered to be a failure of society to look after its most desperate and vulnerable members.

    well said.