Monday, October 20, 2008

Is there a right to die?

I blogged on this issue in February 2007. I'm reposting it in light of the story about the case of Daniel James, a rugby player who died in a Swiss assisted suicide clinic after being paralysed a year previously. I have mixed feelings as he was young and perhaps over time could have been able to find some happiness and quality of life .A year is not long to come to terms with what happened.

I know its not the usual knock about leftie blog fare, but i'm curious as to what people think.

Yesterday I watched the news about a young woman who wanted to die, as she did not want to live any longer with the terminal illness she has. I then went on to watch a programme about children whose fathers committed suicide.

I wondered whether to post on this. My concerns where that I don’t have any answers only questions and that is after thinking about these issues for most of my adult life. In addition, it is very close to home and it is not possible to discuss these issues without reference to my own experiences. This is also a blog post and not a paper, so I am aware I cannot do any real justice to such a complex topic in this form. I decided though to write something. It won't be objective but it might shine some light on the realities behind a heated but often theoretical debate .

So ok, do I think someone has the right to die? Well yes and no. It depends. People choose to die for many reasons. There is the young woman who is terminally ill and wants to die. I would argue that society should provide the best care possible and support for her family. However, if given all that she still wants to die it is her choice. That is fine though if she can get hold of some tablets and take them. However, what happens if the carer sees this. Should they stop them? What happens if he or she needs assistance in order to die or is asking others to do it?

I think its one thing to do yourself, another to ask a loved one to stand by or to help you. If it was possible to ensure there was no abuse whatsoever and the person was making a free choice and had capacity then there is an argument that a loved one could assist or at least not stop them. Trouble is how to put safeguards in place. Should doctors assist? There role is to save life not end it.

Concerns highlighted by those opposing assisting someone are that doctors will decide who lives or dies; the worth of a life. Other risks are that relatives may decide and that it is not the person choosing. Alternatively, that it is convenient in an age of limited resources to help people to die.

Is it possible to have safeguards and to meet these concerns?

Moreover, what about the reality for those caring for the person. I faced this with my mother. She probably would have lived a while longer but she refused treatment and hardly ate during many months in and out of hospital. Doctors and nurses tried to convince her. Psychiatrists assessed her and found she had capacity to make those decisions. They accepted that whether they agreed or not with the decision it was hers to make and she understood the implications. I tried to persuade her to live. However, consistently over six months she said she had had enough. It was not a lack of resources as she had a place with lots of support where she could live.

Did I think she was perhaps confused, would change her mind given that the physical problems were not enough to kill her if she accepted treatment, there was nothing terminal. I looked at what she was saying and what she had always said to me. Over the last few years her mobility was poor and she could do less and less. She had support but she did not want a life where she needed people to help her do the things we take for granted. She did not want the intrusion into her life. She was in pain and she gave up. Give up, that implies weakness. She never gave up in her life, when many others would have. However, she had always said to me she did not want to be ‘poked and pushed around’ and if she were ill, she would rather go. To many it would not make sense. To her a life where she was in more pain, struggled to get around and needed help was not one she wanted. However much the care and support was adapted to try to make it better she was determined to die. I do not believe that was giving up though.

However, that is the point. We all have different bars for what we consider a quality of life. Some may be able to live dependent on others and face great pain and disability, others not. We all may have different points when we feel, that is enough, no more. Others of course may want to live whatever pain or illness they have and still find pleasure in life, right to the end fighting to stay alive.

That is why this is so difficult. It is different for all of us. My mum was determined and stood her ground against doctors, and me, trying to persuade her otherwise.

I had to try to change her mind, but I also accepted her strong views and her rights.

And that brings me on to the TV programme about children. One person’s decision to die has an impact on those they love. The children in the programme had all lost a father to suicide. Many said they felt guilt or responsibility, another phrase was if he loved me how could he do it. This was painful to hear as my father killed himself when I was 16 and those were my thoughts then. Now 27 years later I can rationalise that of course, it was not my fault and yes he loved me but he was ill. Those thoughts though never go away. He thought I would be better off without him. Wrong of course.

So does someone with not a physical but a mental and emotional pain have a right to die? Again, I would argue that everything should be done to help the person. Much of the pain is caused by our society. However, let us deal with what we have and not how we want the world to be. So given the world as it is then, as much help as there is should be given.

Sadly however much someone is loved and however much help they are given its not always enough. I do though think that if someone is trying to commit suicide there is a responsibility to try to stop them. I suppose I believe this more strongly when it is mental pain and anguish because that can change. Mental states can fluctuate and if someone can be helped through the worst, they might stay alive.

Of course, the difficulty is reaching someone when they are that depressed or determined to die. I have since talked to people who are suicidal, through my work, and they are not able to see they will be missed or are of any worth. I also believe that if someone is determined they will do it and the term a ‘cry for help’ makes me angry. Yes it may be but that does not mean the person is not really intending to die. My father made numerous attempts before he succeeded.

His right, as those of the fathers remembered in the Channel Four programme, conflicted with the hurt to the children and loved ones left behind. At times I feel angry at what he did, not hanging around to watch me as an adult. The mindset of the person cannot see past the act, they cannot allow themselves to think about the consequences.

I was pleased to see some support for the children. When I was a child there was none and there was a stigma associated with it. I also chose who to tell about his depression and death. It certainly can cut a conversation dead when asked about my father to tell the truth, yep my father killed himself .

When someone chooses to die people judge those around them. If they are physically ill they perhaps wonder if the loved ones just wanted an easy life and to get rid of them. Did they actually choose or did the relative ‘help’ them. If it is a physically well person then people wonder what went on in that family? Oh it must have been the wife, did not support him or ‘drove’ him to it. As a child, you feel all eyes on you as people wonder.

These are my thoughts.
No easy answers and lots of questions and conflicts of interest.