Monday, January 30, 2006

New NHS Cost-Saving Strategy Unveiled

Ministers are considering plans to let adults appoint someone who could block life-sustaining treatment if they were too ill to do so themselves.
The Mental Capacity Act, which comes into force next year, gives people the chance to appoint someone who can instruct a doctor on their behalf.

Under plans to implement the act, they would need to indicate if this included powers to refuse life-sustaining care.

But critics have said the proposals amount to "back-door euthanasia".


8 comments:

Anonymous said...

Soon everyone will get a health commisar appointed for them to make sure they don't linger on.

Be glad you can at least nominate someone (for now).

Dave said...

Well I know you are extremely against this sort of thing. But I do think there are very serious issues here, modern medical treatment can keep people alive that only 30 years ago would be dead.

I know there are a lot of problems with the idea of letting people die, but I personally wouldn't want to be kept alive if I had zero quality of life. Can you seriously say you would?

Lee said...

Dave,

You are vastly missing the point. Firstly, this new rule is to enable someone ELSE to decide for you whether you should die or not. Even if you have previously expressed a wish to die under similar circumstances, at the actual time of your death, it will not have been your decision.

Secondly, does anyone have a zero quality of life? Even the most disabled person may at some point in the future experience a positive emotion. Who are you to say for someone else that their quality of life is zero, and how do you know if you were as disabled as can be, that your quality of life would be zero?

Thirdly, it is a binding moral principle of society that no human has the right to kill anyone else. This ties in with the medical professions ethical stance which is to save life - even if a person has attempted suicide and therefore clearly wants to die. By tampering with this principle we are in the category of playing God. We are also in danger of opening the flood gates and sacrificing one of the few binding moral principles we have left.

Dave said...

1, you are only allowing someone else when you are so hurt you can't make your own desision. So I don't see the problem because its not like someone is stopping you from having an opinion, you will be unable..

2, yes some people who are brain damaged and kept alive by machine do have zero quality of life imo.

3, I don't think when someone who is on deaths door refuses treatment that that means the doctor is responsible for killing them.
Killing a health person is one thing, letting someone die who has no chance of recovery other than a miracle is something totally different.

Fact is in this country we don't let an animal suffer yet a human can be kept alive while they lose all dignity, identity and self-respect becoming just a collection of twitching nerves that in no way represent the person that used to be.

Lee said...

1. So if you are so hurt you cannot make your own decision, is it right for someone else to speak for you? What if that person has an ulterior motive for wanting you bumped off? What if you truely believed you wanted to die, yet if you had the choice at that exact moment in time, you would not have chosen that? People have a right to change their minds and a right to expect that if they lose the ability to speak for themselves, the medical profession will look after them.

2. Exactly - in your opinion. Opinions are a human characteristic and as such are fallible. People can hold different opinions. Whats more, its an opinion without experience as the fact you are typing this means you are not as disabled as some. So how do you know what goes on in their minds?

3. On deaths door - is that a medical term? How is deaths door defined? What if someone is not on deaths door, but just likely to be chronically disabled? What if someone was not on deaths door but made a serious attempt to commit suicide? What if someone was likely to die, but not definitely going to? What if someone was assumed to definitely be about to die, yet made a rare recovery?

Also, is an omission that leads to death any better morally than an act? Supposing you saw someone about to jump off a cliff and had the power to save them, yet chose not to. Is that not morally reprehensible? So can murder be committed by omissions to act?

Finally, the turning off of life support is hardly an omission to act. It is a direct action. If you or I did it, it would be murder. Currently, if anyone does it, it fits the definition of murder, yet now we are saying if you have trained for a while in medicine and saving lives, you are now in a position to decide when to kill someone?

We dont let an animal suffer because it is an accepted fact that humans are a higher level of species than any other living thing - accepted that is by all but the bunny huggers. Humans are the only species capable of rational thought. Furthermore, the survival of our species depends on a series of immutable principles. Expecting medical personnel to preserve, rather than end life is one of those principles.

Dave said...

You said it all in the last part.
"Humans are the only species capable of rational thought."

Not when they are brain damaged they aren't.

Personally if I was left lying on a bed unable to move for 10 years, being fed through tube, and unable to communicate, I think it would be like a living hell, I would become angrier and angrier. If I knew what was going on that is.
Ofcourse I am talking about people who are in this state long term, not if you are out of it for a couple of days..

If you were a soldier, and your buddy just had half his face blown off but was still alive (barely), you tried to help him but there was nothing you could do, and he points to your rifle and moves the end towards his chest indicating he wanted you to put him out of his misery, would you not pull the trigger?
If you did, would that make you a murder? technically yes, but not really..

There is a point where life 'has' effectively ended, even if not technically so.

Would I try to stop a suicide? yes if I knew nothing about the person, however if I knew them to be a nasty criminal or that they wanted to die for reasons such as intolerable health problems, maybe I would think twice.

JohnM said...

If there is going to be a debate about euthanasia, then it is as well to clarify some distinctions:

Active vs Passive - deliberate actions make the patient die sooner are said to be active. If inaction causes the patient die sooner then it is said to be passive. eg. Deliberately withholding treatment for a life threatening condition.

Direct vs Indirect - in addition we might subdivide Active into direct and indirect. A doctor might give very high doses of morphine for pain relief knowing that it would have the unintended side effect of hastening death. This would be indirect.

The reason that this is important is that a phrase like letting someone die who has no chance of recovery other than a miracle... can clearly be seen to be referring to Passive euthanasia when the thread itself concerns Active. Doctors let patients die every day without it ever becoming newsworthy. The issue here is letting someone be killed who has no chance of recovery other than a miracle

I'm also concerned about the sentence There is a point where life 'has' effectively ended, even if not technically so. I'm sure you can see that this begs the question. Once the term "effectively" is accepted, the debate is over.

Also the example is problematic:

If you were a soldier, and your buddy just had half his face blown off but was still alive (barely), you tried to help him but there was nothing you could do, and he points to your rifle and moves the end towards his chest indicating he wanted you to put him out of his misery, would you not pull the trigger?

Kind of stacked the cards haven't we. Let's just say I didn't pull the trigger, the first aid came and airlifted him to the hospital. The injuries were not as bad as first thought and years later we joked about his request to end his life. "I'm glad you ignored me", he said. Emotive examples work both ways you see.

I have a worry about the advocates. If someone commits suicide it would seem prima facie that they are suffering from intolerable health problems. If so we should never intervene to save the life of someone who overdoses. In fact if they throw up, there's an argument that we ought to forced the pills back down again.

The proponents of euthanasia always talk in emotive terms about people dying in great distress. They name themselves "Dignity in Dying" rather than the more accurate "Dignity in Being Killed". In contrast, they keep quiet about the fact that In Oregon, the only US state to allow assisted death, the overwhelming majority of euthanasia "clients" seek death not because of unbearable pain but for psychological reasons. Depressives have been put out of their misery and that In Holland, a bill similar to the Joffe Bill led on to another which legalised non-voluntary euthanasia for people such as the senile or comatose. Half the legal killings in the Netherlands now happen without the patients permission and thousands carry cards saying "Do Not Euthanise Me" in case of an accident. (both quotes The Spectator 26/1/06)

Proponents of euthanasia say that claims of a slippery slope are a fallacy. Given the evidence to date, it seems beholden on them to prove that is false.

Dave said...

Johnm I agree with much of what you said.

regards the soldier, I said you could do nothing to help them, that includes radio'ing for medical help.
The point I was making was sometimes you can do someone a favour by finishing them off, even though it sounds extreme.

Active vs Passive:
I agree there is confusion, but I thought Laban was talking about Passive.
"to let adults appoint someone who could block life-sustaining treatment if they were too ill to do so themselves."

Thats appointing someone to be Passive isn't it?
I am definately against Active killing because as others have said, people might want to get rid of sick relatives or something. But I don't think its right for doctors to continue to force treatment on people who don't want it and who are never going to recover to live a normal-ish life.

I am not infavour of euthanasia, in any way.

The confusion over Active and Passive comes from the fact some people describe denial of treatment to be 'killing'. I remember a case on the news recently where an NHS patient wasn't going to be given a new drug (cancer drug I think), the person comes on the news and says the government was killing her, or something similar. Now I was sympathetic but it wasn't killing, it was health rationing.
Anyone who supports the NHS supports government controlled health rationing.