Maddie Binns- Draft Project

29 Jan Maddie Binns- Draft Project

Posted at 15:37h in Journalism Project, Level 6, Uncategorized by Binns

Journalism Project

The aim will be to provide answers and context from different perspectives, including personal stories and experiences, on who and how should decide terminating life in euthanasia cases.

 My project is about euthanasia focusing on a case study of Steve Hornby who passed away last year from Motor Neuron Disease. Steve wanted to have an assisted death but was unable to because of the law.  Final project will be presented in shorthand and I will have my article divided into appropriate sections, Amanda’s story first, then have my different arguments scattered throughout the article. My audience for this piece is for anyone who might not be familiar or aware of the issues people face when dealing with the idea of euthanasia. This is because I have tried to explain the topic in a simple easy way.

Intro

Euthanasia is the practice of painlessly killing a patient to relieve suffering for the patient’s benefit. This act contradicts one of the oldest and most cherished moral injunctions: ‘Thou shalt not kill’. Euthanasia is one from if what is generally termed assisted dying. Other forms include assisted suicide and the withholding or withdrawing of life extending medical treatment. Four times in the past hundred years the UK Parliament has given careful consideration to legalizing assisted suicide or mercy killings. However, on each of these occasions the possibility of legalization has been rejected. In the UK and Wales euthanasia is a criminal offence protected under the Suicide Act 1961, a crime punishable by up to 14 years’ imprisonment. The laws on euthanasia do however vary across countries. In the Netherlands and Belgium euthanasia may be carried out under certain conditions within the law. In Switzerland and a small number of States in the US, physician-assisted suicide, when a physician intentionally helps a patient to kill him/herself, is legal, again if certain conditions are met. As euthanasia is not legal in a great deal of countries many people have decided to promote the act of voluntary euthanasia, this is when the patient asks for medical treatment to be stopped.

Assisted dying is an umbrella term for a number of different practices that end in a patient’s premature death.

These include; euthanasia or mercy killing, when a doctor performs an action intentionally killing the patient for their benefit.

Voluntary euthanasia, when the patient requests to stop any life prolonging treatment.  Non-voluntary euthanasia, when the patient is not competent to express a preference regarding the action resulting in the patient’s death e.g. if the patient is a coma.

Involuntary euthanasia, when a doctor performs euthanasia despite the wishes of the patient.

Withholding treatment or passive euthanasia, when the patient refuses to have any life prolonging treatment.

Withdrawing treatment, when a doctor believes it is in the patient’s best interest to stop any life prolonging treatment or the patient refuses to continue with the treatment.

Suicide, the patient intentionally kills themselves.

Assisted suicide, when someone intentionally helps a patient to kill themselves.  Physician-assisted suicide, a physician intentionally helps a patient to kill themselves.

Assisted dying has been the focus of great controversy over the years and as it is such a complex and difficult subject it is extremely hard to find a way to legalize euthanasia as each case is specific to each individual patient. There is no easy way to decide whether it is in a patient’s best interest to die, there are some tools of ethical reasoning that try to illustrate the most powerful arguments for and against a euthanasia case.

Argument 1

The first of these four is logic. When arguing for or against a case it is important that you are aware of false logic, e.g. 2= a number and 3= a number, but 2 does not equal 3. The use of false logic can be seen in the common but invalid argument against assisted dying, known as ‘playing the Nazi card’. This is when the opponent says to the supporter ‘your views are just like those of the Nazis, therefore all your views are immoral’. This is a logically invalid and a classic false argument known as argumentum ad hominin or bad company fallacy.

This fallacy states that a particular view is true or false, not because of the reasons for or against, but by virtue of fact by that particular person or group that holds that view. This argument is therefore invalid because although both sides acknowledge that the Nazi killings took place under a form of assisted dying this is not the main point at issue. The issue is whether assisted dying in certain circumstances is right or wrong. Only then can the arguments for and against the legalization of euthanasia be evaluated properly.

Argument 2

The second of these tools is defining the terms. There are many distinctions between each form of assisted dying that are ethically significant. By knowing the different forms and definitions of assisted dying it quickly becomes clear why ‘playing the Nazi card’ is full of invalid arguments. The Nazis practiced involuntary killing, not euthanasia. Therefore, by knowing all the terms involved it makes it easier to clarify the facts of the matter as they arise; what action is being proposed, why it is being proposed and what the effect will be.

Argument 3

Although knowing the terms helps to ensure that your argument is correct you also need to decode the different concepts and many situations require more than a definition. The big question is: Can it be in the best interests of a patient to die? Many believe that in most cases it can be e.g. if a patient has a fatal illness and then gets a chest infection in addition to the underlying illness, antibiotics could treat the acute illness however it would only extend the patients life by a couple of weeks.

Not everyone agrees however that it would be in the best interests of the patient to die. Some argue that we can never know what a patient’s quality of life is like, this is more of an issue if the patient is unable to communicate. This also raises the question of ‘what if’.  It can be argued further that we can never know how the patient will respond to the treatment and whether it will prolong their life or not.

Argument 4

In addition to this there is an uncertainty about the patient’s experience of being dead. For instance, if the patient believes in some kind of afterlife then there would need to be comparison between the life of the patient alive and the presumed experience after death, deciding which would be better for the patient. On the other hand, if the patient doesn’t believe in an afterlife it could be argued that it is not in their best interest to die.

Argument 5

The final tool for ethical reasoning is to compare cases that are similar in many ways. For example, if you are unsure what is the right thing to do then compare it to a similar situation, then you can ask: are there any morally relevant differences between the cases? And, do these justify treating the cases differently. The logic to these points is consistency. It is inconsistent to treat two cases different unless there are moral differences between the two. This is one of the main issues when deciding whether to legalize the right to die or not. As not one case is the same and all need to be treated with each individual patient’s best interests in mind, this makes it extremely difficult to have set rules and safeguards.

Doctors opinion

One major problem that doctors face if euthanasia was to be legalized is how it would change the relationship between the doctor and patient. The British Medical Journal has said that they believe it would lower the trust between patient and doctor, this is because all doctors take an oath to do no harm and help in any way possible.

On the other side to this the charity foundation Dignity in Dying believes that it would increase the trust between patient and doctor or make no difference at all. A 2015 survey found that only 12% of participants thought legalizing euthanasia would have a negative impact on the relationship. Doctor Samuel King, from Leeds Teaching Hospitals NHS Trust, said ‘I think that the “right to die” debate is a difficult topic. The principles of medical ethics are that we commit to four principles: Patient autonomy, beneficence (doing good), non-maleficence (doing no harm), and justice (the right of all patients to be treated equally). All ethical decisions are made while ensuring the least compromise to these principles. The ethical argument is whether by refusing patients “the right to die” (in this context I have assumed that you mean physician-assisted suicide) we are doing the best by these principles – we are not allowing patient autonomy and we are not upholding the “justice” part,  as patients without the ability to end their own lives are deprived of this. The counter argument is that we are being non-maleficent – i.e. we are not harming the patient as we are not helping them to die. The question is which option does the most good? As a doctor I feel I would struggle quite a lot with the actual practice of assisted suicide, but in that position as a patient, I feel I would at least like to have the option available.’

When I asked him, about how he feels it would change the relationship between patient and doctor he said, ‘It would create a difficult angle. Currently we allow passive euthanasia (i.e. withdrawing treatment and allowing a patient to die). A patient’s relatives vividly remember their last few hours/days, and it is not uncommon to hear them talk about how the syringe driver (a device that is used for, amongst other things, administration of comfort medications at the end of life) “killed” their relative. If we get to the point where we are allowing active euthanasia – physicians actively helping people to die – this can only become more difficult.’

There have been multiple euthanasia cases where it was thought that all safeguards needed to ensure a consensual safe death were anticipated, however there have been plenty of cases where this was not the case. Some things could be argued as impossible to safeguard. One of these for example is whether a patient is psychologically sound in mind to make the decision.

This expresses one of most difficult problems that doctors face when having to make these decisions. It also brings us more questions about ethics, not only involving the patient but also the doctor involved in action. Many people have argued that it is not morally right to ask a doctor to make a decision on the patient’s state of mind and then having to perform the action of actively killing someone.  When deciding if someone is “in their right mind” we refer to this as deciding if a patient “has capacity” to make a decision. We do this all the time – for example if they have capacity to make the decision about whether they can discharge themselves from hospital against medical advice, to choose which kind of treatment they have, to consent to an operation. However, in more difficult situations we seek advice from legal professionals. This I believe is what happens in Dignitas – the most obvious example of physician-assisted suicide – in all cases.’

Other factors involve why the patient has chosen to make this decision. There have been cases when the patient has chosen to end their life prematurely because they no longer want to feel like a burden to their family or to society. Some doctors have stated that they do not feel comfortable to make such a decision on a patient’s behalf. There has also been plenty of debates regarding whether it is possible to have enough safeguards put in place in order to ensure the vulnerable are protected and the healthy are allowed this right if they choose whether they would like to die. ‘There are a number of legal safeguards against this, again used by Dignitas which would translate over here should this ever become part of UK practice. However, these concerns may well be the ones which prevent this from ever becoming a reality in the UK. There are also a number of safeguards used in other countries where assisted dying is legal, including supreme court legislation. A minimum would include medical assessment by two healthcare professionals with an appropriate diagnosis, a period of time for consideration, legal assessment of capacity to make this decision, and assessment to ensure no coercion is occurring.’

As it is a doctor’s duty to treat a patient in their best interest, it could be argued as to avoid physical pain and a manifestation of suffering to the patient there is a need for assisted dying to prevent the prolonging of someone’s suffering. In response to this Dr King said, ‘This is the crux of the debate. As I mentioned in one of the previous questions, the debate is whether the relief of pain and/or suffering given by assisted dying, and the respect it gives patient autonomy is worth the risk to the reputation of the medical practice, the need for strict safeguarding, and the harm caused by causing a patient to die.’

 

Amanda and Steve’s experience (not written in full yet)

Not the full interview, I have more quotes that are recorded but I want to go back for a second interview and get more detailed answers to the questions I asked as the first interview was very emotional and hard to talk about as it was the first time she had properly spoken about the subject since Steve passed away. I have a second interview set up for 2nd February and will hopefully be talking to both sons, Max and Josh.

 

Amanda and Steve’s story is one that shares similarities with many cases when euthanasia is talked about as an option. Steve was diagnosed with Motor Neuron disease in November 2013 And passed away on 28th January 2018. Although Amanda and Steve’s case shared plenty of similarities with other cases there is it has been called a special case as Steve wanted to have an assisted death as soon as his sympathies got bad. Steve was always insisted that he wanted an assisted death but kept his spirit high for his family.

 

‘He worked up to the end, sure he had to have someone help him but he made sure he wouldn’t leave us with any financial problems after he was gone. That was the kind of person he was, he never thought of himself. At the beginning it was so hard for him to open up ad accept help, and even when he couldn’t do anything himself he made sure he wasn’t being a burden to anyone. It was so painful to watch the person you love most in the world completely loose control of all the basic bodily functions and still not ask for help. We did try once to get him to Switzerland and try and end his life but this was in the later stages of his illness and it was too difficult due to the fact he couldn’t even go to the bathroom without needing assistance.’

 

Linsey’s experience (not written in full yet and awaiting a second interview)

Linsey Lonsborogh Husband also died of Motor Neuron Disease in 2016. Linsey has a rather different experience to Amanda as her husband didn’t want to end his life prematurely but still didn’t want to prolong his life as by the end he was paralyzed from the neck down. Linsey met her husband when he had already been diagnosed with MND however his symptoms didn’t start to show until the last 3 years of his life as he has had the disease for 4 years previous. Linsey is not one of the chairmen for the charity dignity in dying and has also become a trained career for MND patients and was the main career for Steve for 3 years before he passed away.  She has since cared for a patent who did manage to have an assisted suicide.

‘the difference between mine and Manda’s experience is that tony didn’t want to die, he wanted to life comfortably for as long as he could. The first time I meet Steve he made it clear that he wanted to die from the beginning, he made it clear to both us as careers and to his family in case the option for a passive euthanasia arose and he was unable to communicate to us what he wished.’

 

Jules Mackay- close friend of Amanda and Steve

‘Forming a friendship over the years is a deeply fulfilling and personally joyous to us. Richard and I had that bond and friendship with Steve and Amanda. The years of knowing about his illness and progressively getting to a point where he wanted to end his life was for us both raw, staggeringly emotional and sometimes honestly too much to bear. That considered knowing what they as couple were going through utterly devastating seeing it happen in front of you. We discussed options of trying to start the process of hoping to get Steve to Dignitas. Conversations were had and they looked into all the necessary ways you have to do this. It seemed impossible. We thought we could drive Steve there in our van. Sort out the appropriate and necessary safety precautions for doing this. The time it would take. His emotional and physical needs. It was beyond overwhelming. I had watched a TV documentary about a man who had MND and successfully went to Dignitas and ended his life very early on in the disease. At the time I remember thinking that he had done this so early. I now without doubt understand why he did that. To be able to take control of your own life. Your choice. Your decision; is one of the most powerful things a human being can do for themselves and should be allowed too in this country. I believe in the right to choose, the right to die. Steve never got there. I wish he had had his wish.’

 

 

To-do

  • Find someone who doesn’t believe euthanasia is in the best interests for the patient to have a counter argument
  • Speak to someone who has any issues due to the religious orientation
  • second interview with Amanda and hopefully her 2 sons, 2nd February
  • Find appropriate photos to fit each section of my article

 

Sources

Amanda Hornby

Samual King, LEEDS TEACHING HOSPITALS NHS TRUST

Linsey Lonsborough, dignity in dying

Jules Mackay, close friend of Amanda and Steve

  • A Right to Assist? Assisted Dying and the Interim Policy

Ben Livings*

  • Neither euthanasia nor suicide, but rather assisted death

Robert D Goldney

Binns
maddiehope@hotmail.co.uk