Oct 28, 2012

On whose terms should we die?

Daniel O’Reilly

Staff Writer

Imagine a world where you are in constant pain, one in which every movement causes you discomfort and the activities you previously loved are impossible to either do or enjoy due to an incredibly debilitating illness. Would you consider taking your own life? What if you were told if you did a loved one may be prosecuted? This is the situation facing Marie Fleming, a long time sufferer of multiple sclerosis, who is challenging Irish law on assisted suicide in the hope that she will be able to die on her own terms. This follows from a similar case in Britain where Tony Nicklinson, a man who suffered from ‘Locked-In Syndrome’ following a stroke, took a case to the high court in Britain in an attempt to avail of physician assisted suicide. When this bid failed he began to refuse food and died of pneumonia shortly afterwards. At what point does someone’s pain become so substantial that they wish to cease living? What other options are available for the terminally ill? One option could be to go to a Hospice Cleveland where they will be looked after extremely well.

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There are a huge number of considerations to take into account when looking at a topic as varied and controversial as assisted suicide. Subjective measures of the necessity of euthanasia seem like the most humane and obvious choice: if someone has a chronic illness and feel that they can no longer live with it then they should simply be allowed to end their own life. However, this is possibly too broad a definition. The anxiety and stress of living with a chronic disease can cause mental health problems which may make someone develop suicidal thoughts despite the possibility that their life could be fulfilled with appropriate help from medical professionals. Is it too much to ask of a loved one or a doctor to help someone die? The repercussions on an individual who has assisted someone in killing themselves could surely be monumental and how do we protect those brave enough to help a loved one in there time of most dire need? The grieving process is complex and often drawn out and even in normal circumstances, it also often contains elements of self-blame – ’could I have done anything to stop this from happening?’. How much worse could these sentiments be if you are in fact directly responsible for that person’s death even if you were acting in a way which you believed was the best course of action?

The various models for assisted suicide also differ in countries where it has been legalised. In Switzerland, the law allows for a loved one or medical practitioner to assist someone’s passing provided that it is an altruistic act and they do not profit or have any other motive for wanting the person dead. The Netherlands on the other hand requires the assistant to be medically trained and acting within the realms of due care, providing reasonable alternatives and only acting if a case is considered hopeless and terminal. The advantages of these models are that they allow the person to choose their time to die and gather family and friends to be around them at their time of passing and allowing them to die in a state that they wish to be remembered or believe will put their family’s mind at ease. Possibly the biggest disadvantage of a very liberal model (such as the Swiss model) is that its terms mean almost anyone can justify their choice in ending their own lives even in situations where they are not terminally ill or dying.

The late Tony Nicklinson, one of the most notable Euthanasia activists.

The late Tony Nicklinson, one of the most notable Euthanasia activists.

In the past, when someone suffered from a serious illness they were simply allowed to pass away in their home in peace but increasingly in the modern era people are put into cycles of futile care where they are maintained by artificial ventilation and kept heavily sedated. This often leads to an unpleasant memory of one’s loved one living their last hours breathing through a machine and hooked up to all manner of monitoring devices. This has perhaps precipitated people’s fear of death that is out of their control and left in the hands of doctors who perhaps do not wish to admit defeat. Assisted suicide is often an effective way of deciding when you go, on your own terms and without having to be kept alive or in a state of quasi-life for your friends and family to say goodbye.

Other options are available for the terminally ill, which are often ignored in the euthanasia debate. Palliative care has evolved from comforting words and a large dose of painkillers into a truly holistic discipline and often paradoxically leading to an extension of life beyond the initial prognosis. People are free to engage with family and friends in settings which suit them (be that at home or at a dedicated hospital) and pass away in a dignified manner.

We live in a society that values choice. We choose our careers, our partners and almost every aspect of our lives. It is then a strange situation that we are ultimately unable to choose the nature of our deaths beyond a small number of options. As the Tony Nicklinson and Marie Fleming cases reach their conclusions in the media and the courts, we may have to reassess this strange paradox and address how we ourselves want to die, on our own terms or on the terms of our final illness?

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