Living With Dignity

From time to time, I’ll feature pieces by great guest writers. If you’ve something you’d love to see up here, drop me a note.

This week’s writer has asked to remain anonymous.


Yesterday evening I watched actor Chis Larner tell an honest tale of his journey bringing his ex-wife to the Dignitas clinic in Switzerland to commit physician-assisted suicide. She was in her 60s suffering from late stages of multiple sclerosis, leaving her with limbs almost completely non-functional, doubly incontinent, in constant pain, fatigued after a 15-minute conversation and consequently housebound. However, her mind was fully functional, and she was destined to continued deterioration for the next decade at least. In her words, “I don’t want to die. But I don’t want to live, not like this.”

[Dignitas](www.dignitas.ch) is a Swiss charity which has assisted over a thousand suicides since it was founded by a Swiss lawyer in 1998. As I have learnt from the monologue, requires a mountain of medical and legal admin, passing a strict selection process and about £7500 to die. A cupful of liquid pentobarbital causes one to fall asleep and heart to stop within 30 minutes. Over the years, it has has seen the flourishing of ‘suicide tourism’, where people from all over the world travel to kill themselves.

In this note, I’d like to propose a controversial perspective that end-of-life clinics should be an integral part of a healthcare system. I can’t imagine this ever happening, at least not in my lifetime, but it could at least make for an interesting discussion.

 1. Living with Dignity

I have often been told by people that they want to ‘die with dignity’. House, M.D. firmly refutes: “Our bodies break down, sometimes when we’re 90, sometimes before we’re even born, but it always happens and there’s never any dignity in it… it’s always ugly, always! You can live with dignity, we can’t die with it.” I see where he’s coming from, after all even in everyone’s ‘dream death’ (in their sleep at a ripe old age), physiologically the final process is ultimately some sort of suffocation, which is by no means dignified. In any case, falling asleep and dying from a lethal drug seems a bit more dignified than driving an electric wheelchair into a lake/off a building or starving oneself to death (or however else a disabled person can commit suicide). But even if we accept that death is universally undignified, then the question rests on life - whether it is dignified or not. This line should not be drawn by lawyers or medical ethics commissions, but rather by the individual. An undignified life to one might not be so for another and vice versa. If one believe that they are living without the level of dignity they desire, then perhaps death becomes the logical and even kind option. So no, I don’t really care about dying with dignity, but I don’t want to live without it.

 2. Anyone can commit suicide (if physically able)

The argument is strongest not for people who are in vegetative states or who are suicidal secondary to mental illness, but for the individual who is fully conscious of their condition sentenced to deterioration over many years. Generally neurological, these conditions are not immediately life-threatening but impairs functioning which renders them physically unable to commit suicide. For them, having a heart attack would be a reprieve. Suicide is lawful in the UK, and although illegal in Singapore apparently this law is rarely enforced (much like Penal Code 377A). So if happy healthy me or the depressed drunk has every right to throw our body under a train, why should those with multiple sclerosis, motor neurone disease, dementia etc (who have more reason to do so) have any less right to end their life? With suicide tourism, there exists an option, but only if one can afford it.

 3. Is the “best interest” always to stay alive?

As a future medical professional, of course I believe in doing no harm, and want to act in my patient’s best interests. I would do everything within my power to ensure the utmost health of my patient, defined by the WHO as a state of complete physical, mental and social well-being (and not merely the absence of disease or infirmity). Chris Larner’s performance portrayed carers and doctors as obstacles who they had to hide their plans from lest she get ‘captured’ by social services and sent to a nursing home for the rest of her years. To be honest, I can’t think of anything worse for a sound-minded patient. If everything within my power was not sufficient for my patient to live with the dignity he or she so desires, then all I would be doing is helping/forcing them live a horrible life. Perhaps what the patient truly desires may just be in the patient’s best interests, and also within the power of my profession to help with.

 4. The End-of-Life Clinic as a complement to healthcare services

It is not uncommon for countries to legalize what is deemed at ‘undesirable behavior’ in order to control it. The Netherlands legalizes cannabis and sees a lower use in young adults than in the UK, and a below-average level of problem drug use. Singapore legalizes prostitution to subject sex workers to frequent health checks. Is it preposterous to suggest an end-of-life clinic for people who express a wish to die? Drawn by the prospect of an assisted painless death, access to such services can provide people with a place to talk about issues of life and death. 70% of those who become members of Dignitas (required to complete the act) never take action, but they relish in the comfort of it just being an option. 13% of those who submit an application to be approved actually complete the process. Such figures suggest such clinics can be useful in helping in a pro-life manner, such as psychological assessments and referral to social services or palliative care. And only if these attempts fail, then to help them in the other direction.

Would such a service increase or reduce suicide rates? I’m not sure. But it would provide people who can’t afford to fly to Switzerland with the right to choose. It enables people who wish to die to do so in the comfort of their home country amongst friends and family and not have to carry it out in a covert fashion in a foreign country. It opens up the opportunity for death to be a celebration of life, where one can say farewell to loved ones and even plan their funeral if they so desire.

From the age of 5, I have wanted to dedicate my life to the naive cause of helping others. If I have such a condition which deprives me of the ability to do so, removes the control over my body or mind, and even worse, if it causes continued pain and suffering of those around me, I would like to consider Dignitas. And if a loved one unfortunate enough to be in such a position asked me accompany them to Dignitas, I would. But it would be nice not to have to fear for my medical licence, and not to travel so far away from home to do so.

I admit the pro-choice view is fraught with emotion & subjectivity. Many arguments against legalizing physician-assisted suicide are legal or religious, which I don’t claim to understand, so comments are very much welcome!

 
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