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This is a subject that is often in the news. Over the last two weeks the Tony Nicklinson case has been extensively reported and Channel 4 had a programme ‘Let our Dad die’. Lord Falconer, the campaign group Dignity in Dying and the all-parliamentary group Choice at the End of Life are behind plans to table a members’ bill and issued proposals for discussion last week.

 

Tony Nicklinson is a man with ‘locked in syndrome ‘who wishes to die and took his case to the high court. He is asking for ‘physician assisted suicide’ as due to his condition the only way he can commit suicide is to refuse food and water and this he argues would lead to a slow, painful death. 

 

‘What is ‘locked in syndrome’? Mr Nicklinson is unable to make any movements except for blinking after a massive stroke. His mind is active and he communicates by looking at a letter board and blinking and his wife interprets the blinks for letters. It takes him a long time to communicate a single word, he suffers from painful spasms and he says he has no dignity as he needs help to empty his bladder and bowels.  He is not arguing for euthanasia to be available to all – he is asking that judges assess cases each on their own merit.

 

Arguments against assisted suicide;

  1. ‘Thou shalt not kill’ is one of the oldest moral commands.
  2. Those that are infirm may be pressurised to die or made to feel selfish or a burden if there was this option.
  3. Slippery slope arguments. The ‘slippery slope’ argument holds that if assisted suicide was practised for people like Mr Nicklinson then it would become acceptable to allow it for less clear cut cases and eventually you may end up with a situation as in Nazi Germany where those deemed to be defective were killed.
  4. With good pain control and counselling, suffering will be minimised.

 

Arguments for assisted suicide: 

  1. The person’s right to autonomy, control over his or her life, should mean that if this is their wish it should be respected.
  2. Some, such as Debbie Purdy who has multiple sclerosis, have argued that if her husband faced prosecution for helping her to commit suicide she would travel to Dignitas earlier while she could do so alone. However if the law permitted her to have help she would delay dying. 
  3. Even with the best palliative care [treatment of the dying] suffering and pain are common. Dr Ann McPherson, who set up the charity and website ‘Teenage Health Freak’, supported a change in the law on assisted dying, died recently from pancreatic cancer. Her daughter wrote in the BMJ ‘our mum died slowly and in pain. …The law needs to change to allow terminally ill but mentally competent people the right to a more dignified death than my mum’.
  4. There was a vote last week by campaigners to change the BMA s stance on assisted dying from against to neutral. It failed.  

For a more detailed discussion of this subject read p83-88 in my book Medical School Interviews. All You Need to Know. The Knowledge 

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