Euthanasia

The statement is that patients with terminal anorexia nervosa deserve the same attendant care and rights as all other patients with terminal illness. The article studies three cases to elucidate this condition then proposes clinical characteristics for a terminal eating disorder: diagnosis of anorexia nervosa, older age (over 30), previous participation in high quality care, and clear and consistent determination by a patient who possesses decision-making capacity. What doors will be opened if “terminal” is redefined?

The bioethics writer Wesley J. Smith argues in the National Review “When psychiatrists give up on their mentally ill patients — and indeed, are allowed to help them commit suicide — who will defend the value and continued importance of their lives?”.

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An amendment to the Government’s Health and Care Bill sought to force the Government into drafting an assisted suicide bill within a year of the Health and Care Bill becoming law. The Association of Palliative Medicine (APM) has warned that the public is being “scared” into supporting assisted suicide through an excessive focus by the media on cases of suffering at end-of-life, This can lead to the perception that there is no hope and create the false choice between a painful, drawn-out and unnecessarily unpleasant death and assisted suicide or euthanasia. But this is not the case at all. Good palliative care is, or should be, an option for everyone at the end of life.

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Freud correlatively differentiates between three fundamental prohibitions, three universal taboos which form the basis of the conditions of existence of culture: the taboos of cannibalism, incest and murder. Since the dawn of human history, this triple prohibition separates the state of culture from the state of nature, writes Freud.

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It has been argued that the legalisation of medical assistance in dying would decrease or, at least, not have an effect on suicide rates. David Albert Jones, Director of the Anscombe Bioethics Centre in Oxford, published a study in The Journal of Ethics in Mental Health showing the opposite. In Switzerland, Luxembourg, the Netherlands, and Belgium there have been very steep rises in suicide compared with those of neighboring non-EAS states. In Switzerland suicide rates have approximately doubled from 1998 to 2017. The data from Europe is not reassuring: The non-assisted suicide rates have not declined relative to comparable non-EAS countries, whereas there have been very large increases in suicide (inclusive of assisted suicide) and intentional self-initiated death, especially among women.

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In France, the public debate about the legalisation of assisted suicide, is raging. In December 2021, psychiatrists published a study that reconsidered the role of psychiatrists in dealing with requests for medical aid in dying. The study was based on 127 articles obtained mostly from Pubmed and Cairn, from 1997 to 2020 in Switzerland, the Netherlands, Belgium, Luxemburg and Oregon. It emphasized that an in-depth visit with a psychiatrist should be provided in all cases, given that the most prevalent reasons for a request to die are “spirituality, attachment style, social isolation, despair, depression […]. Factors, such as a doctor’s qualifications, influence the psychiatric evaluation and can obscure the motivations that lead a person to request assisted suicide.

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In December 2021 Dignitas, a Swiss organisation that promotes “the right to die with dignity”, submitted a Preliminary Question of Constitution (PQC) countering the ban of pentobarbital in France. Pentoparbital is used in Switzerland and Belgium for assisted suicide. On 21 December 2021 the French Council rejected the proposal highlighting the risks of pentobarbital to public healthcare.

Dignitas prides itself on its role in having assisted suicide recognised by the German and Austrian constitutional courts; it attempted to archive this in France, but thus far failed. It’s website explicitly criticises France for its suicide prevention policy;  indicating the association’s ideology to strive to impose its deadly practices in foreign countries.

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Posner argued: People who have no immediate wish to die by suicide get reassurance from knowing that they can exercise the option of suicide at some point in the future. The study used data from ten US states that implemented an assisted suicide law up to the end of 2019. Assisted suicide laws increase overall suicide rates by about 18% and for women the increase is 40%. Assisted suicide results in an increase in unassisted suicides by about 6% and amongst women there is a 13% increase in unassisted suicides. Some argue that these results show assisted suicide empowers women to take control over end-of-life decisions. However, the alternative view is that they are disempowered and become more vulnerable to social pressures and therefore opt for suicide.

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Assisted suicide has been rejected in Connecticut for the tenth time, after a close vote by senators on the State General Assembly’s judiciary committee. The disability rights group Second Thoughts Connecticut and The Euthanasia Prevention Coalition USA strongly opposed the plans. They warned “offering suicide prevention to most people while offering suicide assistance to an ever-widening subset of disabled people is lethal disability discrimination”.

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Palliative care doctor, Suzanne Walter, and her patient, Diethelm Harck, started a court case to legalise euthanasia in South Africa. Walter was diagnosed with multiple myeloma in 2017, while Harck was diagnosed with motor neuron disease in 2013. Both wish to have the option to end their lives when they feel they cannot handle their illness any more. Due to their medical conditions, special arrangements were made in March for the evidence of Harck and Walter to be heard first via a commission headed by Judge Neels Claassen. Their application for an order directing the government to enact legislation which will allow for physician-assisted suicide and euthanasia, is due to proceed in the South Gauteng High Court for six weeks from May 3.

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Tom Koch, an ethicist and researcher, reviewed how things have evolved in the realm of euthanasia since its legalisation in Canada in 2016. Euthanasia has indeed shown to be a “slippery slope”. The eligibility criteria for euthanasia have broadened considerably resulting in a steady increase in the number of people opting for euthanasia. Between 2016 and 2020 the number of reported cases of medical termination increased from 1018 to 7589. This is the very definition of a “slippery slope”. Eligibility criteria have loosened to such an extent that people who are simply afraid of possible future illnesses can choose to end their lives. The other finding which raises concern is that euthanasia appears to be a substitute for palliative care and other supportive services. It was shown that euthanasia is at times promoted especially to those who live in areas where expert care and support are difficult to access. It appears that those so in need are somehow not worthy of supportive care that would make their life worthwhile. The results of the Canadian 5 year review are a cause for concern rather than a recommendation for euthanasia.

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