Assisted Dying

[[XAP]Bob]

Having watched my mum and dad both die a painful death I fervently hope I don't go the same way.
Assisted dying is something that needs to be freely discussed without particular bias especially from religeous groups.
If it beomes legal then of course there will be some abuse but I see this as no more likely than a doctor or nurse deciding to kill a patient. Murderer in the medical profession is rare and I'd expect the same from assisted dying

Really?

There are ~200k abortion in E&W each year:

196,083 (97.7%) – risk of injury to physical or mental health of the pregnant woman;
3,269 (1.6%) – substantial risk of serious physical or mental abnormality in the unborn child;
1,104 (0.6%) – risk of injury to physical or mental health of any existing children of the family of the pregnant woman;
145 – risk to life or to prevent grave permanent injury (non-emergency);
7 – risk to life or to prevent grave permanent injury (emergency).

Reference (PDF)

That 97.7% is limited to the first 24 weeks (and I know people who were *born* at 24 weeks), but is rather woolly in terms of what constitutes injury (it doesn't need to be grave, nor long lasting). Is being upset that you can't have a drink at the pub mental injury?

In many ways more concerning is that "39% of women undergoing abortions had had one or more previous abortions" (same source).

Given the reliability and availability of contraception it's hard to avoid the conclusion that abortion is being treated as a form of contraceptive by some - assisted by the medical profession.



Personally I really struggle with the NHS simultaneously providing IVF and abortion* services (particularly when some of those abortion services are to "selectively reduce" the number of foetuses implanted by IVF).

I can also see significant pressure being applied to vulnerable members of society - and the current defunding of social care isn't going to make that any less likely.
That is where I would be most concerned about changes to the current legislation, and those protections really do need baking in properly (potentially requiring a living will from a time when the person was of sound mind).


* I have no issue with abortion where there is a substantial risk of grave long lasting injury or death, but that is a tiny percentage of abortions in the UK.

[Carlton green]

That’s not to say that the current situation is good but rather that, in the round, changes could make end of life care worse.

A breakdown of doctors' views by speciality is in the BMA paper linked upthread. That includes those working in end of life care and palliative care.

Jonathan

Thank you for the link, it’s an interesting document.

As far as I can see the best way forward is the review and monitoring of best practice and social trends in other countries.

[Jdsk]

As far as I can see the best way forward is the review and monitoring of best practice and social trends in other countries.

Wise words.

And open discussion very rarely hurts development of any policy.

Jonathan

[Carlton green]

There are ~200k abortion in E&W each year:

In many ways more concerning is that "39% of women undergoing abortions had had one or more previous abortions" (same source).

Given the reliability and availability of contraception it's hard to avoid the conclusion that abortion is being treated as a form of contraceptive by some - assisted by the medical profession.

I can also see significant pressure being applied to vulnerable members of society - and the current defunding of social care isn't going to make that any less likely.
That is where I would be most concerned about changes to the current legislation, and those protections really do need baking in properly (potentially requiring a living will from a time when the person was of sound mind).

200K sounds a lot but I really wonder what it is in percentage terms of sexually active women.
https://www.ons.gov.uk/peoplepopulation ... nestimates
https://yougov.co.uk/topics/relationshi ... ons-having
I’ll let some else do the maths and make an estimate.

To my knowledge I know two women who have had terminations, both the pregnancies were unintended and both women were middle-aged and responsible types.

Contraception failure happens and contraception should not be thought 100% reliable. Of course we do put massive amounts of trust in contraception and it has transformed lives for the better, but there’s always some risk(s) with it.

Repeated terminations does imply incompetence or lack of care, but I wouldn’t like to judge others.

I too see - or rather fear - significant pressure being applied to the vulnerable.

[Psamathe]

I find it very difficult to reconcile that I agree with the principle of assisted dying yet also see big risks to safeguards being abused (in a limited number of cases). In the UK our politicians seem very poor at creating legislation to achieve its aims which is compounded by a failure to police/enforce (probably because the costs and payback on enforcement does not create enough profit).

There are a range of circumstances some of which are probably more straightforward (e.g. chronic pain with deteriorating prognosis) but other situations where decisions become the responsibility of others (e.g. dementia). e.g. in the case of dementia the individual may change their previously documented advance decision and even though they are clear in their mind about their new choice, their deterioration means it cannot be legally used. In the case of my father, he was diagnosed with vascular dementia and deteriorating and lawyers wanted his will changed (apparently it used needless complex (and expensive) mechanisms, no changes to who inherited what) but this could not be done as, although he did understand and was happy about the changes, that he was diagnosed and unclear about other things meant change was not possible (on legal advice). Not a massive issue but it highlighted to me the window in life where you might change your mind but changing prior decisions is no longer possible.

Ian

[DaveReading]

Other than the fact that they are both difficult moral/ethical issues, I don't think that drawing parallels between assisted dying and abortion is in the slightest bit helpful.

[thirdcrank]

It's just sixty years since committing suicide was made no longer a crime. Obviously, successful attempts were always beyond earthly jurisdiction, but survivors were sometimes charged with the attempt.

https://www.legislation.gov.uk/ukpga/Eliz2/9-10/60

https://www.bbc.co.uk/news/magazine-14374296

It's arguable that decriminalising assisting suicide is only progress along the same enlightened path.

I'm not so sure about "living wills." To some extent they exist already in the form of lasting powers of attorney (linked higher up) but they can only have limited application because nobody can predict the future, even less control it. So, nobody can declare that they are unwilling to die and thus achieve immortality. IMO, the best you can do is make sure your attorney knows your wishes. eg If you have religious beliefs you want followed. All you can then expect is that they will interpret your wishes in the circumstances as they occur. eg Organ donation is something I'm OK with, although as I age and with the diseases of old age, nobody may want me broken for scrap anyway. However, I'd not trust the decision to switch me off to medics who might consider the lives of people waiting for organ donations more important than mine. So, I'd prefer my attorney to make the decision, based on what they were told.

===========================================

The parallel between abortion and ending the lives of people with dementia, is that with abortion, the safeguards were intended to restrict cases and in the event it did not happen like that. When I made the comparison, I tried to make clear I was making a difference between assisted suicide and the end-of-life of people with severe dementia. Assisted suicide implies to me that somebody retains the mental capacity to decide to end their own life but lacks the physical capacity to do so

[Jdsk]

Other than the fact that they are both difficult moral/ethical issues, I don't think that drawing parallels between assisted dying and abortion is in the slightest bit helpful.

I agree.

Jonathan

[thirdcrank]

Other than the fact that they are both difficult moral/ethical issues, I don't think that drawing parallels between assisted dying and abortion is in the slightest bit helpful.

I agree.

Jonathan

And fwiw I don't consider that definitive.

[[XAP]Bob]

200K sounds a lot but I really wonder what it is in percentage terms of sexually active women.
https://www.ons.gov.uk/peoplepopulation ... nestimates
https://yougov.co.uk/topics/relationshi ... ons-having
I’ll let some else do the maths and make an estimate.

200k is more than 100 times more than the count of deaths on the road, and 300 times more than the count of murders in the UK.

It represents ~four months of *all* deaths in the UK, or twice the death toll of those under 70.

It's over a fifth of all pregnancies.

It is a substantial number.


https://bmjopen.bmj.com/content/9/10/e030708
22% of women sexually inactive (12 months in natsal-3, 2010-2012)

Let's assume that 50% of the population is female, and that ~16-46 is a reasonable age range for "childbearing age" - that's 30 out of ~75 years (current life expectancy for women is 82) or 40% of the population - let's exclude kids actually and push it to 76 years so that we have 30 years of childbearing age and 30 of not - 50%.

So we have an "over 16" population of ~80% of the 65M population, with 50% of those being female, 22% being inactive and 50% of the remainder being of childbearing age.
So that's a pool of 3.5M active women.

It's further estimated that about one in seven couples is affected by infertility (https://www.nice.org.uk/guidance/qs73/d ... prevalence)%3A)

That pool is now 3M women.

https://www.youngpeopleshealth.org.uk/w ... apter5.pdf
Suggests that 16-24 year olds average a little over one sexual activity per week.

So that's ~150M activities per year, resulting in approximately 1M pregnancies.

Condoms (easy access, relatively low effectiveness) fail at about (again assuming 1/week) 0.04% - so maybe 60k condom failures (again assuming that every activity is using condoms - many will use more effective methods of contraception, and some proportion will be attempts to get pregnant.







That second link also suggests that the *average* age for first heterosexual intercourse is also the legal minimum... with 30% (survey was of 16-24 year olds) reporting sex before that age (roughly even between boys and girls). Which should be disturbing.

[[XAP]Bob]

Other than the fact that they are both difficult moral/ethical issues, I don't think that drawing parallels between assisted dying and abortion is in the slightest bit helpful.

I'm intrigued why not.
They are both issues involved with the ethics of deliberately doing harm.

They are both things that are being proposed as having "strong legal safeguards" - history shows us that said safeguards are usually taken from a point where only a few people are unhappy (grave and lasting harm) to the point where they may as well not exist.

[francovendee]

Other than the fact that they are both difficult moral/ethical issues, I don't think that drawing parallels between assisted dying and abortion is in the slightest bit helpful.

I'm intrigued why not.
They are both issues involved with the ethics of deliberately doing harm.

They are both things that are being proposed as having "strong legal safeguards" - history shows us that said safeguards are usually taken from a point where only a few people are unhappy (grave and lasting harm) to the point where they may as well not exist.

I suppose you have to look at 'harm' in all it's aspects. Harm to a parent who didn't want the baby against harm in prolonging someones pain and suffering.
It's not an easy choice unless you follow a religeon that condems it. You then do what the religeon dictates in public but travel to countries where it's not banned.

[Cowsham]

After my stint in hospital and seeing a few old guys suffer with no prospect of getting better. ( I was in much pain myself and needed a lot of help but at least I had a hope of a future) I'd really want to be put down peacefully even if I had to get it done when my quality of life was still relatively good.

[thirdcrank]

Just to make it clear, my comments did not imply any judgment about either abortion or assisted suicide. Just an observation how developments can occur over such issues.

[Psamathe]

After my stint in hospital and seeing a few old guys suffer with no prospect of getting better. ( I was in much pain myself and needed a lot of help but at least I had a hope of a future) I'd really want to be put down peacefully even if I had to get it done when my quality of life was still relatively good.

Taking my Dad into a care hime several years ago also made me reflect on my own life and prospects. Taking him was probably the worst thing I've had to do in my life - even though we (family without Dad) had visited quite a few homes and selected the best, dementia specialist, top of the range private, had him professionally assessed, etc.

But it did also make me reflect on how I will feel about life as I get older. I'm mid-60s now and not good at compromise and not yet seeing any slowing down in what I seek to achieve, no noticeable allowance for my age. I dread the prospect of care home ... and currently doubt I could cope.

Ian