The Tony Nicklinson case - where now?

[silverfox]

A very sad case that raises very serious questions about where we, as a society, wish to go.

He lost his High Court battle to allow doctors to end his life without risk of prosecution - rightly in my opinion.

Why rightly? Because there was nothing stopping him and his family going to Switzerland if he felt the time was right.

It would appear Tony committed suicide, dying from pneumonia at home with his family on August 22, after refusing food, fluid and antibiotics (although the timing of his demise after the court's decision rather undermined his case in my opinion).

The film 'Soylent Green' featured suicide on demand by the individual. Tony's case also has relatives who urged a change in the law for his release, for merciful reasons.

What troubles me is the proposal that relatives should be involved, as any lawyer who deals with wills and estates of the deceased could tell you.

[DJKillaQueen]

Yes that's a concern but it also concerns me that we leave people to die slow and painful deaths who would rather have a quick and painless ending.

As for taking a trip to switzerland, not a cheap option for the disabled and I think he wanted to die at home, not in some strange swiss clinic. I totally get the motive behind his protest. We talk all the time about dignity but yet deny dignity to those living with terminal illness or overwhelming disability. As any one having to care for someone in those conditions knows, it can be a painfully depressing existance for some of those afflicted.

Yes the line between willing euthansia and murder has to be guarded but doctors already do overdose patients who are hours from death, out of humanity.

[Jeremy]

I'm firmly in the "pro" camp.

Having to travel to Switzerland, as well as being expensive, will probably necessitate the involvement of the family for most patients. I believe it the such a service should be available locally, and on the NHS.

[LondonMix]

I am in the pro camp as well. I agree medical staff need to be involved.

[Marmora Man]

I am in the pro camp too. My family know that if I'm terminally ill and in pain I will want to go painless and at a time of my choosing. Also that if I am so unfortunate as to experience "locked in" syndrome I will again want to switch off and die quickly, quietly and painlessly

I have made a living will to this effect but, regrettably, although' it makes clear my wishes I does not, because of the current legal environment, make it legal for my family to assist me in achieving my wishes if I am, for whatever reason, unable to do so. This is both illogical and repressive.

It also fails to recognise the nature of our current lives. Science, research and medical care now make it very probable that the majority will survive into late old age, but living with increasing infirmity. This Faustian pact leads to increasing indignity, pain and despair for many many people. To plan ahead and agree a way out of this situation seems to be to be the responsible course of action and should be allowed, with appropriate safeguards, under the law.

[Loz]

I am in the pro camp, but recognise that a lot of checks need to be incorporated to ensure that people aren't being guilt-tripped into suicide by relatives with dodgy motives.

[DJKillaQueen]

'Science, research and medical care now make it very probable that the majority will survive into late old age, but living with increasing infirmity. This Faustian pact leads to increasing indignity, pain and despair for many many people.'

This comment is absolutely true and poignant. And it also the reason why conditions like dementia are now more prevalent. There's something illogical to me about keeping people alive long enough to only then have a miserable demise.

[dulwichgirl2]

Agree with Loz bu do not see the checks and balances working well enough unfortunately.

What would they be, anyway? The infirm person prevailed upon by others will sign something to the effect he is acting without external influence.

[Burbage]

dulwichgirl2 Wrote:

-------------------------------------------------------

> Agree with Loz bu do not see the checks and

> balances working well enough unfortunately.

> What would they be, anyway?

The easiest way to look at this is as a disability-rights issue. Suicide is legal, and we cope happily enough without any checks and balances against the able-bodied from taking their own lives. The proposed changes to the law merely permit assistance to be provided to the incapacitated in the commission of a legal act. In nearly every other area, the provision of such assistance would be a legal obligation.

There is no way to ensure that the actions of others don't provoke suicide. In fact, it's highly likely that all our legal suicides are prompted by the actions of others. However much, as a society, we might wish to force people to carry on living in a world they hate, among people they hate, or in mental or bodily torment, we can't stop them opting out. Except, happily, when they're held captive by disease, in which case we've got a handy law.

If we change that law, then there will be the possibility that the incapacitated might be pressured into requesting death. But that's why advance directives exist, and they should be essential if the assistance of doctors is required. Not that, if the Daily Mail is right, it would make much difference. Where the assistance of doctors isn't required (and dying at home is, according to our politicians, the dearest wish of everyone), things are probably a bit different. But it's not polite to talk about that.

[DJKillaQueen]

Good post Burbage, and you hit on a point not really talked about, and that is of course the depression and mental suffering of those trapped by their condition. It is that which leads to the request for assisted suicide and it's ironic in some respects because of all the reasons offered for suicide, it is perhaps the easiest and most straightforward to understand.

When an able bodied person commits suicide, we constantly see blatent examples of the level of poor understanding of depression that the press, authorities and general public have in this country. Many times we see along with the reporting of a suicide, a list of all the things a person had, family, good job, etc or alternately things they didn't have, financial problems (so not enough money) or bereavement etc. We seek explanations outside of the mental health of the person when any explanation can only be found within the mental chemistry and the thoughts of the person themself. External experiences or environments can be a trigger for mental health issues, but often are not. In this light, what chance have the disabled got of being understood too?

We know people react differently to a similar set of situations and yet many still can't understand that in the minds of some people, an unbearably painful and negative storm is brewing. And many people confuse having known a sufferer of depression or even sadly a suicide victim for having an understanding of depression too. Association is not the same as understanding. I've seen ignorance on this issue from most non sufferers I've ever discussed it with, irregardless of whether they know sufferers themselves.

In other words, it is ignorance that is currently shaping the general view on depression. The Tony Nicklinson case is only the tip of the iceberg. The real issue I feel is that there needs to be a complete overhual of the attitude towards those who suffer from mental health issues and it needs to start from the top. We are very good at making people cancer aware and encouraging them to have preventative check ups. We need to take away the stigma of mental health by making people equally able to seek help if they feel they need it, and for that experience to always be a positive one. However, given the current governments dismissal of mental health issues as even being a disability (as seen through the current welfare reform re-assessments) I don't expect any movement forward any time soon. The same process is displaying a pretty poor attitude towards physical disability too.

To follow from Burbage's point that it is a disability rights issue. I wholeheartedly agree, and as with all rights issues, the people best qualfied to know what they need and what will work best for them are those affected directly. They need to be listened to.

[silverfox]

...a point not really talked about, and that is of course the depression and mental suffering of those trapped by their condition...it is a disability rights issue...

Tell that to the Paralympians.

There's too much patronising loose talk about 'quality of life' etc, including from the new health minister Anna Soubry.

If a person gets to the stage they wish to end his/her life, why should others be dragged into it to share 'the experience'?

Isn't it strange how after a protracted legal case to try to change the law to help him with assisted suicide, Tony Nicklinson died, through his own choice/action/inaction, within two weeks of losing his court case?

[DJKillaQueen]

See that's exactly what I mean about ignorant dismissal of mental health issues. Depression is not limited to some disabled people. It debilitates a heck of a lot of people without physical disability too. If you'd ever suffered from clinical depression SF you'd never have written such a dimissive comment.

Tony Nickleson went to court becuase he wanted a humane and painless death. Seeking a judgement or change in law would have helped other people in that situation too. Instead he died a slow and painful death....because starvation is just that....... If you can't see that SF then you are truly without feelings.

[LondonMix]

Yes DJ, but when someone has suicidal thoughts (able-bodied or not) we as a society as a first step try to treat the depression if that's the root cause. As depression is a chemical imbalance often unrelated to the specific situation someone is living in, I think Silverfox is just showing that the position is a bit hypocritical. Clearly both the able-bodied and the disabled can lead fulfilling lives or be depressed and we should opt for treatment of a mental imbalance (if that's what we are dealing with) for everyone as suicidal thoughts at times can respond to treatment.

I am in the pro-camp for assisted suicide but in terms of checks and balances clearly ensuring that the suicide is the wish of the person doing it is essential.

[DJKillaQueen]

I agree that there are treatments for depression. Many of them are not cures though.

However, we also have to consider that in Tony's case, he was suffering a condition that completely trapped him in his body, with no hope of ever being free of that. I don't personally think any anti-depressant treatment was ever going to make much difference in his case. The depression that some with debilitating conditions suffer from is the result of their condition.

I agree that we as a society should only ever allow assisted suicide as a last resort, after all other options have been explored and efforts made to take away the need for that. Sadly though, mental health resources are underfunded in the UK and the level of help many sufferers need just isn't available unless they can pay for it. We rely too heavily on medication, which isn't a cure, and not enough on stategies designed to help a sufferer better manage and cope with depression. And then there is the stigma associated with depression in the wider world, from employment down to social stigma.

[Huguenot]

The problem here doesn't appear to be whether or not Tony Nicklinson deserved to get his freedom, but more about framing the legislation to allow it without creating a vast catalogue of unintended consequences.

The judges were at pains to point out that the problem was with legislation and not the courts, likewise MPs are recognising that 'something needs to be done', but are struggling with the somewhat intractable challenge of detailing vague moral convictions into the blunt instrument of the law books.

Regarding the concerns about how we as a society treat mental illness, I can see the point. However, I do think there needs to be a point at which central government has to curtail and account for expenditure.

The problem with mental illness is that although many of us can recognise it, it often lacks the quantitative and arithmetic elements that make it practical for a central government approach.

Pleas for expenditure to be increased in this area are rarely accompanied by requests for it to be curtailed in another area - and so are just another example of an ideological desire to set yet more power and authority given to the state.

I don't agree.

Many mental health issues are to do with social cohesion. The reality is that if we are creating broken families and deserted old folks who fall into depression, that is a matter for society not the state.

[LondonMix]

DJ, good post and while I am in the pro-assisted suicide camp I think what you say highlights how tricky it all is. Given that we try to generally treat suicidal thoughts, when can we say someone's life 'objectively' becomes not worth living and so their desire to end their life isn't symptomatic of a mental imbalance but rather is a 'rational' request? With trapped in syndrome, most of us can agree though I'm sure there are people with this illness who want to live. Where do we draw a bright red-line and what are we saying to people with various illnesses and disabilities about how we as a society view their lives? I'd hate to be a judge!

Before anyone could request assisted suicide, we probably would need to allow them time to adjust to their new circumstances and offer mental health and support group services for a period of time to them and their families before giving the green light...

Hueg- I couldn't agree more that fragmentation of traditional family and social structures is leading higher rates of isolation and depression- not just amongst the elderly...

[DJKillaQueen]

Yes it is complex, which is why it is right that these issues/ requests are dealt with case by case. I think the law could accomodate that approach though.

H...you make some valid pioints. Where I'd disagree with you though is in things like the provision of counselling by the NHS. Currently it is not avaialable when patients need it most (waiting lists of on average six months) and it's rationed to 12 or 24 sessions. That's one example of how treatment that really can work in some cases just isn't funded enough. However, we think nothing of funding a bottomless pit of anti-depressants.

Where I do agree with you though is where lack of social cohesion plays a role, and I would include the level of social ignorance in that equation too. The former is hard to do something about, but the latter is just a question of education surely. My view is that if the general public, employers and so on, had better attitudes to and understanding of mental health issues, it would make things easier for those who suffer from them.

[Huguenot]

I think you've highlighted the problem - one to one sessions with experienced professionals is an incredibly expensive process. If it's 'only' 24 sessions, presumably you're implying that longer may be more appropriate?

Throw in that the symptoms are difficult to identify and frequently based on subjective scoring mechanisms, that success is also vaguely defined, if at all, and that treatment may be endless....

It goes out the window.

Government sponsored healthcare can't possibly be run on such vague ambition. It's not fit for purpose.

The NHS already spends 13% of it's expenditure on mental health, yet campaigners say this only treats 25% of those that need funding - that means they want this spend to increase to the equivalent of 52% of budget (or in practice a 40% increase in the overall NHS budget since nothing else is proposed for cutting).

Since the NHS is a quarter of government spending in it's own right, then you're talking massive increases in income tax and VAT to pay for treatment for people we're not sure are ill, not sure they're being treated correctly, and not sure when they have been 'cured'.

As with the welfare state and pensions, the NHS was created when contemporary modern challenges had never been dreamed of and never budgeted for, and curing depressed women wasn't far from an era of genital massage.

The NHS is NOT there to replace family networks and support, nor provide a fall back from the travails of the modern world. GPs are not there to provide companionship to OAPs deserted by their families. That is a solution we have to find for ourselves, and is an unpaid social responsibility for every one of us.

At some point we have to step back and ask ourselves what we're actually prepared to do with these systems, and it's likely to involve cutting the provision, not extending it.

Like the welfare state and pensions, it's likely that these systems must become nothing more than a safety net for the very lowest, not a comprehensive service for the nation.

[DJKillaQueen]

But the NHS is a bit different. It's there to treat illness....or do we start to say it should only treat those with life threatening conditions? And we all pay into it.

Of course I agree there isn't a bottomless pit of money to spend on these things....and hard decisions have to be made along the way. But that is also why in many conversations and debates (esp around resources and money) I come back to the importance of community, and how we all have a responsibility to help our immediate communities to be supportive and cohesive ones. You would agree with me I think when I say that in this country, far too many people are for themselves only, give little to anyone or anything, and expect the authorities to sort the rest (without wanting to pay for the cost of it all of course).