Art Caplan on Switzerland's Decision that the Mentally Ill May Be Helped to Take Their Own Lives?

This is an incredibly momentous and controversial court decision by the highest court of Switzerland:

Switzerland already allows physician-assisted suicide for terminally ill patients under certain circumstances. The Federal Tribunal’s decision puts mental illnesses on the same level as physical ones.

“It must be recognized that an incurable, permanent, serious mental disorder can cause similar suffering as a physical (disorder), making life appear unbearable to the patient in the long term,” the ruling said.

Assisted suicide has always been linked to the challenge of allowing the terminally ill a choice in managing their inevitable death. That is the policy in the state of Oregon which has had legalized assisted suicide for the terminally ill for many years.

Linking the right to assistance in dying from physicians to the quality of someone's life or their suffering is an enormous and, in my view, very dangerous shift in thinking about assisted suicide.

IF this policy were to be put into place in Switzerland or elsewhere it would put physicians in the position of trying to distinguish 'competent' requests from persons with mental illness alleging emotional despair from 'incompetent' or 'temporarily desperate' persons with mental illness alleging emotional despair --something psychiatry and psychology are not always adept at doing.

Moreover, this policy opens the door to anyone who says they have unbearable psychological or emotional suffering to request help in dying--people with terrible burns, those who are severely disfigured, those who are emotionally bereft at the loss of a child, partner or loved one and even those suffering from career setbacks and failures.

I think the policy is both difficult to enforce and dangerous to apply since it is hard to see how it will not lead to a very slippery slope. Once assisted suicide is extended to those who claim or state that their quality of life is not worth living it puts medical professionals in the very difficult role of trying to figure out if such a claim is valid. It then puts them in the even more difficult role of trying to decide why it is their responsibility to alleviate the suffering, even the most miserable suffering, that people may face through the prescription of lethal doses of drugs.
-Art Caplan

A[nother] Poet on Right to Die

Hunter S. Thompson and Timothy Leary and, well, now that I think about it lots of writers and figures whose lives represented a "stand on independence" with regard to death and experience have long found ways to build death into a narrative long before it occurs. In a memo from Rome in the New York Times, Italian Poet

Piergiorgio Welby is still full of words, hard and touching ones, that may be changing the way Italy thinks about euthanasia and other choices for the sick to end their own lives.

A vigil in Milan on Saturday supported Mr. Welby’s bid to have life support disconnected. “I love life, Mr. President,” Mr. Welby, 60, who has battled muscular dystrophy for 40 years, wrote to Italy’s president, Giorgio Napolitano, in September. “Life is the woman who loves you, the wind through your hair, the sun on your face, an evening stroll with a friend. “Life is also a woman who leaves you, a rainy day, a friend who deceives you. I am neither melancholic nor manic-depressive. I find the idea of dying horrible. But what is left to me is no longer a life.” Now Mr. Welby’s long drama appears to be nearing its final act. Last weekend, an Italian court denied legal permission for a doctor to sedate him and remove him from his respirator. Fully lucid but losing his capacity to speak and eat, he is deciding whether to appeal or to perform an act of civil disobedience that will kill him.

He is doing so in a very public way. Until a recent steep decline in his condition, he used a little stick to rapidly peck out blog entries with one hand. His book, “Let Me Die,” was just released. Near daily front-page stories chronicle the political, ethical and, with the Catholic Church a vital force here, religious issues his case presents.

“Dear Welby: Wait Before Taking Yourself Off” the respirator, read a front-page headline on Tuesday in La Repubblica, written by a top Italian surgeon, Dr. Ignazio Marino, who is also a senator for the Democrats of the Left. He had visited Mr. Welby the day before.

What has given the case a particular political twist is that Mr. Welby, attached to a respirator for nine years, has long been a spokesman for euthanasia and is a central part of the Radical Party’s effort to have it legalized. In fact, members of the Radical Party have offered to personally remove his respirator if asked — and may do so any day now in a frontal challenge to Italian law.

But the Catholic Church and many of this traditionally minded nation’s politicians on the left and the right not only oppose euthanasia generally but are also not entirely sure what to do about Mr. Welby’s case. He says he is not seeking to commit suicide but to remove himself from medical treatment he does not want.

“It is an unbearable torture,” he wrote two weeks ago.

[hat tip Sheila Otto]

Gandhi on Euthanasia

The Times of India received this letter concerning a recent series of stories on euthanasia in India. The subject is Mahatma Gandhi's view of euthanasia, and the writer included this interesting quote:

"A calf, having been maimed, lay in agony in the ashram and despite all possible treatment and nursing, the surgeon declared the case to be past help and hope. The animal's suffering was very acute.

"In the circumstances, I felt that humanity demanded that the agony should be ended by ending life itself. The matter was placed before the whole ashram. Finally, in all humility but with the cleanest of convictions I got in my presence a doctor to administer the calf a quietus by means of a poison injection, and the whole thing was over in less than two minutes.

"Would I apply to human beings the principle that I have enunciated in connection with the calf? Would I like it to be applied in my own case? My reply is yes. Just as a surgeon does not commit himsa when he wields his knife on his patient's body for the latter's benefit, similarly one may find it necessary under certain imperative circumstances to go a step further and sever life from the body in the interest of the sufferer".

[thanks Dominic Sisti]

The Best Euthanasia Movie?

I vote for The Sea Inside, reviewed here by Time Magazine.

In Brief

I'm at a grant meeting this week in New York so comments will be limited to news analysis this week.

A few interesting things out today:

A followup inquiry in Britain on its military's tests on service members during the 20th century is revealing:

The hearing was told how at 10.17 a.m. on the morning of May 6, 1953, Porton Down scientists had applied the liquid nerve gas on to the arms of Maddison and five others in a sealed gas chamber. After 20 minutes, Maddison complained that he was feeling ill. Soon after he slumped over the table and was carried out of the chamber and taken to Porton’s hospital, where he died at 11.00 a.m. The inquest examined what steps Porton took to ensure the safety of the human “guinea pigs”, but was supposed to take into account the differing “ethical climate” of the early 1950s and the “paranoid pressure” generated by the Cold War.

Another chronicle of Hurlbut's tempest in a teapot solution to stem cell ethics debates, this time from Religion News Service.

Baroness Warnock, described in Times online as Britain's leading medical ethics expert, spoke in defense of the proposed 'mental capacity bill', which would simplify euthanasia in Britain (or so many say). Warnock: "I don't see what is so horrible about the motive of not wanting to be an increasing nuisance." Needless to say, lots of people didn't like her comments.

Who will lead the California stem cell program? San Francisco Chronicle reports that it might be a real estate tycoon, Robert Kline. Also in the pool: Michael Friedman, CEO of City of Hope, and former UC president Richard Atkinson, a cognitive scientist. Weren't any actors available?

You knew that Ob-Gyns are sued quite frequently. But in Maryland, 70% have been sued at some point in their practice, bringing average insurance premiums to $150,000 per year. Maryland is typical for the U.S..

A profile of Vanderbilt's Pediatric Advanced Comfort Team is interesting. Mark Bliton of Vanderbilt is quoted.

Boston Globe does a great job on the sports steroids issue.

Of Houseboats and Euthanasia

This is the strangest mix I've seen.

Euthanasia in France and Netherlands

Lawmakers in France today approved passive euthanasia, but, "while a first in France, the legislation falls far short of laws in Netherlands and Belgium that allow active euthanasia under strict circumstances, and Switzerland, which allows certain forms of patient suicide."

AP reports on the incredible announcement from Amsterdam that Groningen Academic Hospital has created an independent board to review cases for euthanasia of terminally ill persons with "no free will," which includes "children, the severely mentally retarded and people left in an irreversible coma after an accident." The Health Ministry is preparing an answer to the regulations.

Three years ago, the Dutch parliament made it legal for doctors to inject a sedative and a lethal dose of muscle relaxant at the request of adult patients suffering great pain with no hope of relief. The Groningen Protocol, as the hospital's guidelines have come to be known, would create a legal framework for permitting doctors to actively end the life of newborns deemed to be in similar pain from incurable disease or extreme deformities.

Euthanasia = Kevorkian?

Wesley Smith thinks so.

Papal Statement on Euthanasia

Pope John Paul spoke today of the evils of euthanasia, using interesting new language. He described what he termed as distortion of ethics, namely the conversion of compassion into a "suppression of human life" through the desire to support it. It is not clear to me what the Pope meant, but his words were provocative:

Euthanasia is among the dramas of an ethic that presumes to establish who can live and who must die

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1 in 3 UK Physicians Asked for Assisted Suicide

Medix UK polling on behalf of the Voluntary Euthanasia Society found this this week. The Guardian also reports more in depth.

Around the Listservs

On MCW mention of a BBC program called "Heaven and Earth" which references a new UK poll on euthanasia that shows 82% approval for choosing time and manner of death although the poll comes from the ever-so-balanced Voluntary Euthanasia Society.