The right to chooseIs there a case for euthanasia orphysician-assisted suicide? Sue Allen reports on this week's Gazette-sponsored debateImagine that you were in a serious car accident that totally paralyses you.
You cannot speak or communicate and are being fed through a tube.
You might be in pain and you may have serious brain injury.
Would you want to live or die? What would you want to do if you could see, hear and understand what was going on?This example was used by Professor Tom McMillan, professor of clinical neuropsychology at Glasgow University, to highlight the real difficulties surrounding the issues of living wills, euthanasia and when it is right to trust professional carers.
These issues formed the backdrop to this week's third Law Society public debate - 'A right to live/A right to die', sponsored by the Gazette.The question of when you would choose to end your own life is a chilling one, but the above example is based on a real case.
A young woman, known as Ms X, made a living will - a statement of her wishes if she were ever to find herself in such a situation - only to change her mind when the worse happened.According to Prof McMillan, who assessed Ms X, he could demonstrate that she responded reliably to questions and wished to live despite her condition and earlier written wishes.This case clearly demonstrates what one contributor said were the 'truly huge and complex' issues surrounding an individual's right to end their own life or have a say in how it is ended once doctors take over.Anne Ball, of London and Manchester law firm Hempsons - who represented Dr Harold Shipman, found guilty of murdering elderly patients with overdoses of morphine - said the public is 'no longer prepared to simply accept that a doctor knows best'.
However, for some patients, such as those with Alzheimer's disease or severe and irreversible brain damage, 'there must come a point when prolonging treatment by artificial means fails to provide sufficient benefit to justify the intervention, and the proper course may be to withdraw or withhold treatment'.Guidance from the House of Lords on how to deal with the withdrawal of treatment came in 1993 when Tony Bland was allowed to die after being in a persistent vegetative state (PVS) following the Hillsborough disaster.
This has now been supplemented by guidance from the British Medical Association (BMA) and the General Medical Council (GMC).While the House of Lords says withdrawal of treatment must be in the patient's 'best interests', recent GMC guidelines go further and specify that account should be taken of any previously expressed wishes and knowledge of background, including religion and culture.
The BMA adds that the likelihood that the patient is suffering severe and unmanageable pain, the individual's awareness of his or her existence and surroundings, the likelihood of improvement and whether the invasiveness of treatment is justified should also be considered.Michael Wilkes, the BMA's chairman of medical ethics, told the debate that he is opposed to euthanasia and physician-assisted suicide, but added: 'It may be that patients are experiencing treatment far beyond that which they would find tolerable and as doctors we have to find a balance...
perhaps we all have the right to live, but the right to be kept alive in any circumstances is probably not something any of us would subscribe to.'Robin Makin is the solicitor at Liverpool firmE Rex Makin & Co who represented moors murderer Ian Brady in his recent legal bid to be allowed to end his own life by refusing food, and Andrew Devine, who has shown some improvement despite being in a vegetative state since Hillsborough.
He pointed out: 'Everyone has the right to live - but that could mean taking resources from someone else.'Mr Makin said there is 'no point standing on the moral high ground' without the government looking at the issue.
'It cannot be right for the government to stand back.
They need to set up a framework to consider how matters are to develop.
Not a committee of the great and the good and the cronies, but a wider cross-section without arbitrary limits on terms of reference.' He went on: 'The conflict between the individual's rights and society's rights has to be sorted out.'Brian Iddon, MP for Bolton South East, spoke out strongly against the concept of euthanasia, which he finds 'personally distasteful'.
Mr Iddon was also critical of the BMA guidelines, which he said also applied to stroke, Alzheimer's and brain injury cases and not just PVS victims.
The guidelines had not been publicly discussed or agreed to by government or Parliament, and many doctors first read about in the national newspapers, he said.Any move towards a Dutch model of tolerance or legalisation of doctor-assisted suicide and voluntary and, in exceptional circumstances, non-voluntary euthanasia, should be strongly resisted, he warned.Sally Greengross, director-general of Age Concern, summed up the views of many when she said that, as adults, 'we want the basic right to be treated as an adult however old or frail we become...
we also want to know that if a decision on ending our lives is taken, that it is on an individual assessment, on a clinical diagnosis and an assessment of need.'
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