Starmer's vision quest

[classic33]

How is 'You have to ask for it' rather than 'Doctors can suggest it to you' a pointless safeguard? The act of a doctor putting it on the table as an option, without the patient even mentioning it, will be enough for some vulnerable people to be swayed into something they don't really want.

How many other things do you have to ask the doctors for, as opposed to them putting the option before you?

 

[bobzmyunkle]

I think it's reasonable to look at the experiences of other countries and see how 'mission creep' has led to unintended consequences with assisted dying. It accounts for 4.7% of deaths in Canada, 5.4% of deaths in the Netherlands.

Or to phrase it differently - they introduced a law, saw it was working and extended it to other areas. The 'mission creep' doesn't just happen behind closed doors does it.

How is 'You have to ask for it' rather than 'Doctors can suggest it to you' a pointless safeguard?

Doctors are there to suggest the options available. This is not a safeguard at all.

 

[Bazzer]

Both are mental health issues. It's offering assisted dying to people who are not terminally ill, not physically ill or even in physical pain. It's a failure because autism, depression, anorexia, are not terminal illnesses. All can be helped or recovered from with good care.

Scaling up for population, Belgium's 19 would be 114 assisted dying deaths for mental health issues a year in the UK.

You are suggesting it is offered to people who have a mental illness, which is not the case so far as the Belgian legislation is concerned.
The criteria is;
Legally competent
Making a well considered, repeated and voluntary request.
Experiencing constant and unbearable suffering that cannot be aleviated.
Is caused by a serious and incurable medical condition.

In terms of the failure of the Belgian mental health system, you seem to be putting yourself in the position of knowing more than the physicians, one of whom must be a psychiatrist, who examined the requestor.

Because mental health issues can be recovered from, they aren't terminal illnesses.

BTW, not all mental health conditions can be recovered from.

 

[briantrumpet]

As noted by lots of people, it doesn't matter how much you pander to the xenophobes - they'll still want more.

 

[Pblakeney]

How is 'You have to ask for it' rather than 'Doctors can suggest it to you' a pointless safeguard? The act of a doctor putting it on the table as an option, without the patient even mentioning it, will be enough for some vulnerable people to be swayed into something they don't really want.

Would that simple change suffice? I am sceptical.
Even I want more safeguards than simply asking for it.

 

[AuroraSaab]

How many other things do you have to ask the doctors for, as opposed to them putting the option before you?

When the doctor suggests a course of antibiotics you're unlikely to feel a sense of coercion though. You might if he/she suggests assisted dying and you're in a care home that's costing your kids £4k a month.

 

[icowden]

Because mental health issues can be recovered from, they aren't terminal illnesses.

That's incorrect on so many levels I'm not sure where to start.

Alzheimers is a condition of mental health. It is not recoverable.

Psychosis is a condition of mental health. It may be recoverable, but often is not.

Anorexia Nervosa is a condition of mental health. For many patients it is recoverable, for some, it is not.

Do you get the picture?

There was a heart-rending account of a young woman who had chosen to go to Switzerland to die due to her anorexia. She had had countless mental health interventions, was in constant pain from the fragility of her own body. Even her parents agreed that all mental health interventions had failed to save her and were at peace with her ending her own suffering rather than waiting to die. I can't find the link now but it was terribly sad.

This is a good read which explains the difference between Anorexia and terminal anorexia.

https://www.theguardian.com/society/2023/jul/13/anorexia-right-to-die-terminal-mental-health

 

[AuroraSaab]

Or to phrase it differently - they introduced a law, saw it was working and extended it to other areas. The 'mission creep' doesn't just happen behind closed doors does it.

Well it kind of does when the legislation is vague enough to allow things that the law was never aimed at. If Canada extend it to depressed children I would call that mission creep not a good sign that the law was working.

Doctors are there to suggest the options available. This is not a safeguard at all.

It's putting the thought in someone's head that they perhaps would never think of themselves. In which case you could argue it wasn't a truly autonomous choice, especially in those already mentally vulnerable.

 

[bobzmyunkle]

If Canada extend it to depressed children I would call that mission creep not a good sign that the law was working

But they haven't and they won't.

 

[AuroraSaab]

Alzheimers is a condition of mental health. It is not recoverable. Psychosis is a condition of mental health. It may be recoverable, but often is not. Anorexia Nervosa is a condition of mental health. For many patients it is recoverable, for some, it is not.

With proper support people with Alzheimer's can often still live worthwhile lives. The recovery rate from psychosis varies depending on the support and resources available, same with anorexia. That alone tells you that what we need is better mental health care, not offering assisted dying as a treatment option.

Do you get the picture?

I get that euthanising people who don't have a terminal illness is a sign of our failure as a society to look after the most vulnerable.

The weird thing is that if a depressed 18 year old threw themselves in front of a train we'd see that as a failure of the NHS and society in general. We don't say 'It was probably the right decision for them'. But if a doctor suggests a lethal injection to the same young person it's a valid course of treatment.

 

[Psamathe]

So surely they would be excluded under the currently proposed Westminster changes.

Not necessarily. If the terminology is sufficiently vague and the safeguards not in place it might. Once a law with insufficient safeguards is passed it's hard to walk it back.

Current proposal to Parliament states

1 Assisted dying

(1) A terminally ill person in England or Wales who ...​

2 Terminal illness

(1) For the purposes of this Act, a person is terminally ill if—​

(a) the person has an inevitably progressive illness or disease which cannot be reversed by treatment, and ...​

(3) For the avoidance of doubt, a person is not to be considered to be terminally ill only because they are a person with a disability or mental disorder (or both).​

I'm not a lawyer but seems specific that "which cannot be reversed by treatment" refers to the disease/condition so even patient refusing treatment does not change that the disease can be reversed by treatment.

And "a person is not to be considered to be terminally ill only because they are a person with a disability or mental disorder" seems pretty specific.

I don't see the vagueness to suggest. Could you explain the loopholes as again, I'm no legal expert.

Ian

 

[AuroraSaab]

But they haven't and they won't.

They have mission creep with other illnesses though. In Canada Track 2 is euthanasia for those without a terminal illness. It has increasingly come to apply to those in poverty, in poor housing or unemployed, those without support. That suggests a driver in their decision is social factors not medical factors.

"The medical disability becomes the foot in the door to open eligibility for MAiD, but social suffering pushes the marginalized through that door to seek state-sponsored death for their life struggles".

https://theconversation.com/maid-an...hed-light-on-assisted-death-in-ontario-241661

 

[AuroraSaab]

Current proposal to Parliament states

I'm not a lawyer but seems specific that "which cannot be reversed by treatment" refers to the disease/condition so even patient refusing treatment does not change that the disease can be reversed by treatment.

And "a person is not to be considered to be terminally ill only because they are a person with a disability or mental disorder" seems pretty specific.

I don't see the vagueness to suggest. Could you explain the loopholes as again, I'm no legal expert.

Ian

The ammendment proposed in February by Naz Shah MP, which attempted to specify that someone “who would not otherwise qualify as terminally ill shall not be considered to meet those requirements as a result of stopping eating or drinking,” would have prevented the Bill from being used to end the lives of those suffering from anorexia. It was supported by eating disorder charities but rejected by the committee by 15 to 8.

 

[Psamathe]

The ammendment proposed in February by Naz Shah MP, which attempted to specify that someone “who would not otherwise qualify as terminally ill shall not be considered to meet those requirements as a result of stopping eating or drinking,” would have prevented the Bill from being used to end the lives of those suffering from anorexia. It was supported by eating disorder charities but rejected by the committee by 15 to 8.

I don't know the details but the bill states

For the purposes of this Act, a person is terminally ill if—
(1)(a) the person has an inevitably progressive illness or disease which cannot be reversed by treatment and ...

(3) For the avoidance of doubt, a person is not to be considered to be terminally ill only because they are a person with a disability or mental disorder (or both).

So it is reversible so they already don't qualify ie already covered by the law. Adding specific clauses that are already defined could potentially raise ambiguity as it raises the suggestion that eg whilst anorexia is specifically excluded bulimia isn't ...

Just because an amendment is rejected does not mean there is inadequate scrutiny and that there is inadequate safeguards.

Ian

 

[Ian H]

Because mental health issues can be recovered from...

That is certainly not always the case.

How can euthanising those with a mental illness ever be guaranteed to be a 'solid decision' by the patient? It's the mental illness that contributes to them thinking dying is the only solution.

That's a patronising attitude. Many people with mental health illnesses are perfectly capable of rational decision-making.