I have a problem, and I need some help. Here’s the story.
I have a good, and affectionate, friend who is an Australian lady in her 40s. She is married, with a family. Being a continent or three away from her parents I think that she uses me as a kind of ersatz father figure. Let’s call her Lauren.
This week she raised with me the question of assisted suicide or euthanasia. (She has no particular religious belief.) I quickly realised that her question was not theoretical. Her father has suffered from Alzheimer’s for some time. The effects are growing but he knows enough to be very miserable about it. He is, she thinks, still capable of rational decision. She made no mention of her mother, though I happen to know that the burden is very heavy for her. Lauren’s husband, who is often away on business for long periods, is an admirable man, but dealing with emotional problems is not his strength.
Now my position on these questions is orthodox, so I don’t need to rehearse it here. I can summarise with the old rhyme: “Thou should not kill, but need not strive, officiously to keep alive.” I did of course state my belief, but it cut no ice since she does not come from a faith position. I toyed in my mind with the usual arguments that accepting assisted suicide is open to abuse if the sick or the old are being put under pressure or feel an obligation to remove themselves for the sake of others, but this sounded, even to me, hollow in this case. She loves her father dearly and is entirely motivated by what would be best for him. I thought it wise at the time to move gently on to another subject, rather than say something stupid and unhelpful.
I reflected afterwards that it is easy enough to express opinions in discussing a question like this at a theoretical level. But it is very different reacting to an actual situation when the emotions are highly involved. If I go through the valuable exercise of considering what I would do if the sufferer were a close member of my own family, the answer becomes even harder. Would I stick to my principles and allow the suffering to continue? Would I retain my principles but choose to go against them because I could not bear the alternative? Would I decide, having faced the test, that I could no longer regard the principles as invariably binding? I don’t know the answer to such questions, but the fact that I take them seriously is, in itself, significant.
I feel that I ought to write to her, and say something constructive. But what should I write? I hope you have some suggestions for me.
secondsightblogdotnet 
Quentin, I don’t know that I have any suggestions for you. I am in a slightly similar position to your Australian friend, my mother being nearly 91, more-or-less immobile as a result of arthritis which has been encroaching for years, and in a nearby residential care home as it had become impossible for me to care for her at home any longer (would have needed large equipment which simply wouldn’t have fitted into my small house). She has been suffering depression (and on anti-depressants) for years (for much longer than she’s been immobile). She has no religious beliefs, and has maintained for a long time that it “ought to be possible” for her to ask the doctor to come and give her an injection to finish it all. We had to agree to differ on this (and indeed, I had private doubts about whether she really meant it, since when she started saying it she was a lot more mobile than she is now, and would have been capable of unassisted suicide – though of course I never pointed this out to her).
It still seems to me that the argument about the danger to vulnerable people which would arise if assisted suicide became legal is a potent one. Also I feel that it would change the doctor-patient relationship in highly undesirable ways. But I look at my mother, who spends most of her time apparently sunk in misery, and wonder why the Lord is keeping her hanging around here. I must trust that He is working in her soul in some subtle ways. It seems a very long Calvary, and she doesn’t even appreciate that it may be serving some purpose.
There is something about this website that makes me feel, at times, rather uneasy something to do with an excess of breastbeating and vicariousness…I feel it now. My mum and Dad live next door to me-I am nearly 60 they in their late 80’s I do not in some ways relish what is to come but will deal with it as best I can. I worked for samaritans for several years and heard many difficult stories-I don’t think there is ‘advice’ on these issues-only solidarity, compassion and prayer.
There really is no answer to your friend that is compatible with Catholic teaching that she would readily accept, or probably begin to understand when confronted by such a situation.
What we have here is another example of the moral maze and of hard teachings that are not open to compromise.
It is the same for any moral situation.
Quentin regulalry writes is support of catholic teaching on the evil of abortion and yet raises by other comments of his on this blog, a doubt in my mind as to what his re-action would be to one of his ‘beautiful grandaughters’ being the victim of violent rape and then becoming pregnant as a consequence.
All morality comes with hard choices and to limit those in some way to matters only of euthansia is to be selective to the point of nonsensical beliefs.
Thous shall not kill is a statute that allows no exceptions and yet we add them by the millions.
It is easy to stand from a distance and dispense advice when not personally affected but to dodge the issue by resorting to ‘I don;t think there is ‘advice’ ‘is also a betrayal of ones own beliefs and therefore to be avoided.
No Claret, The point is that I may have many thoughts on many issues but the only ones which have significance are are those tested in the heat of the lived day- when opinions mainly evaporate like clouds. To refrain from opinionating is not by any means to leave the fray.
Mike
Incidentally I have faced something of a similar situation to those described on here with my own Mother. In the face of her suffering I used to ask myself could I be the one to put a pillow over her face, hold it there for what would only be a minute or two, and painlessly end her life. Like most children I loved my Mother dearly but the answer to my own question was always ‘No.’
So why should I expect or ask someone else to do it for me.
Quentin, the ‘old rhyme ‘ you quoted comes from a satirical poem ‘The Latest Decalogue’ by Arthur Hugh Clough (1819-1861). It is worth quoting in full:
Thou shalt have one God only; who
Would be at the expense of two?
No graven images may be
Worshipp’d, except the currency:
Swear not at all; for, for thy curse
Thine enemy is none the worse:
At church on Sunday to attend
Will serve to keep the world thy friend:
Honour thy parents; that is all
From whom advancement may befall:
Thou shalt not kill, but need’st not strive
Officiously to keep alive:
Do not adultery commit;
Advantage rarely comes of it:
Thou shalt not steal; an empty feat
When it’s so lucrative to cheat:
Bear not false witness: let the lie
Have time on its own wings to fly:
Thou shalt not covet; but tradition
Approves all forms of competition.
On a more serious note, I am considering the points you raise, and will comment further If I think I have anything relevant to say.
I think, perhaps, this moral dilemma is premature. It is difficult to comment on Lauren’s father without making a full clinical assessment; but I would raise two points: 1. In the early stages of the disease, Alzheimer sufferers can become very depressed, and this may become a depressive illness which might be helped by antidepressent treatment. Such depression may colour a patient’s outlook so that they want to die.
2. There is treatment with “Memory pills” available. This is symptomatic treatment which can improve memory in some patients. Has this been considered?
For a Catholic or a secularist, the decision to end a life prematurely has a legitimate window, and an illegitimate one. There might be a smaller window for a Catholic than a secularist, due to the initial starting point of the teaching authority of the church. Catholics can be guided by the Catechism of the Catholic Church (CCC), in Part Three, Life in Christ, Article 5, The Fifth Commandment, Euthanasia, paragraphs 2276 – 2279.
Catholics have an easier answer in some regards. However, in a subjective sense we will never quite know how we will react and think, if we should find ourselves racked with pain with a terminal condition. Paragraph 2278 of the Catechism is of interest regarding the correctness of withdrawal of life-support, providing certain conditions being present. I have quoted it below for everyone’s convenience.
‘Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of ‘over-zealous’ treatment. Here one does not will to cause death; one’s in ability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.’
Regarding euthanasia, there is one single thing that can increase the size of the legitimate window, for both Catholics and secularists. That would be for governments around the world to increasingly provide for more palliative care beds, and dramatically increasing the level of funding for palliative care research. Adequate funding for palliative care research and for the equally important provision of palliative care beds in society, is vital for the practical, social, and spiritual dignity, of the terminally ill person. I believe that Catholicism’s greatest hope lies within the incremental and progressive advances within the science and art of palliative care medicine. This will decrease the window of legitimacy of the secular position of legalised euthanasia.
The present state of palliative care medicine cannot prevent a minor number of individuals suffering from debilitating pain, chronic nausea, total or partial loss of bowel control, and its associated emotional distress. It would be quite confronting to witness a terminally ill person, who cannot be helped further to lessen their physical pains, asking for a means to end their lives as painlessly as possible. This is the central-hub of secularists’ argument for the legalisation of euthanasia.
What would you or I say to a terminally ill secular individual that would be of benefit? I would probably do a lot of listening, talking about pleasant and unrelated matters, offering my time and presence, but as to what good any direct advice I could offer, I don’t have a clue. I suppose the fact that I am not trained in the pastoral care of the terminally ill, regardless of their religious beliefs, which is most telling of our predicament. There is no substitute for genuine compassion and care, married with an expertise in pastoral care. This predicament should be within the competence of such experts.
Within the limits of secularism, proponents of euthanasia have altruistic reasons for their position. They want to offer an escape or release from uncontrollable suffering, providing that they can obtain the legal consent of either the patient or his or her will in case of a loss of consciousness, a peaceful means of ending the life of a terminally ill individual, who has been medically assessed as being in a state of terminal decline, and psychologically and legally assessed or vetted, as to the freedom and maturity of their request. This is probably why it is such a popular proposition in contemporary secular society.
Within these broad parameters, finding the legitimate window for secularists can be a matter of guiding them to closely examine their human conscience, rigorous thinking, reading, discussing, and being informed by various experts regarding the alternatives. Outside of these broad notions, there is very little that I can think of as applying to Quentin’s introductory remarks about ‘Lauren’.
I am broadly with Claret on this issue. I cannot tolerate a request from anyone, to euthanize either one of my parents, regardless of whatever peaceful release from pain that death will bring. I cannot stomach the idea of me or any of my siblings being the author or instigator or provider of such resources. I am most definitely for the maintenance of life at all costs, with paragraph 2278 at the ready, should everything that could have been tried, having been tried.
I don’t know what I would do if I was in the predicament of chronic pain and in terminal decline. It is all very well to talk hypothetically. I hope that I would have the courage and forbearance to hold to the very end of my life with as much grit and determination that I can humanly muster. However, my general hope is for great advances within science and medicine generally, and specifically within palliative care research. This must be married with an adequate and rising level of funding for a sufficient number of palliative care beds by governments.
For once, I find myself in agreement with John Candido. From the age of ten (1961!) I used the prayers after Communion in the Small Roman Missal. They ended with the ‘Act of Resignation to the Divine Will’, which went as follows:
“Almighty God, I readily and willingly accept at Thy hands any kind of death it may please Thee to send me , with all its pains, penalties and sorrows.”
The argument for assisted suicide can be summarized thus: No-one wants a beloved pet to suffer. Poor Fido cannot make the decision for himself, so we have to make it for him. Man is capable of making his own decisions, and these must be respected. The idea that man is made in the image of God, has an immortal soul and is condemned to suffering as a result of the Fall, cannot be justified in utilitarian terms.
The law as it stands has a utilitarian element – the terminally ill might be subject to pressure from relatives etc. – but it is still grounded in the Judaeo-Christian ethic which underpinned most of our laws until quite recently.
And yet, and yet … An army officer told me 25 years ago that when serving in Oman his sangar was hit by a Soviet-made ‘Katyusha’ rocket. His Baluchi signaller took the full force of the blast with the result that every bone in his body was broken; “When you tried to move him , he rippled”. He was put out of his misery with a morphine overdose. What would I have done in a similar situation? I honestly don’t know.
I thought of Clarets comment regarding Quentins beautiful granddaughters being the victim of a violant rape ,and was pregnant.
I feel how could one live with ones self if the baby was aborted-it would be my great-grandchild. We never know the blessings that child would bring into our lives.
The Lord may have planned something wonderful for that child.
The following meditation on death I find very beautiful nothing to do with the subject.
A holy priest told me many years ago
Think of stepping on the shore and finding it heaven,
Of taking hold of a hand and finding it God’s hand,
Of breathing a new air and finding it celestial air,
Of feeling invigorated and finding it immortality,
Of passing through storm and tempest to an unknown calm,
Of waking and finding it home.
There is always hope for important scientific break-throughs that have an impact on the skill and sophistication of palliative care specialists. If you were to go to the online science magazine at http://www.sciencedaily.com , and you were to enter ‘palliative care’ within their search facility, you will find a plethora of articles on this subject.
One good one that comes to mind is an article that can be accessed from http://www.sciencedaily.com/releases/2010/10/101001144207.htm , and is cited as M. L. Olsen, K. M. Swetz, P. S. Mueller. Ethical Decision Making With End-of-Life Care: Palliative Sedation and Withholding or Withdrawing Life-Sustaining Treatments. Mayo Clinic Proceedings, 2010; 85 (10): 949 DOI: http://www.mayoclinicproceedings.com/content/85/10/949 . Clicking on the immediate above link will provide you with access to the abstract of this journal article only. I have copied the abstract for everybody’s convenience below.
‘Palliative sedation (PS) is the use of medications to induce decreased or absent awareness in order to relieve otherwise intractable suffering at the end of life. Although uncommon, some patients undergoing aggressive symptom control measures still have severe suffering from underlying disease or therapy-related adverse effects. In these circumstances, use of PS is considered. Although the goal is to provide relief in an ethically acceptable way to the patient, family, and health care team, health care professionals often voice concerns whether such treatment is necessary or whether such treatment equates to physician-assisted suicide or euthanasia. In this review, we frame clinical scenarios in which PS may be considered, summarize the ethical underpinnings of the practice, and further differentiate PS from other forms of end-of-life care, including withholding and/or withdrawing life-sustaining therapy and physician-assisted suicide and euthanasia.’
The next article looks at the provision of palliative care as a human right. Despite its author suggesting that this is an equitable prerequisite to making legalised euthanasia available in future within Canada, it is significant and important that at least palliative care should be bolstered by conceptualising it as a human right, under article 12 of the United Nations Universal Declaration of Human Rights. The article can be accessed here http://www.sciencedaily.com/releases/2011/01/110131132953.htm .
The next article refers to social research pointing to the strong influence of the religious beliefs or lack of religious beliefs of doctors, and end of life care. According to the Journal of Medical Ethics, doctors with agnostic or atheistic beliefs were almost twice as likely to make decisions that they think will hasten the end of a very sick patient’s life, as doctors who have deep religious convictions. This article seems to be rather unsurprising in the main but interesting none the less. It can be accessed here. http://www.sciencedaily.com/releases/2010/08/100825191656.htm .
The next article, which was published on the 2nd July of 2007, is absolutely fascinating. A majority of terminally ill patients with cancer, that are receiving palliative care, would consider euthanasia if it were entirely legal. However, such a request would only be tenable if their worst fears about uncontrollable and debilitating pain were to come true. For most patients, these fears do not actualise, according to the Journal of Health Psychology. This was a social survey of 379 patients receiving palliative care across Canada.
Amongst its highlights are, and I quote;
‘Sixty-three per cent of participants believed that euthanasia and / or physician-assisted suicide should be legalized.’
‘Forty per cent of participants indicated they would consider making a future request for physician-assisted suicide if their situation deteriorated to a “worst-case scenario”.’
‘Ten per cent of participants believed that had the option been legally available, they would already have requested physician-assisted suicide, usually because of uncontrolled pain. When their pain was brought under control, however, they tended to change their minds about suicide.’
This study was led by Dr. Keith Wilson, an Associate Scientist at the Ottawa Health Research Institute. He surmises that, and I quote;
“The results of this study are helping us answer fundamental questions about the factors that lead some people to consider euthanasia and physician-assisted suicide,” said Dr. Wilson. “For example, we found that people who said they would request suicide were not necessarily closer to death and were not in significantly more pain, but they were much more likely to be experiencing drowsiness, general malaise, depression, and a feeling of being a burden to others. We also found that those people who reversed their desire for suicide may have done so because their physical and mental symptoms subsided, either on their own or through treatment.”
This conclusion highlights the importance of proper palliative care, of it being continually open to rigorous social and medical research, of the critical importance of eliminating as far as possible the patient’s thoughts of being a burden to others, and of minimising general malaise, and the obviously natural occurrence of depressed feelings for patients undergoing palliative care, so they may be dealt with by an expert and highly trained multi-disciplinary team. This article can be accessed here. http://www.sciencedaily.com/releases/2007/06/070627142213.htm .
The next article is focused on the unnecessary and painful visits of terminally ill patients to emergency departments across Canada, and how with proper palliative care, either at a hospital ward, or at home, or at a hospice, it can prevent patients from visiting a hospital unnecessarily. This can be accessed here. http://www.sciencedaily.com/releases/2010/03/100315125543.htm .
This final article is a warning bell from present day Germany. Due to the effect of Germany’s Nazi past during World War II, discussions about physician assisted suicide or euthanasia, have almost been taboo for more than 50 years. Intense debate is currently underway due to the findings of a study that has been published in the Journal of Palliative Medicine. Some physicians in Germany actively hasten the death of their patients, which is against current ethical guidelines in their country. In some cases, these deaths were without sufficient patient involvement and presumably without their express or written consent. Private and confidential replies to this survey were more than half of the number sent, and were numbered at 780.
The findings of researchers were that physicians alleviated symptoms in 78 per cent of cases, and limited the provision of medical treatment, with the likely possibility that life shortening effects occurring in 69 per cent of cases. In only 10 cases medication was administered by the physician (9 examples) or the patient himself or herself (1 example), to deliberately hasten death. Physicians with qualifications in palliative care were less likely to report deliberate actions to hasten the death of their patients. This survey can be accessed here. http://www.sciencedaily.com/releases/2010/09/100907104033.htm .
St Joseph Hospices all over the country and the world, are doing wonderful caring work for the dying. Also Jospice-Care Homes.Plenty of info by typing ‘St Joseph’s Hospice’ or Jospice in Google.
I ought to have mentioned other Catholic Care Homes and Convents.
Sue Ryder Care Home.The Little Sisters of the Poor. Our Lady of Grace and Compassion Benedictines ,and many many more.
It is a wonderful thought that when we grow old and infirm to know that there are Catholic homes to spend our last dying days in the comfort of Religious Houses,
where Mass will be celebrated, and the Sacraments are available.
We have a wonderful church,and are very blessed.We pray for all those who do this good work for the elderly and the dying.
Not forgetting those who take the sick and handicapped to Lourdes,
The catholic youth who give their time taking pilgrimages and the many doctors and nurses who help at Lourdes yearly.
My own experience of this problem is limited to a single case when I was a young doctor in the early 1950’s. A patient was dying of cancer and in severe pain; I prescribed 4 hrly injections of Morphine (there were no other useful drugs available at that time) and I had to explain to Matron, who was worried about the effect that this would have on her nurses, that the object was simply to alleviate his pain. There was no question of ‘killing’ or even trying to hasten death – although this was indeed inevitable.
I am impressed by John Candido’s long post on ‘palliative care’ above.
This surely is the answer to Quentin’s question. Everything possible must, and I am sure will be, done to alleviate the patient’s suffering but the decision simply to end life is to take the easy (indeed callous) way out.
I have some more good news about new American palliative care research, which is published in the New England Journal of Medicine, entitled ‘Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer’, with the full journal article accessible to everybody here, http://www.nejm.org/doi/full/10.1056/NEJMoa1000678. This research claims that the use of palliative care much earlier than what is thought to be its proper introduction, can lead to an increase in both the quality of life, and the survival rate of terminally ill individuals with lung cancer by an average of three months. The story about this research has come from The Age newspaper in Australia and can be accessed here, http://www.theage.com.au/national/palliative-care-adds-months-to-life-20110302-1bewh.html .
The study split 151 newly diagnosed individuals with lung cancer into two groups. The control group received standard treatment, while the treatment group received an earlier referral to palliative care within 12 weeks of diagnosis. The reported median survival time of individuals within the treatment group, was about three months longer than individuals within the control group. The individuals that had earlier access to palliative care were also noted to have a greater quality of life than individuals that had the later access to palliative care.
This research has been described by one oncology specialist as a watershed moment, due to palliative care being normally thought to be appropriate when all previous medical avenues had been exhausted. Professor Ian Haines of Cabrini Hospital in Melbourne Australia is quoted in an article in the Medical Journal of Australia …
‘If early referral for specialist palliative care were an expensive new drug, it would quite appropriately be marketed as a major advance in improving the care of patients with incurable cancer.’
This quote is the final sentence in an editorial letter contained within the February 2011 issue of the Medical Journal of Australia called, ‘Managing patients with advanced cancer: the benefits of early referral for palliative care,’ by Professor Ian E. Haines, MJA 2011; 194 (3): 107-108. The full editorial letter is accessible here, http://www.mja.com.au/public/issues/194_03_070211/hai11104_fm.html.
In another study, this time from Spain, which is published in the Journal of Clinical Oncology called, ‘Can This Patient Be Discharged Home? Factors Associated With At-Home Death Among Patients With Cancer’, a trial followed 380 patients who had advanced forms of cancer to their eventual deaths. Some patients had died at hospital while the others had died with palliative care at home. This study suggests that those patients that had died in hospital experienced more emotional and physical distress, than patients who died at home and had access to palliative care.
Hospital death was associated with greater grief for patients, and more post-traumatic stress counselling for family members and the patient’s friends. This reasonably unsurprising study, which is located within a Spanish context, suggests that patients with palliative care, and their relatives and friends, fare much better than patients who die in hospital without such considerations. The above article can be accessed here, http://jco.ascopubs.org/content/early/2011/02/16/JCO.2010.31.6752.abstract?sid=5f48b96a-927c-43c3-b276-c39428cfcba2.
P.S. Thank you Horace for your reply and kind words.
I mentioned on another site, The Human Life Disappears. how my mother-inlaw at 102 deveoped a chest infection and anti-biotics were witheld., the reason being she was 102-otherwise no other ailments,only a little dimensia since my husband died.
I made sure she received anti-biotics, and lived another year.
This is what worries me in situations like this.I fought for my mother-in laws medicine. I can see situations whereby ‘convenience’ and finance can alter a situation
towards the elderly. NHS cutbacks-shortage of nurses.They hardly have time to look after patients who are not dying never mind to give care to those who are..
And I speak from experience from my late husband, and many more I know of.
I mentioned the Catholic and other Christian organisations, believing that the proper palliative care will be assured in a sympathic environment.
I believe that the home is the better place-as it was for my husband, but Laurens case as Quentin mentioned ,her mother would not be capable of taking on the responsibility
of a full time carer. She would have to have help physically and financially.
There must be Hospices other than Christian-there is one locally near me, which do wonderful work, but there again it is struggling financially, and if it wasn’t for fund raising from the ordinary public it would be difficult to carry on.
Maybe that is the ‘Big Society’that David Cameron is speaking about.
I visited a friend in hospital, a few months ago who had bowel cancer. The patients bells were buzzing all the time. The nurse told me that there were two nurses for 28 patients.I said maybe if they had some volunteers to just see if they had fallen or needed assistance ,but the answer was ‘ it is against health and safety’.How bizarre is that!
Just to add another little comment about health and safety . My mother-in-law was in hospital at 101 having a hip operation after a fall.
There was an elderly lady in the same Ward who was feeding herself with her hands and putting the food all over her face and hair. I called a nurse and asked if I could feed her and was told No -It is against health and safety,
she said she would do it later-when she had time. Another lady rang her bell needing to use the toilet-was desperateThe nurse came but in fact warned her abruptly that it should not happen again just before lunch, or else she will ‘just have to wait’.The lady was very distressed and didn’t want to tell her daughter in case the nurse would take it out on her. I told her daughter!
These may be cases few and far between-but I am not so sure.There is just not enough staff.
If health and safety are so important,why do nurses go outside in their ‘uniforms’?
Another thought of care for the elderly. When my mother-in-law as I mentioned above broke her femur, she was 102. When in hospital awaiting an opereation. 4 weeks went past, with her in so much pain. It was agony for her to sit on the comode,where she was left for ages.
The 4 weeks waiting list was not because of her being last on the list,but always’ last on the list.’ I went in often ,especially at meal time, her food was left on the side,waiting for someone to feed her. My daughter and I complained so many times, only when we said we would take legal action did the hospital operate. The hospital’s excuse was that there were more urgent cases! Which I knew there wasn’t.
I suppose at 102 there isn’t, according to some!
A friend of mine whose husband died, had 36 apologies. I had 9 for my husband.
None for his Mum.
I wonder if elderly people have no one to fight for them,what care do they have?
Thanks to John Candido for his exhaustive comments – what you’ve written may be a useful reference in future.
Lauren’s case is very difficult, and a lack of a clear moral compass makes it all the more difficult.
Despite all the horror scenarios, one thing I notice is that advocates of euthanasia seldom want to be the people who actually have to do the deed. Baroness Warnock opined recently in the RCN journal that ‘Nurses are ideally placed to hold people’s hands’ during assisted suicide. A trenchant letter appeared in the very next issue saying, ‘I did not become a nurse in order to kill people.’ Debators in favour of euthanasia insist that people should be ‘helped on their way’ by ‘competent professionals’; but there seem to be precious few competent professionals willing to perform it. Indeed, if you knew your doctor was a ‘Thanatologist’ (a word someone coined in lobbying the Lords), would you trust him/her with end-of-life decisions?
I know that the Catechism teaches that palliative sedation (thanks to JC again) is acceptable. In this case, the intention would seem to be everything. I know I myself, if I was in Lauren’s position, that I would find it difficult to trust a decision for PS from someone who didn’t have similar pro-life views to my own.
My thanks go to Horace and James H for their support and kind words. I would also like to thank st.joseph for her support and for her posts pointing to heart-rending examples of inadequate staffing levels in public hospitals. I think that this points to the fact that governments have not been vigilant enough with tax avoidance.
The revenue to pay for the health system comes from consolidated revenue, and this of course can only come from you, me, and others in the form of taxes. Those who are involved in tax avoidance, whether its businesses or individuals, need to be made aware that without taxes there can be little spending in the way of national infrastructure. The American jurist, Oliver Wendell Holmes Jr., has said that ‘Taxes are the price we pay for a civilized society’.
It is estimated that billions of English pounds are lost annually due to tax avoidance and evasion. It is important that HM Revenue & Customs be given the funding, staff, and independence required to clawback the community’s money, in whatever ingenious ways it can. Tax avoidance has rightfully become a public issue that has now been the subject of public protest. A pressure group called ‘Uncut’, has been active on the issue of tax avoidance by the corporate sector. This can be read about in The Guardian newspaper here… http://www.guardian.co.uk/uk/2011/feb/19/barclays-protests-uk-uncut-corporate-tax-avoidance.
A 2009 interview by Guardian journalists David Leigh & John Domokos of Mr. David Hartnett, who is the permanent Secretary for Tax at HM Revenue & Customs (HRC), which is about the tax avoidance regime of Revenue & Customs. David Hartnett says that the HRC is not soft on tax avoidance. He does say that there is a lingering gap between what the HRC expects to get in any financial year and actual receipts; of somewhere in the order of several billion pounds annually.
What can the UK do with billions of pounds of lost revenue, which it loses annually to greedy people, for its health system? What effect will the recovery of such an enormous amount of money on an annual basis have on the staffing levels of nurses in hospitals? What effect will such recovered monies have on medical research, including the full gamut of research within palliative medicine? This interview by the Guardian newspaper can be viewed here… http://www.guardian.co.uk/business/video/2009/feb/06/tax-gap-dave-hartnett. I applaud the HRC in its efforts to recover taxes that are evaded, as well as employ whatever legitimate methods that prevents tax evasion and avoidance occurring in the first place.
I would like to suggest another initiative that can be gradually introduced within the UK, which will have an enormous effect on preventing tax avoidance and evasion, as well as other crimes such as the theft of money, and the illicit trade in drugs. This is the gradual movement towards a cashless society within technologically advanced nation-states. In one sense we are nearly there with contactless readers that cater for Visa’s PayWave and MasterCard’s PayPass.
We have had credit cards and debit cards for a number of years. The internet is a veritable highway for cashless payments and money transfers. The mobile phone is something that Apple wants to develop towards replacing our wallets, with credit or debit cards set within them as microchips. You can find more about the looming cashless society by watching the following BBC News videos and stories accessible from here… http://www.youtube.com/watch?v=5MyC25OKrto.
This is a story by the BBC about the decline of the cheque within Tesco’s checkouts and within society generally. http://news.bbc.co.uk/2/hi/business/7215454.stm.
Although a little dated, we have the BBC News story about the ban on cheques at Shell petrol outlets, and a small discussion about the possibility of a cashless society in future. This story can be accessed here… http://news.bbc.co.uk/2/hi/programmes/moneybox/4233002.stm.
The issue of counterfeit cash as well as a small discussion about the advantages and disadvantages of a cashless society can be read here… http://www.bbc.co.uk/news/business-12578952.
Sweden is considering the advantages of becoming a cashless society. You can examine their reasoning here… http://www.bbc.co.uk/news/world-europe-10538032.
South Korea is almost there judging from this 2009 BBC report here… http://news.bbc.co.uk/2/hi/business/7882229.stm.
If a cashless society is to be implemented in future, there would need to be a national regime of privacy legislation covering this contingency, with its particular set of problems such a society will bring. Not only will a future cashless society have less violent crime associated with today’s cash robberies, the police force will find it easier to police individuals who break the law, banks and businesses will not have the task of counting, securing, and transporting cash, and the integrity of the income tax base will be bolstered by a cashless society as governments will be able to collect taxes in a much more exact and consistent fashion. This will be the case regardless if the collection is income tax from wages, salaries, or profits, or the VAT from consumer transactions nationally.
Perhaps we could have a separate discussion about tax avoidance and evasion. An interesting topic – but is it really on point here?.
Thank you for your reply Tim. I thought that I could include the topic of a cashless society only as it relates to the provision of adequate funding for essential things like the health system with its need for more adequate staffing levels for nurses in hospital wards, more funding for all types of medical research including palliative medicine, and an adequate level of funding for palliative care beds. I do understand your point in that it is somewhat indirectly related to palliative care as it relates to what would be appropriate advice for ‘Lauren’ in Quentin’s introduction of ‘Dealing with Dad’.
I would really appreciate it if Quentin could offer the moral perspective of tax avoidance or evasion, and the issue of a cashless society generally, as a topic of discussion within SecondSight. I have long held a private view that a cashless society would be a beneficial outcome, in terms of the reduction of crime associated with the availability of cash, and the protection of the integrity of the income tax base. A cashless society has about zero interest within the population and is most probably something that will happen at its own time, rather than an active political policy of any party in parliament.
Although the issue of a cashless society might presently have near zero interest with members of the general public, this matter is most definitely in the public interest, and worthy of our society’s consideration. I believe that a cashless society will have far more benefits than disadvantages, or costs for that matter. Our society will be very foolish indeed if it were to ignore the quite considerable benefits, such a society can accumulate for itself.
We presently have the technical know-how and the necessary infrastructure to implement a cashless society contemporarily. This would only be justified if such an unlikely aspiration be manifestly within the UK, at some point in future. A greater and more rigorous collection of taxes that can be used for the benefit of the entire nation-state, in terms of education, welfare, health, policing, defence, infrastructure projects, and scientific research, awaits us. Apart from these considerations, a cashless society will have a most salutary effect on solving and preventing a huge amount of crime that we currently tolerate as part of life. What is probably required is for our community to engage in more discussion and debate on this unacknowledged but vitally important issue of future reform.
The comment made above from the nurse who said ‘I did not become a nurse in order to kill people’.
If we had more nurses to think pro-life like that it would undoubtably save more babies from being aborted.
I have found another study within the online science magazine called ‘ScienceDaily’ that could be of interest to us. This is a descriptive study, which has been published in the British Medical Journal on the 14th March 2008, and reports the declining use of euthanasia within the Netherlands together with the increased use of palliative sedation (PS). This was reported by physicians through a questionnaire relating to their medical decisions that preceded the death of their patients.
The use of continuous deep sedation increased from 5.6% of deaths in 2001 to 7.1% in 2005, mostly in patients treated by general practitioners and in those with cancer (in 2005, 47% of sedated patients had cancer, with only 33% with a diagnosis of cancer in 2001). In 2005, 78% of cases responded to the questionnaire, while in 2001 74% of cases responded. The conclusion that this study settled with was that, and I quote,
‘The increased use of continuous deep sedation (in effect Palliative Sedation – my comment only), for patients nearing death in the Netherlands and the limited use of palliative consultation suggests that this practice is increasingly considered as part of regular medical practice.’
The general story of this research can be accessed here within ScienceDaily… http://www.sciencedaily.com/releases/2008/03/080320205207.htm, while the original paper can be freely accessed within the British Medical Journal here… http://www.bmj.com/content/336/7648/810.full.
With a plethora of publicly available, peer reviewed, and published scientific papers on the subject of palliative medicine, and the inevitable incremental advance and use of social, medical, psychological, pastoral, and nursing research within palliative care; Catholics can be fairly confident in assuming the eventual demise of the proposition for legal euthanasia, and the progressive ascendency of palliative medicine, throughout the world. I personally have no doubt whatsoever about the eventual progressive ascendency of palliative medicine. What is required is that Catholics from all walks of life must continue to discuss and debate the value of palliative care over the practise of euthanasia, to anybody that is interested in listening.
John Candido.
Thank you for your research on euthanasia.
I am concerned with the use of PS. I feel that it could become a’moral word’ for euthansia. I am of the same opinion as James.H.
I read somewhere that the name ‘euthansia’ could be changed;this would seem a good starting point. To me the thin end of the wedge!
We ought to be very prudent here!
Some useful information on terminal sedation can be found by typing: Spucpalliativesedation. Then Terminal Sedation. Lots of info there!From SPUC.
While I do not have any real insights inside any medical school at any university in the world, I am sure that like the rest of society, it is composed of the usual cohort of conservatives, moderates, and liberals, only this time within the context of medical education. Secular forms of meditation have been known to appear in the curriculum of some medical schools. This is for the future use of general practitioners who can offer meditation as a way of helping future patients with low-level stresses and anxieties.
As a non-physician, I am very confident that scientific advances within the field of palliative medicine will continue to grow in an unstoppable and incremental fashion. Providing that governments continue to fund palliative research and continue to provide for an adequate number of palliative beds, I am very confident of the progressive ascendency within society towards palliative medicine in preference to either any form of legalised physician assisted suicide, or legalised euthanasia.
As I understand it as a non-physician, palliative care is a specialty in its own right. Any doctor that seeks to work in such a specialised area of medicine will need to obtain the necessary postgraduate qualifications in order to legally do so. As more progressive medical schools have introduced various forms of secular meditation within their curriculum to arm future general practitioners with non-drug forms of anxiety control, it will also be increasingly incumbent on all schools to also introduce reforms to the subject of medical ethics, palliative sedation, as well as a basic introduction to the study of palliative care, as a multi-disciplinary, expert field of specialisation in its own right.
A story, published on 9 March 2011, has the opening para: “UK doctors consistently oppose euthanasia and assisted suicide
Los Angeles, CA (March 10th, 2011) – A review of research carried out over 20 years suggests that UK doctors appear to consistently oppose euthanasia and physician-assisted suicide (PAS). The findings – which appear in the latest issue of the journal Palliative Medicine, published by SAGE – highlight a gap between doctors’ attitudes and those of the UK public.”
Fuller details at: http://www.eurekalert.org/pub_releases/2011-03/sp-udc030711.php
Quentin thank you for this information.
I believe the public are very vulnerable to voluntary euthansia,especially when a certain Dr Phillip Nitschke is holding meetings in various parts of the country at the moment.
I think we had the subject before ,and I mentioned the Dr a couple of years ago having a meeting which I attended along with about 100 or more people.
It was surprising to note how many were interested-even signing up for the knowledge as to how one can perform euthansia (which they had to pay for) it when needs be.
It was a cold ,calculated meeting,and people were sucked in to the ‘goodness’ of it.
All local churches were praying outside, I was volunteered to go inside, and did a report in the local newspaper. There was only one other comment who wrote their disgust.
The Peaceful Pill is one of the things, and also something else was spoken about.
Many years ago about (30 yrs or more) Exit were doing their rounds , and were speaking at a local secondary School, on their methods. I ,and many others who then belonged to an organisation called Exist, in conjuction with St Joseph,s Hospice, managed to speak the week before in the school.
It was unbelievable. And to note that Doctor Nitschke is now doing the rounds again.
That is mostly why the public are in favour which highlights the gap between doctors and the public. When they go to these meetings they are brainwashed.
This doctor was stopped at the airport when he was here before, but allowed in.
I didn’t hear anything this time!
Dr Nitschke’s organisation is now called Exit International,which he founded in 1997.
‘Exit’ I think are in Scotland. But all do the same thing.
John Candido, I can see the point you are making.
When the Government admits indirect funding of one child policy on forced abortion and sterilisations in China.
Then 22million pound a year to the United Nations Population Fund (UNFPA) and that it had agreed to allocate 99million to the International Planned Parenthood Federation (IPPF) from 2008 to 2014. ( Catholic Herald 28.5.2010)
The Government are looking for cuts in public expenditure they could begin by cutting the millions of pounds that pour out of the Treasury into the UNFPA and IPPF.
Our aid programmes should be used for relief and poverty and for developement.
(needed in this country too)
John Candido, I think the question of tax avoidance and tax evasion is an interesting one. and leads on naturally to a consideration of our duties to society. Bu I do agree that it is rather remote from Dealing with Dad.
I’ll look for an opportunity; meanwhile I have it on my list of “possibles”.
Thank you Quentin, I really appreciate your interest.
I would like to urgently bring to everybody’s attention, an upcoming interview of euthanasia supporter Dr Phillip Nitschke, on an Australian television religious program called ‘Compass’. Compass is an Australian Broadcasting Corporation (ABC) television channel. It will air at 10.00pm on Sunday, at Australian Eastern Daylight Saving Time, which is 11.00am Sunday London time.
It can be watched online after the interview has gone to air, however I am not sure as to how long people have to wait before they can watch the interview online. Compass’s website is http://www.abc.net.au/compass/.
Thank you John. Where do I find ABC Television.? I have Sky Freeview and digitel
Can I get it on there.
My apologies st.joseph, I can’t help you as I don’t really know. Can someone assist st.joseph as well as other interested people on how they can view ‘Compass’ with Sky Freeview and digital? Thank you.
I have neglected to specify that the channel in question with the ‘Compass’ program is ABC 1. I don’t have satellite television so I can’t tell you how to view the program using this medium. As I said previously, it will go to air tomorrow morning (Sunday) at 11.00am London time. Even if you can’t view it via satellite, you can always view the episode through Compass’s website at http://www.abc.net.au/compass/. I hope that it will be an interesting interview for all.
Thank you John, I managed to get into the web site and hopefully I will view it when it comes on the computer.
It won’t be very pleasant to watch, if it is anything like the meeting I attended. but necessary to find out what is being said.
The personal dilemmas in these situations where the long life of a parent is reaching its end are as intense and profound as anything that will be met in the course of one’s life. They bring together powerful emotions such as guilt and grief, and the fear of unbearable and irreversible loss, in ways that most people find difficult, if not impossible, to resolve except through the passage of time, notwithstanding a religious faith.
It is good that the Catechism recognises that a point is reached where we simply have to let go (and thank you to John Candido for the research) and that efforts to continue life can be disproportionate or over-zealous. This is, I suspect, from my own experience and what I have seen happening with relatives and friends, the much more common drama than the desire to see life ended on compassionate grounds. Sons and daughters have found the prospect of the utter loss of a parent impossible to contemplate, and have urged the doctors to extend life even when it is clear that a natural end has been reached. It is because of these circumstances that ethical medical protocols developed, some more transparent than others, which have sought to resolve such moral dilemmas.
But the context is changing. Never in the history of the human race have so many people lived to such advanced years. The expectations are that year after year the numbers will continue to grow. This is a marvellous phenomenon, arising out of numerous modern developments, such as higher standards of living, better health, better health care, and advances in the medical sciences. There are lots of instances where life is being lived to the full. The mother of a friend of mine is in her late 90’s and is sprightly of body and mind, being able to do the crossword faster than her son. Recently, in a local supermarket a customer announcement was made that Mrs X, who was 100 today, was with her trolley in the produce department and would be happy to receive their congratulations.
But there is, as we all know, another side to the story, where very old age is not accompanied with the good health and mental capacity to give it any quality. It means that there is a growing dependency on personal care of the most challenging kind being provided by strangers, and at great cost. I don’t think it is appreciated that it takes special attributes to be able, day in and day out, to behave compassionately when intimate care is required by dozens of patients/residents/clients who are unable to make a relationship and give the normal human responses, or may even be aggressive, and to be paid the minimum wage to do it. Of course, as John Candido shows with ample research, the development of all aspects of palliative care is desirable and possible, but the simple truth is that because of the demographic pressures it will require significantly greater additional resources. This is not a reason for not pursuing it; however, the most important job for politics and politicians is the allocation of resources and it will have to compete against many other priorities for the working population whose taxes will be required to pay for it.
Furthermore, there are signs that there simply aren’t the number of people available to provide the intuitive, compassionate, personal care required – that is, that have a vocation to do so. A friend has recently removed a close relative with Altziemer’s from a nursing home run by a prestigious national private health care company, at a cost of over £1000 a week, because of a litany of dismal failures, attributable to the quality of the staff employed, to provide even approximately the standard of care expected. The manager apologised for failing to achieve the response he desired to the legitimate complaints.
As the examples of poor standards of care for the elderly with dementia mount, with, sadly, the NHS also being in the frame (witness the article by 78 year old Eva Figes in the FT magazine of Feb 5/7 2011, with communications with foreign nursing assistants suggesting that we cannot look abroad for a solution) I suspect we will find that the standard improvement model of sorting out the management, recruitment, training, supervision and support for care staff will founder on the fundamental question of the availability of people with the aptitudes and a willingness to do a job that many will regard as the least attractive of the employment options available. It is a pessimistic view, but the problem urgently needs a sober and dispassionate analysis.
About three years ago SecondSight had a topic called, ‘Dealing with Dad’. This was about the euthanasia debate. I have come across a very interesting article in today’s edition of The Age newspaper in Australia. It is entitled, ‘Crossing paths daily with Death Incorporated’ and is written by an intensive care specialist located in Melbourne’s Box Hill hospital.
Anyhow, he is supportive of maintaining life and against euthanasia, and he details his experiences as a clinical physician. I think it is an interesting read for everyone. It is not too long either!
http://www.theage.com.au/comment/crossing-paths-with-death-incorporated-20140513-zravc.html
I think the doctor is confusing different things in this article. “Overwhelming community support” for euthanasia surely doesn’t translate into the expectation that a large number of terminally ill people would want to be euthanised. I would have thought that the support is mostly for the option to be there, not for it to be popular.
I was glad to be reminded of this 2011 discussion; it was deep, frank and thoughtful. And I thought the article you recite was inspiring.
You may have noticed in the papers today a report deploring the standards of hospital care for the dying. This is not so much a question of technical medicine as it is a lack of care about the condition. Many hospital staff have had no particular training, despite the importance put on this care by the authorities. Many people are not told that they are dying, and liaison with relatives is poor.
I wonder whether this is connected with a general secular view that ultimately people only matter when they contribute to society. In their last days they are effectively just so much rubbish – better thrown in the bin than waste the time of those who can help others who have life in front of them.