Euthanasia debate

[spot]

Welcome to the Westcliff Rules Debate on Euthanasia.

Postings into this thread are to be made in fixed rotation, in good time, by the listed participants only. We welcome discussion as the debate progresses, and afterwards, here and we ask that no posts be made in this thread other than those required by the rules governing this debate which may be found here.

This is a Switched Debate, the debating teams arguing for or against the motion during the first half and then reversing their role in the second.

A Motion was made, the Question being that

this House calls for the legalisation of assisted euthanasia

The motion is initially proposed by Bryn Mawr who is seconded by spot and opposed by Raven who is seconded by Accountable. Following their opening statements there will be a second round in which rebuttal will be heard.

During a third and fourth round, the proposers and opposition will switch roles and put the reverse of their original case.

A final fifth round, in the order shown in the rules, will allow each participant to sum up and conclude the debate.

I now call on Bryn Mawr to make his opening statement and on the other participants to follow in rotation.

[Bryn Mawr]

spot wrote:

I now call on Bryn Mawr to make his opening statement and on the other participants to follow in rotation.


Thank you.



Whilst euthanasia is a very wide subject area, I would like to concentrate on one aspect of it – Physician Assisted Suicide.





You might well ask why anybody should expect another person to help them kill themself?



The only time I would advocate legalizing PAS is when a person in the advanced stages of a degenerative, debilitating, illness – whether physical or mental – specifically requests it and satisfies the legal safeguards placed around it.



Firstly, as this covers both physical and mental debilitation, a form of pre-election must be available.



Secondly, in the case of pre-election, the patient must be examined at the time of that election to ensure that they are neither depressed nor coerced and that they are making their choice from an informed position.



Thirdly, where the request is actual rather than pre-elective, the patient must undergo the above checks and must receive counseling and advice, and be given a period of grace in which to change his / her mind.





Why PAS? Partly because, in the latter stages of a degenerative illness, the patient might well be incapable of performing the task him / her self, but mainly because the physician is a professional who will have access to the correct drugs, know the proper dosages etc and will be able to ensure that the correct safeguards have been observed.





Recent medical improvements mean that doctors can now prolong life beyond reasonable bounds. Whereas in the past a person would have died from “natural causes” before an illness had caused an enduring loss of dignity and robbed a person of the ability to perform even the basics for him / her self, nowadays it is possible, for example, to keep a body alive for years even though brain dead.



With this ability comes responsibility to ensure that life is not extended beyond a person's ability to endure it. It is for each person to decide their limits and, where they have legally expressed their wishes clearly and unambiguously, I contend that it is society's duty to allow a person to elect to end their life under those circumstances.

[Raven]

Thank you Bryn. I will take your argument point by point, if I may.



Physician assisted suicide. Why would they? They take a Hippocrotean oath when becoming licensed physicians. That oath alone, forbids the willful killing of a patient. Now you might argue that the physician isnt the one who actually 'pulls the trigger', so to speak, but setting up the means by which a patient does the 'suicide', means he is in full knowledge of intent, which makes him an accomplice to the killing.





A form of pre-election. We already have something of this nature. Currently the patients have the right to say whether or not they wish to be resuscitated and have their lives prolonged by artificial means.



A patient must be examined. Doctors are not infallible with their diagnosis of disease. They misdiagnose on a shocking and grand scale. So with the legalisation of what you propose, would involve many cases of sensless death. Furthermore, when a diagnosis of terminal illness is given, the first stages of reaction involve extreme depression. Most attempts at suicide, involve such a state of emotion. Despair and depression.



A period of grace. This is underestimating the human spirit to want to survive. All cases I have ever witnessed cling to the hope of a cure. They go to extreme measures at times, to achieve just this. From clinical medical trials of new treatment, to bizarre alternative medicine. The fact remains that most people choose to live.



There is no need for PAS. The latter stages of terminal illness is already relieved humanely where the patient does not suffer. At this point, it is familiy members and loved ones who need this time to say farewell and gain closure. It is phsycologically imperative that families be allowed to have this time.



Dignity? To be allowed to die in dignity? What makes you think they dont? Death is a natural part of life. Braindeath? When a person is pronounced braindead, all life support is removed and they are allowed to die peacefully. The controversy lies in the diagnosis. A simple eeg is how this diagnosis is obtained. No activity of the brain means clinical brain death. If there is activity of the brain, then that person is still living. The fact that the observer feels a person is suffering is incorrect. Most controversy lies in the next of kin wanting the insurance money or relief from the commitment. Saying that the pt. is suffering is just a feeble excuse. We have adequate medicines and treatments to insure people dont suffer. From pain, or infection. In the case of clinical brain death, the body is allowed to die.



Responsibility. People who are perceived as suffering, are just an excuse for others to be rid of them for one reason or the other. We have the responibility to protect vulnerable patients from those who would kill them off for convienience sake. We need to take a good look at motives here. Death isnt pretty. We have a repugnance for the death penalty, yet society is willing to impose just such a thing on people who have commited no crime? And even more perverse, impose killing on those who swore to preserve life?



Thank you for allowing me to resond. The floor yields to the chair.

[Accountable]

My compliments to my fellow debaters. Masters all.



In my mind, the issue is simple. Who owns the life? We love our freedom and our power of self-determination. Our love of freedom should dictate that an adult of sound mind should be allowed to decide how he should die. When our love of life and love of freedom collide, freedom takes priority.



No law allowing an action requires that action, meaning that no one would be required to commit suicide, assisted or otherwise. Along the same lines, no doctor ever has to perform a surgery to which he or she objects, such as abortion. He or she would likewise not have to assist with a suicide against his or her will.



The Hipocratic Oath is "first, do no harm." The act of extending a life of suffering arguably violates that oath, so assisting suicide can be argued as upholding it.



So, to allow assisted suicide supports freedom of choice, supports the Hipocratic Oath, supports our love of self-determination.

[spot]

I'm grateful for the invitation to second Raven in opposing this motion which calls for the legalization of assisted euthanasia.

To expand on her initial approach I'd like to divide the issue of assisted euthanasia into two broad categories - bringing about the premature death of those who can and do ask for it - the capable - and bringing about the premature death of those who are incapable of any legal declaration of their wishes.

The "incapable" category is itself two major areas. Those deemed medically to be unable to recover consciousness and those for whom periods of further consciousness may be possible. Medical practice currently terminates life in the first area, Persistent Vegetative State (PVS, or Cortical Death, or more loosely termed Brain Dead), on a regular basis with the consent of the family of the patient, or with a court order without such consent. Where the patient is on life support, life support is removed. Where the patient doesn't need life support (and this is more controversial, perhaps) feeding the patient is stopped as in the case of Terri Schiavo. PVS is discussed in the New Scientist where "three patients, all of whom have been in a PVS for at least three years" have been roused and held conversations after drug treatment. "An article published in the British Medical Journal in 1996 (vol 313, p 13) found that 43% of 40 patients were considered misdiagnosed with the condition. Only 13% of the patients remained vegetative, the study reported." Perhaps the prime consideration for prematurely and deliberately terminating the life of PVS patients is to free up resources or to relieve the family of further obligation. On the basis of the article I'm going to classify all genuine PVS patients with those who might recover consciousness (for simplicity and because I don't believe that current medical practice is sufficiently competent, cautious or careful to categorize with absolute accuracy) and merely describe them as "incapable" along with, predominantly, patients with dementia for whom periods of further consciousness are possible but who can make no rational legal declaration of their wishes.

I use the term "capable" to refer to those who are terminally ill and ask for assisted euthanasia and to those who make a Living Will providing a written euthanasia directive, the conditions of which are subsequently met. (To be quite clear, I am referring to these people at the point where they make a legal statement of their desire, not at the point where the conditions are met).

To look first at the incapable, I would ask in what way they continue to function in this world. I'd argue that at some level they reminisce, either fully consciously or in a more fragmentary but still real fashion. I would not willingly deprive anyone of that part of their life whether they possess the means of expressing the experience or not. For those who can still occasionally interact with friends, family, carers or visitors, there is a connection between past and future which would otherwise have been extinguished.

As for the capable, and without the least intention of trivializing the issue, does anyone remember of Good Queen Bess that she "seldom bathed, something typical of her time and particularly worrisome to modern generations who find it repugnant"? I remember people from my youth who grew up at a time when it was common enough to be sewn into thick vests and long-johns once the snow started falling and to take their next bath the following spring. Social pressure is very powerful. Which of you now would meet their neighbour after even a week without batheing and not feel an overwhelming pressure to conform to social practice? I suggest that if assisted euthanasia becomes legal in any circumstances it will eventually become socially acceptable. Is daily batheing socially acceptable now? I'd say it was more a social demand. I can hear, in my imagination, the earnest middle-aged head of household telling her bedridden parent that "if you go now we'll still have the money to send the kids to college, but if you hang on as long as you can it'll all be gone". Raven's statement that "most controversy lies in the next of kin wanting the insurance money or relief from the commitment" goes to the heart of the euthanasia debate, though I'd add government interest in reducing unproductive overheads as well. I see no way whatever that socially acceptable assisted euthanasia is not going to engender a pressure on the terminally ill to conform to societal practice and volunteer to go quietly. The pressure on people to sign a written euthanasia directive long before they become elderly or ill may well be even more intense. I can easily imagine circumstances where life insurance premiums or healthcare insurance plans are significantly reduced in price for people who sign such a clause, should they be made legal and binding. I find it difficult to imagine any legal framework enabling either a requested written euthanasia directive from a terminally ill patient, or legal recognition of a written euthanasia directive, which would not put society on a path toward these other pressures I have described.

I note that assisted euthanasia is legally practiced in Oregon, Belgium, Colombia, Japan and the Netherlands. A considerable period should elapse before this is widened into more jurisdictions, if only to see how cultural assimilation of the concept proceeds in those places, and by that I mean generations rather than decades. I fear that such a period of observation is unlikely. Assisted euthanasia is the thin end of a wedge with major financial implications. The only moral absolute at which the introduction of these ills can be prevented is refusing to take the initial step of allowing obvious and exceptional cases to be dealt with legally. I would much rather that people in such extreme circumstances deliberately broke the law and pled not guilty in court and relied on a jury to exonerate their behaviour (or pled guilty in court before a judge recognizing the injustice of more than a token penalty) than that society establish the practice in law and open the floodgates of habituation.

The day may come when our history books say that "they practiced natural death, something particularly worrisome to modern generations who find it repugnant". The time to prevent that outcome is now, by refusing to legalize even exceptional voluntary premature death. I urge the House to reject the motion.

[Bryn Mawr]

I welcome the opportunity to respond to the cogent arguments put forward by Raven and Spot and to defend the position taken by Accountable and myself.



Firstly to address Raven's points :-



The Hippocratic Oath was formulated two thousand years ago and, as medical knowledge has moved on, has been modified several times in the interim. The original oath, for example, forswore aiding abortion but many doctors now do this with some frequency.



Quoting from www.pbs.org/wgbh/nova/doctors/oath_today.html shows that :-



“paradoxically, even as the modern oath's use has burgeoned, its content has tacked away from the classical oath's basic tenets. According to a 1993* survey of 150 U.S. and Canadian medical schools, for example, only 14 percent of modern oaths prohibit euthanasia”



Where Raven says that we already have a form of pre-election I have to disagree. Not only is a living will not legally binding, its major failing is that it is only effective where a patient's body fails. There are many cases where the physical body might continue to exist for 10 or 20 years beyond the patient's ability to endure their condition whether this be due to continual physical pain, debility, or irreversible mental damage.





Doctors are not infallible, nobody is, but the patient's know their own ability to endure. I agree, the first reaction is often one of despair and depression, but even after this the patient's wishes are disregarded. Whilst I totally agree that most people will chose to live and I am in no way suggesting that the uptake of PAS will be widespread (in 2005, after 8 years of legal PAS in the state of Oregon, only 64 requests for PAS reached the stage of a prescription being made out and only 32 of those prescriptions were used by the patient – for many the knowledge that the option is available is enough). What I am suggesting is that, for those few who chose it, the right of choice should be there.





Let me put it more personally, I, as a dignified human being, do not wish to continue this existence if my body is in a Persistent Vegetative State or if my mind is so damaged by disease or stroke that I am unable to know my own family with no realistic prospect of recovery within 6 months. Nothing to do with next of kin wanting insurance money, no pressure to “do my duty”, no depression nor anything but a rational decision made in the cold light of day – this is my will.





That covers the cases where I would be in no mental state to make my case at the time. In cases of physical illness or disability I would be equally decided in what I would consider to be an unacceptable state of existence.





Nowhere in my initial proposal did I suggest that others should be allowed to get rid of the inconvenient. The prime rule throughout the proposal is the will of the patient, which leads me on to Spot's response.





All of the cases to which I have referred fall explicitly into the class of Capable. I too would neither suggest nor sanction euthanasia of those he terms Incapable.





Indeed, I see this as the immovable barrier preventing the proposed legislation from entering the slippery slope to perdition – it must always be at the express wish of the patient.





Many hundreds of years ago, several civilizations existed which routinely sacrificed their own young children to appease the gods. This is nowadays considered to be totally socially unacceptable and the social pressure against it is overwhelming. In the same way I expect future civilizations to be different from ours – life is not static.





I do not believe that we can predict the course of the future and I do not believe that we should rule our lives by what may happen many generations in the future. If we see injustice in our society we should do our best to rectify it now.





I put it to this house that forcing competent people to continue a life they find repugnant is an injustice and that the proposed legislation would be of benefit to society.





Thank you.

[Raven]

I beg your pardon for the delay gentlemen, but let us forward this debate.

Bryn, what you are suggesting is that you could possibly predict the unpredictable. One cannot know if one is going to suffer a stroke or any debilitating process. The legislation provided, already covers a myriad of conditions that prohibit the rescusitation of people who suffer with these.

The case put foward is PAS. Asking to legislate a procedure that forces physicians to help in the process of killing another human being.

If a person wishes to exit this life, then why involve another in the process?

It's been my experience that doctors already push the envelope by easing the passing of terminal and vegetative patients by prescribing massive doses of morphine anyway. There is no need for such legislation. What I am trying to say in a nice way, is that we already do something about these conditions! We already use drugs to do this! Without the person having to choose suicide, we already ease the suffering, and quicken the passage, with the utmost discretion!

As it stands now, it's an act of mercy. By what you propose, it will turn into acts of execution.

And why, in the clear light of day, would anyone in their right mind choose to die? Life is precious. And as it stands right now, suicide is against the law. No matter who chooses it. There are too many loopholes that can give way to legalisation of murder.



Thanks for bearing with my short absence!