8 ms·

During the recent debate around the Assisted Dying Bill in the UK, I listened to a radio phone-in in which a palliative care doctor explained that it wasn't pos

During the recent debate around the Assisted Dying Bill in the UK, I listened to a radio phone-in in which a palliative care doctor explained that it wasn't possible to relieve all suffering for all patients. They relayed an example of a person who had spent their last days vomiting fully-formed faeces. If we can prevent five, ten or perhaps twenty percent of people having gruesome deaths, then not doing so feels like a moral failing.

SapporoChris 2y ago
"They relayed an example of a person who had spent their last days vomiting fully-formed faeces." Sounds like a fully-formed exaggeration. Vomiting once or twice a day is not spending your last days vomiting. More frequent vomiting? The supply could not possibly meet the demand. Especially if the patient stopped eating.
- gnfargbl 2y ago
  You can listen to the account yourself at https://www.bbc.co.uk/sounds/play/m00253mt https://www.bbc.co.uk/sounds/play/m00253mt, from around 25 minutes onwards. I found it convincing.
  - treis 2y ago
    It doesn't sound particularly possible.
    - winocm 2y ago
      This is entirely possible. See copremesis, ICD10 code R11.13. It usually occurs due to intestinal blockage or fistulae.
  - nashashmi 2y ago
    vomit is usually liquid or heavily digested stuff. feces is compacted and excreted. my imagination maybe a little specific here but so is the description "fully formed feces"
    - tokioyoyo 2y ago
      If your intestines are obstructed, and the fecal matter has started forming, and it's trying to come out, where do you think it will come out from?
    - djeastm 2y ago
      When there's no place for the compacted feces that's building up to go (due to a failure in peristalsis, for instance), it backs up into the the stomach, which naturally irritates the stomach and causes the person to vomit the contents, which includes their feces. I wouldn't wish it on anyone.
- david38 2y ago
  You are incorrect. You don’t have to be doing something 24 hrs a day to be spending your days doing it. If you were a child who was raped every night by your father, you could absolutely say with honesty that you spent your nights getting raped. What matters is - does the event significantly affect the rest of your day? Not - is the event happening non-stop. If that were the case, you could vomit every hour and still not be able to make the claim, since there are periods of rest.
nurettin 2y ago
Even if this is true, it appeals to extremes to make a point. People agajnst the motion are against the misuses of assisted suicide due to conditions that may get better in time, or misunderstandings, or conditions of a mental nature which may change or be cured.
- swat535 2y ago
  That’s part of it, however they are also against it from a morality and ethical point of view, with the central argument being that you can’t take an innocent person’s life, no matter how “good” you think your intentions are. Basically they uphold the value of life above all else, including one’s desire to end it. By the same token, they are against any form of suicide.
  - mistrial9 2y ago
    citing individual cases is not the road to reason here IMHO. Every single person dies at some point. This is an "entire population" question. Ethics and Morality play an educational, character formation role.. and, a medical decision is not the same as other kinds of decisions.. Another point -- people who are unstable or overwhelmed personally often leap to extreme, graphic and emotional examples first and without context. The original post here fits that description IMHO
    - kspacewalk2 2y ago
      This is emphatically not an "entire population" question. This is an individual rights question. I don't know what safeguards exist in other countries to prevent "people who are unstable or overwhelmed personally" from "leaping to the extreme", but in Canada the rules are strict and multiple doctors have to sign off. You can read the MAiD eligibility criteria and the approval process here[0]. [0] https://www.canada.ca/en/health-canada/services/health-services-benefits/medical-assistance-dying.html https://www.canada.ca/en/health-canada/services/health-servi...
ZeroGravitas 2y ago
A more important point is that even in a more normal palliative care situation, which previously may have involved a borderline illegal increase of drugs near the end to hasten and ease death, might now be recorded as an assisted death instead. So a more interesting stat might be the expected quality of life adjusted years that have been cut off by the assisted deaths. I'm not sure if QUALY can go negative but some measure that can might be appropriate when talking about assisted death.
- gnfargbl 2y ago
  Negative QALY values do appear possible, according to https://linkinghub.elsevier.com/retrieve/pii/S1098301510600460 https://linkinghub.elsevier.com/retrieve/pii/S10983015106004... (via Wikipedia).
  - eru 2y ago
    I'm not sure a link will contribute much? It's just the basic question whether some years (or days or whatever) are so awful that you are better off being dead. In any case, the linked article says 'States worse than dead can exist and they would have a negative value and subtract from the number of QALYs.'
    - gnfargbl 2y ago
      Yes, it's a fairly obvious point. The link was in the context of whether negative QALYs are a concept used by the medical profession.
- x0x0 2y ago
  Anyone who's been close to a dying cancer patient knows what the last couple months are like for many: unending suffering plus tomorrow will be worse. Many people would choose not to suffer like that and I can't understand who anyone else is to tell them they must endure utter misery for nothing.
- LorenPechtel 2y ago
  Whether the official measure can go negative or not on a practical level it clearly can. I saw my father near the end--the morphine robbed him of the ability to make long term memory. From when he was on that dose it was short term memory only, his world was frozen to before that point. And he was still in pain. How can that be anything but a negative quality of life?
hackeraccount 2y ago
Hard cases make bad law.
afh1 2y ago
There is no "we". There are people and their bodies and their wishes. And authoritarians who want a say on it. Doesn't matter if nice sounding words like law and democracy are used to describe the tyranny.
- PittleyDunkin 2y ago
  "tyranny" also seems like a concept mostly unrelated to the topic at hand. Practically speaking, nobody can really prevent you from taking your own life.
  - Retric 2y ago
    If only that were true. Someone unable to move is unable to take their own life without assistance. A surprisingly large percentage of people go through some horrific experiences before their bodies completely fail.
    - bluefirebrand 2y ago
      This is a vanishingly small percent of cases Someone who is unable to move is probably also unable to unambiguously communicate their wish to be euthanized as well so I really don't think it's that relevant
      - Retric 2y ago
        Bed sores are a reasonable proxy for people being unable to move and they are a common enough risk to be a significant concern. If you can’t even roll over then you’re at the mercy of whatever people are willing to bring you even if you can speak or use a TV remote just fine.
    - PittleyDunkin 2y ago
      > Someone unable to move is unable to take their own life without assistance. Denying this assistance isn't really "tyranny", though, even if you do accept that suicide is a right.
zer8k 2y ago
This is an appeal to emotion. While people should have autonomy over their lives we should not be legalizing assisting them. This is a path that is well-trodden. Many dictatorships have "mercifully euthanized" various sectors of people. It always starts out as the disabled, cancer-stricken, or unviable. Then it becomes a simple way to get rid of the people deemed to be a burden. Suddenly being depressed is a good way to get the needle. Can't perform your job well enough? Yep you guessed it, needle. Or I guess these days they've made sarco pods for the personalized gas chamber experience. This isn't even a slippery slope, we're watching it happen in real time as the bar for euthanasia continues to be lowered. There's been several cases that MAID has willfully disobeyed the law. Doctors not filing the correct paperwork, rushing patients, etc. We are already seeing the sprouts of a system that if allowed to continue will become a virtual Soylent Green. Of course I'll be downvoted for this by the bleeding hearts but history has not been kind to people who allow this.
- gravitronic 2y ago
  slippery slope fallacy that giving people control of their own deaths will turn into the state euthanized anybody against their will
  - bluefirebrand 2y ago
    It's not a slippery slope if it's actually happening But you're right, the state isn't euthanizing anyone against their will, and they don't need to They can simply change incentives in such a way that people decide that it is what they want all on their own
    - standardUser 2y ago
      If there are abuses we should strive to minimize or abolish those abuses. The alternative - to tolerate incalculable human suffering and force the loved ones of those suffering to stand there and watch - is unacceptable.
      - 2y ago
mensetmanusman 2y ago
If we can prevent even one person from having a gruesome death, it’s worth the sacrifice of the other 99?
- barbazoo 2y ago
  Who's being sacrificed and how in that case?
  - mensetmanusman 2y ago
    Those who jumped off the Golden Gate Bridge but weren’t caught (intentionally).
GordonS 2y ago
Right, but there's a problem - the UK is in a real mess! Social services, medical services, all the services are underfunded and crumbling. There is a cost of living crisis as wages have barely moved in 15 years, food banks are everywhere, and now "multibanks" are popping up. Our country first needs to ensure that people can choose to live, and if needed be cared for; nobody should feel pushed into assisted dying because of financial reasons. I say this as someone who will be in pain for the rest of my life, and euthanasia has been on my mind at times. As much as I might "benefit" from such a law in the future, I don't believe it should be passed until we have a stable society with good services and safety nets.
- jncfhnb 2y ago
  What if we triple your pain?
- 01jonny01 2y ago
  100% you articulated exactly what I couldn't - thank you. It feels very wrong to be considering this in the UK when we are on the decline. Espcially since the current government have demonstrated that they don't really care about pensioners.
  - quasse 2y ago
    OTOH, it's interesting that you and the parent comment are basically saying "We, as a country, are failing our pensioners so badly that death has become the more appealing option for many of them. Therefore, we must trap them here with us until we improve the conditions that lead to them making that bargain (which we will never do)" Taking away someone's right to assisted dying because you live in a society that has made death preferable to living for many seems like a totally orthogonal leap of logic. That doesn't reduce net suffering one iota.
    - 01jonny01 2y ago
      I am eluding perverse incentives by the government to employ such a scheme. I am sure if they use pure logic and numbers it makes sense to roll this out, especially at time like this. It would indeed help the balance the books and get rid of that pesky voter base who typically vote right. The decision to offer assisted dying needs to be based on compassion and logic, not on logic alone.

SapporoChris 2y ago

"They relayed an example of a person who had spent their last days vomiting fully-formed faeces." Sounds like a fully-formed exaggeration. Vomiting once or twice a day is not spending your last days vomiting. More frequent vomiting? The supply could not possibly meet the demand. Especially if the patient stopped eating.

gnfargbl 2y ago
You can listen to the account yourself at https://www.bbc.co.uk/sounds/play/m00253mt https://www.bbc.co.uk/sounds/play/m00253mt, from around 25 minutes onwards. I found it convincing.
- treis 2y ago
  It doesn't sound particularly possible.
  - winocm 2y ago
    This is entirely possible. See copremesis, ICD10 code R11.13. It usually occurs due to intestinal blockage or fistulae.
- nashashmi 2y ago
  vomit is usually liquid or heavily digested stuff. feces is compacted and excreted. my imagination maybe a little specific here but so is the description "fully formed feces"
  - tokioyoyo 2y ago
    If your intestines are obstructed, and the fecal matter has started forming, and it's trying to come out, where do you think it will come out from?
  - djeastm 2y ago
    When there's no place for the compacted feces that's building up to go (due to a failure in peristalsis, for instance), it backs up into the the stomach, which naturally irritates the stomach and causes the person to vomit the contents, which includes their feces. I wouldn't wish it on anyone.
david38 2y ago
You are incorrect. You don’t have to be doing something 24 hrs a day to be spending your days doing it. If you were a child who was raped every night by your father, you could absolutely say with honesty that you spent your nights getting raped. What matters is - does the event significantly affect the rest of your day? Not - is the event happening non-stop. If that were the case, you could vomit every hour and still not be able to make the claim, since there are periods of rest.

nurettin 2y ago

Even if this is true, it appeals to extremes to make a point. People agajnst the motion are against the misuses of assisted suicide due to conditions that may get better in time, or misunderstandings, or conditions of a mental nature which may change or be cured.

swat535 2y ago
That’s part of it, however they are also against it from a morality and ethical point of view, with the central argument being that you can’t take an innocent person’s life, no matter how “good” you think your intentions are. Basically they uphold the value of life above all else, including one’s desire to end it. By the same token, they are against any form of suicide.
- mistrial9 2y ago
  citing individual cases is not the road to reason here IMHO. Every single person dies at some point. This is an "entire population" question. Ethics and Morality play an educational, character formation role.. and, a medical decision is not the same as other kinds of decisions.. Another point -- people who are unstable or overwhelmed personally often leap to extreme, graphic and emotional examples first and without context. The original post here fits that description IMHO
  - kspacewalk2 2y ago
    This is emphatically not an "entire population" question. This is an individual rights question. I don't know what safeguards exist in other countries to prevent "people who are unstable or overwhelmed personally" from "leaping to the extreme", but in Canada the rules are strict and multiple doctors have to sign off. You can read the MAiD eligibility criteria and the approval process here[0]. [0] https://www.canada.ca/en/health-canada/services/health-services-benefits/medical-assistance-dying.html https://www.canada.ca/en/health-canada/services/health-servi...

ZeroGravitas 2y ago

A more important point is that even in a more normal palliative care situation, which previously may have involved a borderline illegal increase of drugs near the end to hasten and ease death, might now be recorded as an assisted death instead. So a more interesting stat might be the expected quality of life adjusted years that have been cut off by the assisted deaths. I'm not sure if QUALY can go negative but some measure that can might be appropriate when talking about assisted death.

gnfargbl 2y ago
Negative QALY values do appear possible, according to https://linkinghub.elsevier.com/retrieve/pii/S1098301510600460 https://linkinghub.elsevier.com/retrieve/pii/S10983015106004... (via Wikipedia).
- eru 2y ago
  I'm not sure a link will contribute much? It's just the basic question whether some years (or days or whatever) are so awful that you are better off being dead. In any case, the linked article says 'States worse than dead can exist and they would have a negative value and subtract from the number of QALYs.'
  - gnfargbl 2y ago
    Yes, it's a fairly obvious point. The link was in the context of whether negative QALYs are a concept used by the medical profession.
x0x0 2y ago
Anyone who's been close to a dying cancer patient knows what the last couple months are like for many: unending suffering plus tomorrow will be worse. Many people would choose not to suffer like that and I can't understand who anyone else is to tell them they must endure utter misery for nothing.
LorenPechtel 2y ago
Whether the official measure can go negative or not on a practical level it clearly can. I saw my father near the end--the morphine robbed him of the ability to make long term memory. From when he was on that dose it was short term memory only, his world was frozen to before that point. And he was still in pain. How can that be anything but a negative quality of life?

hackeraccount 2y ago

Hard cases make bad law.

afh1 2y ago

There is no "we". There are people and their bodies and their wishes. And authoritarians who want a say on it. Doesn't matter if nice sounding words like law and democracy are used to describe the tyranny.

PittleyDunkin 2y ago
"tyranny" also seems like a concept mostly unrelated to the topic at hand. Practically speaking, nobody can really prevent you from taking your own life.
- Retric 2y ago
  If only that were true. Someone unable to move is unable to take their own life without assistance. A surprisingly large percentage of people go through some horrific experiences before their bodies completely fail.
  - bluefirebrand 2y ago
    This is a vanishingly small percent of cases Someone who is unable to move is probably also unable to unambiguously communicate their wish to be euthanized as well so I really don't think it's that relevant
    - Retric 2y ago
      Bed sores are a reasonable proxy for people being unable to move and they are a common enough risk to be a significant concern. If you can’t even roll over then you’re at the mercy of whatever people are willing to bring you even if you can speak or use a TV remote just fine.
  - PittleyDunkin 2y ago
    > Someone unable to move is unable to take their own life without assistance. Denying this assistance isn't really "tyranny", though, even if you do accept that suicide is a right.

zer8k 2y ago

This is an appeal to emotion. While people should have autonomy over their lives we should not be legalizing assisting them. This is a path that is well-trodden. Many dictatorships have "mercifully euthanized" various sectors of people. It always starts out as the disabled, cancer-stricken, or unviable. Then it becomes a simple way to get rid of the people deemed to be a burden. Suddenly being depressed is a good way to get the needle. Can't perform your job well enough? Yep you guessed it, needle. Or I guess these days they've made sarco pods for the personalized gas chamber experience. This isn't even a slippery slope, we're watching it happen in real time as the bar for euthanasia continues to be lowered. There's been several cases that MAID has willfully disobeyed the law. Doctors not filing the correct paperwork, rushing patients, etc. We are already seeing the sprouts of a system that if allowed to continue will become a virtual Soylent Green. Of course I'll be downvoted for this by the bleeding hearts but history has not been kind to people who allow this.

gravitronic 2y ago
slippery slope fallacy that giving people control of their own deaths will turn into the state euthanized anybody against their will
- bluefirebrand 2y ago
  It's not a slippery slope if it's actually happening But you're right, the state isn't euthanizing anyone against their will, and they don't need to They can simply change incentives in such a way that people decide that it is what they want all on their own
  - standardUser 2y ago
    If there are abuses we should strive to minimize or abolish those abuses. The alternative - to tolerate incalculable human suffering and force the loved ones of those suffering to stand there and watch - is unacceptable.
    - 2y ago

mensetmanusman 2y ago

If we can prevent even one person from having a gruesome death, it’s worth the sacrifice of the other 99?

barbazoo 2y ago
Who's being sacrificed and how in that case?
- mensetmanusman 2y ago
  Those who jumped off the Golden Gate Bridge but weren’t caught (intentionally).

GordonS 2y ago

Right, but there's a problem - the UK is in a real mess! Social services, medical services, all the services are underfunded and crumbling. There is a cost of living crisis as wages have barely moved in 15 years, food banks are everywhere, and now "multibanks" are popping up. Our country first needs to ensure that people can choose to live, and if needed be cared for; nobody should feel pushed into assisted dying because of financial reasons. I say this as someone who will be in pain for the rest of my life, and euthanasia has been on my mind at times. As much as I might "benefit" from such a law in the future, I don't believe it should be passed until we have a stable society with good services and safety nets.

jncfhnb 2y ago
What if we triple your pain?
01jonny01 2y ago
100% you articulated exactly what I couldn't - thank you. It feels very wrong to be considering this in the UK when we are on the decline. Espcially since the current government have demonstrated that they don't really care about pensioners.
- quasse 2y ago
  OTOH, it's interesting that you and the parent comment are basically saying "We, as a country, are failing our pensioners so badly that death has become the more appealing option for many of them. Therefore, we must trap them here with us until we improve the conditions that lead to them making that bargain (which we will never do)" Taking away someone's right to assisted dying because you live in a society that has made death preferable to living for many seems like a totally orthogonal leap of logic. That doesn't reduce net suffering one iota.
  - 01jonny01 2y ago
    I am eluding perverse incentives by the government to employ such a scheme. I am sure if they use pure logic and numbers it makes sense to roll this out, especially at time like this. It would indeed help the balance the books and get rid of that pesky voter base who typically vote right. The decision to offer assisted dying needs to be based on compassion and logic, not on logic alone.