Death and dying

Discussions that deal with moral issues. Key questions in ethics include: How should one live? What is right (or wrong) to do? What is the best way for humans to live?

Death and dying

Postby Serpent on April 27th, 2021, 12:52 am 

Who has a right or responsibility to make decisions over when and how a person dies?
Does everyone have a right to end their own life? For what reason? Should they consult other people before deciding?
Does a legislative body have the right to decide what each person's rights are regarding their own death?
Does a religious body have the right to decide?
Does/should anyone have a right to assist another person in ending their life? Should they get prior permission to do so? Should they prosecuted for doing it without consent from a legislative or religious body?
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Re: Death and dying

Postby charon on April 27th, 2021, 9:28 am 

Depends on the circumstances.
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Re: Death and dying

Postby TheVat on April 27th, 2021, 10:50 am 

That's a lot of questions, S. Of them, perhaps the most interesting for an ethics forum is the one of assisted suicide. The right to die is not an issue for me, and I view it as a fundamental element of any ethos of personal autonomy and freedom. But I think the matter of how assisted suicide may be done, and with what supervision by government and courts of law, does have thorny issues. I think a good step would be new legal forms, akin to a living will, in which a person while still mentally competent can specify their wish for assisted suicide and under what conditions of health they would want that. And the document could specify a trustworthy neutral party, a non-relative with no financial stake in someone's death, to oversee the AS.
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Re: Death and dying

Postby Serpent on April 27th, 2021, 1:58 pm 

TheVat » April 27th, 2021, 9:50 am wrote:That's a lot of questions, S.

I wanted to see whether there was interest in the subject in general. Didn't want to make it too narrow too soon.

Of them, perhaps the most interesting for an ethics forum is the one of assisted suicide.

Yes, but even before that, we have the primary question of suicide. How did it get to be a sin in the first place, and why does the notion of its sinfulness still permeate nominally secular legal systems?
I know the "concern" is usually dressed up as guarding the feeble old person from greedy relatives - but, really, most of the affected population has nothing to leave but huge medical debts. The same unctuous judge, with his Cadillac health insurance and diversified portfolio, can respond "Aha! They want to kill Grandma because she's costing them money. We can't allow that!"
Then you have idjit conservative legislators, who don't even know what they're talking about, weighing in on end-of-life decisions of people who are not even their constituents! That's not a personal or financial interest; it can only be pandering to religious factions.
One of the issues I'd like to examine are:
How aware are legislators, jurists and voters of their own bias?
What causes the apparent anathema of discussing the logistics, the economics, the structural and social consequences of prolonging human life, even if it's non-functional, non-sentient or non-consenting?
Where do people get the idea that they have a right to power over other people's death?
Why are the same people opposed to suicide - DIY or assisted - and for wars of aggression; against abortion and for state execution? What forces shape this contradictory belief?
I'm interested, generally, in the ever-changing cultural attitudes toward death.

The right to die is not an issue for me, and I view it as a fundamental element of any ethos of personal autonomy and freedom.

I expected no less.
It's finally been legalized and carried out successfully in Canada, but that doesn't mean the wrangling over terms and conditions is over.
But I think the matter of how assisted suicide may be done, and with what supervision by government and courts of law, does have thorny issues. I think a good step would be new legal forms, akin to a living will, in which a person while still mentally competent can specify their wish for assisted suicide and under what conditions of health they would want that.

One problem is that some legal luminary will always argue that, when you're healthy and safe, you can't foresee how you will feel when confronting death. And, indeed, some people do change their minds and hang on long past where they imagined they would.
Another problem is making such a document legally binding on persons not actually named in it : at the time of writing, you're trying to cover general circumstances and don't yet know the particulars.
Families and friends all have a personal interest, whether in trying to keep the sick person alive or in helping them out of their suffering, in their money or their autonomy, knotted up with pity, guilt, fear and denial.
If those people have to decide, they form up into pro and con factions, and that animosity can continue long after the bone of contention is buried.
Nobody wants family discord as their legacy. So, yes, it would be much better all around if the dying person had the strongest voice.
https://www.willful.co/learn/living-wills
And the document could specify a trustworthy neutral party, a non-relative with no financial stake in someone's death, to oversee the AS.

Most people can't afford, or even know know how to engage a professional representative, and I doubt it would be easy to recruit a colleague or acquaintance for such an onerous task. It might have to be an appointed or elected ombudsman - a Death Tsar ?
(I know.... and it's only mid-day!)
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Re: Death and dying

Postby charon on April 28th, 2021, 6:24 am 

The problem with absolutists and fundamentalists is that, not being very bright, they can only see things in binary form. It's black or white, yes or no, allowed or not allowed. So we'll dispense with them. Life can't be contained in a formula.

I heard a story once about Chinese families hiding from Japanese invaders. The women had babies. If the babies cried the Japanese would hear it, discover the whole group, and kill them all... so the women smothered the babies to save the group and themselves.

It depends on circumstances if, how, when, and whether one takes life. There's no one answer, and there never was.
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Re: Death and dying

Postby doogles on April 28th, 2021, 6:04 pm 

We have what's called palliative care in Queensland.

I have been closely involved with the final days of my own eldest daughter and with my father in law.

My eldest daughter was wheelchair-bound with rheumatoid arthritis with no real quality of life, when she contracted Ross River Fever and gastroenteritis simultaneously. She developed anasarca and was in serious pain. A family discussion (with Power of Attorney) resulted in agreement that the kindest procedure was palliative care. Even if by some miracle, her recent morbidities could have been reversed, she had no quality of life to return to.

The attending physician and the palliative care specialist agreed. No further official documentation or permission was required and everything was done to make her comfortable and free of pain. Increasing doses of morphine and other drugs resulted in her passing in a few days.

My father-in-law was in his late 80s and totally sedentary with mild dementia. A mechanical hoist had to be used to put him in a wheelchair for the toilet and for the shower. He was placed in a comfortable chair in front of a TV each morning and stayed there till it was time for bed. The grown children (in their 60s) loved him very much and wanted him to survive for as long as possible. A bout of cellulitis with rigors put him into hospital for intravenous antibiotics. The cellulitis improved but his general health status declined to the point where it was obvious that he was dying. Once again it was a case of making him comfortable and assisting his passing with increasing doses of morphine (palliative care). The decision was entirely that of the family and the attending physician without any official documentation or review.

On the other hand, I've had a close friend with disseminated prostate cancer who walked into a medical facility and requested and received high dose palliative care. He was gone in a few days.

Another female friend in her 60s found that she had residual inoperable brain tumours following brain surgery. While still in hospital and quite conscious, she requested and received palliative care.

This palliative care is really euthanasia, but for some strange reason, the 'right-to-lifers' do not appear to have realised this.

To my way of thinking, our system seems to be working.

As a registered veterinary surgeon, I killed thousands of animals quickly and efficiently. the decision only had to be made by the owner and not an entire family, if you know what I mean. I respected any owner's decision to request euthanasia, because I was the professional in the community who was trained for the job.

I see a small problem with quick and efficient euthanasia in human beings, even though my own personal preference would be for intravenous concentrated barbiturate if I decided to go.

I imagine that if such a method became legal, then it could become something akin to an execution. A medical professional would have to do the job, and a date and time would have to be set to perform the act. It could not be just an ad hoc decision, because there would be people who would claim that they did not get a chance to say "goodbye" etc etc.

Everything considered, I think that the Queensland 'palliative care' procedure is the way to go.
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Re: Death and dying

Postby Serpent on May 5th, 2021, 6:30 pm 

doogles » April 28th, 2021, 5:04 pm wrote:We have what's called palliative care in Queensland.


I'm so sorry, Doogles! Can't imagine how I missed this for a whole week. Wasn't absent in body - just in attention, I guess.

First, I had to take a moment to reflect on what you've said about your experience. Losing a child like that - after watching her suffer - that must have been horrific! You have my most profound sympathy.

The only close relative I watched die was my mother. She had a small stroke we didn't know about (she did; she'd been a nurse), and four months later, a big one. They were most likely caused by previously invisible tiny malignant tomours in her brain, and there was no effective treatment. (In fact, the attending physician who explained it to us did lay out available options in chemo- and radiation therapy, and tried to keep her voice level, but she obviously believe in them any more than I did, and was visibly relieved when we answered "No!" It would have been beyond cruel, as she couldn't defend herself or even speak intelligibly).

We had an amazing amount of help from the health service. Not only were there no obstacles to bringing her home - except a solemn warning that it could be six or seven months. They delivered a hospital bed, a wheelchair, boxes of supplies and drugs (The only thing we had to pay for was the ambulance). They taught us how to transfer a patient safely from one surface to another; how to change her bedding and IV drip - everything. A nurse came to check on her every day and a longer visit once a week. They even provided a home helper to spell us off for an afternoon each week, but I was in charge of meds. She actually had some good days, able sit out on the deck and even to articulate some clear sentences. My brother came from Manitoba; our grown children had a chance to see her one more time.
Mercifully, the decline was rapid; she died within six weeks of diagnosis. Her GP came by a few times. On the last visit, he told me: "At this point, there is nothing you can do wrong." Tacit permission to increase the morphine. I believe that's been standard practice among compassionate medical staff for decades.

The courts and legislatures lagged for fear of the religious back-lash. (And I suppose judges are always afraid of wielding a god-like power.) That was 8 years before they finally struck down the law prohibiting assisted suicide. But she wouldn't have qualified anyway - and still wouldn't now - as she was neither lucid nor articulate for most of that final month.

This palliative care is really euthanasia, but for some strange reason, the 'right-to-lifers' do not appear to have realised this. To my way of thinking, our system seems to be working.

You live in a civilized country. In fact, I'm surprised you haven't arrived at legal euthanasia.
I think some, or most religious do realize it, but are too decent to raise a ruckus, as long as the pretense is maintained. And even in Catholic hospitals, doctors increase the dosage as much as they dare, to keep the patient just barely alive until close to the predicted termination date. End-of-life pain management is a tightrope for many good medical practitioners - and has been, for seventeen hundred years.

I killed thousands of animals quickly and efficiently. the decision only had to be made by the owner and not an entire family, if you know what I mean.

I do, indeed! Sadly, we've had several occasions to avail a cherished pet of that service.
And, yes, I do very much want that option to be available to me!

I see a small problem with quick and efficient euthanasia in human beings, even though my own personal preference would be for intravenous concentrated barbiturate if I decided to go.

I imagine that if such a method became legal, then it could become something akin to an execution.

That's what everyone seems to be afraid of: that we'll suddenly go on a rampage, knocking inconvenient relatives, right and left. But I think people who would do that, already do it - for both reasons: murder for gain and mercy killing from pity. In fact, it's more usual - by a very wide margin - for the patient to have to fight their spouses, siblings and children for the right to leave them.

A medical professional would have to do the job, and a date and time would have to be set to perform the act.

Yes, and the guidelines are very strict. So stringent that patients who already have the legal right to die * https://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html#s1were, until recently, forced to suffer an extra 10 days, just to be sure they mean it. Sometimes they die while waiting. If we hear that a prisoner was tortured for three days on end, we think that's pretty bad. Making thousands of people wait a day, a week, a month live beyond where palliative meds stopped working is torture.

It could not be just an ad hoc decision, because there would be people who would claim that they did not get a chance to say "goodbye" etc etc.

No, it really can't!
be 18 years of age or older and have decision-making capacity
be eligible for publicly funded health care services
make a voluntary request that is not the result of external pressure
give informed consent to receive MAID, meaning that the person has consented to receiving MAID after they have received all information needed to make this decision
have a serious and incurable illness, disease or disability (excluding a mental illness until March 17, 2023)
be in an advanced state of irreversible decline in capability
have enduring and intolerable physical or psychological suffering that cannot be alleviated under conditions the person considers acceptable


Even so, it doesn't allow for a living will, and doesn't cover anyone who is incapable of making the application. There has been some expansion of eligibility and a little loosening of the requirements. We're getting there - but, oh, so slowly for people who live in discomfort, shame, fear, self-disgust, frustration and feel helpless, day after day after day day after....

Everything considered, I think that the Queensland 'palliative care' procedure is the way to go.

It's all right, as long as some fundamentalist crusader doesn't start bringing criminal charges or 'unlawful death' law-suits against doctors. I wouldn't want to live on the tightrope, either!
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Re: Death and dying

Postby TheVat on May 5th, 2021, 7:17 pm 

Doug, your post carries considerable weight, given the tragedy you experienced. Thanks for mustering courage to write about it here.

I admit I'm not sure what the range of options is in hospice care (palliative care in the States) here, but am aware that Canada, Australia, and several EU nations allow more leeway on a merciful end.

Still mulling all the attendant issues raised here, including how suicide is so condemned by many religions and the theological bases for that. Will try to get back here before the weekend.
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Re: Death and dying

Postby Serpent on May 5th, 2021, 10:31 pm 

The theological foundations are ... shaky. (The moral ones are laughable.) Seems like the RC biblical commentators did a good deal of 'expanding' and extrapolating from very few reference points.
In the Commandments on which Christianity so heavily and often leans, #7 (higher priority than adultery, but lower than honouring of parents) "Thou shalt not kill."

Well, when that happened, up on Sinai, obviously God didn't mean it literally or generally, because he'd just helped the Hebrews defeat the Amaleks and was about to launch them against Jericho, and would, many, many more times, exhort them to kill all sorts of people and a whole lot of the purest animals they could find for sacrifice to him, as well as whichever ones they ate,+/- that one goat a year driven off to take its chances against the jackals.
Lots and lots and lots of exceptions! Lots and lots of wars, stonings, not sufferings to live, etc. Notable is the case of the Amalekites - long-time feuding antagonists of Israel. That same "Thou shalt not kill: Jehovah directs his chosen people to commit genocide++ :
Samuel 15:3 Go and attack Amalek. Utterly destroy all that they have; do not spare them, but kill both man and woman, child and infant, ox and sheep, camel and ass.
(I mean, what the camels ever done to Jehovah?) Saul kinda does - kills the women and children all right, doesn't even bring back a few souvenir virgins, but his soldiers liberate some of the oxen and sheep and take the king prisoner, whereupon God gets quite irate, until Saul has his unarmed pow hacked in pieces by the prophet.
But God is still wroth with him anyway.

The same mentality persists in modern Christians. Suicide and abortion - utterly wrong; war, including some pretty underhanded black ops, and execution, even of marginally responsible and dubiously guilty accused persons, righteous. The priest or pastor who makes those arguments has to do some incredible feats of theological trapeze-work.
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Re: Death and dying

Postby charon on May 7th, 2021, 12:47 pm 

Religions have no authority whatsoever except that which we voluntarily invest in them. Only the law of the land has any actual authority, not that one necessarily has to obey it.
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