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Cheers - AE

Tuesday, 15 June 2010

End of lifeline.

Strolling past the Ambush Predator's cave again today I saw that she's again baring her fangs over euthanasia and assisted suicide, prompted by something similar (which I'd missed somehow) over at Counting Cats. Julia, and probably Cats too, and I don't completely see eye to eye on this subject, but I'm not posting about it here instead of commenting at Julia's out of fear of those impressive upper canines - you can always get away safely if you throw a couple of CiF articles behind you as you run - but because the reply was just too big for a blogger comment (now I know - 4,096 characters isn't just a good idea, it's the law).

Taking up the gaunlet thrown down by Counting Cats..., here's my take on the euthanasia report from last week:
A high proportion of deaths classed as euthanasia in Belgium involved patients who did not ask for their lives to be ended, a study found.

More than 100 nurses admitted to researchers that they had taken part in 'terminations without request or consent'.
And why are these admissions not made in the dock, following the words ‘I swear to tell the truth, the whole truth, and…’?

In spite of my pro-euthanaisa views and my desire for a big dose of barbiturates or something if I'm ever at a stage where continuing my life looks much less attractive to me than ending it, I also have to ask why this hasn't emerged in a court and why the fuck nobody has been charged with murder. Turns out the answer is that the study was designed in such a way as to guarantee anonymity, so it's rather hard to know who to charge. Not only that but since it's the result of a survey it's all a bit anecdotal. Pity, because this sort of thing damages the pro-euthanasia position and shook my faith (inasmuch as I have faith in anything in particular), so I'd really like someone to have been in the dock over this. However, my faith in newspapers is less than my belief that I should have the option to end my life at a time of my choosing and to be able to seek (not necessarily successfully) medical expertise in doing so, and that goes double when the newspaper in question is The Mainly Fail, who I feel are not as unbiased on the issue as we might hope for. So I went back to the article for another read.

The fact that they just say the research is from "a study" and don't give a source for it beyond the fact that it appeared in a Canadian medical journal made me wonder if that was the whole idea. It's hardly unheard of for something described as a study to turn out to have been the result of funding from a source pushing a particular agenda. Would this study, I wondered, turn out to have been funded by one of those groups that, like one commenter on the Fail's article, believe your life is still about serving their 13 billion year old invisible friend even if every waking second is merely prolonging an agony - an agony which they also believe the same 13 billion year old invisible friend inflicts on people to begin with, the sick fuck? But not to worry because after a little googling it looked like just sloppy journalism - I found and read the paper (via this related paper, which incidentally is also worth a read) and it's nothing like that at all, though I feel the Fail still restricted itself to what supports the anti-euthansia position.

For example, the wild-eyed headline claimed half of Belgium's "euthanasia nurses" admit to killing without consent, and from what I can see that's complete bollocks. For one thing it's far from established in the paper that there's any such thing as a euthanasia nurse - if there is the survey certainly wasn't looking at them so much as nurses who had said in an earlier survey that they were involved in a case where the patient was euthanised or had assistance to commit suicide. And that's it. Not the Angels of Death at the Belgium version of the Dignitas clinic, if there is one. And the claim that half the nurses admit to "killing" without consent is an even bigger load of bollocks. What the paper actually says is:
"In our study, more than half of the nurses surveyed in Flanders, Belgium, reported that they were involved in the physician’s decision-making about the use of life-ending drugs. In most cases, the involvement was merely an exchange of information about the patient’s or relatives’ wishes and about the patient’s condition."
The Fail seem to be equating a nurse passing along a patient's wishes to the doctor with strapping 'em down and sticking the needle in without asking. Make of that what you will, but in my opinion impartial reporting it ain't. Incidentally, the criticism here seems to be that Belgian law apparently says that doctors must always discuss such a decision with nurses, and far from being Angels of Death running around with syringes full of poison without the knowledge of the doctors it's actually doctors failing to meet the legal obligation to involve the nursing staff all the time. The only hint of this given by the Fail is... uh... it's er... well, there isn't one as far as I can see.

Then there's the caveat. Or rather caveats. (My bold.)
"In previous surveys, physicians reported that nurses sometimes administered drugs explicitly intended to hasten death. Nevertheless, uncertainty remained about the understanding by the nurses of the act that they performed. In our study, nurses did administer life-ending drugs with the recognition that the death of the patient was intended. In the cases of euthanasia, 12% of the nurses administered the drugs. In the United States, where no legal framework for euthanasia is provided, 16% of critical care nurses 10 and 5% of oncology nurses reported engaging in euthanasia. Similar findings have been reported in other countries."
In other words if you look at other countries it doesn't seem to matter if the law allows it or not. Kind of makes the supposed slippery slope that the Fail is getting all excited about seem rather flatter and high-friction than their article suggests, though in fairness they covered this when they said... er... just bear with me, I'll find it in a tick... sorry, no, my mistake. They didn't mention it.

"First, we wonder whether nurses overestimated the actual life-shortening effect of the drug administration, especially when opioids were used, and whether the physician had intended to end the patient’s life when he or she ordered the nurse to administer the drugs. Nurses may have thought that they were ending the patient’s life, when in fact the drugs were intended to relieve symptoms in an aggressive, but necessary manner."
This is a very important point. I certainly don't want to denigrate nurses or have a pop at their pharmacological knowledge (which will be a hell of a lot better than mine) but when the doctor says to give the patient X milligrams of something potentially dangerous they can't know the doctor intends it to oil the hinges on the door to the next world unless the doctor actually says so. Further, if it's a dose that's certain to be lethal then you'd hope the nurse would have raised the matter there and then. What could well be happening here is that the nurse gives the drug, the patient then carks it and it's not clear that the drug was not responsible, and the nurse then begins to wonder if the doctor actually meant that to happen. As Julia's title points out, they're not mind readers, and that applies as much to the intentions of the doctor prescribing a big syringe full of morphine as to a patient's desire to live or not. In the Mail this was dealt with by ... sorry, no, actually it wasn't dealt with at all.

And on that topic...
"...the nurses we surveyed who administered the life-ending drugs did not do so on their own initiative. Although the act was often performed without the physician being present, it was predominantly carried out on the physician’s orders and under his or her responsibility."
Which the Mail's article made crystal clear in... er... oh, actually they didn't mention that either.

"We also have to consider that the administration of life-ending drugs without the patient’s explicit request may have included situations of terminal sedation or an increase in pain alleviation, in which the delegation by physicians to nurses to administer the drugs is considered common practice."
Which occurs in places without legal assisted suicide and/or euthanasia, as pointed out by the Mail when they said... er... uhm... oh, who am I kidding? Of course they didn't fucking point that out.

Sure, I've been selectively quoting too, and the caveats themselves have caveats which strongly suggest that there are cases that are at the very least a bit iffy and more probably downright illegal. I'm not arguing that and I'm still disappointed that some Poirotesque Belgian isn't exercising his leetle grey cells to get someone in the dock. I want the choice of when to go, preferably after first getting utterly off my tits on all the highs (legal and otherwise) that I've never indulged in, and there's no element of choice if some medico, no matter whether for sick kicks or a kind and well intentioned act, sticks me with an armful of Happy Exit Juice. On the other hand I've quoted rather more than the Fail and provided the fucking source so people can read and decide for themselves. But for those in a hurry I can boil it down to a few sentences.

Firstly, Belgian euthanasia law is almost certainly being broken but actually instances of euthanasia and assisted suicide are no more common than it is in countries where the law does not permit it at all, which suggests we have nothing to fear from legalisation that we should not already fear anyway. Secondly, and from the other study, euthanising patients without their consent seems less common in Holland and other countries where it's legal, which suggests that there is something unusual about where this survey took place. And thirdly, The Mainly Fail really is waste of a perfectly good tree sometimes.

Post(humous) Script: it's slightly depressing that the only commenter at The Mainly Fail to even mention that the findings of the survey were "more complex" than the article suggested (an understatement if you ask me - I'd have said the Fail got it arse about face in places) and to suggest that a properly framed law to allow rational adults the choice of when to end their lives got a large negative rating. Choice means no more and no less than that. It emphatically fucking does not mean Lifeclocks in everybody's hands or anything like it since this would not be a choice.


JuliaM said...

Very interesting! Will link.

Angry Exile said...

Glad you thought so, and ta for the link. Like I said, no dispute that the law isn't being followed in Belgium, though it seems likely that it was being ignored even before legalisation just as it still is in places where it's still illegal. How much of that is down to serial killer Belgians in white coats :-) and how much to poorly drafted law is anyone's guess - I certainly don't pretend to know and I lack the language skills to check it out properly. What I am sure of is that either I have interpreted the findings of the study very inaccurately or the Daily Mail have.

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