Starving to Death
I might have known that the case of Margaret Page, the woman who has decided to starve herself to death, has been taken up as a cause célèbre by the euthanasia lobby, notably Lesley Martin. It seems to me, however, that there is a substantial difference between actively participating in the ending of another person’s life and not intervening when a person refuses medical treatment (and in Margaret Page’s case – food). Mrs. Page has a perfect right to refuse to eat if she wishes.
There is a substantial difference between actively participating in the ending of another person's life and not intervening when a person refuses medical treatment
”I should point out that this is not a medical matter at all. She has had three psychiatric assessments that all agree that she is of sound mind. She does not require acute psychiatric intervention. It is therefore not the responsibility of doctors and nurses to force feed her, as they are sure her voluntary starvation has no psychiatric genesis. Her husband cannot, therefore, insist that the staff of the facility she is in force feed her, insert IV lines or generally over-ride her wishes in any way.
I also note that Mr. Page is making an issue of this against the wishes of Mrs. Page. I suspect he is doing this to try and force the St John of God care home and the DHB to provide the facilities Mr. Page feels Mrs. Page needs. In other words, he is trying to jump the queue. Mrs. Page, on the other hand, makes no such statement, declaring that she “no longer wishes to live”. This all rather leaves it “up in the air” as to whether this is a protest or a genuine attempt to end life. I am inclined to go with Mrs. Page’s version of events because her husband is somewhat incoherent as this statement shows:
“If Mrs Page was young and fit – she suffered a cerebral haemorrhage 20 years ago and is disabled – society would not put up with it, Mr Page said.”
If Mrs. Page was young and fit, of course, she would not need the interventions that Mr. Page is asking for.
In addition, Mrs. Page has been at St. John of God’s since 2003. It is very unlikely that these are new, acute problems. One wonders quite why there is such a hurry for these extra things. Admittedly, one also wonders exactly why a more comfortable wheelchair is taking so long to arrange.
While Mrs. Page is perfectly entitled to end her life in any way she chooses, that does not mean that we should support active intervention in any way. Lesley Martin tries to make out that a euthanasia law would prevent Mrs. Page from seeking such a painful and protracted death. This is not exactly true. While I do not know this lady’s exact circumstances, there is usually little preventing a person from ending their life in a more active way, should they choose. Granted, sometimes circumstances make choices very limited indeed.
As I have blogged more completely here, euthanasia issues are far more complex than the good Ms. Martin would have us believe. In I recall correctly, Ms Martin was convicted in 2004 of attempting to murder her terminally ill mother with an overdose of morphine. It is exactly this sort of active intervention that I have most problem with. Ms. Martin was utterly unqualified to make this decision – being emotionally involved, unable to make a psychiatric assessment and unable to judge accurately the morphine dose required. It was, therefore, right that her nursing registration was terminated and she was convicted of attempted murder. Even if there had been a legal form of euthanasia available, there is no doubt that Ms. Martin would not have fulfilled the criteria in any way.
However, even had Ms. Martin’s mother been formally psychiatrically assessed and her fatal dose administered professionally and expertly, I have qualms about the decision processes involved. They seem to me to be suspiciously similar to the decision processes we would use to determine if someone should be given the death penalty – mental status assessment, motivation, circumstances etc. If we are so unconfident of our judgements that we steer clear of the death penalty for murder, can we be truly confident of our decisions for euthanasia? And I am well aware that euthanasia, in this context, is voluntary and the death penalty is not. But in both cases a person is being asked to terminate a life. Would the death penalty really be any better to administer if it was only done on criminals who volunteered? (Not so far fetched as it sounds – some may truly prefer death to life imprisonment)
All of this argument does not even consider that there are many other factors involved such as coercion (sign this or I’ll hurt you), manipulation (you can’t really want to go on living…), guilt (you are such a burden on the family…), peer pressure (…a burden on society), boredom , loneliness, personality types (negatives) and incorrect diagnoses (the cancer that really wasn’t) to name but a few factors that can seriously cast doubt on the validity of a person’s decision to “end it all”.
Euthanasia is one of those difficult issues where the proponents sound compassionate and reasonable, but have simply not thought enough about the consequences to other people. There will be people for whom euthanasia may be a reasonable alternative to a life they do not wish to lead. Unfortunately, for many people such a law would open the door, not to a pleasant death surrounded by family, but to legalised murder and an end that can truly be categorised by the title of Ms. Martin’s book – “To Die Like a Dog“.
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Mar 26 10 11:17 am
Difficult case. Here we have someone who, as far as I can tell, is essentially unable to move (but not paralyzed) or speak other than the odd word, who you agree is permitted to commit suicide if she so wishes, and yet is only able to do so by not eating, a lingering and ultimately probably painful death through organ failure. What if she had become unable to feed herself effectively and thus was on IV feeding, would you allow her to ask that the IV be removed and agree that it be removed ?
I agree that euthanasia is a very hard subject, yet here is a case that highlights the deficiencies of the opposition, if she has the right to end her life, yet you won’t allow humane ways of doing so.
Mar 26 10 10:15 pm
I would certainly allow this lady to stop her IV if she was on one. That is her right. However, it is not her right to demand that I or anyone else kill her. The problem here is not the few clear-cut cases like this lady, but the myriad numbers of far more dubious cases that will be allowed inadvertently by attempting to legalise this. My experience is that death by dehydration is neither as painful nor as protracted as proponents of euthanasia try to make out, so even that argument is somewhat flawed.
Mar 29 10 9:04 am
And yet, by removing her IV you would be killing her as surely as if you cut her throat, only slower and more painfully. Would you allow her morphine for pain, and let her self control the dose ? What if she could self control the dosage to a lethal one, still OK ?
I think I’ve seen too many relatives or close friends relatives descend through Alzheimer’s or Parkinson’s to a state of complete vegetability, there in body but completely gone in spirit. Supported by family and friends, sometimes for months, sometimes for years, no-one there, but unable to start the grieving process or to say goodbye. And one can add costing a lot of money, often the families until they’re so poor the government steps in. Is there a satisfactory compromise ?
Mar 29 10 8:03 pm
And yet, by removing her IV you would be killing her as surely as if you cut her throat,
This is a silly argument. You could just as easily say that not giving her treatment is “killing” her – yet you would almost certainly be the first to criticise a doctor who treated a patient against their will, unless they could demonstrate that the patient was not of sound mind.
I would certainly allow her patient-controlled morphine for pain, if it was an appropriate treatment. However, if the patient expressed her intention to kill herself with the morphine, I would have to seek an alternative form of pain relief, such as a syringe driver.
I agree that Alzheimer’s and Parkinson’s are distressing diseases. However, I think you are a very brave man to think you know whether an Alzheimer’s patient or a patient with severe Parkinsonism truly wishes to die.
The “compromise” you speak of is already in use. In consultation with family (and the patient, if compos mentis), we often withdraw active treatment on a patient and allow them to die naturally, rather than prolonging the dying process. I am uncertain whether you can morally call food and water “treatment”, so I do not advocate withdrawal of food or water, although I know of a number of colleague who do.
Actively providing the means of death is the antithesis of what doctors are called to do. I, for one, would want no part in it.
Mar 26 10 1:09 pm
Its a dreadful case.. as many of them are, and it wont end well.
Yet I’m a little comforted by that.. the day we accept a suicide or an assisted death with equanimity could be a sadder one.
JC
Mar 26 10 4:49 pm
I find it difficult to understand how it is possible for a doctor to say that he or she has no right to force a patient to eat against their wishes, and to also to justify a position that he or she has the right to refuse ‘futile’ treatments such as food and water should the doctor make this determination in light of the patient’s physical and/or mental condition.
Not that I can see that the doctors involved held both positions at the same time, but I guess that I am noting the hypocrisy of a doctor making a case for refusing ‘futile’ treatment, while never considering that this would logically lead to a doctor being able to force a patient to eat against their will should the doctor determine that the patient will recover sufficient quality of life.
Seems that either argument can be used if the result is death, but not if the result is life?
Mar 26 10 10:21 pm
Your argument is a bit flawed, Johnnieboy. Futile treatment does not prolong life, it merely prolongs dying. Understand that the definition of futile treatment is treatment that will neither change the prognosis nor provide succour to a patient. If you cannot at least postpone death or provide comfort to your patient, you should not be providing treatment. Treatment in this scenario violates the tenet “first do no harm”.