Autonomous till demented

The Lecretia Seales case in the High Court in Wellington is continuing with submissions made yesterday by the Care Alliance, which is against the legalisation of euthanasia.

The groups lawyer Victoria Casey, reportedly said that disabled people, including children were being euthanised in other countries. For example in 2013 97 people with dementia were euthanised in the Netherlands. Now I am not sure if Victoria Casey used that as evidence, all I have to go on is the NZ Herald account, since I am not a fly on that particular court room wall.

However, I do have at my disposal a mountain of research from around the world on anything to do with health, and I can perhaps help to clear the air on this particular matter.

First of all the Netherlands example makes it appear that there is some kind of conveyor belt of death upon which physicians can place the demented elderly. In fact the first case of a patient with advanced dementia being euthanised in the Netherlands was in 2011. The case was duly reported and assessed by a review committee which judged that in this case all legal criteria for due care was met. There is quite a stringent system in place to protect against abuse, and although dementia is very much a disability, it is misleading to say that people with disabilities face euthanasia. I believe my point is clear.

The difficulty with dementia is that the patient who has it is no longer competent. Therefore they cannot voluntarily request that a doctor help them die even if that is precisely what they would want if they were competent. It is an old fashioned catch-22, and such a paradox may well befuddle the legal system here, but the Dutch have carefully come up with a solution. The advanced euthanasia directive (AED) may be used in lieu of a voluntary request for euthanasia if the patient is not competent. It must be in writing, and all the legal criteria for due care still applies.

A qualitative study was published earlier this year that found that members of the general public understand dementia to be a debilitating and degrading disease. Such a disease poses a problem for assessing the wishes of patients, and the AED manages to solve the problem of direct communication in those cases. Still, physicians are reluctant to replace direct communication with the patient, and on these grounds the study concludes that the use of AEDs is limited.

On the matter of child euthanasia, which sounds more like a grenade lobbed into the courtroom by the anti-euthanasia brigade, the reality is far more sensible. Belgium and the Netherlands both legalised euthanasia with strict measures in place in 2002. Both countries view ‘legal age’ as less important than whether a child is able to make decisions concerning themselves, and their welfare. This is not the slaughter of undesirable children in Nazi Germany. If anyone doubts the value the health system places on disabled young people, I invite them to come and see  me at my place of work.

In Belgium you have to be either over 18, or an emancipated minor to be granted euthanasia. In the Netherlands the age is 16, or 12 provided one is terminally ill and has parental consent. The issue is whether or not one is competent to make decisions, and in the current era personal autonomy has so replaced doctor paternalism that if a patient ignores a doctors recommendation for treatment and goes to some spook with an elongated title, the patient is treated as some kind of hero.

How often stories appear in the newspaper about people who ignored doctors orders. Some old Granny diagnosed with cancer of the g-spot with only weeks to live, but that was years ago and only last week she was base jumping in the Andes… You cannot uphold personal autonomy with one hand while drowning the decision of how and when to die with the other. This is an issue that needs to be discussed. It needs to be debated. And just as I am hostile to the idea that society as a whole should decide whether I marry a woman or a man (or both), I am disgusted by the notion that some hysterical group will prevent me from one day dying with dignity.

Finally, to return to the case of Lecretia Seales, she is not a child, she is not demented, and yet she is terminally ill. Her legal career has been brought to a close, as has her ability to walk, and easily swallow. She is competent, and we all know what her wishes are. All her doctor requires is the assurance that they will not face prosecution for murder if they help Seales die peacefully at a time of her choosing. Failing a proper rethink of euthanasia practice in New Zealand, we can at least do that much.

One thought on “Autonomous till demented

  1. A very thought provoking article. Very good to show the errant logic in the premises weakens the argument and proves detrimental to the case against euthanasia.
    A highly readable piece with a touch of irony to illustrate and amuse.
    Good stuff Joe.


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