In the UK, it is reported that some doctors may already be using continuous deep sedation (CDS) to euthanise patients slowly, whilst in the US, Barak Obama’s America’s Affordable Health Choices Bill threatened to force the elderly and those on social security to attend counselling sessions on end-of-life care every 5 years in an attempt to persuade them to refuse treatment in order to end their lives sooner.
Alerting the public to the dangers of the Bill, Betsy McCaughey, Chairman of the Committee to Reduce Infectious Deaths and also Patient Advocate, warned listeners to her interview that in attempting to cut healthcare spending by $500bn, the Bill aims to reduce healthcare and benefits for senior citizens.
Pages 425 to 430 and following concerned “advance care planning consultations”, that is, compulsory advice sessions for those on Medicare (America’s answer to the NHS for the elderly and those on welfare benefits). These sessions, which would have to be provided at least once every 5 years (and more often if the patient became ill — page 428) were to comprise advice on advance directives and could even include the “formulation of an order regarding life sustaining treatment”. Such orders would dictate to all medics, clinicians and lawyers for the rest of the patient’s life which life-sustaining treatments the patient would be prepared to undergo and those that the patient wished to refuse — including resuscitation and artificially administered nutrition and hydration.
It is not clear whether such patients were to receive any independent advice on the subject, or whether they were to be persuaded to refuse treatment in order to shorten their lives. Many suspect the latter, including Betsy McCaughey, who called the provisions a “vicious assault on elderly people and the boomer generation”. “These are sacred issues of life and death, Government should have nothing to do with them!” she added. She also alleges that Dr. Ezekiel Emanuel, Health Advisor to the President has said that people who have incurable or irreversible illnesses should not be given basic health services. She quotes from one of his papers: “an obvious example is not guaranteeing health services to patients with Dementia”. To listen to the interview, click on this link: Fred Thompson Interviews Betsy McCaughey.
Writing on a Canadian website, Sultan Knish argues that it all comes down to the utilitarian view the State is bound to take of insignificant individuals given that “The family as the basis of society however has crumbled in favour of the State. As people increasingly turn over the care of their children and their parents to the state, the social investment becomes not in the family, but in the State.” His argument continues: “At the system level, only the system itself matters” so that “From the State's perspective, it makes a certain utilitarian sense to give life to productive citizens, while denying it to non-productive citizens.” This is the stated aim of that same advisor to the President, Dr. Emanuel, who defines some as "irreversibly prevented from being or becoming participating citizens" and therefore, presumably, not entitled to health care. As the argument concludes “Absolute power corrupts absolutely by granting Godlike power, without Godlike wisdom. And any horror quickly becomes tenable in the name of the system, which itself becomes the god.” To read the full article, click here.
Thankfully, it was announced on Thursday, 13th August that the Senate Finance Committee is to drop the provision on consultations for end-of-life care from its proposed Healthcare Bill, according to its top Republican member. Click here for further details.
What of the UK?
The news that some clinicians may already be using continuous deep sedation (CDS) was reported by the BBC on Wednesday, 12th August. This treatment is apparently being used by doctors to hasten death instead of euthanasia. Dr Nigel Sykes, medical director of St Christopher's Hospice in Sydenham, South London, states that only a handful of patients each year require CDS as a last resort if they become confused and very agitated, but that the need for it is very rare. Speaking to the BBC, he said that “There is really no excuse for a doctor to take the line of consciously using deep sedation as an alternative to euthanasia because he can't think of anything else to do”.
According to research by the Professor of Medical Sociology at St. Bartholomew’s and the London School of Medicine and Dentistry, Clive Seale, however, 16.5% of all UK deaths are attributable to CDS. This figure is twice as high as in Belgium and the Netherlands, but may account for the declining rate of euthanasia in the latter.
Anecdotal evidence also abounds: Dr Philip Harrison, a New Zealand GP who has long experience in palliative care recently experienced the death of his father. He wrote of his horror at finding his father under CDS in the two hours before he died, without having been consulted, without having had the chance to say goodbye to his family and without there being any evidence that he had been in any pain. Dr. Harrison’s view was that this practice was “as near to a form of murder” as anything he had seen. He fears that the practice may be widespread across the NHS.
Dr Sykes said that further research is needed to ascertain the reasons for and the extent of the use of CDS, not to mention who is using it. He pointed out that: "There are sources of advice available because specialist palliative care is now available and accessible across the country."
Polls suggest that while a majority of the public would support a change in the law to allow assisted suicide, most doctors are against it. To read the BBC article in full, click here.