A Matter of Life and Death. Who Decides?

[00:00:00] The Y curve with Phil Dobby and Roger hearing.

[00:00:04] Do we have a right to die the way we want?

[00:00:07] Should we be able to choose if we wish to end our own lives?

[00:00:11] And should people be able to help us without fear of prosecution?

[00:00:15] Or would such a change in law risk the old, the vulnerable,

[00:00:19] and those with expensive needs being pushed into a convenient debt?

[00:00:23] Is euthanasia a fundamental right or a dangerous precedent have people, you know, at a certain level, people should surely have the right to control their lives and even to end their lives. I mean, you know, your life is your life. But the risks that are in terms of pushing people, because there are a lot of people out there who some people say, oh, well, it's very poor quality of life, you know, they're barely there at all. And they vast amounts of resources and needed for them.

[00:01:40] So then then then then, then, then, the question is if we haven't got the resources to enable

[00:01:44] people to live comfortably, then the obvious choice is, but being depressed, suffering from deep depression is a reason has been used as a reason to say, well yes, you know, with that circumstance, the doctors, yeah, the doctors sign up and say, and that it's just so wrong, isn't it? Because, well, I mean, pain, you know, psychological pain is as

[00:03:00] almost as bad as it is about. Yeah, but is it terminal? I mean, can you,

[00:03:04] I think you don't have to be terminal? Yeah, can we actually support all the people with terminal illnesses in the country? Do we have the resources to make them all comfortable? And isn't the situation just going to be that we're going to have

[00:04:21] more people who are needing palliative care at an increase in cost? And maybe we just

[00:04:27] don't have those resources. where their laws are a bit more liberal in relation to this, those that have the responsibility for actually doing this, for actually giving the drugs or the cocktails or the injections that people are going to take. The people that I know are very case-by-case on it, so they really do have to be convinced that in this case,

[00:05:40] yes, this person is suffering to a point that their family and they

[00:05:43] and we as clinicians are do have the right to kill yourself if you want to. But it's the question of assistance, isn't it? That's the core problem. And I imagine in the Netherlands and Belgium, presumably that has to be the point. If someone could do away with themselves all they would, but if they have to have assistance, they need that kind of underwriting by clinicians.

[00:07:00] And again, how do you draw the line there?

[00:07:02] So if you're a physician that helps someone die

[00:07:05] in Holland, presumably,

[00:07:07] if you don't go have the right of autonomy of my body, should I not also, at a very simple level, be able to get someone to help me do what I want with it? Yeah, it's very simple terms, but that surely is true. It certainly makes sense to me, that argument.

[00:08:21] But then you get complications like, am I compostmentous enough to say, yes, I do want been helped if it was easy for them to kill themselves. I'm sure one or two of them might actually have done that. And yeah, life has sorted itself out for them. What a travesty for us to have made it so easy that that happens. And I think that's the rub in the sense that you can never be 100% sure of that. And I've talked to older people typically in my research with people who are at the

[00:09:43] older end of the spectrum. I've talked to people who have this is not going away, so to speak, or this wish? And isn't there some sort of board or some sort of consultative process? It's not just a person's choice. Absolutely. Yeah, there would be there is a board and consultative process and you've got you can only be as sure as you really understand the story of how they got there. And what's behind it for them is it because they can't bear living in chronic pain, in which case, maybe getting rid of the pain in some way, shape or form would take it away. Is that possible? If that were possible. Yeah.

[00:12:20] We don't know. I mean, there have been big moves in palliative medicine.

[00:13:21] problem? Is that the right way to put it? I'd say what it feels like for these people is that I am just done. I'm not in pain necessarily.

[00:13:28] My life, it's some of them even have like thriving family lives, etc. But there's a real sense

[00:13:33] in these people. They're typically older people that I've finished living. My life's

[00:13:37] lived its course and I'm done. I don't want to see another summer. I don't want to see

[00:13:41] another spring. I've seen all the roses. You can definitely see the sincerity in their eyes when they say I'm done. I don't want to be here anymore and I'm finished. My life is I've finished living and I don't feel bad about cutting it short. I'm ready. It's like they're ready to go but they're sitting in a waiting room

[00:15:01] and that doesn't necessarily mean to say they've got awful circumstances around them.

[00:15:06] Sometimes they've got really good ones. You know they're pretty wealthy, they've got And I'm not, I do, I'm definitely sometimes surprised by the number of people who do have a secret kind of death wish Kind of like yeah, I really do feel like if you ever had to choose between living and dying I'd probably choose dying. It often is the very end of life where you get to that point where you just feel like psychologically and spiritually you've finished

[00:16:22] But your body's not quite packed up yet. But in the Netherlands what you know about this tiredness of life

[00:17:26] contact with other people. And in a way that's what's required, not euthanasia, but just making people more involved in society.

[00:17:29] And that's part of the debate too. We always find when people are suffering from this notion

[00:17:34] of tiredness of life that one of the key ingredients that's always there is a real sense of disconnection

[00:17:39] to the world that was once there. It could be people, but it could also be identity,

[00:17:45] who I used to be. I'm just not that person anymore. I don't have to work. We're not going to put him back on the ventilator. Right. And he was left to die. That was a decision that he was going to die. I mean, he was while he was on the ventilator, he was quite happy, but they just knew there's no way they could fix his conditions. So somebody made a call there, he was going to die. And yet, that is ethically sound, as I understand it.

[00:19:03] Yeah, same thing happened to my own dad two years ago. He called me very hard. Because I mean, what we are talking about, the reason we're talking about this is there has been a push towards trying in Britain to move perhaps to a similar situation to the one in Belgium, the Netherlands, or indeed in parts of Canada and the United States too. Do you think this can be done safely? I mean, there are, when here's stories about people

[00:20:21] who are pushed towards that potentially by relatives

[00:20:25] who don't want them to be around anymore

[00:20:27] or feel under pressure, even if they're not under pressure, And when you look at the literature on things like what do doctors think about this issue, it's certainly not unanimous in the UK, the doctors are for this. But when you look at the families of people who've died, they are more unanimously in favour of it, for example.

[00:21:41] But maybe not always necessarily for the best reason.

[00:21:45] That's not the key.

[00:21:46] That's another good point. Yeah, and it's those who fit might feel that they are being pushed either because society considers them to be a bit superfluous. Yeah, they're costing maybe their relatives They're certainly or costing the state or whatever it is and that sense of why weighing up life as a value as a Quality of life index almost putting almost a monetary value on it. I mean, that's a very bad area to get into it

[00:23:04] It's a dangerous area. also actually quite in a way that's actually one way of saying, well, you can't you know, society. So you mean it's not because one of the things they say, you know, one of the the rebukes against suicide in a way is that the idea that

[00:24:21] of the people that you would

[00:24:23] yes hurt or damage by doing it.

[00:24:25] It's a selfish act.

[00:24:26] This has always been one of the in some ways because you're right. I think you do sort of train to preserve life as far as you possibly can. And then we're saying something that's a little bit different to that. You've got to know when to let go. But I wonder how many of those people that astronomical number that we were seeing in Holland, that 50,000, that would be the equivalent here of 200 a week. I don't know if these

[00:25:43] are accurate or not. The Office of Health not paying and arguing, they just want to end it all. It's just relentless. They can't go on anymore. That feels like, you know, if there's no way that's ever going to be fixed, that is a bit like turning the ventilator off, isn't it? There's just no way out of it. Simple decision. It's when you've got these mental issues. And if we've got, we've got people who've, you know, it's a mind issue. And doesn't that say an awful lot about the state of mental health in the country,

[00:27:04] which we know is heavily underfunded. And is actually just a depression in disguise or something else that they can diagnose and treat. They argue. Let's move into one another area, which is another ethical issue in this, which actually comes up a lot, because people, we may not want people legally

[00:28:20] to have the choice in this country

[00:28:21] to be able to do this at the moment.

[00:28:24] But people do, we know people go to Switzerland.

[00:28:27] It's almost a phrase now, your partner is not in a fit mental state. You manage to convince them. You want to get rid of them. You manage to convince them that they should end your life and you say, I'm going to help you. And if you hadn't convinced them, they wouldn't have even been thinking about that. You know, that's the problem in all of this. There's two sides to every argument. How do you enforce it? I mean, you know, because one of them's made

[00:29:41] or another one's sort of like a mess.

[00:29:43] But how do you see inside the mind of an individual?

[00:29:46] That's because that's the fundamental problem in this. these people by allowing them to end life, but we can't do it cheaply. Now, which way are the Boris Johnson's of this world going to go? Yeah, and you can certainly see the scales, can't you? We're putting different things on different sides of them. They certainly teeter when you start looking at it that way. And as I said before, I don't think it will ever, it's always going to be an imperfect science

[00:31:02] this, because you can't look into people's heads.

[00:31:05] And you can't know everything you might want to know in relation to this. us do, that there is something that needs to be done about it. Whether it's changed, maybe in some cases the sort of demographic of society is changing, so we might have more people who value certain things or don't value certain things as much in the sort of population. That mean the bigger a podcast that'll sort of... That's the way forward. I mean, that's the first step, isn't it? What can we do to make life more old age, more meaningful for people? Those roadblocks that you talked about, though, I imagine one of

[00:33:43] them in the past might have been religion. The question is, can they afford it? You know, they've got student loans now, they've got unaffordable houses. We've got this crumbling infrastructure that, you know, we're leaving them with saying, oh, you fixed that up. And also, you know, the range of things they are actually

[00:35:01] able to do is perhaps somewhat less than security,

[00:35:03] isn't there as it used to be?

[00:35:05] Jobs being replaced by artificial intelligence,

[00:35:06] supposedly.