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More categories of lawful killing?

Commentary: The Case Against Physician-Assisted Suicide: For the Right to End-of-Life Care - Psychiatric Times

My post last Thursday on the emotive issue of "assisted suicide" predictably attracted many comments. One of my readers forwarded me a piece by Gerald Warner from the Daily Telegraph "blog" section. One of the comments to that, rather intemperate, post referred to a 2004 article from The Psychiatric Times about the Netherlands' experience with euthanasia/assisted suicide. It highlighted an aspect I had not previously considered;

"Euthanasia, intended originally for the exceptional case, became an accepted way of dealing with serious or terminal illness in the Netherlands. In the process, palliative care became one of the casualties, while hospice care has lagged behind that of other countries. In testimony given before the British House of Lords, Zbigniew Zylicz, one of the few palliative care experts in the Netherlands, attributed Dutch deficiencies in palliative care to the easier alternative of euthanasia."

It is the unspoken, because unpalatable, truth that in a socialised medical system the authorities have no choice but to prioritise patient groups. If the market doesn't allocate resources, they must be rationed. There is no "third way". The law of unintended consequences has, it seems, reduced the availability of palliative care. If Dr Zylicz's evidence is true, the medical authorities have, to be blunt, found euthanasia/assisted suicide a cheaper, more efficient alternative

And Guardianistas tell us that markets are harsh and cruel?

Given that those "progressive" enthusiasts of euthanasia/assisted suicide are fond of selecting horrific cases to support their case, let me cite some horror stories from the same article;

An illustration of a case presented to me as requiring euthanasia without consent involved a Dutch nun who was dying painfully of cancer. Her physician felt her religion prevented her from agreeing to euthanasia so he felt both justified and compassionate in ending her life without telling her he was doing so. Practising assisted suicide and euthanasia appears to encourage physicians to think they know best who should live and who should die

This god in a white coat knew that euthanasia was a sin, in this woman's eyes. So he murdered her to spare her conscience. Where does that leave his?

a patient with disseminated breast cancer who had rejected the possibility of euthanasia had her life ended because, in the physician's words: "It could have taken another week before she died. I just needed this bed."

Another "compassionate" and "progressive" professional in pursuit of "dignity" for his patients? No. A murderer, even under Netherlands law.

A wife, who no longer wished to care for her sick, elderly husband, gave him a choice between euthanasia and admission to a home for the chronically ill. The man, afraid of being left to the mercy of strangers in an unfamiliar place, chose to have his life ended; the doctor although aware of the coercion, ended the man's life.

I believe in freedom to choose, but choice under duress is not real choice. Correctly analysed, this poor man was murdered for his loving wife's convenience.

A healthy 50-year-old woman, who lost her son recently to cancer, refused treatment for her depression and said she would accept only help in dying. Her psychiatrist assisted in her suicide within four months of her son's death. He told me he had seen her for a number of sessions when she told him that if he did not help her she would kill herself without him. At that point, he did. He seemed on the one hand to be succumbing to emotional blackmail and on the other to be ignoring the fact that even without treatment, experience has shown that time alone was likely to have affected her wish to die.

How many of us would feel suicidal if we lost a child? The only thing more natural is, through grieving and the support of family and friends, to come back to life treasuring fond memories of the loved one lost. The psychiatrist could have turned her ultimatum back on her and said "no euthanasia unless you try therapy first", but perhaps it was easier to submit. This poor, sad woman could have lived a rich life for 30-40 years, but he executed her. Is that what people go into medicine to do? Can no-one else see the difference between her killing herself and that?

None of these killers will be brought to justice because the Netherlands government, to investigate the matter properly after complaints, offered immunity to all who spoke frankly. I am glad it did, because in exposing the consequences of the Netherlands' "progressive" law, these murderers may save lives elsewhere.

I have been accused of taking a non-libertarian position on this issue. I don't agree, but if I am wrong, so be it. I don't adopt a political position as an ideological game. I am not trying to belong to a tribe. I support libertarian policies because I believe they would lead to a better, richer, happier, more fulfilling society with greater opportunity for a greater number of people than the present statist shambles. If I were required to approve of such horrors to be a "pure" libertarian, then I would say to hell with it.


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Moggsy, I didn't select to distort. If you click through to the article, you will find that I repeated every word of that particular quote.

I don't know if your scenario is more "likely" than the one reported. Neither, with respect, do you.


Tom, What's with this "If my wife gave me that ultimatum"?

You know perfectly well that there was unlikely to have been any ultimatum.

The likely scenario is an old couple who are both failing in health and the wife is desperately trying to look after her husband despite this.

Eventually it becomes clear to both that they just can't keep going and probably the husband decides to try to avoid placing any more breaking strain on his wife reluctantly does something he can do. maybe he is in pain and tired of it all too.

What you quoted, I believe semantically distorts the situation into what amounts to practically a lie to to support an argument.

I think you are willing to go along with it without looking at it too closely because it supports your position and it is more likely to be a faulty example you are trading on.

I would be more impressed by your arguments if you didn't rely on such stuff. If a similar sort of thing were being quoted about some ethnic minority in some other argument you would rightly not give it house room.


Great question! I think the honest answer is that I know what the right thing to do is, and therefore sitting here I can say that, subject only to my own failings, I can be 100% sure I would not!! However, I think that re-inforces my point - if we collectively start from a position that this is NOT the right thing to, then only the very very few will take place as they do now and have done through pain management etc. over the years; if we start collectively from a position that this is just like any other choice one has in life, and there is no right answer for everyone, then it won't be long before the weak and vulnerable will be subject to the selfish and greedy, or even worse, the government!

As an aside, Charles Moore (one of my favourite commentators) has written on this briefly in todays Spectator (

I have enjoyed the discussion, but head off on my summer holidays today, so I am not sure when I will next have the chance to post, but have enjoyed this first foray into TP's comments page, and hope to share some thoughts with you again soon.


Navigator, that is the first and last time I have been/will be accused of Libertarian thinking I am sure, since I am more likely to be called a socialist, especially by TP. I would class myself more as a Liberal with socialistic leanings on certain topics. What the heck that really means I'm not always sure. (I'm Canadian by the way.)

I probably am more of an prolifer than a prochoicer, since I believe that because every foetus from the moment of conception has the capability to be born as a child they do have a right to life. But over the years I have accepted that many others think differently and if abortion is their choice then I want them to have one legally and safely. So I have changed my thinking somewhat.

Now you ask me to ask myself the same question regarding regarding assisted suicide or euthanasia.

In the previous post here on this topic I don't remember you being a commenter although you may well have read the whole post and comment section by now. I cited the case of Sue Rodriguez, ALS sufferer, incapable of arranging her own death, who took her fight to the supreme court of Canada to have the law against assisted suicide struck down in 1993. The judges ruled 5 to 4 against. Not such a clear case of it being wrong/unlawful for some of them apparently.

Despite the decision Sue did find a physician to assist her and he helped her in the presence of a Canadian MP. Neither were ever prosecuted. That case affected every Canadian who was adult at that time, no matter which side you stood on, for it gave us a real person to identify with/empathize with in this set of circumstances.

I asked TP, what are we to do in cases like this? He felt she should carry on, even though she would have done the deed herself if she had been able. Well I suppose she could have refused food and starved herself to death. I wonder if they would have let her.

Now I said this to TP about how I saw it personally, if I were asked, not in the comment section but in an email, so I will reproduce it here.

I've held a beloved dog in my arms as the vet ended her suffering. It wasn't an easy decision even though it was the right one. If a loved one asked me to help end their suffering because they could not manage it I know I could not do it personally. But could I find a vet equivalent for them if asked? Probably not. Would I hold them in my arms if they found one for themselves and asked me to be with them? I hope I would be able to do that, although it would not be easy and I hope I will never find out.

I can say that now. But what would I really say if I saw a loved one suffering so much that I could not bear it? Would I agree? Maybe I would. Tom says most vehemently, no loved one should ask another to do that for the burden of guilt would be too great to bear. But maybe that person is so out of it with pain, that they don't think that way any more. May it please God, I hope I don't find out personally. Plus I hope I am not ever in a position where I would ask it of a loved one. But these are not intellectual questions at a time like that, maybe not even rational ones.

I know from my experience that many deaths are hard and unfortunately not all suffering can be totally eliminated. Fortunately pain control is better understood and better handled than when I first started in hospital pharmacy thirty years ago.

But I have seen the dying process last for many long unpleasant months. I remember a colleague coming downstairs to the pharmacy in tears. An elderly German patient who had been an officer in the German army told her he had carried cyanide capsules which he had been instructed to use in certain circumstances. He asked her if she could give him something like that to end his suffering. No, I'm afraid not. He had to live through those next few weeks, months, although we gave him ever more powerful morphine infusions as his body adjusted to the higher doses, trying to alleviate his pain until he finally succumbed.

I don't know if he ever asked his family the question he asked that clinical pharmacist. If he were my grandfather, father, and had begged me, would I succumb? In the case in the UK of the young man bringing the gun into the hospital for the father to shoot himself, he obviously did. You see I can't be 100% sure that I would not. Can you?

It's not wrong to be emotionally charged on this topic Navigator. It is an emotional issue. It should be and we all have strong feelings about it. That said we should be respectful of each other's stance/conclusions and I believe we have been.

Sorry TP, this reply is to Navigator but I'm afraid it will come to your inbox too. I promise to go back under my rock now.:)


As TP knows, I am not convinced about libertarianism as an absolute - I have a very strong dislike of government and for that reason (as you outline above) we have much in common. However, this topic is which shows up the very strong reason for libertarianism to be considered together with an overiding moral code.

You have both applied a classic libertarian (or modern Western liberal) response on the subject of abortion - I am afraid I have a real issue when facing significant questions with saying that 'I wouldn't do x but wouldn't presume to tell someone else not to'. I appreciate that (most) others have a different view on this, and I am happy to leave it aside, but i would ask that you ask yourself the same question in relation to assisted suicide or euthanasia? I think you get an answer which is very much on point?

I hope I haven't come across as emotionally charged. I have enjoyed the opportunity to think about such items and to contribute my thoughts on such a significant topic. We all may face the wrong end of this one day, so i think it is important that we each face up to these issues and seek to ensure the debate is not dominated by the mainstream agenda, which prohibits any serious discussion.


It was kindly and well meant. :)


I did not take your reply personally Tom, well perhaps a little, as I did not think it addressed what I said, rather put your own point of view again in very harsh language. Parallel conversations as I said.

Having checked out the link, if this is truly an influential medical ethicist in your country I can see why you fear any change to the current laws whatsoever in this area. Her position is totally untenable to most I hope.

With regards to what you said below, I still think the report/article which started this whole topic may well be flawed in that it was not totally unbiased. But even a few of these ugly stories should make one stop and think perhaps we should leave well alone and I think that is what I concluded somewhere along the way. I would not change anything I have said here in that light however.

How is it that being called a kind well-meaning person sounds like an insult/putdown? LOL. Just teasing. I've been called so much worse over these many months so I will take it in the spirit with which it was meant. I think.


I am sure he did. If my wife gave me that ultimatum (whether bimbo or tired old lady) I would lose the will to live.


"Overly dramatic?" Well these are matters of life and death. I would like to think the British are more compassionate too. If you doubt the decline in British respect for the sanctity of life however, then consider this account of the views of "influential medical ethics expert" (and bog-standard left-leaning British academic) Baroness Warnock;

People like her, not people like you or me, will shape these laws if they are introduced in Britain.

Socialised medicine is not, in the end, "nationalisation" (i.e. expropriation) of medical services. It is the nationalisation of human life itself. Warnock's reasoning is, that having been taxed your whole life so you have no resources to look after yourself, you then have a duty to let yourself be killed so as not to be a burden to the taxpayers. How long before her view is considered by her successors to be insufficiently radical and "progressive" do you think. How long before exhortation to be responsible becomes something more?

I see her Wikipedia page suggests she was misrepresented, but her words as quoted are as clear as day. And she, in Britain, is one of "the Great and the Good."

I am very sorry if you thought my reply harsh. That was not intended. Nothing in this exchange has lessened my respect for you. I entirely accept that you are a kind, well-meaning person.


It's interesting because, unlike so much discussion here, it's on the boundaries of libertarian thought. 90% of British statute law is unnecessary and I spend most of my blogging life saying, in effect, "repeal it and all will be well." Libertarians are not anarchists. There is some law we do want. Protecting the weak and vulnerable from the initiation of force (including force they have been persuaded by depression, duress or interested third parties to "request") is within my definition of the minimum.

Does the availability of an option to kill change people? Yes. Despite murder being the only physical (as opposed to thought-) crime still taken seriously in Britain, there are still murders. Some people are prepared (in the words of Johnny Cash) to shoot a man "..just to watch him die..." It's hard for nice people like you and me to imagine, but consider the Harold Shipman case.

Some idiots think if there's "no law against it", it's ok. That's why it's so hard to get stupid laws repealed, because statists portray that as approval (e.g. drugs law, which doesn't work, but in advocating its repeal I am certainly not recommending you become a heroin addict).

The report I referenced seem to suggest that in the only country which has legalised euthanasia, it has rapidly become a preferred alternative to expensive palliative care. So much so that old people are afraid of hospitals, as they used to be in the 19th Century. The stories I cited were of nice people who became murderers because they had become casual about making life and death decisions. I am sure your recollections were accurate, but every careful decision you saw taken was conditioned by an unspoken legal background in which the wrong decision would be murder.


Navigator, my problem is that I see everyone's point of view as equally understandable which makes for a lot of wooly thinking on my part.

Certainly euthanasia and assisted suicide can overlap and maybe you could say the latter is a lesser form of the former, which is why some countries have legalized assisted suicide and not euthanasia.

Let's not touch abortion. Like TP, I could never have personally done it but I have to defend the right of those who choose that route, although it does sadden me when I see statistics that show there are more abortions than live births in whatever jurisdiction is reporting.

We all have a store of personal anecdotes as you have quoted, I more so than most through my many years as a hospital pharmacist plus the fact that I have been around a long time.

I can only say that in my experience turning off life support systems was only done after establishing that there was absolutely no chance of recovery (ie the patient was brain dead) or that the patient had left directions that no extraordinary means were to be used in their treatment and they had known what that included. Now that can be a bit of a cloudy issue sometimes as technology advances. What was extraordinary yesterday is the norm today.

This was something I had to work my way through as I was legal "next of kin" to an friend who had Alzheimer's Disease. He had always insisted that no extraordinary means were to be used in his medical treatment. Certainly there was a do not resuscitate order on file as per his wishes. Did I sanction IV antibiotics if he got pneumonia? No, in consultation with the doctor I okayed oral and that worked. Did I sanction or insist on a feeding tube as he was progressively unable to swallow? I thought long and hard about that one but in the end decided no. Fortunately I did not have to act on that decision as he fell into a coma and died before that became necessary.

Families, and even I as a close friend, do not make these decisions lightly. While I am know the ones you envisage TP do exist I am sure they are the exception,just as the medical personnel you describe exist but are also not the norm. Do you believe that suddenly making euthanasia or assisted suicide legal changes people's fundamental behaviour? I do not.

It's been an interesting, very emotionally charged discussion you started Tom. None of us comes to the table with unbiased opinions as we all have been shaped by our personal experiences, each so different. I am sure as a young adult I would have held totally different views.


What a harsh and overly dramatic reply to what I actually said in my comment. We seem to be speaking in parallel conversations.

That you believe those last sentences you wrote saddens me. I'd like to thing the British are more compassionate that what you envision.


Hmm, now the waters are muddied. You are right about the precise moral equivalence between euthanasia and assisted suicide. In legal terms it's only the difference between murder and being an accessory. That's why I simply don't understand jmb's insistence that there's a big distinction.

I am personally very uneasy about abortion. If I were a woman, I don't think I could ever have done it, but I don't criticise those who do (especially to save their own lives, to avoid merging their DNA with a rapist's etc.) I would not encourage abortion (still less fund it with taxes taken, amongst others, from people like yourself with strong moral or religious objections) but I would argue that until the foetus is realistically viable outside the womb, a woman must have the right to make this uncomfortable choice.

There are some valid comparisons. How many girls have been pressured into an abortion they regret because it has become so normal since legalisation, for example? But I am happy that (save to the extent all human morals are one river) that you are fishing in different waters now, muddy or otherwise.



I am not sure that one can 'muddy the waters' between assisted suicide and euthanasia. On a moral basis the two are the same point - however benign - of one person assisting another to end their life.

The examples in this story may be ugly, but to my mind any such story is ugly - the most heartbreaking are those which never happen, and I have heard two in past month. The one I feel I can mention was a colleague in Australia who had an ill relative in a coma, with a grim prognosis; their followed much discussion amongst the family about how 'he wouldn't want to live like that...', and this added greatly to their burden. This is a good loving family, who have raised someone with a severe handicap, and the moral torment to them at their time of grief was difficult to watch. (Happy ending - he fought through the coma, and opened his eyes to see and hold his first grandchild, born while he was in the coma. He has a tough time ahead, and has already set his goals - to walk, to learn to write again etc.,).

I have a friend who is insistent that 'ideas have consequences'. He often mentions this as a criticism of me when I make a liberal (classic sense!) comment. This is area where I think I finally see his point - assisted suicide, euthanasia, abortion - are all one and the same, in that they permit, then sanction, then require a certain action; in each case against the most basic moral principle - the sanctity of human life. To refer to the most settled of the three examples, abortion, which is now routinely accepted in most Western liberal countries - initially enacted with the good intention of eliminating the danger to life (ironic?) of unofficial abortions, then becoming commonplace and now we are at a point where there is an implicit societal criticism of anyone who does not abort a Down's child, let alone any form or handicap etc. Tom mentions the Nazi regime - to my mind we are not far now, using abortion, from a cultural version of their perfect society without defect or deviation. In my view, the same applies to assisted suicide and euthanasia - the outcomes highlighted above that are 'ugly' are inevitable as the idea of allowing another to assist the ending of a life is at its heart a bad idea - to open the door to that as society is to start down a path that has no inherent good.


What JMB said.

Eventually it becomes a matter of definitions.

If things are so bad then a Dr must prescribe and administer painkillers. Eventually the dose has to become so strong it can kill in it's self. The alternative is terrible pain and death in any case.

As for palliative care. How do you think UK hospices keep going providing the services they do? Peoplle raising cash, people making donations, people giving their own time. If it were down to the government I think things in the UK would be much worse.

As for your, "A wife, who no longer wished to care for her sick, elderly husband"

So was she a heartless 25 year old bimbo married him for his money then? Or, just maybe, she was elderly too (it is possible), and just maybe it wasn't a case of "longer wished to care". maybe it was "just couldn't manage to any more"?

Isn't that more likely to be the truth than playing with word meanings?

And maybe the husband felt he was doing the only thing he could to help/protect his wife?


Democracy has its limits. Does Hitler's democratic mandate (now rarely mentioned) justify his regime's notorious medical innovations? One reason why constitutions, properly viewed, should not be about the state "granting" rights to the people but the people limiting the powers of the state is that no citizen should be at the mercy of the well-intentioned sentimentality of his fellow citizens. Assisted suicide will become law in Britain; now one of the most amoral places on Earth. A heartbeat later it will become a duty of the old to relieve their families' emotional/financial suffering by dying. Two heartbeats later many murders will be disguised as assisted suicides as families enforce that "duty" and progressive doctors unblock beds.


Tom, Tom! Once again you are muddying the waters mixing euthanasia with assisted suicide when they are totally different things. However the article does the same thing, while supposedly arguing against assisted suicide it included many examples of "euthanasia".

But in the examples you cited, that was indeed murder disguised/justified as euthanasia. Even the psychiatrist acted reprehensibly and I have no idea what he was thinking justified his assistance. A clinically depressed person is in no shape to make a rational decision. In fact it is a psychiatrist's duty to try to keep his patient from committing suicide during treatment. Mind you I don't seriously think he found it easier to submit to her wishes. But he should have just sent her on her way if she refused treatment. The clinical depression may well have lifted on its own as many do and as he would be well aware.

Naturally when one argues a point of view one includes only stories which suppport one's premise. The uglier the better in this case and they are all pretty ugly stories, pages of them. Since the article is more than five years old I hope that things have changed since it was written.

While I do not support euthanasia, misuse of any law does not necessarily make the law wrong. I assume the majority of the Dutch people supported euthanasia for the law to have been passed in the first place but if it is being misused so blatantly and often, then it certainly needs rethinking. It is interesting that only two countries have ever legalized euthanasia.

While emotionally I can see a case for assisted suicide, I envision it as being used in the very exceptional case. Perhaps I am naive and maybe that is the message I should get from that article. The thin end of the edge you could say.

Fay Levoir

I can attest that an aspect of traumatic grief is feeling suicidal but as you say it passes and life is more than worth living again.
I am horrified to read these examples.

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