Pissflaps wins right to die.
I'm not sure I'd like to read all of the Daily Mail's journalists' takes on this story (something along the lines of "bring back hanging - hanging's too good for him, etc") but this really quite an interesting story from a scientific and ethical point of view. I'm hoping that our chum Enzyme will be along to weigh in with his views on this in due course.
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Fray Brentos *mega-belms*, Tue 16 Sep 2014, 9:36,
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Still thinking about it.
Though since I think that assisted should be available for pretty much anyone, irrespective of their reasons or status, I'm inclined to think that there's no especial problem here. It doesn't follow from that that anyone has a duty to provide it - and so the State might in this case decide not to make particular efforts to accommodate his request - but, again, there's no particular difficulty from a moral point of view that I can see offhand.
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Enzyme is powered by sunlight, Tue 16 Sep 2014, 9:47,
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The only thing that I can think of, via a short string of logic, would be that the person doing the injecting (or whatever) could be classed as a killer.
Or even a mass killer if he does it lots of times. Which seems a bit unfair. I'm possible making a wholly stupid statement there, which is why I'm blaming it on my understanding of logic :)
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Fray Brentos *mega-belms*, Tue 16 Sep 2014, 9:52,
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Technically, yes.
But since Belgium has some fairly liberal euthanasia laws - they've even legalised it for children (again, defensibly in my view) - that's not so huge a consideration.
Fun fact: euthanasia is legal in Belgium, but assisting suicide isn't. That means that some people are allowed to kill others legally, but not allowed to help people kill themselves.
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Enzyme is powered by sunlight, Tue 16 Sep 2014, 10:10,
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surely if this guy wants to die just because he has a miserable life
then this would be assisted suicide?
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mutated monty, Tue 16 Sep 2014, 10:24,
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It's the means by which it's done that's important.
Very loosely, euthanasia involves Smith administering a life-ending treatment to Jones at Jones' request. Assisted suicide involves Smith providing to Jones the means to kill himself, and Jones administering it to himself.
Under Belgium's 2002 law, the former is legal, and the latter illegal. That's precisely the opposite to what we find in other assisted dying regimes - Washington, for example, or the repeated proposals in the UK - under which providing assistance to Jones to self-administer his own death is or would be legal, but actually killing him wouldn't be.
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Enzyme is powered by sunlight, Tue 16 Sep 2014, 10:31,
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I appreciate that it is different but I have often wondered why we are allowed to remove life support
from loved ones without their consent (as they cannot provide consent) but cannot do it if they give consent. Speaking as someone that has had to do the former I have often wondered why in the eyes of the law i am not a killer?
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herd of chickens First part only £1.99 and comes with a free, Tue 16 Sep 2014, 10:44,
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If they're not competent,
then treatment has to be provided if it is in their best medical interests. If it is not, then it might actually be required that it be removed - to provide futile treatment, for example, would be treatment that is not in their interests, and might qualify as assault.
More, if we have reason to believe that a non-competent patient would have refused certain treatment had she been competent, then we may withdraw it; the Mental Capacity Act actually goes further, and makes certain advance refusals of treatment binding.
If the patient is competent, then a medic is perfectly entitled to withdraw futile treatment too: there's no obligation to provide treatment that is not in the patient's best interest. (cf a case called Burke, from about 2004, for this.)
Consent to withdraw treatment is a trickier one - that would, by implication, describe a case in which treatment was not futile, but the doctor (for some reason) came up with the idea of withdrawing it anyway. I can't see how that'd happen.
It can be withdrawn at the patient's request, though - indeed, it must be, again to avoid assault and/ or battery.
"Loved ones" make no odds. There is no proxy decisionmaking for adults in English law - it's the best medical interests that count strictly speaking, and best interests in a slightly wider sense that count in practice. (Thus a patient's beliefs about dignity might be taken into account when assessing what is in her best interests.) Even with children, next of kin only get a say insofar as that they're assumed to know best what would be in the child's best interest - but that's a rebuttable assumption.
The law wouldn't see a medic who withdrew treatment as a killer, though, because - quite correctly, I think - simply withdrawing treatment won't kill anyone who is well. That is: it's the underlying condition that kills. The most that happens is that death is allowed.
Some ethicists think that killing and letting die are morally equivalent; but I disagree, and the law agrees with me!
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Enzyme is powered by sunlight, Tue 16 Sep 2014, 11:06,
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What were your thoughts on that severely disabled guy who took his fight for the right to die to the high courts...
He lost and ended up starving himself to death a few months later :(
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Fray Brentos *mega-belms*, Tue 16 Sep 2014, 11:12,
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Hang on -
I'm writing something on the Belgian case for the Oxford Practical Ethics blog - I need to be quick before some other bugger publishes something - but on that case, go to blogs.bmj.com/medical-ethics/ and search for "Nicklinson". In short, I think he had a reasonable moral case, but his legal case was hopeless.
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Enzyme is powered by sunlight, Tue 16 Sep 2014, 11:27,
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Actually, I thought I'd done more on that case.
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Enzyme is powered by sunlight, Tue 16 Sep 2014, 12:30,
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Why not have an IV line put in, then a simple button press to administer the dose
The person who wants to die connects the IV to the feeder, presses a button, and the anaesthetic dose is administered, followed by the lethal dose a few minutes after. The doctor wouldn't have to be in the room.
(, Tue 16 Sep 2014, 12:57, Reply)
That'd still fall foul of the intention claim -
setting up the machine'd count as assisting suicide, which is illegal in England and Wales under the Suicide Act. (Not sure about Scotland and whether the Act applies there as well.)
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Enzyme is powered by sunlight, Tue 16 Sep 2014, 13:16,
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but shirley
there would have to be a certain point in the set up of the machine. if it was a modular device, say 5 components, left in parts in the room...
This is where it gets silly, if someone tops themselves in my bathroom with a hot bath and some razor blades whats the difference?
(, Tue 16 Sep 2014, 13:28, Reply)
Well, as long as you hadn't provided the blades in order for them to off themselves, you'd be OK.
Like I said, it's all about intention. (If you know someone is suicidal and foresaw the attempt, but did nothing to prevent it, you might fall foul of negligence laws - but I'm not sure of that. I don't really know anything about negligence.)
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Enzyme is powered by sunlight, Tue 16 Sep 2014, 13:35,
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Until now, I thought of Belgium as a country of war memorials, chocolate and paedo gangs.
I reckon there's a TV series begging to be made called The Euthaniser. Bit like a sort of hit-man but he goes around humanely killing people who are terminally ill. Danny Dyer can star.
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Fray Brentos *mega-belms*, Tue 16 Sep 2014, 10:26,
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They should get that Jihadi John in to chop his head off.
Live stream it on Sky Sports and then put the highlights on Youtube, would be ace!
(, Tue 16 Sep 2014, 10:38, Reply)
You're back! I thought someone had hacked your password.
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Fray Brentos *mega-belms*, Tue 16 Sep 2014, 10:43,
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Hacked his password to stop him from posting?
Also, what happened to tab hunter, did he go the way of Mr. Hands?
(, Tue 16 Sep 2014, 10:48, Reply)
Mr Hands is his nickname in the nonce's wing in HMP Bristol
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Fray Brentos *mega-belms*, Tue 16 Sep 2014, 10:50,
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Tab Hunter is now "The Queen Mother"
b3ta.com/search/posts/50726
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mr.dogshit The world's premier anthropomorphic canine faeces, Tue 16 Sep 2014, 11:01,
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Well, I never.
He's a sneaky one. Didn't think he'd be coming back for some reason.
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Fray Brentos *mega-belms*, Tue 16 Sep 2014, 11:23,
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All those stories in the press.
He's got a damn nerve.
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Pig Bodine., Tue 16 Sep 2014, 11:41,
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Jihadi John is quite the breakout star, isn't he?
I hope we see more of him. He'd be good on Saturday night telly... Host of Blankety Blank or something.
(, Tue 16 Sep 2014, 11:29, Reply)
OK:
Here's my hastily cobbled-together and ill-conceived brain-fart on the matter.
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Enzyme is powered by sunlight, Tue 16 Sep 2014, 12:20,
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"Except that one aspect of his arguments is that the state has been failing him by not providing him with adequate therapy in respect of his behaviour."
This is where it gets fecking complicated for me. Given that there's no guarantee that our treatment of such individuals will change and that, if change does occur, the timescale on which it occurs is likely to be years, is it worse to make him wait out the process?
Nice article btw, as always!
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Hol[]y - WHAT CAN THE HARVEST HOPE FOR, Tue 16 Sep 2014, 13:09,
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Ta!
Yeah: it's really tricky, and I'm trying to avoid giving a clear answer...
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Enzyme is powered by sunlight, Tue 16 Sep 2014, 13:17,
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the liberalness and slipperiness of these Euthanasia laws in Belgium is why I'm out
(, Tue 16 Sep 2014, 12:21, Reply)
Why should being liberal be a reason to oppose them?
Their slipperiness is another matter; but that'd require further evidence.
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Enzyme is powered by sunlight, Tue 16 Sep 2014, 12:27,
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prejudice - the linking of the words 'liberal' and 'euthanasia laws' in the same sentence
no well-thought out reason
(, Tue 16 Sep 2014, 12:47, Reply)
Couldn't he have that chemical castration thingy pedophiles in other countries have?
(, Tue 16 Sep 2014, 12:44, Reply)
supposedly doesn't work. It hasn't stopped me.
but it does make you worry that with all these government cuts, potentially treatable offenders like him, and those suffering mental distress due to mental illness, are being pushed into the only sure and cost effective way out
(, Tue 16 Sep 2014, 12:50, Reply)
He's said he wants to die, hasn't he?
I question whether a violent rapist is "treatable". Unless he's discovered the empathy he probably wasn't born with. What's the mental illness you're referring to? Paraphilia or ASPD? I don't think either respond to treatment.
(, Tue 16 Sep 2014, 13:13, Reply)
Treatbility opens a hell of a can of worms.
There's a link between antisocial (violent) behaviour and a mutation in the MAOA gene, for example; in that case, there seems to be a reasonable argument for the behaviour being a symptom of a deeper pathology, and so something that (a) shouldn't be punished, and (b) should be treated.
There's also evidence of a link between lead pollution and violence. It's mainly circumstantial at the moment, but it's still reasonably powerful.
We know that empathy can be boosted by oxytocin. So suppose that someone's lack of empathy could be shown to be related to a neuroendocrine glitch in relation to oxytocin: again, there'd be a candidate for treatability there.
Indeed, why shouldn't we think of antisocial behaviour as treatable? (There's a lovely line in Nietzsche somewhere along the lines that Christianity invented free will in order to be able to punish people; the underlying thought is interesting. What if punishment is the wrong approach because behaviour isn't chosen? It seems worth considering to me...)
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Enzyme is powered by sunlight, Tue 16 Sep 2014, 14:19,
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I absolutely agree that punishment is in most cases not productive in the slightest. It certainly isn't a deterrent when criminality is pathological. In reference to irrational criminality, at least.
A friend of my father who is a clinical psychologist and works at a London acute MH unit always spoke of punishment as being absolutely useless in practice. And just speaking on a personal level I don't believe in the concept of penal harm beyond deprivation of liberty. I think all we have a duty to do, as a society, is to remove bad people to prevent them from doing more bad things. Deprivation of liberty is enough. Many would disagree.
I have read some of Dr. James Fallon's stuff on the "warrior gene". Absolute fascinating; though I've not read anything about the possibility of any related treatments, beyond theory. All I know from my own understanding is that pathologically "bad" people are probably the hardest psychological cases to treat in practice - incidentally, my dad's friend also said quite bluntly that personality disorders "are untreatable" - assuming they don't end up running corporate banks or countries, of course.
(, Tue 16 Sep 2014, 14:39, Reply)
Rehabiliation of offenders has always been based on this idea that prisons and hospitals should have a similar function and that criminality is treatable
Whether crime was caused by race, mental illness, poverty, or bumps on your head, there has long been a belief that humans are not responsible for their crimes. Genetics is not going to radically change this tradition.
So, from the 18th century, punishment inside the prison was one method to treat the disease - a dog or cat is not responsible for its bad behaviour, but we correct it through punishment and reward.
The problem is that this tradition attacks the idea of free will and personal liberty. Whether we treat prisoners through punishment, drug therapies, genetic therapies, psychotherapies, etc, (and even the euthanasia solution) we are still denying the liberty of the individual, objectifying the person, and travelling the road of dehumanisation.
(, Tue 16 Sep 2014, 15:23, Reply)
Hang on...
You're confusing free will and liberty - which aren't the same thing at all. And you're assuming that (a) there is such a thing as free will, based on apparently nothing more than a desire that there should be; and (b) that freedom must be understood in one particular way.
I don't see what worrying about dehumanisation has to do with it - if the world is thus and so, whether or not its dehumanising is neither here nor there.
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Enzyme is powered by sunlight, Tue 16 Sep 2014, 16:19,
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many people want to die. Doesn't mean we should help them do it.
by 'potentially treatable' I mean both the potential to reform, of which modern penal regimes are based on, and the potential of medicine to understand and treat pathologies. That people like him are deemed 'untreatable' in both the penal and medical sense, and may be disposed of by euthanasia, perhaps shows that the State and civic society are failing in their duty of care.
As for mental distress due to mental illness - this is roughly an idea from Enzyme's blog - I'm not speaking of offenders (although, it has been argued that the US prison system has a large majority of mentally ill inmates because the US has inadequate mental health care). I'm speaking of the right to die based on mental distress. There are many people suffering treatable and untreatable mental distress - schizophrenia, chronic depression, bipolar, DID, etc. Even before the Government cuts, the NHS was unable to fully help the mentally ill and disabled. So, in places like Belgium (or in a future Britain) I worry people are being deemed (or will be deemed) viable for euthanasia because there just aren't the finances to treat them, as well as taking away incentive to find a cure.
(, Tue 16 Sep 2014, 14:46, Reply)
I think that shifts the context slightly, though
If you're talking about somebody suffering from a mental illness like chizophrenia, chronic depression, bipolar or DID, those individuals should absolutely be treated. And if their culpability is deemed due to mental illness, then the treatment should absolutely be the same.
I just don't think this example, where no specific mental illness has been listed in the article beyond "violent sexual urges" - which leads me to assume likely a paraphilia and ASPD comorbidity - can be placed in the same context. Because neither is currently regarded as a mental disorder which responds to treatment. It's rare that a person is hospitalised because of a personality disorder.
Society would say he was responsible for his actions. I don't at all believe he should be killed or mistreated beyond deprivation of liberty by the state if he's assessed as a risk to society, but if he wants to die in a country that allows euthanasia then what can be done?
(, Tue 16 Sep 2014, 14:58, Reply)
if the question of a mental disorder is taken out then we are left with the state's failure to rehabilitate...
as well as a person seemingly wishing euthanasia based on self awareness and guilt
are not self awareness and guilt the road to redemption, and thus shows the man to be treatable in some way
(, Tue 16 Sep 2014, 15:37, Reply)
But how would you know that self awareness and guilt are genuine in somebody with an ASPD?
Isn't that one of the hallmarks of the disorder? The so called mask of sanity?
I'm all for rehabilitation if possible - I just don't believe it is possible in pathologically "bad" people. Maybe I'm wrong.
(, Tue 16 Sep 2014, 16:46, Reply)
Didn't they try that somewhere
and the guy used knives instead?
Not entirely sure why keeping someone like that alive is such an ethical issue to be honest
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Jahled Three shades of black, Tue 16 Sep 2014, 13:55,
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what's one more dead belgian, ay? Are you with me?
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cumquat may will not be commenting further on the allegations, Tue 16 Sep 2014, 15:11,
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one more dead belgian means the start of another Poirot murder mystery
(, Tue 16 Sep 2014, 15:39, Reply)