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  • #46

    February 3, 2010 -- For seven years the man lay in a hospital bed, showing no signs of consciousness since sustaining a traumatic brain injury in a car accident. His doctors were convinced he was in a vegetative state. Until now. To the astonishment of his medical team, the patient has been able to communicate with the outside world after scientists worked out, in effect, a way to read his thoughts. They devised a technique to enable the man, now 29, to answer yes and no to simple questions through the use of a hi-tech scanner, monitoring his brain activity. To answer yes, he was told to think of playing tennis, a motor activity. To answer no, he was told to think of wandering from room to room in his home, visualising everything he would expect to see there, creating activity in the part of the brain governing spatial awareness. His doctors were amazed when the patient gave the correct answers to a series of questions about his family.

    The experiment will fuel the controversy of when a patient should have life support removed. It also raises the prospect of some form of communication with those who have been shut off from life, perhaps for years. "We were astonished when we saw the results of the patient's scan and that he was able to correctly answer the questions that were asked by simply changing his thoughts," said Dr Adrian Owen, assistant director of the Medical Research Council's cognition and brain sciences unit at Cambridge University. "Not only did these scans tell us that the patient was not in a vegetative state but, more importantly, for the first time in five years it provided the patient with a way of communicating his thoughts to the outside world." Dr Steven Laureys, from the University of Liège in Belgium and co-author of the paper on the patient, said: "It's early days, but in the future we hope to develop this technique to allow some patients to express their feelings and thoughts, control their environment and increase their quality of life."

    The patient has not been identified, but his family was said to have been happy with the outcome. "That's not unusual," said Owen. "The worst thing in this sort of situation is not knowing." He said that as many as one in five patients in a vegetative state may have a fully functioning mind. The British and Belgian teams studied 23 patients classified as in a vegetative state and found that four were able to generate thoughts of tennis or their homes and create mind patterns that could be read by an fMRI (functional magnetic resonance imaging) scanner – although only one was asked specific questions. Owen said that misdiagnosis of vegetative state was fairly common: in about 40% of cases people are later found to be able to communicate in some way. He said he believed that the patients who responded in the study were probably "perfectly consciously aware", although he knew others would disagree. "To be able to do what we have asked, you have got to be able to understand instructions, you have to have a functioning memory to remember what tennis is and you have to have your attention intact. I can't think of what cognitive functions they haven't got and still be able to do this," he said.

    When it was suggested that to be conscious but trapped in an inert body might be a worse fate than to know nothing, Owen said: "On the plus side we are making enormous advances. Things have changed so much in the last few years." Owen was speaking from Austria, where he had travelled for a conference on the latest in brain-operated technology – computerised devices powered by thought – which is attracting interest, including from the games industry. "Perhaps some of these patients could benefit from some of these activities," he said. In the meantime, doctors will at least be able to ask patients if they are experiencing pain.

    The paper, published tonight in the New England Journal of Medicine, generated immediate excitement. "These findings have broad implications, not just for concerns about the accurate assessment of vast numbers of patients in custodial care situations, but in the context of any clinical encounter where we currently rely on behavioural assessment alone to identify consciousness," said Dr Nicholas D Schiff, associate professor of neurology and neuroscience at Weill Cornell medical college in New York. He called for urgent efforts to identify and help such patients. "The most important question left unanswered by these findings is what mechanism accounts for the stunning dissociation of behaviour and integrative brain function. I think we can be sure that as the biological answers underlying this question become more clear this will have a profound impact across medicine."

    Professor Chris Frith, of the Wellcome Trust's centre for neuroimaging at University College London, said Owen and his colleagues had opened the way to communicating with patients in a vegetative state. "It is difficult to imagine a worse experience than to be a functioning mind trapped in a body over which you have absolutely no control," he said. "Obviously, more technical development is required, but we now have the distinct possibility that, in the future, thanks to Owen and colleagues' work we will be able to detect cases of other patients who are conscious, and what's more, we will be able to communicate with them."

    Patients in a vegetative state are defined as having "wakefulness without awareness". They are people who have survived an acute brain injury who are not in a coma – they may go through sleep cycles, for instance – but they do not respond to any stimuli. Some stay this way permanently, but others start to show some awareness, although without being able to communicate. They may be able to move a finger when asked to do so, but not always, and they are not able to signal yes or no by their movements. These patients are now referred to as being in a minimally conscious state (MCS). It can be hard to know whether their movements are intentional or merely reflexive. Recovery from a traumatic brain injury – such as a blow to the head in a car accident – is more frequent than that caused by disease, such as a stroke. But after a year in a vegetative state, most health professionals do not recommend further treatment, because official advice is that the chances of recovery are virtually zero. With the consent of the family, doctors may go to court for an order allowing them to sedate the patient and withdraw nutritional support, allowing them to die. This study may cause a rethink.

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    • #47

      February 25, 2010 -- Rules on assisted suicide intended to clarify when helping someone to end their life will result in prosecution will be published today after almost 5,000 people responded to the interim policy. The eight pages of guidelines will be released by Keir Starmer QC, the director of public prosecutions (DPP), this morning along with a 45-page summary of responses, the vast majority of which were from individual members of the public, according to the Crown Prosecution Service. Assisted suicide remains a criminal offence in England and Wales, punishable by up to 14 years in prison, but individual decisions on prosecution are made depending on the circumstances in each case. An interim policy was published in September and has been in force since. It made clear that someone acting out of compassion, to help a terminally ill patient with a "clear, settled and informed wish to die" was unlikely to face the courts. But persuading or pressuring the victim to kill themselves, or benefiting from their death, would encourage prosecution.

      Starmer was forced to issue the guidelines after a law lords ruling in favour of Debbie Purdy, who has multiple sclerosis. She wanted to know whether her husband would be prosecuted for helping her to end her life. Writing in today's Times, the DPP said the recent debate about "mercy killing" made it important to draw the line between those who help a loved one to kill themselves and suspects who have ended someone else's life. "Assisted suicide involves assisting the victim to take his or her own life," he wrote. "Someone who takes the life of another undertakes a very different act and may well be liable to a charge of murder or manslaughter. That distinction is an important one that we all need to understand. Each case is unique, each case has to be considered on its own facts and merits; and prosecutors have to make professional judgments about difficult and sensitive issues. The assisted suicide policy will help them in that task." He said that he found "compelling" the large number of responses arguing "that the factors tending against prosecution should focus more on the suspect than on the individual who committed suicide".

      Campaigners for the right to die welcomed the initial guidelines and called for the government to legislate on the issue, but ministers were reluctant to intervene. Critics have complained Starmer is effectively legalising assisted suicide. The prime minister, Gordon Brown, writing in a newspaper yesterday, said changing the law would "fundamentally change" attitudes to death and could lead to pressure being put on frail elderly relatives. Purdy said his intervention showed a "lack of respect" to the public. Scope, a charity for disabled people, warned its members were "genuinely frightened" about any changes that would weaken existing safeguards. The chief executive, Richard Hawkes, said: "We recognise that assisted suicide is a complex and emotional issue. However, as a charity which supports thousands of disabled people with complex support needs, we are very concerned about the potential impact of the DPP's new guidelines on assisted suicide."

      Comment


      • #48

        February 25, 2010 -- Family members involved in "mercy killings" will still face criminal charges despite the publication today of new guidelines to clarify the rules on assisted suicide. After one of the most widespread public consultations ever carried out, the director of public prosecutions, Keir Starmer QC, has created six mitigating factors against an individual being prosecuted for assisting the suicide of another. One of the other key changes is the removal of any reference to the condition of the victim – whether they are terminally ill or near death – as a mitigating factor. Instead, the focus has switched to examine the motivation of a suspect when considering whether to prosecute anyone for assisted suicide.

        Starmer made it clear that relatives who actively help a terminally ill individual to die are not covered by the guidelines and individuals could be expected to be charged with murder or manslaughter. "Someone who takes the life of another undertakes a very different act and may well be liable to a charge of murder of manslaughter. That distinction is an important one which we all need to understand." The distinction means people like Kay Gilderdale – who was prosecuted for the attempted murder of her daughter who had ME – could still face criminal charges. A judge last month criticised the Crown Prosecution Service for charging Gilderdale and a jury found her not guilty in less than two hours.

        Crucially Starmer has removed one key mitigating factor from his original draft guidelines published last September – the fact that the person assisting is a family member. Starmer said it had been removed after a public response raised concerns that family members could be "manipulative" or even "antagonistic" towards the individual who was sick. Debbie Purdy, whose legal challenge led to Starmer being forced to issue the guidelines, welcomed their publication but said the law criminalising assisted suicides needed updating. "Keir Starmer and the CPS have done the best they can in bringing the 1961 Suicide Act [up to date, and] how it will be interpreted in the 21st century," Purdy told the BBC. "It's 50-years-old, we live in a different world. We need a law that is appropriate for the 21st century world."

        Starmer said the law lords' ruling in favour of Debbie Purdy – who has multiple sclerosis and wanted to know whether her husband would be prosecuted for helping her to die – did not change the law and the policy was not a change in the law. "Nothing in this policy could be taken to amount to an assurance that a person will not be prosecuted if he assists the suicide or attempted suicide of another person. The policy does not open the door for euthanasia or so-called mercy killings. "The act of suicide requires the victim to take his or her own life. Euthanasia or mercy killing are where the suspect takes the life of another," Starmer said.

        Starmer's policy now lists six key mitigating factors against the prosecution of individuals who assist another's suicide. His original draft policy contained 13 factors. One key point is the focus now on the motivation of the suspect rather than the characteristics of the victim. He also lists 16 public interest factors in favour of prosecution. The six factors which could mitigate against a prosecution for assisted suicide are:

        the victim had reached a voluntary, clear, settled and informed decision to commit suicide,

        the suspect was wholly motivated by compassion,

        the actions of the suspect although sufficient to come within the definition of the crime, were of only minor encouragement or assistance,

        the suspect had sought to dissuade the victim from taking the course of action which resulted in his or her suicide,

        the actions of the suspect may be characterised as reluctant encouragement or assistance in the face of a determined wish on the part of the victim to commit suicide, and

        the suspect reported the victim's suicide to the police and fully assisted them in their inquiries into the circumstances.

        Starmer said the 4,800 public responses were the "most extensive snapshot of public opinion on assisted suicide since the 1961 Suicide Act was passed". Asked if he could have been swayed by groups or individuals involved in an orchestrated campaign, he said: "We carefully considered all of the responses. Nearly 5,000 is an extraordinary response and it is clear from our analysis that the responses were from a range of individuals and groups expressing their views. It was clear the views were widespread."

        Comment


        • #49
          Afua Hirsch:


          February 25, 2010 -- The DPP's new policy on assisted suicide is *described as "guidance for prosecutors", but its real target audience is the public. The nine-page document, published by the CPS today, is a direct result of the case brought by Debbie Purdy, who wanted clarity about the likelihood of her husband's prosecution if he helps her take her own life. It explains the law of assisted suicide, the role of the police and prosecutors, as well as the difference between assisting suicide and committing murder or manslaughter.

          But all attention is focused on one crucial paragraph, where the DPP sets out the "public interest factors" that determine whether a case which has sufficient evidence to go to court should be dropped for other reasons. These factors do not come as a surprise. The motives of the person assisting the suicide are key, and the policy singles out the mental capacity and express wishes of the person ending their life as central questions. Coercion, abuse or the existence of bribes are set out as factors making a prosecution more likely. Similarly, the fact that a person's suicide resulted from a voluntary, clear decision, and that the person assisting was motivated wholly by compassion, are factors against prosecution.

          The value of providing this clarity – albeit that prosecutors are possibly the only group who will not learn anything from it – is not to be underrated. Purdy had to exhaust the entire legal process – from the high court to the House of Lords – at a time when her health was deteriorating in order to secure yesterday's document. Its significance is a clear symbol of her victory. But for people in Purdy's situation, it is a limited victory. The policy leaves no doubt as to its limits: "The case of Purdy did not change the law," the document states. "This policy does not in any way 'decriminalise' the offence of encouraging or assisting suicide. Nothing in this policy can be taken to amount to an assurance that a person will be immune from prosecution."

          Nevertheless, critics have already described the policy as a "weakening" of the law, with groups including the disability charity Scope and the Medical Defence Union expressing strong concerns about the fact of its existence, if not the content itself. Their objections reflect public concerns that a strong stance on prosecuting assisted suicide protects vulnerable people who could be pressured into ending their lives by overburdened carers, or compromise medical decisions.

          For those in support of a change in the law, the policy is likely to provoke anger through its use of the phrase "to commit suicide", regarded by some as a linguistic throwback to a time when suicide was, itself, illegal. Similarly the DPP recognises that the term "victim" for those contemplating killing themselves is divisive. "Not everyone may agree that this is an appropriate description but, in the context of the criminal law, it is the most suitable term to use," the policy states.

          Both these perspectives reveal where the real debate lies: with the criminal law itself. An end to the criminal prohibition on assisting suicide is what Purdy and others really want. They argue that just as suicide itself has ceased to be a criminal offence, the time has come to end the criminal prohibition on assisting suicide. But hopes that her case will push parliament into action remain at the mercy of deeply divided opinion among MPs and their constituents. As the DPP pointed out today, that question is not for him.

          Comment


          • #51
            Saimo Chahal:


            February 25, 2010 -- The new policy for prosecutors in respect of cases of encouraging or assisting suicide, published today by the director of public prosecutions (DPP), was issued in response to last year's House of Lords ruling in favour of campaigner Debbie Purdy. The law lords required the DPP "to clarify what his position is as to the factors that he regards as relevant for and against in cases of assisted suicide". The DPP had no option but to comply with the ruling. The consultation provoked an intense public debate, with 4,710 individuals and organisations moved to express their opinions on this deeply emotive subject. The DPP also had to take into account a Commons early day motion signed by 63 MPs calling for the interim policy to be withdrawn on grounds that it overrode the will of parliament, suggested to would-be offenders how to avoid prosecution and put the vulnerable at risk.

            The DPP has now done exactly what we argued on Purdy's behalf was both possible and necessary to give clarity to her and others faced with a desperately difficult dilemma: to what extent should I involve my loved one in an assisted suicide, and will he or she be prosecuted for helping me to implement my choice? The factors against prosecution are now focused on the victim having a voluntary, clear, settled and informed decision to commit suicide. The Suicide Act 1961 itself has been amended to extend culpability to a person who arranges for the suicide of another person, and makes it an offence for a suspect who threatens or puts pressure on the victim. These changes are intended to protect the vulnerable further and to show would-be offenders that they will be prosecuted if they attempt to exploit the vulnerable. The new policy will no doubt have its objectors, but it is difficult to see how it can possibly put people at risk where they were not before.

            However, it is not quite right for the DPP to say that the case of Purdy did not change the law – clearly, it did. Significantly, the requirement that the victim have a terminal illness, a severe, incurable physical disability or severe degenerative physical condition, as a factor weighing against prosecution has been removed – and rightly so. Arguably, the provision implied that the lives of the ill and disabled are less valuable, creating the potential for indirect discrimination against disabled people. The absence of this requirement is clearly consistent with the right of any person to end their life, whether ill, disabled or otherwise. This is also consistent with the DPP's decision in the Daniel James case (the 23-year-old rugby player, who was not terminally or incurably ill); while, for Debbie Purdy personally, as a multiple sclerosis sufferer who is not incurably or terminally ill, it is easy to see that the public interest factors against prosecution are clearly satisfied.

            The DPP is at pains to say that the guidelines do not open the door for euthanasia or so called "mercy killings", which are quite different from assisted suicide and may result in charges of murder or manslaughter. But is this right? One has only to look at the recent cases of Frances Inglis, Kay Gilderdale, and Ray Gosling (not yet charged) to see that, with their compassion for the suffering of a loved one, there is a very fine line between assisting a suicide and being accused of murder – yet it is one that carries devastating consequences and a possible life sentence if found guilty.

            Take also, for example, the situation of a man with locked-in syndrome, who has the mental capacity to make a decision about suicide, and has a clear, settled and informed wish to commit suicide, but is physically unable to do so and needs the assistance of his family to implement that decision. Can it really be right to say that public prosecutors should not take account of public interest factors similar to those published today? Given the new guidelines on assisted suicide, we must ask if the law of murder is too inflexible and whether we should look now at making a distinction with mercy killing.

            Comment


            • #52
              Margaret Jay:


              February 25, 2010 -- I welcome the final decision of the director of public prosecutions, which go some way to clarifying the law on assisted suicide. As the interim version Keir Starmer published last autumn indicated, the new guidelines will allow people who are considering an assisted death to make better-informed decisions about the likely consequences of their actions to their loved ones. While the DPP has made clear that his new guidelines do not alter the existing law, the six factors that could mitigate against a prosecution emphasise that the Crown Prosecution Service observes a clear distinction between an act of compassionate help towards someone who wants to die and those acts that have a malicious or selfish motivation.

              But, however welcome today's guidelines, they will not solve all of the problems that we as a society face around end-of-life decision-making. I disagree with Gordon Brown's comments yesterday – ultimately parliament needs to take responsibility for updating the law. There are two key questions for any proposed legislation: will an assisted dying law with up-front safeguards better protect people against potential abuse, and how should the law deal with those who go beyond assisting, and directly end a loved one's life for compassionate reasons?

              These are not theoretical problems. In the last few weeks we've seen some high-profile cases: Kay Gilderdale, Frances Inglis and Ray Gosling. These are often reported as though they are identical and should be considered in identical ethical and legal terms. But, in fact, the three very difficult human stories reflect the extraordinary complexity of different end-of-life decisions which may all be taken on compassionate grounds but will not necessarily be helped by the DPP's new guidelines. Last month the courts heard the case of Gilderdale. She assisted her chronically ill adult daughter to die by providing her with an overdose of morphine, to inject herself. Due to questions over the extent to which Gilderdale helped her daughter, she was tried for attempted murder as well as assisted suicide, but treated leniently.

              In a different courtroom a week before, Inglis was found guilty of murder, an offence which carries a mandatory life sentence. She had given her severely brain-damaged son an injection of heroin in order to end what she imagined for him would be a "living hell". The key difference between these two cases was the consent of the person who died and the level of assistance given to help the person die, one case was considered help, the other direct action. As a result of these differences Inglis faces a minimum of nine years in prison, whiles Gilderdale was given a 12 month non-custodial sentence.

              Regardless of the factors set out in the DPP's guidance, Inglis would still face life in prison. There is clearly an ethical difference between assisted suicide and involuntary euthanasia and this has to be reflected in sentencing. However, the imposition of a mandatory life sentence for murder can sometimes seem unduly harsh in cases, such as Inglis's. Gosling's case is also considered to be a potential mercy killing as he took the final act to end his lover's life, even though Gosling says his lover asked him to do this. This means that if there is sufficient evidence to charge Gosling he faces a similar fate to that of Inglis. How do we find a way out of this ethical mess?

              In my view, an assisted dying law for those who are terminally ill and mentally competent with up-front safeguards would better protect all people. It would mean considering cases of assisted dying in advance and would highlight any potential abuse before the death. At the moment a post-facto investigation can only discover any evidence of abuse after the person has died. An assisted dying statue would give terminally ill people who are suffering unbearably, and their loved ones, the option of choice and control.

              We also need an urgent review of murder law. In 2006, the law commission recommended separate categories of offence to cover mercy killing, or a partial defence to cover compassionate cases. The new House of Commons should consider this whole area again. Obviously people who break the law should be investigated, but those who do so out of love and compassion should be treated proportionately and in the context of the motivation for the actions they took. The DPP's guidelines address one part of the problem, but now we need to address the bigger picture, which is not the application of the law – it's the law itself. Society has moved on, so should parliament.

              Comment


              • #53

                February 25, 2010 -- The author and euthanasia campaigner Sir Terry Pratchett has welcomed new guidelines on assisted suicide set out by the director of public prosecutions (DPP) today. Pratchett used his Dimbleby lecture this month to call for euthanasia tribunals to give people with incurable diseases the right to medical help to end their lives. He said the new rules were the best possible outcome in the absence of a change in the law. "I am really pleased, I think we're going as far as we can go without legislation," he said. "It's rather more looking into the mind of the person [who is] helping assist the person to commit suicide. I rather like that it's getting away from the 'tick-box' approach the preliminary guidelines seemed to be suggesting."

                The DPP, Keir Starmer QC, said the final advice was not intended to be a tick-box exercise and the policy was now more focused on the motivation of the suspect. Pratchett, who was diagnosed two years ago with a rare form of early onset Alzheimer's disease, said that while he welcomed the guidelines he would continue to campaign for a change in the law and for the introduction of euthanasia tribunals. The author of the bestselling Discworld fantasy novels, and patron of Dignity in Dying, said what he had heard from the DPP strengthened the case for tribunals, which would provide a "safety net" for people who might be coerced into ending their own lives.

                Sarah Wootton, Dignity in Dying's chief executive, called the guidelines a victory for common sense and compassion and a milestone on the way to legalising assisted deaths. But she said the situation remained flawed as assisted suicide was still illegal and, even with the help of the guidelines, people faced stressful investigations. "The law still needs to change and we'll continue to campaign," she said. Lord Carlile QC, chairman of Care Not Killing, said the guidelines greatly reduced the risk of undermining existing law. "Our main concern was that the interim guidelines singled out as a group those who were disabled or ill, thereby affording them less protection than other people under the law," he said. "We are very glad this has been removed."

                Comment


                • #54

                  February 25, 2010 -- The director of public prosecutions, Keir Starmer QC, today rejected calls to create a regime in which assisted suicide is permitted in England and Wales, saying it is an issue for parliament. Publishing guidelines to clarify when an individual might not face prosecution under the 1961 Suicide Act for helping a friend or loved one die, Starmer said he was not decriminalising the offence of encouraging or assisting suicide, which carries a maximum prison sentence of 14 years. "Nothing in this policy could be taken to amount to an assurance that a person will not be prosecuted if he assists the suicide or attempted suicide of another person," the DPP said.

                  The guidelines place closer scrutiny on the motives of the suspect rather than the condition of the victim, such as whether they are terminally ill. They also make clear that to be related to a victim will not be considered a mitigating factor, given that some relatives might be manipulative. Starmer said so-called mercy killings, such as the case of Kay Gilderdale, recently acquitted by a jury of her daughter's attempted murder, were not covered by the guidelines. "The policy does not open the door for euthanasia or so-called mercy killings," he said. "The act of suicide requires the victim to take his or her own life. Euthanasia or mercy killing are where the suspect takes the life of another and they may well be liable to a charge of murder or manslaughter. That distinction is an important one which we all need to understand."

                  The guidelines outline six factors which could mitigate against prosecuting someone who has assisted the suicide of another. These include:

                  The victim reached a clear, voluntary decision to commit suicide.

                  The suspect was wholly motivated by compassion.

                  The suspect reported the suicide to the police and fully assisted inquiries.

                  In all there are 16 factors which will be seen to favour a prosecution, including if the victim is under 18, the suspect stood to gain or was paid. Starmer said the guidelines had been drawn up after the "most extensive snapshot of public opinion" since the drawing up of the 1961 Act. Some 4,800 individuals responded in a six-month consultation exercise. Crucially, the issue of whether a victim had a terminal illness, incurable physical disability or severe degenerative physical condition, will no longer mitigate against prosecution. Starmer said respondents had suggested the inclusion of these factors gave the impression that vulnerable people were less protected by the law. The guidelines now concentrate not on the health of the victim, but on the motivations of the suspect – for example, clear evidence of compassion will mitigate against prosecution. Starmer made clear he was not changing the law, passing the responsibility for any statutory change to parliament.

                  On whether a living will mitigated against prosecution, Starmer said it was not his job to set out a context in which assisted suicide was accepted and legal in society. "Only parliament can set out what processes or procedures might be appropriate in the context of encouraging or assisting suicide that may lead to an automatic decision not to prosecute," he said. "Any requirement for there to be a Living Will or for a doctor to confirm that the victim was terminally ill, another suggestion, is clearly within the scope of processes and procedures that... create a regime for encouraging or assisting suicide. Only parliament can determine the legality of such a regime, not the DPP ... and we have rejected any factor against prosecution that could be said to be a stepping stone towards the creation of such a regime," he said.

                  Starmer had been required to publish the guidelines after the House of Lords judgment in the case of Debbie Purdy, who has multiple sclerosis, who wanted clarification of whether her husband would be prosecuted if he accompanied her to the Swiss clinic Dignitas, which helps the terminally ill to die. Purdy said today she was delighted with the published guidelines. "Because I will know the likely consequences of any decisions I choose to make about my death I won't have to make those decisions early," she said. She still wanted the law to change. "I will continue to campaign for assisted dying to be legal in the UK," she said.

                  Other campaigners said it was time for the government to fulfil its responsibility and address the need to create a compassionate regime around end of life issues. Jayne Spink, the director of policy and research at the MS Society, said: "There is still a long way to go before the palliative and end of life care offered to people with MS is the best it can be. The DPP guidance does not detract from the unfulfilled duty of care from the government." Richard Hawkes, the chief executive of Scope, however, feared the guidelines could frighten disabled people. "We are very concerned about the potential impact of the DPP's new guidelines on assisted suicide," he said. "We know that many disabled people are genuinely frightened about any changes which risk weakening the protection offered by existing law and which could effectively create legislation by the back door."

                  Comment


                  • #55

                    Comment


                    • #56

                      March 5, 2010 -- Thirty-six people have killed themselves in the state of Washington during the first 10 months of its assisted-suicide programme, known as "Death with Dignity". The figures released by the U.S. state's health department [.pdf file - refers to Oregon statistics] give the first official indication of how the controversial law, passed by electoral ballot in 2008, is being applied in practice. Almost 60% of voters backed the law, which came into effect on 5 March 2009, making Washington the second state after Oregon to allow doctor-assisted suicide. Under the law any resident of Washington who is at least 18, is mentally competent and has been diagnosed with a terminal illness that gives them six months or less to live can ask to be given a lethal dose of medication by a doctor. The law was closely modelled on a pioneering law adopted in 1997 by Oregon, where 460 people have so far died under its terms.

                      Washington's first year of assisted suicide has seen 63 people take up prescriptions under the right to die law, of whom 47 actually died — 36 with the help of an overdose, seven through their illness and four through causes unknown. The ages of those who died by overdose of barbiturates ranged from 48 to 95. Sixteen people did not take the prescribed drugs by the cut-off period or have already killed themselves without notification yet coming through. More than half of those who went through with the procedure were men, with women comprising 45%. Overwhelmingly, the participants were suffering from cancer. The main reason given for ending their lives was losing autonomy – a concern raised by all 36 who died.

                      Opponents of the law fear that elderly people might be coerced into killing themselves by relatives who see them as a financial burden. Indeed, a fifth of those who died were worried that they were a burden on family, friends or carers. One participant cited the financial implications of health treatment as a factor, although all who took up assisted-suicide had health insurance. "From the start we have been worried that the law will put vulnerable populations such as elderly people at risk of abuse from relatives pushing them to take up assisted suicide to stop the cost of their care eating into their inheritance," said Eileen Geller of True Compassion Advocates, which opposes the Washington scheme.

                      A group of doctors which also opposes the law, Physicians for Compassionate Care, pointed out that the doctor who prescribed the overdose was present in only three of the 36 cases when the drug was taken. "Without an unbiased, disinterested witness at death there is no way to know if the patient was of sound mind … when the actual ingestion took place, or even if the patient ingested it voluntarily." But Tom Preston, medical director of Compassion and Choices of Washington, a leading backer of the right to die, said that psychological screening was carried out to ensure all patients were capable of making an informed choice.


                      Comment


                      • #57

                        March 19, 2010 -- The son of the conductor Sir Edward Downes will not be charged with assisting his suicide, the director of public prosecutions said today. Keir Starmer said there was sufficient evidence to prosecute Caractacus Downes but it was not in the public interest to do so. Sir Edward, one of Britain's most respected conductors, died with his wife, Lady Joan Downes, at the Dignitas clinic in Switzerland on 10 July last year. The Metropolitan police launched an inquiry when officers were contacted by solicitors acting on behalf of Mr Downes to report their deaths. They found evidence that he had booked a hotel room in Switzerland for his parents and accompanied them overseas. Starmer said these acts would be sufficient to charge him with an offence under the Suicide Act 1961, of assisting suicide. But he said there was further evidence that Downes's parents reached a "voluntary, clear, settled and informed" decision to take their lives.

                        Starmer said that in helping them, Downes was "wholly motivated by compassion". He said: "Although his parents' wills show that Mr Downes stood to gain substantial benefit upon the death of his parents, there is no evidence to indicate that he was motivated by this prospect. Other factors against prosecution are that Mr Downes' actions in booking the hotel room can be characterised as of minor assistance and, after reporting the matter to the police, he fully assisted them in their inquiries into the circumstances of his parents' suicide." Starmer said he took into account new guidelines, which he published in February, making clear that motive should be at the centre of any decision on pressing charges. Prosecutors were also provided with evidence in relation to Downes's sister, Boudicca Downes, but took no further action against her.

                        Sir Edward had a long and distinguished career, including conducting the first performance at the Sydney Opera House. He worked with the BBC Philharmonic and the Royal Opera House in London, and was knighted in 1991. His 74-year-old wife, a choreographer and TV producer, had become his full-time carer. At the time of the couple's death, Caractacus and Boudicca released a statement saying their parents "died peacefully, and under circumstances of their own choosing". The statement continued: "After 54 happy years together, they decided to end their own lives rather than continue to struggle with serious health problems ... They both lived life to the full and considered themselves to be extremely lucky to have lived such rewarding lives, both professionally and personally."

                        This is the first case in which the public interest factors outlined in the new guidelines have been applied. They state that anyone acting with compassion to help end the life of someone who has decided they cannot go on is unlikely to face criminal charges. The document was published after law lords ruled in favour of Debbie Purdy, who has multiple sclerosis. She wanted to know whether her husband would be prosecuted for helping her to end her life. Assisted suicide remains a criminal offence in England and Wales, punishable by up to 14 years in prison. But prosecutors have not pushed forward cases against families and friends of the growing numbers of Britons who have travelled to Dignitas to die. Some people fear that relaxing the law on assisted suicide would lead to an increase in cases, and put people at risk of being pushed into taking their own lives.

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