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Books Video icon An illustration of two cells of a film strip. Video Audio icon An illustration of an audio speaker. Audio Software icon An illustration of a 3. Ignorance is dangerous. It is a basic human right to live and die with dignity. The Peaceful Pill eHandbook is our contribution to ensuring that your passing will be as proud and strong as your living.
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The reasons that lead an elderly person or someone who is seriously ill to seek information about their end-of-life choices are many and varied. All are intensely personal. Rewriting the ways in which society can plan for and experience death and dying is the challenge of our time.
The development of an end of life plan is one small step that all of us can take to protect those we love from the ravages of the law. While most of us will never use our plan, we can all draw comfort in knowing that if things ever become too painful or undignified especially in the context of serious illness and age , we will have a plan in place that will allow us to maintain our dignity and our independence. Introduction The Wonders of Modern Medicine In any discussion of end of life issues the role of modern medicine is paramount.
While no one can be critical of the huge advances in medical science over recent decades - improving beyond measure the length and quality of our lives — there is also a flip side. In contrast to previous generations, we are now far more likely to die of slower, debilitating conditions that are associated with old age and illness.
Yet we are also more likely to be kept alive through an increasingly sophisticated array of medical technologies. A longer life can be a wonderful thing, but should we be forced to live on, if we come to a point where we have simply had enough? Our Ageing Population Acentury ago when life expectancy was approximately 25 years less than it is today, few people had the opportunity to reflect on how they might die. Then people were much more likely to die quickly with little warning.
For example, one hundred years ago infectious disease was common. People considered themselves lucky if they were still alive in their mid 50s.
The widespread introduction of public health measures such as sewerage, water reticulation, good housing, and of course the introduction of modern antibiotics have all played a part in greatly reducing the toll of infectious disease. The Peaceful Pill eHandbook In modern times, those living in the developed west have a life expectancy of 75 to 80 years.
Now in industrialised countries, we will be more likely to experience diseases and disabilities that were rare in earlier times. This is why we see the issue of control in dying as being an increasingly common concern for many elderly people. Although few who attend these workshops have any intention of dying in the near future, most see a need to organise and plan for this inevitable event. Just as many of us plan for other aspects associated with dying eg. And that means information.
While for some people suicide is a tainted concept, for a growing number of older people it is an issue of great interest and discussion. In this context, taking your own life after careful consideration is a way out of a life that an individual might consider is not worth living. Introduction People who come to Exit workshops are well aware of the importance of making that ultimate of decisions, the decision to die.
They are all acutely aware of the need to get it right. In this Chapter, we examine the phenomenon of suicide in the context of the modern life course, and why access to the best in end of life information is so important. Suicide has not always been seen as the act of a sick and depressed person. In ancient Greece, Athenian magistrates kept a supply of poison for anyone who wanted to die.
You just needed official permission. For the Stoics of ancient times, suicide was considered an appropriate response, if the problems of pain, grave illness or physical abnormalities became too great. With the rise of Christianity, however, suicide came to be viewed as a sin a violation of the sixth commandment. It was at this point that penalties were first established for those who attempted suicide. If the suicide was successful, it was the family of the offender who were punished with fines and social disgrace.
The Peaceful Pill eHandbook With the emergence of modern medicine in the 19th Century, the meaning of suicide changed again and it is this understanding that prevails today. Suicide is now generally thought of as the result of mental illness. If a person wants to end their life, then they must be sick a psychiatric illness, with depression the usual diagnosis. Are we seriously postulating that the suicide bombers of the Middle East are depressed? Rather, the act of suicide is better seen as context dependent.
In Oregon, for example, where physician-assisted suicide PAS is legal, one study found symptoms of depression to be present in 20 per cent of patients who request PAS. At Exit, we believe that feelings of sadness as opposed to clinical depression are anormal response to a diagnosis of a serious illness.
To assume that suicide amongst the elderly or people who are seriously ill is, necessarily, the result of depression or other psychiatric illness, is to adopt a biomedical way of seeing the world. And there can be no doubt. People who suffer from clinical depression are clearly at risk of suicide.
Severe depressive states can rob a person of the ability to make rational decisions. These people need care and treatment until they are able to resume control. That said, illness of this severity is not common and needs to be distinguished from a larger group of people within society who may show occasional signs of depression, but who remain in full control of their decision-making abilities.
There is a significant difference between a person having moments of feeling down or having a transitory feeling that their life has lost purpose and the person who has severe clinical depression, where even the most basic daily decisions of life are problematic. This is untrue, but to understand the claim, one needs to look at the background of the medical speciality that is palliative care. Rather, palliative medicine is about symptom control. It is about improving the quality of life of those who are seriously ill and dying.
To date, palliative care has been most successful in the treatment of pain. Indeed, it is often claimed - perhaps exaggeratedly - that palliative care can successfully address pain in 95 per cent of all cases.
Nor does palliative care always guarantee a good death. No where are the shortcomings of palliative care be more obvious than in the tragic death in of 31 year old writer, Angelique Flowers. On 9 May , shortly before her 3 1st birthday, she was diagnosed with Stage 4 colon cancer. Her doctors told her that her days were numbered. They also told her that there was very little they could do to ensure that her death was pain-free and dignified. As history now tells it, this courageous, clever, beautiful young woman died in the most difficult and unpleasant way.
As a young palliative care patient she received the best that modern medicine could provide and that money could buy. What was not so good and what the law prevented medicine from addressing, was her death. She knew that her death could come fast and it was unlikely to be peaceful.
As it happened, Angelique died vomiting up faecal matter after experiencing an acute bowel blockage. This was just as her doctors had warned. Her death was simply awful. Her brother Damian held her in his arms through this awful ordeal. Angelique had been terrified of dying this way. This was why she put out a call on the Internet for Nembutal. However, when the bowel blockage occurred, Angelique was in the hospice. Her Nembutal was at home. She had no chance to take control. Shortly before she died, Angie made a video diary.
See: http. But, like Angelique, they still wish to be in control of their death. They say that while they might not be in pain right now, the quality of their life is seriously affected by their illness. They know that there is often nothing that modern palliative medicine can do about it. Some of these people are so weak that they cannot move unassisted. Others have shortness of breath which makes independent living impossible.
For a significant number of people, it is non-medical issues that have most impact upon the quality of their life. One memorable case concerned a middle aged man called Bob. Bob was suffering from lung cancer. He was incredibly sad that his favourite past time - a round of golf with his mates - was no longer possible. This person was clear. It was his frustration at being house-bound and dependent on visits from friends and family, rather than the physical symptoms of the cancer, that made him choose an elective death.
While palliative care has a valuable contribution to make, this branch of medicine is not a universal panacea. While a life without pain is clearly better than a life with pain, this is not always the most important issue.
The physical symptoms of an illness are often only one of many considerations. These people are not depressed. In , the Crofts sent Exit their suicide note in which they explained why they had decided to go together.
The Crofts did not need to write this note yet they wanted us to understand. And in return they asked for our respect. We have thought clearly of this for a long time and it has taken a long time to get the drugs needed. We are in our late 80s and 90 is on the horizon. At this stage, would it be wrong to expect no deterioration in our health?
More importantly, would our mental state be bright and alert? In we both lost our partners whom we loved very dearly. For two and a half years Marjorie became a recluse with her grief, and Sid became an alcoholic. We would not like to go through that traumatic experience again. Hence we decided we wanted to go together.
We have no children and no one to consider. We have left instructions that we be cremated and that our ashes be mixed together. We feel that way, we will be together forever. Please don t feel sad, or grieve for us. But feel glad in your heart as we do, Sidney and Marjorie Croft The Crofts are the private face of an increasingly common sentiment among older people; that is that a good life should be able to be brought to an end with a good death, when and if a person so chooses.
In , Lisette Nigot also took her own life, consuming lethal drugs she had stockpiled over the years. She said she did not want to turn Lisette Nigot insisted that she had led a good and full life. Intelligent and lucid to the end, Lisette knew her own mind. A fiercely independent woman, it is not surprising that she expected control in her dying, just as she had in her living.
I dont like not being able to do the things I used to be able to do Perhaps my mind will go and I would hate that. And certainly my body will go and I wouldn t be very happy with that either. The Peaceful Pill eHandbook When details of the deaths of the Crofts and Lisette Nigot were made public, many tried to medicalise their situations.
An assortment of diseases and conditions were suggested as reasons for their decisions to end their lives. But the trend continues. He was not sick but he was years old. What he meant by this was that because he was no longer able do the things he loved field work in the Australian bush , he felt his life had run its course. At 91, Laura Henkel was not sick. However, she said that her life was no longer enjoyable. A peaceful death at Pegasos in Basel. Such a decision can occur equally in the context of old age, as in the context of serious illness.
This is why all elderly people should have access to the best end of life information. Conclusion If we all have the right to end their lives peacefully, reliably and with dignity and other than nature intends it , then access to accurate, up-to-date information is critical.
Remember, suicide is legal, yet assisting a suicide is illegal. This is why everyone should develop an end of life plan.
An end of life plan not only provides control and peace of mind but keeps families and loved ones safe from the law. An end of life plan is the responsible thing to do. Generally speaking, no one can help another person to die, no matter their intention. Furthermore, even in places where there is end of life legislation, the person providing the assistance must be a medical doctor. Only in Switzerland can someone other than a physician assist another to die. In Switzerland alone, the determination of illegality depends on the motives of the person who provides the assistance.
There is no other example in modern western law where it is illegal to help someone to do something which is legal. And it is not just a little bit illegal to help someone to die. Again, generally speaking, the State has little tolerance for this type of behaviour. The Peaceful Pill eHandbook This is why any person who chooses to be involved in the death of another - however tangentially and for whatever reason — needs to be very careful.
Voluntary euthanasia is legal in countries such as the Netherlands, Belgium and Luxembourg. Readers can see the confusion that exists. In most countries assisting a suicide carries severe legal penalties. In the US, the penalties for assisted suicide also vary from state to state with assisting a suicide illegal in just over half of all states. This is similar to the Scandinavian countries.
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