This page started up in response to the original television program, in 2004 that got me started somewhat on the path to developing a web site initially.  I continue to use it for additional "slow snail" items that indicate people are still dying by inches as the pro choice battle the pro life when all that should matter is the individual pro decision for themselves.  It should not be a government or even a doctor's right to choose for another person, their capacity to endure pain and suffering.   Those who tell me to view suffering as a "personal growth experience" to be endured and embraced as God's Will need to understand that there are many of us who do not view suffering as anything but unnecessary and even cruel,  at a particular stage of living.   Firstly in order that suffering be endured there should be a purpose to it-  eg a reasonable hope for recovery.  

I put legislative change in Victoria, Australia together with the easy production of the peaceful pill on about a par,  for success....It will eventuate - but not in my lifetime. 

Dying by Inches is the appropriate title for the circumstances many find themselves in.

We must try and influence Government decisions by whatever means will work.   Dying by inches comes at a cost both in terms of pain and loss of quality of life, but eventually the "God Almighty"  Dollar must surely impact on the reality of its costs to the Nation - taking away valuable resources that could be better expended on the young, the fit and those who feel they can leap over the inches and die by the rule of law.  It doesn't matter which country we refer to, the problems associated with maintaining life at any cost for some, is just too expensive to justify.   An innate body lying comatose is not living - it is dying by inches.  As increased taxes continue to bite to pay for more non productive members of society, those who champion pro choice should be heard.  Terminating life is sometimes the best use of limited resources.

Perhaps financial considerations will succeed with Politicians and Law Makers,  where compassion has failed.   The Growth Industry of Health Care has failed to consider the implications for the person most important in the equation - the individual dying by inches. 

                                                        _________________

2006-11-12 From: The Guardian, UK
Some sick babies must be allowed to die, says Church
http://observer.guardian.co.uk/uk_news/story/0,,1945866,00.html?gusrc=rss&feed=1

· Bishop admits right to life for newborns is not absolute
· Nuffield inquiry to publish guidelines on premature births

Amelia Hill and Jo Revill
Sunday November 12, 2006
The Observer

Church of England leaders want doctors to be given the right to withhold treatment from seriously disabled newborn babies in exceptional circumstances. The move is expected to spark massive controversy.

The church leaders' call for some children to be allowed to die - overriding the presumption that life should be preserved at any cost - comes in response to an independent inquiry, which is to be published this week, into the ethics of resuscitating and treating extremely premature babies.

The decision by religious leaders to accept that in some rare cases it may be better to end life than to artificially prolong it is a landmark for the church. The Rt Rev Tom Butler, Bishop of Southwark and vice chair of public affairs of the
Mission and Public Affairs Council, states in the church's submission to the inquiry, that 'it may in some circumstances be right to choose to withhold or withdraw treatment, knowing it will possibly, probably, or even certainly result in death'.

The church's report does not spell out which medical conditions might justify a decision to allow babies to die but they are likely to be those agonising dilemmas such as the one faced by the parents of Charlotte Wyatt, who was born three months prematurely, weighing only 1lb and with severe brain and lung damage.

The report also suggests the enormous cost implications to the NHS of keeping very premature and sick babies alive with invasive medical care and the burden on the parents should also be taken into consideration.

Doctors wanted to switch off Charlotte's life support machine because they said her severe mental and physical handicaps left her in constant pain with an 'intolerable' quality of life. They pointed out that every time she had an infection, staff would have to give injections or set up drips that caused yet more pain.

After the case went through the courts, the child, now three, survived but with severe disabilities. She is now in care as her estranged parents found it too hard to meet her 24-hour healthcare needs.

The church's call comes in their submission to the Nuffield Council on Bioethics, an independent body that publishes guidelines on how doctors should deal with ethical issues. The council set up the inquiry nearly two years ago in order to consider the implications of advances which enable babies to be born halfway through pregnancy and kept alive.

Their statement comes the week after one of Britain's royal medical colleges called for a public discussion over whether to permit the euthanasia of the sickest babies. The proposal from Royal College of Obstetricians and Gynaecologists was welcomed by geneticists and medical ethicists, but described it as social engineering by others.

In its submission, the Church of England said that although it could not accept the argument that the life of any baby was not worth living, there are 'strong proportionate reasons' for 'overriding the presupposition that life should be maintained'. 'There may be occasions where, for a Christian, compassion will override the "rule" that life should inevitably be preserved,' wrote Butler. 'Disproportionate treatment for the sake of prolonging life is an example of this.'

The church states that it would support the withdrawal of treatment only if all reasonable alternatives had been fully considered 'so that the possibly lethal act would only be performed with manifest reluctance'.

But it accepted there were a range of reasons why the final decision to withdraw or refuse treatment should be made, including the question of cost. 'Great caution should be exercised in bringing questions of cost into the equation when considering what treatment might be provided,' wrote Butler. 'The principle of justice inevitably means that the potential cost of treatment itself, the longer term costs of healthcare and education and opportunity cost to the NHS in terms of saving other lives have to be considered.'

Very premature babies run a higher risk of brain damage and disability. If they are born at 22 weeks, 98 per cent of them die, though by 26 weeks the chances of survival has risen to 80 per cent. Different counties have different policies for very tiny infants.

Babies born before 25 weeks are not given medical treatment in the Netherlands and in certain conditions, euthanasia is permitted.

When the Nuffield Council produces its long-awaited report on Thursday, it is expected to reject a Dutch-style limit, with hospitals required to let a baby below a certain age die, arguing that even two infants born at exactly the same age can vary widely. Instead, they are likely to call for much clearer guidelines to doctors about the issues of viability.

Parents of very premature infants will also be asked to start talking to doctors at a much earlier stage about the likely health outcome of their babies, so that they can be prepared for the worst.

The church's submission counsels parents against expecting too much from medics, and asks doctors to refrain from giving parents false hope. 'The principle of humility asks that members of the medical profession restrain themselves from claiming greater powers to heal than they can deliver,' it said.

'It asks that parents restrain themselves from demanding the impossible from the medical profession and indeed from themselves and their own capacity to cope.'

"Choice" suggests opponents to a review of existing guidelines in allowing seriously deformed babies to die are selfish.  The child itself is the victim twice over, once of nature and again with humanity.   We put a dog out of its misery, yet cuddle and canoodle a child - a human being badly deformed should be at least be equal to mankind in compassion by alleviating pain when there is no chance of a worthwhile existence.  Worthwhile, in terms the that which they would chose to live themselves, should bring reality sharply into focus.     

The parents are placed in an intolerable position which frequently results in the breakdown of an otherwise happy marriage.   Invariably the mother is left to cope alone until even she succumbs to the stress of the burden of care provision.   There is a woman I know with two autistic children who succumbs to massive migraine on a weekly basis, another whose then 12 year retarded son was so strong and frightening to her, he was capable of throwing an armchair down a flight of stairs.   Extreme stress as a result of the ongoing grinding responsibility of children who 50 years ago would not have survived nature's nature selection program. 

Religions often provide the problems with their dogma but not the solutions, with daily practice assistance of 24 hour care.

                                                                        ________

2006-10-18 From: USA Today
Debate surrounds end-of-life costs
http://www.usatoday.com/money/industries/health/2006-10-18-end-of-life-costs_x.htm?csp=34

By Julie Appleby,
USA TODAY

If you are dying in Miami, the last six months of your life might well look like this: You'll see doctors, mostly specialists, 46 times; spend more than six days in an intensive care unit and stand a 27% chance of dying in a hospital ICU. The tab for your doctor and hospital care will run just over $23,000.

But spend those last six months in Portland, Ore., and you'll go to the doctor 18 times, half of those visits with your primary care doctor, spend one day in intensive care and stand a 13% chance of dying in an ICU. You'll likely die at home, with the support of a hospice program. Total tab: slightly more than $14,000.

Researchers at the Dartmouth Atlas Project, a program at the Dartmouth Medical School that evaluates variation in medical care, analyzed Medicare data on patients with chronic illnesses to develop those statistics, showing that it costs far more to die in some parts of the country than in others.

While researchers are able to show differences in costs, the real question remains how much of those additional hospitalizations, tests and doctor visits resulted in better care or better quality of life? Finding answers to that question is difficult and controversial, but health policy experts say doing so will become increasingly important as the U.S. seeks ways to slow the rapid rise in health care spending.

"There's a tremendous opportunity for both improving quality and enhancing efficiency in the care of people with very serious illnesses at the end of life," says geriatrician Joanne Lynn, who spent much of her career at think tank RAND studying end-of-life care.

She says substantial progress could be made in slowing rising costs if the U.S. health system could find better ways to reduce hospitalizations for people at the end of life, such as providing more in-home services.

Portland and Miami reflect that tremendous variation among regions. The most expensive city out of 309 hospital referral regions is Manhattan, at a cost of $35,838 for the last six months; the least expensive is Wichita Falls, Texas, at $10,913.

Estimates show that about 27% of Medicare's annual $327 billion budget goes to care for patients in their final year of life.

While that's not altogether surprising given Medicare's demographics ­ most patients are over 65 ­ researchers say it's important to find out if that is money well spent.

While not the major factor driving health care spending, costs involved in sustaining patients in their final days are likely to get a closer look by both Medicare and private insurers as health costs continue to spiral and the population ages.

Why costs vary

Why is it more expensive to die in some areas of the country than others?

The number of doctors and hospital beds is part of it: The more there are, the more care a person gets. Also playing roles: the expectations of patients and the practice patterns of doctors.

Portland has fewer ICU beds and specialists per person than Miami, which is also more multicultural, with a greater variety of views on end-of-life medical care.

But experts on the end-of-life care say one main reason for the vast difference between the two cities may be that in Oregon, doctors, or staff at hospitals and hospices, encourage patients with life-threatening illnesses to talk about the end of life, what kind of medical care they want and where they want to die. The state has a history of such debate: Oregon residents have long supported palliative care, a term usually used to describe medical care for the terminally ill that focuses more on comfort treatments than cures. And, in 1994, voters there became the first in the nation to approve doctor-assisted suicide, a referendum signed into law in 1998.

"We have fewer hospitals and ICU beds than Miami does and, yes, that's a factor. But making a plan and how everyone supports you to have that plan is what makes the difference," says Susan Tolle, a medical doctor and director of the Center for Ethics in Health Care at Oregon Health & Science University.

The ways people die in Portland and Miami illustrate the vast variation in what is done at the end of life in America.

Across the nation, some patients spend much of their final weeks seeing specialists, having tests, trying new drugs. Many die attached to machines, such as ventilators, in hospitals.

For some patients, that's exactly the right care. Doing everything that can be done to save an 18-year-old motorcycle-crash victim makes sense. But what about an 85-year-old with heart failure, diabetes and cancer? Do you continue aggressive chemotherapy?

Then the answers are not so clear-cut.

Complicating matters is that medicine often doesn't know what the most effective treatments are. And doctors are trained to save lives. As a result, some patients may be pushed into more than they want by a medical system that values doing something over doing nothing, even when futile.

"One of the things that frustrates us all is to see care being provided in an absolutely futile situation ... and doctors and hospitals are not accountable but are also being rewarded (financially) for that (futile care)," says John Santa, medical director for the Center for Evidence-Based Policy in Portland.

When not to treat

Not so long ago, Americans were felled by a bad infection or an accident or a sudden illness, such as a heart attack. Advances in medicine mean more of us are living longer, but often with disabilities.

"Many more of us make it to older age, and so there's much more we can do (medically)," says geriatrician Lynn.

But, increasingly, ethicists, economists and patient advocates are questioning whether the spending mentality is best for elderly patients or the long-term financial future of programs such as Medicare.

"We are going to double the number of people who are sick, old and frail in about 15 years," says Lynn. "It would be a good thing to try on some ways of thinking about how to live that well ... and at a cost the community can sustain."

She and others say there's not enough money to give everyone a treatment with a one-in-a-million chance of success. "None of us wants to bankrupt our community on desperate, long-shot treatments," Lynn says. "The question is, how do we build a sustainable health system?"

Those questions about what care to give and when to quit are deeply personal. A USA TODAY/Kaiser/ABC poll of 1,201 Americans taken by telephone in September found the public divided on the answers.

When asked if it is better to keep a terminally ill person alive as long as possible, regardless of the expense, or to make a judgment as to whether it's worth the expense, 48% said it's better to weigh the costs, compared with 40% who said to keep the person alive as long as possible, regardless of the cost.

Among those 65 and older, 60% said expense should be considered, compared with 28% who said cost should not enter the decision. The nationally representative poll has a margin of error of plus or minus 3 percentage points.

Improving quality of care

Still, not everyone agrees that slowing spending at the end of life is a panacea for rapidly rising health costs. Such costs are driven by a host of factors, of which the amount spent in the last six months of life is but a part. "There are so many things that would result in very substantial resources being saved, and (end-of-life care), on my list of things, is not at the top," says Santa.

Things closer to the top of his list include unnecessary back surgeries, hysterectomies and what he calls an over-reliance on some expensive brand-name drugs when generics would work just as well.

But Santa and other proponents of the Oregon model say its importance goes well beyond any cost savings that might result. Rather, they say it's a way to give patients more control over their own medical treatment and is changing a culture of medicine that has been reluctant to discuss dying.

Oregon's program allowing people to register their wishes on the single page Physician Order for Life Sustaining Treatments (POLST) form began in 1995 and is widely accepted in the medical community, although it took time to build.

On the forms, patients can say whether they want cardiopulmonary resuscitation, antibiotics or feeding tubes. Conversely, they can specify that they want full treatment, including breathing machines and feeding tubes. And for how long.

The forms differ from so-called advance directives, which are also called living wills, which name someone to speak on behalf of a patient and state patient wishes. Instead, the forms are doctor's orders, similar to directions written into medical charts, that are recognized and followed by medical personnel from technicians on ambulances to staff at hospitals and nursing homes.

Tolle says most of her patients want to talk about their care and the way they want to die, although the adult children of many are often more reticent.

"It's actually not that difficult to talk to approximately 80% of my patients for the first time about an advance plan," Tolle says. "What is horribly difficult is to talk to their children, who are not ready to talk about Mom and Dad dying."

She says younger people or those without life-threatening illnesses are encouraged to fill out legal documents for an advance directive, mainly to name a person who can make medical decisions for them if they are unable to make them for themselves.

The POLST forms in Oregon, which are printed on bright pink paper and can be transmitted electronically by hospitals and other medical providers, are "for the individual who is in life's last chapter," she says.

Robert Smith, a 79-year-old retired accountant in Portland, says he brought up the subject with his doctor and filled out the form as part of his overall estate planning, which includes a will, a designation of someone to speak for him if he is unable and funeral arrangements.

His form says he wants antibiotic treatment but does not want to be kept alive artificially. "If there's no hope of my continuing to live, I do not want a feeding tube," says Smith, who encourages others to write down their desires and talk with family and friends about them. "It's part of the care you have for your family, that you told them what to do," says Smith.

Tolle says the program's designers did not focus on whether it would save money. "A few individuals might want to spend more and want everything done," says Tolle. "And we would fight for them, too."

                                                                        _____________
 

2006-09-08 From: The Globe and Mail, Toronto, ON, CA Do-it-yourself suicide pill goes on show <http://www.theglobeandmail.com/servlet/story/RTGAM.20060908.weuthanasia/BNStory/National/home>http://www.theglobeandmail.com/servlet/story/RTGAM.20060908.weuthanasia/BNStory/National/home

TENILLE BONOGUORE

Globe and Mail Update

A controversial do-it-yourself suicide pill will go on show in Toronto this weekend in a move expected to highlight deep divisions in the right-to-die debate.

A group of elderly Australians gathered in a rural farmhouse last year to illegally concoct a lethal chemical designed to end their lives.

That process will be outlined by controversial Australian doctor Philip Nitschke this Sunday at the World Conference of Right to Die Societies in Toronto.

Dr. Nitschke said the extreme actions of that group of 20 elderly Australians ­ who pooled their money to buy the drug-making equipment and ingredients, and all took part in its manufacture ­ were likely to split the conference.

“There are those that believe to go down this route will lose public support,” Dr. Nitschke said of the elderly Australians' actions.

“Many of the people organizing this conference are of that opinion, and are nervous of the topic being discussed. But interest is very strong indeed amongst the rank and file of the right to die movement. This is something that has never happened in the right to die movement before.

“I'm really wanting the broader conference gathering to see there are strategies that are as important as the dogged pursuit for legislative change.”

Dr. Nitschke was dubbed “Dr. Death” in 1996 when Australia's Northern Territory Government passed a law permitting voluntary euthanasia.

In the eight months before that law was overruled by the Australian Federal Government, Dr.
Nitschke became the first doctor in the world to publicly assist terminally ill people to die.

Since then, Dr. Nitschke said Australia has regressed to a more conservative position, and this year outlawed any electronic discussion of human euthanasia. The new laws have forced his pro-euthanasia group Exit International to move their website and help-line to New Zealand.

That is indicative of a global move towards censorship and repression of the right-to-die debate, Dr. Nitschke said in a telephone interview during the first day of the conference on Friday.

“In 1996, Australia could be considered a world leader. Now we're leading the world in going backwards,” Dr. Nitschke said. “You can't even talk about one's options. That makes elderly people feel increasingly desperate.”

He blamed the increasing restrictions on euthanasia on “the religious right” and said the Australian trend was being mirrored in the United States and Canada.

But that was likely to change this century, when he said the right to die issue would become one of the world's main debates.

“There'll be many attempts to suppress and bury the issue, but it will continue on,” he said.


                                                                _____________

2006-07-04 From: The Times of London, UK
No doctor for the deathbead
http://www.timesonline.co.uk/article/0,,6-2254601,00.html

By Carol Sarler

YET ANOTHER bunch of doctors, this time at the annual conference of the British Medical Association, has rejected the publicly popular calls for any and all forms of assisted dying. Immediately the decision was widely reported as a serious setback for supporters of euthanasia, as if without the backing of doctors one could not possibly progress, when what really needs to be challenged is why the matter should be any business of doctors in the first place.

We don’t staff abattoirs with vets. We never required hangmen to have a degree in medicine. Diane Pretty, who campaigned all the way to her own remorselessly grisly death from motor neurone disease for a more merciful end, argued only that her husband should have been allowed to speed it. She understood, as common sense dictates, that doctors should be the last people to get involved in a process that is counter-intuitive to them both professionally and personally.

Happily for them, if they would but realise it and take an unaccustomed back seat, they need have no part to play. The decision to die has nothing to do with them; mental competence is and has always been a legal, not a medical issue (think of Whose Life Is It Anyway?); in disputed cases a doctor’s only proper role is as a witness when a court requires one.

Once the decision is ratified as sane, even less should the consequent death be a matter for a doctor ­ for does it not make sense that death be induced by an expert in death rather than by an expert in the preservation of life? All reports of assisted suicide chez Dignitas make mention of the kindly compassion of the woman assistant in the Zurich flat; none mentions her “qualifications” if, indeed, she has any.

Frankly, were I to prefer that my days were done, I would be far happier to think that my release came at the hands of a watertight expert in, say, barbiturate cocktails than one who knows the difference between an ulna and a radius. And if this means that Lord Joffe ­ or whoever has the next shot at it ­ needs to add to a Bill the establishment of a whole new profession giving a whole new meaning to “licensed to kill”, then so be it.

Unappetising? Death tends to be. But better than dragging to a sickbed the services of a sullen, reluctant MD, commandeered and cussing Hippocrates in your fading ear? You pick.


                                                                                    __________________

July 2, 2006 (an article received in an email.  I even know what he is talking about!)

"I am responding to the print dialogue surrounding the proposed assisted suicide legislation in the 6/28 issue. There was the not unusual arguments we have come to recognize as forms of "slippery slope" claims. However, the canard that caught my eye was, "Opponents also said that sometimes dying people learn valuable lessons about life and love and care, lessons they would have missed if they had hastened their end." What lessons exactly? And what would they do with all that hard-to-come-by wisdom?
Would it act as an opiate, maybe? When I was in seminary (in another lifetime 45 years ago), I tried to find out where all the myths about suffering came from. There is the standard myth that the suffering of followers is joined to the suffering of Christ as he died on the Cross.
Thus, suffering is holy and the sufferer almost deified. Along with this, the sufferer is said to obtain wisdom through pain. This myth is centuries old, I believe, and myth is the right word. There is no scriptural basis I could find. The myth, or fragments of it, keep creeping into the folklore about suffering, dying people. It makes no sense, when it is challenged, but it persists anyway. This idea is in contrast to the experience of volunteers who witness dying people delivering themselves from their suffering. Planned dying is likely to lift desperation and assemble loved ones to support the dying person and even celebrate that life. Of course something like this may happen, also, when there is no planned date of death. The person who chooses to end his suffering early is more in charge of his mind and dignity and is actively preparing to die. The person who plans his/her death, is more emotionally ready for it and can leave in a peace not induced by drugs. Suffering people, who plan their own deaths, are more able to focus on their past lives and make peace with themselves because they are freed from the terrible dread of what is to come. There IS wisdom in a planned, peaceful, dignified end rather than a drawn-out, suffering end to a life. So, there, you persistent, ugly myth! "
--Wye Hale-Rowe, Aurora, Colorado US

                                                                                            _______________________

This article was sent to me by a contributor today June 8th 2006, and as in 2001,  absolutely nothing has changed in how and why people do commit suicide.  Why are Conferences held when the lessons taught by the experienced voice of the professional, are not learned by those less qualified to understand the brutality of living regardless of taking the cost into consideration!  Who has listened to Dr Rodney Syme?  Certainly not Mr Steve Bracks, the Victorian Labor Premier - what will it take for someone to listen to a man who spoke on behalf of thousands in 2001 and continues to do so in 2006.  Some of us living in Victoria want Choice about our own end of life decisions.  Not any one else's life - just our own!

A CONSIDERATION OF RATIONAL SUICIDE

Presented by Dr Rodney Syme at the 8th National Conference of Suicide Prevention Australia – “Suicide Prevention 2001: A Human Odyssey” on 9 April, 2001

Let me say at the outset that I have no argument with the general view that the prevention of suicide is an admirable aim. However I would argue that it is not an absolute, because in some circumstances it is a rational act and should not be interfered with.
The general perception of suicide is of an irrational act, carried out or attempted during a period of extreme emotional and psychological distress due to circumstances which are overwhelming at the time, but with care and time may recede and disappear, allowing the resumption of normal life. There are also those with specific psychotic diagnoses who require intensive and ongoing psychiatric care because of ongoing risk. Shame, guilt and fear may lead to depression which if not recognized and counseled may lead to a suicide attempt. In most of these situations, there are circumstances which can be changed and a new view of life emerge. Looking back, the attempt will be seen as irrational, as a cry for help.

There are other situations where the circumstances which lead a person to consider ending their life cannot be altered; in fact, those circumstances are predictably going to get even worse with time. During such a person’s life she will have made many decision’s not to do certain things because the consequences of doing them would cause them great distress, either physical, emotional, psychological or existential. Such decisions would be considered rational if they are made after careful thought and considering all the facts (even if another person of sound mind would have made a different decision). If such profoundly distressing and unalterable circumstances exist, the decision to avoid those circumstances by ending one’s life (if no acceptable alternative exists) may be a rational one.
There a number of circumstances where such a decision might be considered which may be broadly categorized as follows:

1. The terminally ill with a relatively short time frame to a predictable or actual physical disaster

2. The hopelessly ill (for example profound stroke or multiple sclerosis) with no hope of recovery and the prospect of a prolonged period of distress

3. The dislocated elderly, threatened with or actually displaced to a nursing home

4. The early dementee who views the inevitable decline into full-blown dementia as the greatest disaster which could befall him

5. The chronic psychotic whose disease has resisted all attempts at cure or adequate long-term control and whose mental anguish is greater than most of us can imagine.

Apart from the physical suffering which may be involved, these situations all have common themes of loss of control of one’s life, total dependence, loss of dignity, loss of cognition and loss of personality. These are all powerful reasons for some people to consider that under these circumstances their life has little or no value. Moreover, not only is their life a burden to themselves, but they perceive that they are a burden to their family. Many parents who have dedicated their lives to the welfare of their children cannot accept that they will be a physical, emotional or financial burden to those children, and despite those children being willing to shoulder that burden, that perception cannot be annulled.

I would like to give you three brief true clinical pictures to illustrate these categories.

Firstly a 79 year old man with cerebral metastases from malignant melanoma who has become hemiplegic and is dependent in palliative care. A proud, independent and active man, he decides that a slow decline in a state of total dependence over a few months is
anathema, and refuses all food and fluid and with the help of sedation dies in 3 days.

Secondly, a talented artist afflicted with slowly progressive multiple sclerosis finds the remaining function in her right hand arm and hand is declining so that she will be unable to paint, and she will be faced with total dependence for some years. She requests help to
end her life, and a psychiatrist found that “the only symptom related to depression from which she suffers is a wish “for it all to be over”, and in the circumstances of her progressive disablement, with no hope of recovery, I regard that as an appropriate emotion.”

 Thirdly, an 80 year old woman, widowed and living alone in her own home and tending her own garden, has failing eyesight and is threatened with placement in a nursing home. As her health is otherwise good, this condition could last for years. Having a personal knowledge of conditions in nursing homes she is appalled at this prospect and requests assistance in suicide.

Each of these three suicidal ideations is to me perfectly rational. They are all based on notions of unalterable physical, emotional and existential suffering.

With regard to terminal illness, Palliative Care Australia, in its position statement on Euthanasia, states that “while pain and other symptoms can be helped, complete relief of suffering is not always possible, even with optimal care”, and “some people rationally
and consistently request deliberate ending of life”. Shah et al reported in The Lancet in 1998 the result of a large survey of senior members of the Royal College of Psychiatrists and found that 86% believed that suicide may be rational (in relation to the question of
voluntary euthanasia). They said “Widespread agreement that so-called rational suicide exists is interesting since most suicides are said to occur in the context of mental illness”.

It is self-evident that not every request for assistance in suicide by a person with a potentially terminal illness is rational, and the possibility of treatable depression affecting the request must be very seriously considered. However, anyone who is suffering from
an irreversible illness, and is to die within six months or less is in denial if they do not show some features of depressed mood. Hopelessness is not depression, and is not a mental illness; it is facing reality!

Webster’s Dictionary defines suicide as a “person who deliberately takes his own life”.

Such acts carry a great stigma in our society, and this is applied to rational suicide, a concept which has little understanding in the community. The Committee of Enquiry of the Victorian Parliament which recommended statute protection of the right to refuse
treatment even if this should cause or hasten death was at pains to argue that this did not constitute suicide or involve assisted suicide. In the case of the man I described earlier with malignant melanoma, he clearly wanted to end his life and ceased drinking, aided by
sedation, in order to do so. When I reported this case to the Victorian Coroner, he found that this was not suicide! In Oregon, where assisted suicide is legal, the assisting doctor is advised not to put suicide on the death certificate but rather the underlying disease
which led to the request for suicide. The reasons for this are obvious and natural – to avoid the stigma of suicide as a cause of death. The Victorian Coroner said that such cases were not reportable deaths, in clear conflict with the wording of the Coroner’s Act.
This stigma creates a conflict between the proper use of language and the comfort of society. We face an ongoing hypocrisy and dishonesty in relation to rational suicide by failing to recognize its reality, or we do so and redefine suicide and our laws relating to it.
I believe we need to either recognize rational suicide, or develop a new term to describe it. Given that such suicides are rational, is it not also rational to allow such patients the benefit of discussion of their dilemma without patronization, and unwanted attempts at
psychiatric treatment. If their desire is rational must we deny them a rational means to accomplish their desire; the alternative is for them in desperation to use the common methods employed by the elderly such as hanging, shooting, gassing, drowning, cutting, jumping, or to be forced to suffer that which most dread without relief. If their desire is rational, how should medical practitioners deal with a request for assistance in achieving that rational suicide in a humane manner? They can ignore it, or patronize it, or try to change it (which they should do if they have any doubt that the request is rational), or they can assist by veiled means (terminal sedation) or directly by a prescription of appropriate medication, coupled with counseling and ongoing support, trying to ensure that such action is never taken before it is absolutely necessary.

A further issue is how to deal with an attempted suicide which may be rational in the light of the associated circumstances. Should the doctor intervene to prevent the suicide, or merely ensure its completion whilst palliating any adverse effects. This may be an
extremely difficulty situation, but in my view, doctors should hasten slowly and seek information and advice before intervening if there is clear evidence of a terminal or hopeless illness associated with the attempt. If there is a clear advance directive in these
circumstances requesting no treatment except palliation, the doctor would be in ethical and legal difficulty if he intervenes.
The extreme grief associated with a suicide which is physically traumatic and not discussed, even if rational, stands in sharp contrast with a rational suicide which has been discussed with the family who have an opportunity to say goodbye and which occurs in a
peaceful manner.

Statistics on suicide are seriously distorted by a failure to recognize rational suicide. The Australian Bureau of Statistics in 1996 found 672 cases of suicide by people 75 years and older in the 5 year period 1990-1994. It is extremely likely that many of these would have been associated with hopeless or terminal illness. Personal experience tells me that there are also many rational suicides which are not recorded as suicide, the doctor who has rendered assistance recording another cause of death for obvious reasons.
In conclusion, rational suicide is a reality which needs to be given more thought by the medical profession and our lawmakers. Its recognition and careful treatment will go a long way to replacing some horrid deaths with some characterized by choice, dignity and
humanity.

Presented by Dr Rodney Syme at the 8th National Conference of Suicide Prevention Australia –

“Suicide Prevention 2001: A Human Odyssey” on 9 April, 2001

                                                                                                    _____________________

This page was originally dedicated to one of the first articles I felt hit a nerve creating a pro possible scenario for choice and dignity in dying, the original article has slipped to the bottom of the page as others take its place.   We are still "dying by inches" in the thousands - but our slowed down due to advanced technology "dying by inches", nevertheless,  is creating an industry in itself which is blooming - The Health Care System itself, creates its own workforce for those whose interests it is to keep people breathing regardless of the costs in terms of pain and loss of purpose in living . 

To the Health Care Industry,  we are a unit of work...the production line. the customer who can't escape out the door.

Governments will only change the law with the assistance of the Churches and the Australian Medical Association, neither of which wants to lose their customers.   The patient suffering the pain or lying vegetative, unable to feel anything is not their genuine concern.  Keeping up the numbers is what it is all about.   It is Politics, and like politics it is just "a game" but for those people under their "care", it is their inability to care for themselves that leaves them at the mercy of those who exploit their dying.    Eventually Governments will understand that the economy cannot continue to maintain an unproductive terminally and chronic ill society which is unable to contribute to the tax coffers but continually drains it without any return whatsoever.  Many I refer to cannot even speak a coherent sentence, are drugged to the eye balls and have no idea where or what their surroundings are.   Not mentally ill people, "just" people dying by inches.

I am chilled by the thought that some nurses are actually challenging a doctor's orders for prescribing morphine sufficient to keep the patient comfortable.   The nurse herself has made a decision about what constitutes "comfortable"  by a patient who is dying by inches.   One nurse, I spoke to was quite proud of herself that Doctors were becoming more circumspect in their dosage allocations to ensure the patient lived on.   I was afraid to ask which hospital she worked at in case I might end up in her care.  Another admitted that although she had taken it upon herself to limit the pain killer for weeks to one dying cancer man - his moans of distress eventually got to her and she concurred with the doctor's directions.   I do hope, selfishly that there are more compassionate nurses for the needs of many people I've spoken to.

No one but myself can assess my tolerance for pain.   Many of us are already dying by inches of the illness itself without the necessity of a health care work allowing it to continue just that little bit longer in case medication causes death.   WE ARE ALREADY DYING, THAT'S WHY WE'RE UNDER YOUR CARE, UNFORTUNATELY.

In answer to a question  "Do you want to die?", I answered the obvious "No, of course not - but we don't have a choice.  We will all die - it is how we die that I lobby for!"..... and I loved those responses that said "I will think about it".  Good - I hope they have time to "think about it" before the decision is taken out of their hands by circumstances beyond their control. 

I work hard now because I know there will come a time when "dying by inches" is a very real possibility for any and all of us.
 

A fried wrote me this observation, (by email) which is food for thought and reinforces my views that the patient's care is sometimes the least important consideration.  I wished she'd written it under "Your Say" elsewhere on the website.

Mary

I have been pondering on what effect " Tuesdays With Morrie" had on the audiences.

It certainly brought tears. But what was the main message? Not ending the suffering, but keeping the person alive at all costs. I know the author had his own journey to unravel, but it showed the medical profession etc, doing
everything to keep the person alive. At different stages in your own life you hone into "your" needs.

The illness has to have a NAME, THEN WE CAN CALL FOR MONEY FOR RESEARCH. I had two letters yesterday, one for stroke, and one for diabetes.

What about my friend 15 years in a nursing home from a stroke, and my cousin, unable to talk, move, feed herself, from Motor Neurones Disease. The wife of a friend ( he died last year) who has been 31years in a home with MS, these are the brave people.!! People who opt for VE are the cowards!!.
Solution, place them in care, and get on with your own life and let nature take it's course.....

Is this why Mademoiselle hit the raw nerve. Do you remember the series Andrew Denton did on the teenagers with cancer, and later he interviewed some REMAINING participants. Teenage death from cancer is accepted, but teenage suicide is a no no, and gets media coverage. Even murder and mayhem is acceptable media food, but the idea of a place to go to have a peaceful exit as in "Solent Green" was also a no no. Fear is the operative word,

Just some thought ..going to bed now JR

 
Dying by Inches Response (based on the original TV program)

Channel 9, Sunday Program, July 18, 2004

- A personal response: 
ENCOURAGING LEGISLATIVE CHANGE IN THE CHOICE FOR DYING WITH DIGNITY

The general public, require a program of public awareness and information regarding death, and its natural place in society, in the context of the aged, terminally ill patients, and those of us when the quality of life is such, there is no point in continuing treatment.

The most important person is the subject of the medical treatment.