Eleanor Roosevelt, 1958

'Where, after all, do universal human rights begin? In small places, close to home -- so close and so small that they cannot be seen on any map of the world. Yet they are the world of the individual person... Unless these rights have meaning there, they have little meaning anywhere. Without concerted citizen action to uphold them close to home, we shall look in vain for progress in the larger world.' Eleanor Roosevelt, 1958

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Sunday, 2 February 2014

Does the public oppose 'euthanasia', or a loss of autonomy in end of life care?

ComRes has recently published a poll commissioned by the anti-euthanasia organisation Alert, ostensibly about the Mental Capacity Act 2005, but in fact about a very specific category of end of life decisions, concerning the withdrawal of hydration.  The survey asked two related questions:
Q1. Under the Mental Capacity Act, doctors can allow people who cannot communicate for themselves to die of dehydration, if they think that it is in the patient's “best interests” and if they believe their death to be approaching soon. Would you  support or oppose a change in the law to prevent this from happening... If the patient has asked to be given water if necessary through a tube in advance of them losing their ability to communicate?
They found that 58% of people supported a change in the law, that only 17% opposed it and 25% of people responded 'don't know'.  The percentage of people supporting a change in the law increased with age.  This headline finding was reported in Christian Today as 'Euthanasia by dehydration lacks public support'.

But ComRes asked another question about withdrawing hydration, which had rather different results:
Q2 Under the Mental Capacity Act, doctors can allow people who cannot communicate for themselves to die of dehydration, if they think that it is in the patient's “best interests” and if they believe their death to be approaching soon. Would you  support or oppose a change in the law to prevent this from happening... If there had been no mention about whether water should be provided or not, in advance of them losing their ability to communicate?

In response to this question, the number of people supporting a change to the law which permits the withdrawal of hydration from a person approaching the end of their life fell by almost half, to 33%.  The number of people opposing a change in the law rose to 28%, and the number of people who responded that they didn't know increased to 39% (the largest category).

The crucial difference between the two polls is whether decisions around the withdrawal of hydration respect a person's previously expressed wishes.  In the first poll, there was public opposition to the withdrawal of hydration where a person has specifically said that they would want to be given water in these circumstances, but this opposition to the withdrawal of hydration dramatically decreased where a person's wishes were unknown.

So did ComRes find opposition to euthanasia in their poll?  It looks, to me, like what the poll actually found was public support for an approach to end of life decisions which was founded on a person's previously expressed views, rather than 'objective' best interests.  People can make 'advance decisions' refusing treatment for future loss of capacity - and many people do make advance decisions refusing life sustaining treatment.  But there is a long line of legal authorities - from Lesley Burke through to David James' cases - finding that people cannot request to be given particular treatments.  And whilst their past expressed preference for treatment is one factor that would be taken into consideration, it could still be trumped by other 'objective' factors in a best interests decision.  I'm not sure that ComRes did find opposition to euthanasia per se, so much as opposition to a state of affairs where a person's past expressed wish to be tube fed water in end of life care can be overridden.

3 comments:

  1. There is a difference between 'euthanasia' and the removal of feeding when someone loses the ability to swallow and it is not considered practical to insert a tube. When a young person becomes unable to swallow (or becomes prone to choking when they try) it is the norm to intubate, and to progress to a PEG tube when tube-feeding becomes the norm. With an elderly person, or someone in the advanced stages of a terminal illness, thought to be near the end of life, they do not do that. This is the usual course of action, regardless of the patient's normal mental capacity. A couple of weeks ago, that happened to my 90-year-old Grandad, who had congestive heart failure and pneumonia; he was unable to drink anything from the Sunday and was kept sedated from then until he died on the Friday. Euthanasia is the administration of a sedative that would kill the person when they would not otherwise have died at that time.

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    1. Hi Matt, I think you're referring to the difference between 'active' and 'passive' euthanasia. Passive euthanasia means a decision not to provide a treatment, or undertake a course of action, which would prolong a person's life. Active euthanasia is taking action which hastens death. Then there's the 'doctrine of the double effect', where a treatment intending to palliate symptoms has the secondary effect of hastening death.

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  2. Just read the article and found it very informative and gained a lot of knowledge about "End-of-Life care issue".

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