This week’s reflection will be short and sweet as I spent alot of time on my original blog post arguing both sides. I will therefore reflect of what I’ve learned and concluded from my fellow participants’ blog posts on this sensitive and controversial subject of assisted-dying.
I really identified with other participants, who felt uncomfortable and unsure about their opinions on assisted-dying. I had to challenge my own opinions and really try and see both sides of the argument for/against assisted-dying. Wendy said that “we should just to stick to the clear moral path that Killing is Wrong and we should always strive to save lives and to enhance the quality of life”. On the other hand, Jackie concluded that “because we will never truly understand and empathize with somebody who legitimately requests for assisted suicide, the bottom line is that assisted suicide is “necessary” and it should be allowed for severe and extreme cases but it must never be abused by patient or physician”. I don’t think that there will ever be a consensus on this topic, just as abortion has been legalised, although the majority believes this still to be wrong. I completely agreed with Kim’s opinion that we should respect and support the decisions of our patients without judgement.
What I have realised in life, is that when you are in a certain phase of your life, it is impossible to imagine how you would react or feel about a certain topic at another time in your life, when you are experiencing something you’ve never experienced and are faced with difficult decisions you’ve never had to consider. As I discussed in my original Week 5 blog post, I cannot make hard and fast decisions and form opinions about something I have never faced as currently my life has a different meaning than what it would if I have children, or if I have a terminal illness. I also cannot judge another human being for wanting to end his/her suffering. Who are we to judge? As discussed in my original blog post, the story of the South African Professor who assisted his mother to end her life and fulfill her last human right, made me think that, given the situation and how it impacts your life, I would do that for my mother. Seeing someone suffer and in constant physical or emotional pain, breaks your heart. I agree with Jarryd comparing human assisted-dying with euthanasia of our pets. We as humans choose to end the life by euthanasia of a beloved pet who is suffering when medical intervention will not be effective in curing or reducing the pain and disability. But as human beings, with all the Human Rights, we have no say about when and how we choose to die and that we should just suffer and keep fighting. Sometimes it’s braver to let go and be at peace with your life and to say that you have had enough. I will only know when I get there. Lisa also mentioned that perhaps assisted-dying can be understood and regulated under the law without having such dire consequences.
Theo made a very valid point: “What is worse… Letting that person suffer or offer to end their suffering so they can have peace?”. She continues saying that as health care professionals, many believe that we should promote and value human life… Cecil also touched on this but took it further by saying that our ability to make our own choices and take responsibility for our decisions is part of the human gift of autonomy and we should exercise this right in life, and death.
I still believe, “my life, my choice” and everyone deserves a dignified death.
“A belief in assisted-dying is by no means a fringe view in western society.
There is broad agreement, associated with notions of modernity and evolved thinking,
that assisted-dying is an appropriate action to take in certain cases and should be allowed by law” Bruce Falconer
Discussing this concept of assisted-dying, which is a choice at the end of the day, with anyone can be difficult and challenging, not just because of differences in religious/spiritual beliefs, moral values, legislation and medical-ethical considerations, but for the multiplicity of terms used to describe it. Terms I think are relevant to this discussion are active and passive, voluntary and involuntary assisted-dying and physician-assisted-dying. Many other terms such as suicide and euthanasia (active/passive, voluntary/involuntary, by omission/action) and are also used but carries social stigma and negative religious connotations.
This week’s theme of assisted-dying and end-of-life decision-making, has been difficult for me as a physiotherapist and a Buddhist, trying to see both sides of the coin… The individual right to life and to be treated with dignity and respect versus the bigger picture of the society and the impact of such legislation. Buddhists are not unanimous in their view of physician-assisted dying, and the teachings of the Buddhadharma don’t explicitly deal with it. In Buddhism, the way life ends has a profound impact on the way the new life will begin. So a person’s state of mind at the time of death is important – their thoughts should be selfless and enlightened, free of anger, hate or fear. This suggests that suicide, albeit assisted or not, is only “approved” for people who have achieved enlightenment and are at peace with themselves and the life they had.
Personally I do not believe in artificial means of prolonging life. I believe in the “do not resuscitate” order, also known as the “No Code”, which may be seen as a passive assisted-dying by some. Dying does not scare me as it’s part of life, the natural progression of life, or if your life is cut short, it’s part of the path you had to or need to walk. Perhaps my perspective will change once I have children. Then the thought of leaving them behind will make me reconsider. But at this stage in my life, I believe that your time is your time and letting nature takes it’s course after you’ve exhausted all your options in medicinal and therapeutic terms. But science has made it possible to cure disease, recover from disability, reduce perceived pain and suffering and improve quality of life, so I do believe that you should make use of what is available. Therefore I am not pro assisted-dying for myself, but I am not against it for others.
The potential negative consequences or effects after resuscitation and prolonging life artificially is a reality, so too are the life saving chances. I have seen this with some of the kids I have treated. One is a little boy who was brain dead after a car accident and his parents instructed the doctors to save him and keep him on life support as long as possible. They had to resuscitate him 3 times and after 5 months of living on machines, he only recovered enough to sustain breathing through a trachi (tracheotomy), with a “Glasgow Coma Scale” of 3 (Eye 1 (no reaction or movement), Verbal 1 (no expression, sound, attempt), Motor 2 (reacts to painful stimuli)), which hasn’t improved or deteriorated in the last 2 years. But he needs 24h care, therapy and constant medical attention and intervention. Is this a life worth having or living, or is it selfishness to have forced life despite the package it comes in?
Then there’s the question of physician-assisted-dying. This really hit home in 2012, when Sean Davison, a physician, professor and head of the Forensic DNA Analysis Lab at The University of Western Cape in South African, returned home after five months’ house arrest in New Zealand for helping his terminally ill mother die. He was found guilty of the lesser charge of counselling and procuring the suicide of his mother, by giving her, as requested and consented, a lethal dose of morphine after she tried to starve herself to death. He has formed a non-profit organisation, Dignity SA and hopes to educate people and champion a law change in South Africa.
I agree with the slogan of Dignitas, “To live with dignity, to die with dignity” and that this is the last human right, or it should be. But unfortunately the mastermind behind the Dignitas organisation (an international centre for assisted-dying), Ludwig Minelli (a self-described humanitarian and lawyer), who might have had the best intentions to start with, has become something of a side show and with his toxic reputation, has resorted to shocking the public and forcing his opinions on others. Under Switzerland’s permissive and unique legal environment, assisted-dying has developed into suicide-tourism.
The problem we have is that every human being has the right to life and a quality life at that, but quality is subjective and each person has their own perspective on what living a quality, full life means. Two people with terminal cancer will not consider assisted-dying the same, they will not consider medical management and intervention the same… but is their suffering the same, as pain, stress, discomfort and fear are all perceived emotions, reactions and sensory processing which varies from person to person? So why does one person choose to fight to the end, whilst another lets nature takes it course? And what about people who are choosing to “give up” or end the suffering and requires assistance? Should they have the choice? Tony Nicklinson who suffers from Locked-in Syndrome has been fighting against the legal system for “Death with Dignity” laws. These laws allow a terminally ill patient to hasten an inevitable, insufferable and unavoidable death. It’s not suicide or euthanasia; rather, a possible option if the physical or emotional pain from the underlying illness gets to be too much or quality of life too degraded. If one is of the opinion to agree with legal active and passive assisted-dying for compos mentis, suffering, living, human beings, what would be the criteria? Should this be a right to all suffering human beings, a choice of how they want to live and die? But what about a person who has lost the will to live? Should they have this right or is this only for people who have exhausted all medical or health/healing interventions and therapies in trying to recover, reduce or manage the pain and disability? And then, is emotional and physical pain the same? Are we to say that such people are weak? Are we to say that everyone should endure?
If we think about it, compared to abortion, it makes the moral question a bit more simple. In South African it is legal to have an abortion, even from the age of 13, as shocking as it may be for some. Medically speaking in terms of anatomy and physiology, the embryo as a blastocyst has living cells after implantation on day 8-10 and then the embryo develops into a fetus at 8 weeks gestation when heart cells start beating. Furthermore, from 10-13 weeks gestation, the fetus’s nervous system sensitizes and develops integration of pain/noxious stimuli which cannot be termed a mere reflex. The fetus also bears all human traits at this stage including the basic/core structure of cardiac-circulatory and nervous system cells, which are reactive. But abortion is legal up to and including at 13 weeks gestation. Thus it can be seen as involuntary assisted-dying of the unborn fetus (although the mom is the active participant and decision maker). Others might call this murder. Just because the baby is inside the womb, once it has a heart beat, it is considered alive, a living human being. So what makes a born living human being’s life more important or special than a unborn human being’s life? Thus scientifically speaking within morality and ethics, the answer to involuntary and passive assisted dying is quite straight forward, it’s wrong. I believe that voluntary assisted-dying is a choice as you alone are responsible for your own life, and the choices you make.
“The healthy man does not torture others – generally it is the tortured who turn into torturers” Carl Jung
I completely agreed with Emma, Amie and Tamaryn’s posts on Torture, concluding that torture in an unacceptable practice and in violation of Human Rights.
Tony discussed the implications and use of torture by physiotherapists, a side of this topic that I didn’t even think of when I wrote my original post. What about when a physiotherapist is causing unintentional pain and discomfort to an uncooprative bedridden patient with Alzheimers and Dementia with contractures and bedsores. Let’s say this patient is not “compos mentis” and their family (right of attorney and legal guardian) have agreed to therapy as prescribed by her physician. Now this patient is refusing any touch or movement…. If you stretch or mobilise her and it hurts, or she communicates that are you causing her pain just by touching her skin and she is refusing to do any movements or exercises, is this torture? If you move her and she screams, and you continue with the stretches, although you know this pain perception is abnormal due to her cognitive state, are you torturing this patient? This really made me think as most physiotherapists have been in this position. I don’t believe that this is torture as we are not deliberately trying to cause pain to obtain something from her or to teach her a lesson or just because we are sadistic and want her to suffer. We are trying to help her as a health care professional with the medical knowledge to know what physical and emotional reactions are appropriate or normal in terms of anatomical and physiological functioning. As physiotherapists we know that the discomfort felt from stiffness with light stretches or mobilising exercises or supported positional changes (without forcing into end range etc), is more “soreness”, not painful as perceived. Especially if this patient reacts with abnormal perceived pain with any touch (such as being washed, dressed, hair combed, teeth brushed etc). We are not doing any harm, but improving functional ability and preventing further damage or secondary complications through our treatment. Thus I believe in this instance we are not torturing the patient. This patient might view being washed by the nursing staff as torture, but those sound of mind know what is being done is esssential care and not harmful. If a “compos mentis” patient refuses your treatment and you go against their will and force treatment on them, or hurt them on purpose by forcing stretches beyond subjective comfort or refusing to help them when they are in pain or discomfort, that is another story. Marna also discussed this area of potential torture in patient care in her blog post.
Torture can also be seen as intentionally delaying essential care or providing minimal or refusing assistance or intervention causing a patient to remain in pain and suffer. This is also against to Hippocratic oath and the HPCSA National Health Act and Health Professions Act, to do no harm. This is what happened in the Steve Biko case I discussed in my original post. Kim also discussed this and I found the words from one of the offending medical practitioners in this case, very central to this topic of allowing or assisting with torture due to the political or social context; “a medical practitioner’s first responsibility is the well-being of his patient, and that a medical practitioner cannot subordinate his patient’s interest to extraneous considerations.” Tucker 1991
Still, torture is being used behind closed doors by police and military forces.
This is a 2013 video of the torture and violence inflicted on innocent human beings in South Africa:
What about the saying “an eye for an eye” or that a criminal such as a murderer or child rapist deserves to be violated or tortured and stripped of his Human Rights? Well, in recent weeks, Carte Blanche ran a story of men that were accused of being child rapists only to be released after 3 months in prison where they were subjected to violence and were told that they “deserve to be tortured, violated in prison and suffer a painful death” by many in the community. As there were no circumstantial evidence and forensics linking them to this, they were released and the actual guilty child rapist was identified by DNA analysis and charged. Do you even know how many innocent people go to prison for crimes they didn’t commit? This happened with another man who was “framed” by the police for allegedly killing his girlfriend, but only after spending time in prison and going through the process of appeal did the legal system prevail and found that evidence was fabricated and that he could not be linked to this murder. The court also found that the police maliciously pursued this young man and knowing that he was innocent, they tried to ruin his life. So taking Human Rights away from prisoners or saying that they deserve to be violated or tortured, can never be the right answer.
I will end off with the words by Ghandi as quoted by Jackie and Jamie-Lee:
“The argument cannot be that we should not torture because it does not work.
The argument must be that we should not torture because it is wrong.” Jason Michelich
Next month will mark the 36th anniversary of the death and case resolution of anti-apartheid activist Steve Biko, who in 1977 died of head injuries sustained during interrogation/torture while in South African Security Police custody, with identified gross inadequacies in the medical management. In addition, since 2008, Xenophobia hit South Africa like a disease, and it’s still relevant. Many black South Africans living in the townships felt that the massive, uncontrolled influx of “illegal immigrants” or “asylum seekers” were taking the job opportunities from the “native black South Africans”, which has led to acts of Xenophobia (including discrimination, violence and torture) in a community already suffering from social crises and poverty. The concern needs to be on the protection of the human rights of all human beings, including foreign nationals. Another relevant issue of torture and human rights violation occurred in the South African “Marikana” massacre in 2012, with 44 deaths and 76 injured South Africans. Police brutality (lethal use of force) reared its ugly head again, but this time it was not the white Apartheid Police Force firing upon black South Africans, it was the “new South African” Police Force, firing on their own people, supposedly in self-defense and crowd control. The South African president commissioned an inquiry to investigate matters of public, national and international concern arising out of the tragic incidents at the Lonmin Mine in Marikana. Should the police have acted so brutally and opened fire on all the strikers or just those that were attacking them, those that “initiated” the attack? What about those human beings, the “strikers”, who were shot in the back as they were running away and those that were “gunned down” and even tortured before death?
There has also been much talk and controversy surrounding the 2013 released blockbuster “Zero Dark Thirty” as it depicts the use of military and intelligence interrogation and torture-practices in the “fight against terror”. Torture, carried out or sanctioned by individuals, groups and states throughout history from ancient times to modern day, is the act of deliberately inflicting intense physical pain, combined with emotional/psychological stress and deprivation of basic care and needs, to a person who is unable to protect himself. The reasons for torture include interrogation, punishment, revenge, political or the sadistic gratification. Many support the anti-torture argument on the fact that torture is hugely unreliable means of obtaining information, that often turns out to be redundant or misleading. Others argue that the “well-being and protection of defenseless human beings and for the greater good of the country” it is more important than the issue of violating Human Rights of a terrorist or criminal/prisoner of war. Pro-torture individuals or groups often state that “brutalization brings breakthroughs”, and that torture is at times necessary or required to gain valuable intelligence/insight/information to stop future attacks/violence and to bring criminals/terrorists to justice. For me, more importantly, and from a Human Rights point of view, torture is morally and ethically wrong.
We all know that terrorist activity violates various Human Rights, including the right to life; rights to non-discrimination, including equal rights for women and girls; right to a fair trial; freedom of religion and belief; freedom of expression and information; the right to vote and participate in public affairs etc. Therefore, measures against terrorism can have an important role in protecting human rights but counter-terrorism laws can also have a profound impact in limiting fundamental human rights and freedoms, including the right to a fair trial; the right not to be subjected to arbitrary detention; freedom from torture and cruel, inhuman or degrading treatment or punishment; the right to freedom of expression; the right to freedom of movement; the right to privacy; the right to non-discrimination and the right to an effective remedy for a breach of human rights.
So the question is, should a terrorist “loose” his rights as a human being? What about a criminal who took the life of an innocent human being or child? Should he/she still have rights? I believe we should respect the rule of law and the principle of upholding fundamental rights and freedoms, for all, even when we personally feel that a person (terrorist or criminal) is not deserving of any rights as a human being.
Chantelle van den Berg 