Assisted Suicide OR Mercy Killing - Like for Like - Socrates

"Assisted Suicide" is topical at the moment. It is also being called "Mercy Killing".

In law case precedent is supposed to be processed on a LIKE FOR LIKE premis. This means that the "ratio decidendi", ie the reasoning of the judge which discovers the point of law is supposed to be similar in every case thereafter, ie it sets the standard of what the law "ought" to be. "Obiter dicta" is persuasive argument to be followed should the law require to progress in a direction beyond a historical case precedent which is being followed for its significant ratio as a point of law.

Law does go out of date, society does progress, sometimes there is a gap in the law or lacuna as it is called which requires to be "discovered" but not created. The legislature create law, the judges discover it (they have the benefit of evidence and pleading bundles to assist truth and the common good). Law is uniformly applicable to all. Ignorance of the law is no excuse, but the Judges are facilitated with an ability to be subjective, ie act in their discretion via the doctrine of equity, one example of which is "in the interests of justice", which can be used where there is foul play by the othersides solicitors which is certain, ie removal of discovery evidence from agreed court bundles is an example - the judge is supposed to provide equality before the law to all parties.

The greatest suicide in law anyway, was Socrates. He was put on trial and eventually killed himself by drinking "hemlock".

Which brings me to the Assisted Suicide and/or Mercy Killing issues currently being played out before us, the public.

I can understand well the issue of assisted suicide, especially the need for dignity. I also read Terry Pratchett's article in the Mail yesterday* which was of some interest, but also threw up some questioning in myself. I also read Dr Sentamu's article** and was particularly heartened to read that any questionnaire of a broad range of the public should really be done by disabled people, as they know the issues that affect their lives daily and somehow they cope - would they kill themselves willingly?

Concerning Terry Pratchett's article (TP) his diagnosis comes within the mental health sector and he well knows that anything to do with mental health medicine has side effects. You should read the medication side effects list, it beggars belief that the medication prescribed is designed to assist you. You have heard the terms "chemical cosh". It is also very easy to appear to be ill when prescribed mental health medicine. I therefore urge caution in relation to any assisted suicide bill permitting mental health consultants to determine death issues. Many people do actually die in mental health hospitals, possibly as a result of side effects affecting underlying diagnosis - you can be invisible in a system too. How many people focus on the statisticss in relation to mental health hospitals and deaths, or which medication is given for the prognosis/diagnosis and who the consultant is prescribing and his death statistics? It is dangerous to therefore create a legislated pathway to death.

TP raised a very significant issue - quality of life. We are an ageing population in the UK, there is likely to be an increase in particular prognosis but not the facilities to go with it, unless significant breakthrough is made in prognosis. The money is going to have to be allocated more towards the mental health sector to ensure facilities due to the ageing population. Therefore, the issue is not quality of life - this can be manufactured by providing funding or not, providing training or not to nursing staff and others. The issue is "opportunity of quality of life": listening to your favorite music - TP refers to his favorite "Thomas Tallis" - how many elderly people do you see with MP3 players on wards! Ward radio system! Or more importantly, personal "notebooks" and "Skype" keeping in contact with family and friends - if this is not available if I go to older people's services, I will be most annoyed!! Currently in Edinburgh there has been a move (when I was Chair of the Patients' Council) to remove the age 65 cut-off between acute and older people services: just because age 65 is the official retirement age concerning employability, it should be mutually exclusive all other services! The issue is that there is currently a better service available on the NHS in acute than older people services and no one is going to notice if you have a cut-off impact, or very few - you are already invisible in mental health services.

Therefore, Dr Sentamu has got a very very real and serious point - that it should be disabled people who make the decisions in relation to Assisted Suicide in our current society.

The Daily Mail yesterday also have a further interesting article *** of which two paragraphs were of note:

"... In yesterday's report the MPs made a wide-ranging attack on Government counter-terrorism strategy, saying complacent civil servants could be putting the public at risk by settling for second best..."

... Some of these leading the national counter-terror effort are paralysed by a dangerous institutional inertia, the committee said ..."

This is an important issue, counter-terrorism is irrelevant for current purposes of this blog post, but words such as "complacent", "second best" and "institutional inertia" in our Government also exist in other areas of professionalism. TP's article presumes the best, not necessarily the average or the worst. Trust in authority should be done by degree only. Trust only yourself 100%.

Concerning legislation, other areas need to be considered in an Assisted Suicide bill. Joining up legislation included, such as the Disability Discrimination Act 2005 and the Human Rights Act 1998.

Issues to include are :

- LIVING WILLS and don't resuscitate clauses
- ORGAN DONATION and a tick in the box does the deed via your Boots Advantage card
- HUMAN GUINEA PIGS for medical trials
- CLONING - the Ewan McGregor and Scarlett Johannsen film "The Island" is futuristic, but how many movies become reality over time.
- STEM CELL RESEARCH and Superman - therapeutic science is in its infancy
- ETHICS AND JURISPRUDENCE - there is no jurisprudence in Scotland in mental health, and lawyers are not accredited so far as I am aware in mental health law, even although it is covered by the legal aid fund which accredits family lawyers and defence lawyers - the legal aid umbrella should have a minimal accredition scheme to include human rights and jurisprudence and ethics in mental health law.
- CODIFICATION OF EXISTING LAWS in relation to medicine and the NHS
- DATA PROTECTION - the NHS in Scotland is still paper based in mental health, bolt on databases are not procured, and Data Protection only facilitates a statement of accuracy to go on your medical record, not deletion of erroneous information : it is completely easy to falsify or fabricate mental health records - psychiatrists are not expert in everything but they do not reach out to expert fields external mental health. Admission, Care Plans and Discharge should all be working from the same version and this is better facilitated electronically with pick lists for key diagnosis and the avoidance of unreadable long-hand or code forms etc in simplified databases which would also assist statistical gathering and "unmet needs", ie the opportunity for the quality of life.
- PROFESSIONAL COMPLICITY, COLLUSION AND RUBBER STAMPING - it is easy for professionals to be complicit especially where you are deemed somewhat odd, a misfit, eccentric, obsessive etc.
- STATISTICS FOR MENTAL HEALTH IN SCOTLAND IS (1 IN 4) - this should make you think with clarity in relation to Assisted Suicide.
- TECHNOLOGY and MRI scans
- APPLICANCE OF SCIENCE - your prognosis will determine your medication diagnosis - there are usually more than one drug type in any diagnosis. Whether you get the right one first time is up to your Consultant. But you will be proferred medication to medicate the side effects over trying another drug which might assist. You can be a zombie quite easily in a mental health system assisting your appearance of being ill unnecessarily. People you don't know also fill in the forms, yet you are deemed "vulnerable" - the power of suggestion and the ability to influence for subjective reason is powerful but there is little check on the procedure. You can also be processed subjectively by family and friends with no objective check on their subjectivity.
-GENETICS and the ability to "know" a diagnosis prior to its event. Genetic genealogy is an area where genes can be identified through history and people do appear to have a right to this information and to participate in safe and protective investigation together with just society. This is likely to impact on insurance law.

Where I consider there is some merit is that Dignitas in Switzerland does exist. They surely capture statistical information - diagnosis, religious background, male / female / child / youth. If it is the case they do, then perhaps we should look there before coming up with our own option - caution is necessary in this area, which as I have shown above is largely "new" law and potentially wider on legal issues than is being promulgated at the moment under mental health legislation. Switzerland could assist drafting too wide to narrow on prognosis with evaluation and monitoring of impact and outcome on those who make the decision with further legislation to follow if needed. Specific prohibitions or permissions could tie in the Human Rights Act and the Disability Discrimination Act, and delimit to specific diagnosis in the first enacted Act, if legislation over case precedent is deemed the way forward. It is right to have the debate in any event - we are in the 21st Century and law must progress society to make it safe and just. Concerning Dr Sentamu's article - the natural law is facilitated via the reasoning of a judge only. Legislation is a political slice of time which ages, hence we still have statutes going back to the 16th Century. Case law which is ancient can be brought up to date by a new case = progress to what the law "ought" to be by discovery NOT creation in law. Dr Sentanu's understanding of natural law is in relation to religion.

An area which I consider needs repeal is the Mental Capacity Acts. If Stephen Hawkins can communicate with his considerable disabilities, so also can any human being. With the ability to make people appear more ill then they may actually be via mental health medication the virtue of "patience" over "capacity" should be the judicial issue - go to any disabled conference and you will get a judicial eye opener at peoples abilities in relation to communication : there is a governmental body the Office for Disability Issues - all judges and legal professionals could usefully attend a conference as part of their training. All people can communicate to some degree. I would therefore like to see "reasonable adjustment" as particularised in the Disability Discrimination Act concerning employability extended to mental health and disability or it could be added to the Human Rights Act under right to life and also liberty: there should be no such thing as incapacity in the 21st Century with government policy requiring social inclusion.

The publicity of assisted suicide is perhaps of note. Care has to be taken when writing about issues in relation to the mental health sector by journalists - the ability for libel, defamation, slander, misrepresentation, mistake, malicious falsehood all of which is high risk and costly. But that does not also follow that issues should not be made public especially where there are public interest issues when a person has a mental health diagnosis - people are not supposed to be invisible. Government policy also requires that people are socially included, assisted by anti-poverty issues, and equality and diversity issues, financially included, but the stigma of mental health is a very serious one.

Lastly, back to Socrates. He took hemlock. I rather thought that if my opportunity for quality of life was so poor, I would order a rather nice bouquet from a florist, and eat it. I do a bit of gardening, and have a 4 page list of poisonous plants with the symptoms and the words "can be fatal" at the end of each plant description.

Hemlock (Conium maculatum) : poisonous part - whole plant. Symptoms to look for : vomiting, diarrhoea, mental confusion, convulsions, coma and respiratory failure. CAN BE FATAL

I noted Monkshood (Aconitum napellus) : poisonous part - whole plant, especially the seeds, leaves and root. Symptoms to look for: immediate burning and tingling in the mouth, fingers and toes, numbness, vomiting, diarrhoea, convulsions and breathing becomes very difficult. NOTE: the poison acts very fast. CAN BE FATAL

Bluebell (Endymion) : poisonous part - bulb. Symptoms to look for: Gastric pain, diarrhoea and blood in urine.

(Choosing the plants would be the interesting part, you would not want to get it wrong. I could have them sent via a living will.

Bear in mind dehydration at above 20% will cause death, and also it is possible to be put to sleep and not awaken through hypnosis - I am not a botanist or medically trained so check these).

What I don't get is why all the fuss about assisted suicide/mercy killing legislation and its need thereof in today's society with trips to Switzerland occurring over local library and local florist or garden centre. I do get the need to look at "death" in the widest sense in the 21st century to capture ethics, jurisprudence and scientific research to protect, provide safe and just society and balance issues in relation to the mental health sector via legislation. Also, I would prefer to see people receiving permission to do assisted suicide or a mercy killing before a court, ie before the fact, rather than after the fact. In an ageing population this issue is likely to increase, therefore getting it right now may be pertinent to include narrowing the opening of legal floodgates!

Given the Greeks have the trial of Socrates embedded in philosophy and history, it is possible to turn to Europe as the trial of Socrates could provide the ancient case precedent for the progress of this area and the Greeks may have historical data or documentation in that regard. However, beware the "spirit" in relation to philosophy, mind and body. In times of cruelty, sustained negativity and harshness, the spirit is raised - sixth sense. Some call it "animism" and there are different forms "hylozoism" being one of them

Hylozoism (click here)

NB: Psychiatrists potentially may claim this to be psychotic perhaps, others may call it "Hex" or "witchcraft" or something else. But it could also be shown as a sign of life and cognition.

However, I have pondered some more on this one and my thoughts should be deemed speculative below:

There is a saying in law which may assist clarity. A lot of people hide behind the words "it's your opinion". In law "OPINION" can be held to be objective where it is based on fact as it has legal effect. Subjective when it does not and is premised on emotional colouring, ie bias, prejudice, emotion.

As such "Assisted Suicide" as a term of art would require professional objectivity, whereas "Mercy Killing" would not necessarily do so as it involves someone particularly close to the person who is suffering. What society appears to be doing at the moment is focusing the judiciary and law to make the decision - which where a judge is "reasoning" in case precedent sets a 21st century stance, which can only be overborne by a further case or by the legislature.

I want to focus somemore on Dr Sentamu's statement concerning Christianity and natural law in religion. Jesus Christ's message was "LOVE". And his concept of love was not physical in relation to sex. That is why people who are in love say: they "KNOW".

Therefore, turning this to the current situation in relation to "mercy killings", there are several factors:

Unconditional love as a child receives from a parent or guardian
The love between partners, usually signified by marriage
The love for close relations and friends in the absence of family

Concerning marriage, there is deemed to be a "union of the souls" and this is usually premised on love where religious based, especially certain Christian doctrines. Taking this as an exempler, to include longevity as a factor in older couples, I would argue, or at least speculate, that it is appropriate for a person to assist death in their other half where that person is significantly suffering and has no opportunity for a quality of life. The issue would be dignity which should be assured as a person's other half is also suffering - there is not just one involved but two or more. A person should die in peace and any suffering should cease in both. Love should be involved in a mercy killing and the act, should imply care and trust. The act should be deemed "good" as cause and effect in law as there would be balance and harmony in law - the right thing to do. There should be no act of killing by the state - in law safeguards are available, if it were otherwise than a mercy killing people could step forward with testimony, such as friends, relatives, colleagues, community to cause a sufficient check enabling safe and just society (there is therefore a need for a judge and law intervention on this topic). There is a difference from a negative state of mind and a positive one - there should be an absence of disruption. In Scotland we have a concept in contract law "consusus ad idem" meaning a meeting of the minds - people who are couples by marriage or co-habiting are "in union" as they are seen to be by society in general. As are legal guardians. The burden of keeping someone alive where the mind and body has failed is a tough call, and we all have our time even with the "spirit" seen as separate the mind and body - assisting someone is not taking away from Time, it should be seen as their Time. There is no reason to presume that a consenting couple cannot reach that decision together where there is an inability in another. Mutuality, reciprocity, respect will all exist in both because the souls are united. There should be no penalty Christian or lawful, where the other half of a union has to make a decision concerning the other's life and death. With technology it is now possible to show to a judge a person's life, and the extent of their suffering and quality of life and opportunity for a quality of life (which can also be safeguarded by a judge) and its impact on the closest person and others who may also be elderly and have health issues - the burden can be too great. If the issue is "out of love" then I cannot see that there is an issue.

*Daily Mail 02/01/10 article by Sir Terry Pratchett - "When the time comes I'll sit on my lawn, brandy in hand and Thomas Tallis on my iPod. And then I'll shake hands with Death"
**Daily Mail 02/01/10 article by Steve Doughty and Fay Schlesinger - "Archibishop condemns the push for mercy killings"
* **Daily Mail 02/01/10 article by James Slack, Home Affairs Editor - "Taxpayers £8m legal bill for terror suspect control orders".