View Full Version : Moral dilemma: Helping others with suicide

Jun 16th, 2005, 07:05 PM

In my country there have been a lot of debates about euthanasia and helping people with suicide. One of elements in this discussion is the work of a foundation called the Einder (horizon in dutch). This foundation was established in 1995 to guide people with a serious death wish. It currently employs 15 counselors. The counselors try to offer guidance to people and give them practical advice about making the right choices and how to actually commit suicide. Learning about this foundation my first reaction was one of horror. How could anyone actually tell someone what medication to take or how to best suffocate yourself? I would think a counselor would try and help someone finding a solution to his or her problems, so he or she can go on. But after reading some information I got to thinking. What about people who are so set on committing suicide that they will do it no matter what? People that are not to be saved anymore. They tend to go for more violent ways of suicide that end up hurting even more people like jumping in front of a train. What if there was someone to counsel those people with a veritable death wish, so that things will be not causing more pain than necessary. But that still leaves many questions. How does a counselor verify whether there is really no other alternative or if the patient truly has a death wish. I can't seem to make up my mind on the question if the work of this foundation should be tolerated or not. I would appreciate the input of others in solving this dilemma. What do you guys think?

Helen Lawson
Jun 16th, 2005, 07:15 PM
Unless they're terminally ill, I'm not for it. Put those resources into counseling. Also, if a person intent on suicide has the wherewithall to go to a place like this to assist them, then they can probably do it themselves without assistance correctly and without endangering the public, so the center is a total waste. I mean, that weirdo who parked his truck on the train tracks in L.A. a couple of months ago, I don't see someone that disturbed actually going to a center like the one you're describing. He's too messed up to think that straight. But suicide is not my area of expertise, so what do I know?

Jun 16th, 2005, 07:27 PM
there was a case in the UK a while ago about this elderly couple. the wife was seriously ill and was in a tremendous amount of pain and discomfort and she felt her life was not worth continuing...feeling that she had led a happy life there was nothing more she could do. no medication was helping her and it was a painful process of a slow death. her and her husband had discussed euthenasia and sought the advice of the police...will the husband be arrested for murder if they went ahead with it....they were told yes. i cant for the life of me remember if they went somewhere else to do it as it was a while ago. but another couple who were both ill went to switzerland to die here is link to it http://news.bbc.co.uk/2/hi/uk_news/2952123.stm

i personally am undecided on the issue in some cases i can the benefits....like the trri schiavo case in america. if it is medically proven that this person will live in a vegitated state for the rest of there lives and not be able to live it as they would choose then i agree with it....but its proving this that is a problem. i think familly members alwys have a hope that a miracle will happen and things will be fine but its not the case once u have serious brain damage thats it. personally wouldnt want to live in a situation like that where i will be on a machine for the rest of my life but at the same time if it was someone i loved i couldnt let them die. its a win lose situation and its a subject that will go on for many years to come. check out www.euthanasia.com (http://www.euthanasia.com) for more info and interesting articals

Jun 16th, 2005, 07:34 PM
Problem is that most of the people this foundation helps do not suffer from medical conditions like Terri Schiavo or something. In the Netherlands euthanasia would be possible in that type of case mostly. They tend to deal with people with psychological problems, which makes the debate even harder, because it's difficult to tell whether people will actually be able to get better.

Jun 16th, 2005, 07:55 PM
if it psyhcological then this is not the answer....there are other ways to deal with it that death. i honestly dont know what to say....if they are intent on dieing then they can throw themselves of of a bridge or take an OD....u dont need help with that. the help they need is to understand why they want to do this to themselves and find the routes of teh problem

Dana Marcy
Jun 16th, 2005, 10:41 PM
James, the service that De Einder provides isn't any different from a clinic that performs abortions. The doctors who perform abortions are there because there's a demand just as the De Einder counselors are there because there's a demand.

In reading the attached article, Rob Jonquière (a Dutch doctor) gives a vivid example of helping a woman take her own life. She is a 52 year-old nurse whose own health had deteriorated but being proud of her profession, she thought it wasn't acceptable for others to see her ailing. I can see why there's outrage but the doctor below describes the very involved communciation that he had with the nurse. James, you would know better but I take it that De Ender has the same 'beside manner' as Dr. Jonquière. I would think the De Einder counselors would be because it is a very "extreme" (drastic) service that they are providing.

How can the counselors validate their service? I think they can do it effectively by stipulating to those that disagree with their chosen occupation that they work very closely with their clients and that there is a checklist of things that must be confirmed before they assist in the suicide. The checklist would include (according to Dutch law, as it says below):

-Suffering must be continuous and unbearable
-Patient has to be of sound mind
-Doctor must get second opinion
-Lethal drug can only be given by doctor - family cannot help

These are precautions that personally would put me at ease. The couselors aren't in a rush to take your life but they are helping elicit answers out of the paitent that the patient might be too reluctant to say to their family members.

For example, James, if you have a sick relative who doesn't want to see his or her family suffer emotionally nor does he or she want their illness to be financially taxing to their family, a De Einder counselor would serve as a good facilitator. He or she would be able to convey to the family the wishes of the patient. In some cases, when pressed, I'm sure some family members would admit with some hesitation the toll the sick relative was taking on the family as well as the financial burden. I know that sounds heartless but I firmly believe that there are people who love their families so much, they would get assistance to take their lives to take away the entire burden from their family. It's not a farfetched example and it illustrates the kind of situations and challenges that the De Einder counselors face on a regular basis.

What it's like to help someone die

Here Rob Jonquière, a retired Dutch doctor, reflects in our weekly Real Time series on a patient who asked him to end her life.

I have twice helped patients to die. This was at the beginning of the 1980s, so it was still very punishable. Like many doctors, I reported the cause of death to the authorities as 'natural'.

Both were patients with terminal cancer. Pain was a factor, but maybe even more importantly for one, she was a nurse who was used to looking after people. She thought it unacceptable for her to be completely dependent on others.

She was 52 when she died. In earlier days, she had had Hodgkin's disease which was cured, and then she developed breast cancer which was cured, and after that she had ovarian cancer.

When the doctor told her he could not cure her this time, she raised the issue of assisted suicide with me. I had been her family doctor for many years; I had accompanied her on her way through all these medical problems, so she knew me very well and that's why she dared to talk to me about it.

Long and considered process

We had spoken about her condition many times. If you talk about that - and neither of us was shy to give death its name - you talk about the fact that the end is near.

Law in the Netherlands

Suffering must be continuous and unbearable
Patient has to be of sound mind
Doctor must get second opinion
Lethal drug can only be given by doctor - family cannot help
Law takes effect 1 January

For months, we talked about what to do. Eventually she described the situation in which she wanted to have euthanasia.

At first she said her limit was the moment she could not get out of bed, could not get herself to the toilet. Once that moment arrived, she said, 'Now I'm here, I want to wait a little longer'. I think she realised that others could care for her, and that it meant something to them to do so.

She set new limits, and again she shifted, maybe three or four times in all.

Her last limit was quite symbolic. She saw some snowdrops coming out in the garden outside her window, and said, 'Once more, I want to have a bunch of those flowers at my bedside.'

She told me then that because she knew I would help her if it was too bad in the end, it had made it possible for her to shift her limits, to live a little longer. The fear of unbearable suffering was worse than the suffering itself.

The time comes

The morning after those snowdrops were by her bed, I got a phone call from her partner to say that she wanted euthanasia. I hesitated, a bit frightened that I had to do it at last, and said that I would be there once I'd seen my other patients.

" She told me that because she knew I would help her, it had made it possible to live a little longer "

Five minutes later, her minister phoned and said, 'Bev says now - if she says now, it's now.'

We gathered around her bedside - her partner, the reverend and I - to talk and say goodbye. She knew what was going to happen, and again she told me that this was what she wanted.

I administered first a large dose of sleeping pills and she drifted into a deep sleep. After five minutes, I gave her a muscle relaxant which lames the breathing apparatus and the heart - this is the way we do it still. Her breathing stopped, her heart stopped and she died quietly a few minutes later.

My reaction was a complex one - a sadness at losing a friend, but also a feeling of content. I had been able to give her the last thing she wanted, which was help to die peacefully.

It was an utterly criminal act then. But I did not feel that I had committed a crime - I had done something good for somebody.

Dr Rob Jonquière is the director of the main pro-euthanasia lobby in the Netherlands, the Dutch Voluntary Euthanasia Society.

Jun 16th, 2005, 10:51 PM
Well, I can speak from personal experience on this one. A few years ago, during a particularly bad period of my life, I decided to commit suicide. As I usually do when I make plans to do something new, I spent some time researching different methods on the internet. I found it surprisingly hard to come across reliable information on this subject, however there was this one website with a wealth of information such as statistics, success rates, techniques, and the pros and cons of every form of suicide imaginable. Now, while this information may be shocking to many people, it was invaluable to me in preparing my own departure from this world (I chose asphyxiation by hanging, one of the most successful, practical and idiot-proof methods out there).

Now, as you can tell from reading this, I did not go ahead with the suicide; instead I chickened out, sorted out my life, and realised what an idiot I would have been to kill myself. (You may wonder how I can write so frankly about such a huge issue; it surprises me too but now that I am no longer suicidal I am quite happy to discuss it.)

Anyway, the point is that without that information, I could very well have done something stupid. I might have jumped off a bridge and broken my legs, jumped in front of a train and broken everything, or slit my wrists without getting into a bath of warm water first to keep them bleeding. I might have tried hanging, but done it badly and ended up with permanent brain damage, a vegetable. The information made the issue black and white for me. No grey area in the middle where you don't know what will happen - only two sides of a coin, life and death. I think that clarity could even have been what saved me in the end - the knowledge that if I did it, it would be The End, no turning back.

Many people may say that suicide is a bad thing and must be prevented whenever possible, but I think there is a justifiable place for the Einder organisation. It can help suicidal people to decide for themselves whether they really want to go ahead with it or not (for some methods, the low % of success and the gruesome details can be an effective deterrent), and for those who do go ahead with it, it improves the chances of an easy death and reduces the number of cases in which people get seriously injured (which can be even more traumatic than the victim's original situation). You have to face it, if someone is really determined to kill themselves, they are not going to be stopped, so they might as well be helped.

I guess this post was more about able-bodied suicide cases than euthanasia, but I'm in favour of "assisted suicide" too, as I don't see any point in keeping humans alive if they are in a lot of pain or basically just vegetables plugged into machines (if I were in that situation I'd be begging them to pull the plug on me).

Dana Marcy
Jun 16th, 2005, 11:02 PM
Anyway, the point is that without that information, I could very well have done something stupid. I might have jumped off a bridge and broken my legs, jumped in front of a train and broken everything, or slit my wrists without getting into a bath of warm water first to keep them bleeding. I might have tried hanging, but done it badly and ended up with permanent brain damage, a vegetable. The information made the issue black and white for me. No grey area in the middle where you don't know what will happen - only two sides of a coin, life and death. I think that clarity could even have been what saved me in the end - the knowledge that if I did it, it would be The End, no turning back.

Thanks for sharing such personal info! The point that stands out to me from your post (that wasn't mentioned already) is that SOMETIMES people choose suicide methods that can inadvertently injure or even kill other people e.g. jumping in front of a train (could potentially harm others if passengers were on board), jumping off a bridge (a mishap could occur during the attempt injuring/killing others). As you said, idiot-methods are the safest and it's great that the information is available.

Jun 17th, 2005, 04:24 PM
:hug: for controlfreak.

im really gald you got through your problems....i too had 'issues' but was never suicidal, i took my problems out in different ways and i am over most of them but still have ocasions where i feel like crap, but compared to other people my problems are trivial.

this is a realy interesting thread james.

Jun 17th, 2005, 08:12 PM
I think there's a big difference between physical and mental issues that lead to a desire for suicide.

People suffering from depression that ask for help to commit suicide need counselling, they can almost always recover.

As for people who are terminally ill or just bed-ridden and have no hope of recovering, I am very pro-euthanasia. Forcing someone who is in horrible pain to continue living is just cruel in my opinion. Euthanasia is done out of compassion, not malice. Right now my grandmother has suffered from major strokes and is bed ridden. She wants to continue to live, so I'm not faced with this issue. But, if she told me that she wanted to die and wanted my help to do it, I would probably help. My only holdup would be that it is illegal in my state.

Helen Lawson
Jun 17th, 2005, 08:13 PM
If I have to hear ONE more thing about Terri Shiavo, I might need to go to one of these clinics. A dame can only take so much!

Jun 18th, 2005, 11:02 AM
Here's my preliminary take on this highly charged issue. First, start with the subject whose life is at stake. Does he/she consent to his own death? If the subject wants to live, killing him/her is murder -- that's easy enough. But the mere fact that someone wants to be killed doesn't necessarily excuse his killer. I believe that, under most circumstances, suicide is a terrible wrong. In those cases, fulfilling someone's suicidal wishes should be a criminal act -- possibly considered less heinous than garden-variety murder, but maybe not. There can be no justification for killing a person who is suicidal with teenage angst, or with treatable depression, or with shame and guilt because of a personal scandal or business failure.

There are situations, however, when suicide seems to me to be a morally acceptable choice -- namely, when someone is suffering a terminal illness and enduring excruciating pain. In those situations, if a person clearly indicates that he/she wants to die, I tend to think it should be permissible for a friend or a doctor to assist that person's death.

The Tracy Latimer case raises a particularly tough question: Can killing ever be justified when the subject is incompetent to give consent? Here are the basic facts of the case (http://www.cbc.ca/news/indepth/background/latimer_robert.html): Robert Latimer, a farmer working a spread in Saskatchewan northwest of Saskatoon, murdered his 12-year-old daughter Tracy on October 24, 1993. There has never been any doubt about this.

Latimer told police he did it. He said he loved his daughter and could not bear to watch her suffer from a severe form of cerebral palsy. So he placed her in the cab of his Chevy pickup, ran a hose from the exhaust to the cab, climbed into the box of the truck, sat on a tire and watched her die.

Tracy was a 40-pound quadriplegic, a 12-year-old who functioned at the level of a three-month-old. She had been repeatedly operated on and at the time of her murder was due for more surgery, this time to remove a thigh bone. She could not walk, talk or feed herself, though she responded to affection and occasionally smiled. Tracy was in constant, excruciating pain yet, for reasons not entirely clear, could not be treated with a pain-killer stronger than Tylenol.

On November 4, 1993, Latimer was charged with first-degree murder. A year later, he was convicted of second-degree murder…. Over seven years later, January 18th 2001, the Supreme Court of Canada eventually upheld his conviction and life sentence.

What an awful case. I don't know how I would have voted if I had been on the jury. I certainly don't think that there can be a rule that parents can kill their severely disabled children. On the other hand, I would find it very difficult to judge someone who had gone through the kind of torment that father surely suffered. Here I'm fairly clear that the rule should be that this was an unlawful killing. But, under certain circumstances, I might nonetheless decide that in this case the rule should be tempered with mercy. My judgment would probably turn on how much the father appeared to love his daughter.

There are other cases involving incompetent subjects in which I think euthanasia is permissible -- in other words, situations where it seems appropriate to impute consent even where none was expressly granted. Consider the famous Karen Ann Quinlan case from the 1970s, in which a young woman lapsed into a comatose and brain-damaged "persistent vegetative state" after mixing alcohol and tranquilizers. There I would have been quite unconflicted about respecting her parents' desire to remove the respirator that supposedly kept her alive (as cruel fate would have it, the respirator was removed and she continued to live in a coma for another ten years). It seems less dreadful to remove life support rather than affirmatively kill, and to end the life of an unconscious, brain-damaged person rather than a conscious, brain-damaged person.