Finlay-WMA EoL Presentation Vatican-Nov2017

11/23/17
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Portraying assisted suicide and
euthanasia
Prof. Ilora Baroness Finlay of Llandaff
Wales 2017
House of Lords
National Mental Capacity
Forum
The Policeman’s Dilemma
An isolated highway
Fuel tanker overturns
Driver trapped in the cab
A policeman patrol car arrives at the scene
‘Shoot me before I burn to death’
What would you do?
‘Assisted dying’ legislation
• Physician assisted suicide
Oregon’s ‘Death with Dignity Act’ 1997
• PAS and euthanasia
The Netherlands ‘Termination of Life on
Request and Assisted Suicide Act’ 2001
Getting the language right
• The ‘right to die’?
• End-of-life or ending life?
• The right to involve doctors in deliberately
bringing about our deaths
• This means: licensing doctors to supply or
administer lethal drugs to some of their
patients
• What is portrayed
• What is not portrayed
• What is the role of the WMA in end of life
care?
Media Reporting
Media reporting focuses on what is
exceptional, not on what is normal
Examples:
Crime, air disasters, political failures, health care
scandals
These stories sell papers and boost
viewing and listening figures – but they
present a distorted picture of real life
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Heroes and Villains
“Journalists like to show ordinary people
behaving like heroes, or being ‘victims’ in
need of rescue, in this case from the
deterioration of their own bodies and from
those who will not accede to requests for
assisted dying, who are thereby
constituted as ‘villains’”
(Professor Clive Seale “How the mass media report social statistics:
A case study concerning research on end-of-life decisions”, Social
Science and Medicine, 2010)
The Human Interest Dimension
News: increasingly encouraging empathy / feeling rather
than analysing facts and stimulating thought.
Professor Seale again:
“A degree of voyeurism is involved in press reporting of
serious and terminal illness, and this too requires
personal stories about dying people rather than dry
outlines of general ethical debates. The prominence of
particular personal accounts then encourages readers to
believe that these are typical of all such experiences.”
Public Opinion Surveys
Two Key Questions:
What do respondents know about
the subject under discussion?
How is the question phrased?
Knowledge of the Subject
Q. Where does most public knowledge of
the ‘assisted dying’ debate come from?
A. The media
Q. What do we learn from the media?
A. That death is agonising, that the law is
cruel and that most people say they want
it to be changed
Q. So what do we tell the opinion polls?
Shaping the Question
“A proposed new law would allow terminally ill
adults the option of assisted dying. This would
mean being provided with life-ending
medication, to take themselves, if two doctors
thought they met all of the safeguards. They
would need to be of sound mind, be terminally ill
and have 6 months or less to live, and a High
Court judge would have to be satisfied that they
had made a voluntary, clear and settled decision
to end their life, with time to consider all other
options.”
(Online poll, Dignity in Dying, UK 2015)
Shaping the Question
“A proposed new law would allow terminally ill
adults the option of assisted dying. This would
mean being provided with life-ending
medication, to take themselves, if two doctors
thought they met all of the safeguards. They
would need to be of sound mind, be terminally
ill and have 6 months or less to live, and a High
Court judge would have to be satisfied that
they had made a voluntary, clear and settled
decision to end their life, with time to consider all
other options.”
(Online poll, Dignity in Dying, UK 2015)
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What drives a desire for death?
• Feeling a burden: low correlation with physical symptoms
(r = 0.02-0.24) and higher correlations with psychological problems (r
= 0.35-0.39) and existential issues (r = 0.45-0.49)
Wilson KG et al A burden to others: a common source of distress for the terminally ill.
2005;34(2):115-23.
• Depression and hopelessness are mutually
reinforcing, independent predictors
Rodin G et al Pathways to distress: the multiple determinants of depression,
hopelessness, and the desire for hastened death in metastatic cancer patients 2014
e-pub
• Major depression(p40m people / year need
palliative care
• 80% – no access to analgesia
• 6% are children