The University of Southampton

Should Euthanasia be legal in the UK?

Trigger Warning – this blog discusses terminal illness and suicide.

If anyone is affected by the topics in this blog, please ring the Samaritans helpline on 116 123.

In the lecture about bioethics and law, one of the areas we focused on was the Nazi’s during WWII and their mass murder or ‘euthanasia’ of people who they deemed ‘unsuitable’.

That made me think about euthanasia and the laws surrounding it. It is legal in Switzerland, and some other European countries and UK citizens often fly there to be euthanised.

My personal opinion is that euthanasia should be legalised in this country with strict legal restrictions and multiple approvals from medical professionals needed.

One of the reasons for my view is because my sister is a nurse who works in ICU in London. She has patients who are on life support machines and have no quality of life yet are kept alive. Some of these were born with such severe conditions, that they have never left the hospital, been able to talk or move, and are also blind and deaf. Is it not crueller to keep them alive, knowing there is no hope for recovery or improvement than to let their parents/medical professionals put them to rest?

In addition, last year my family had to put down our 13-year-old golden retriever. She had cancer and went through surgery and chemotherapy. Unfortunately, the tumour continued to grow, so we stopped treatment and until she became uncomfortable and unhappy. As hard as the decision was to put her down, it was in our home and was the most peaceful and graceful way to die that I could possibly imagine.

Why do we treat our animals with such love and allow them to be euthanised, as the ‘kindest thing’, yet we don’t treat humans with that same compassion? Especially if the human is able to consent?

In 2002, Diane Pretty was diagnosed with motor neurone disease – a chronic and terminal diagnosis. She did not want herself nor her family to suffer through the final stages of the disease. She wanted to end her life peacefully at home. Unfortunately, she was not granted this wish. She went to court to appeal to change the law; however, they did not grant her the right to die. Because of her condition, she had 24-hour care and was unable to commit suicide alone. She wished her husband could assist her with this, however this is illegal in the UK.

Video about the Diane Pretty case
Sharon Johnston and Sue Lawford

How can it be that someone who is able to commit suicide alone is not breaking the law, but someone who needs assistance is unable to? Surely this is discriminatory against those who are disabled.

Last year, Sharon Johnston, who was paralysed but mentally competent, decided that she no longer wanted to live. She therefore chose to be euthanised at Dignitas in Switzerland. Unable to travel alone, a retired NHS worker, Sue Lawford, took her to carry out Sharon’s wishes. Sharon was euthanised but, when Sue got back to the UK she was arrested and questioned on suspicion of attempted murder. She was investigated for six months before being cleared of charges.

It is an incredibly difficult and sensitive topic, and inevitably there will never be a unanimous opinion regarding it. There will undoubtedly be a grey area between assisted suicide, euthanasia, and manslaughter. This potentially puts doctors in a difficult position legally, especially if the patient is unable to consent for themselves. I’m unsure what precise restrictions and requirements should be put in place, but I firmly believe that people who have terminal illnesses or are suffering from incurable conditions should be able to have the choice to end their pain and suffering.  

News article about Sue and Sharon: https://www.bbc.co.uk/news/uk-wales-63599107

My death my decision, a movement that Sue Lawford is a member of: https://www.facebook.com/MyDeathMyDecision/

Should ICD’s be classed as Prosthesis or Orthosis?

A few weeks ago we had a lecture and a workshop all about prosthesis. Before the lecture I thought it would mostly be about prosthetic limbs and joint replacements. I didn’t consider the wide variety of things that could be considered prosthesis and I also didn’t think about orthosis.

I was particularly interested when he mentioned there is some debate as to whether pacemakers should be classed as prostheses or orthoses.

An X-ray image of my brother’s torso with his ICD fitted. This image was from a year after its implantation when he fell out of a tree and snapped the wire!

This in particular interested me as my brother has a heart condition called Long QT syndrome where, as you may guess, he has a prolonged QT interval of his heartbeat. Due to this, when he was a child, he collapsed three times and each of these times, his heart stopped. Therefore, at the age of ten, he had an Implantable Cardioverter Defibrillator (ICD) implanted subcutaneously.

A few fun facts about ICDs and people who have them:

Every 8-10 years he has to have it replaced as the battery wears out, and he gets an updated model – like a phone upgrade!

Also – magnets interfere with its function; therefore, he is unable to go through metal detectors at the airport, and when we hug him, we can’t have our phones in our hands!

Now back to the debate:

The definition of a prosthesis is an artificial device that replaces a missing or impaired body part. This can be internally e.g. a hip replacement, or externally e.g. a prosthetic leg.

An orthosis is defined as a device used to modify the structural and functional characteristic of the neuromuscular and skeletal systems through systems such as immobilisation or support. Orthoses are also usually external e.g. a foot orthotic corrects flat feet and other foot injuries.

An example of an ICD. Medtronic is the brand of ICD my brother has.

Next, what is the difference between a pacemaker and an ICD?

ICDs are similar to pacemakers. According to the NHS website, pacemakers send electrical impulses to your heart to keep it beating regularly and not too slowly. However, ICDs monitor the heart and send a larger electrical shock to the heart to restart it when it stops or to make the heart rate stop beating abnormally or dangerously.

So where does it fit in the prosthesis vs orthosis debate?

Tested against the definition of a prosthesis:

ICDs do not replace a missing body part, but it does replace the impaired function of the sinoatrial node, the body’s natural pacemaker.

And against the definition of an orthosis:

First of all, it is internal not external which is already rare for an orthosis. It doesn’t modify the structure of the heart, but it does modify the function in the event of abnormally high heart rate or when the heart stops.

The heart is not part of the skeletal system, but is it part of the neuromuscular system? The neuromuscular system is defined as the system affecting nerves and muscles. The heart is a muscle and also has electrical activity, so yes, it is.

The debate comes about because it does not fit either definition perfectly, I don’t think there is necessarily an answer. However, in my opinion it fits the description of being an orthosis more than it fits the description of being a prosthesis. Therefore, I would class ICDs as internal orthoses.

This is a video from the British Heart Foundation talking about ICDs

Growing up with Chronic Heart Disease

My name is Emma and I have Dilated Cardiomyopathy.

Dilated Cardiomyopathy is a heart condition where the left ventricle of the heart is larger than it should be and the muscle is thinner than it should be. This means that it is a lot harder for my heart to pump blood around my body.

Visual comparison of a normal heart against a heart with dilated cardiomyopathy.

I was diagnosed at the age of one after having parvo virus. This is what triggered the beginning of my symptoms. Dilated cardiomyopathy is also known as “sudden death syndrome” as many people never experience symptoms, in this way I was lucky.

My mum took me into the hospital and they noticed that all of my organs had a lot of fluid surrounding them, and I even had fluid on my lungs. I was nearly in kidney failure and heart failure.

I was rushed to the Royal Brompton Hospital in London where I was put into the Intensive Care Unit (ICU). My mum was then informed that I had a 1/3 chance of death, 1/3 chance of having a heart transplant, and 1/3 chance of being on medication for the rest of my life. It dawned on her then… none of those options were me getting better.

Thankfully I was very lucky. Despite being on the list for a heart transplant, there was a new drug that was available called Carvedilol, this along with six other medications and a strict high calorie diet, saved my life.

Picture of me with the doctor who saved my life – Piers Daubeney

Now, with the help of daily medications I am able to live my life normally. I just have to go once a year for a series of investigations and be slightly more careful than most at exercising and high adrenaline activities.

It is miraculous really, I feel incredibly lucky to be alive and live in an age that I can rely on medication for the rest of my life.

Video of an MRI image of my heart beating