Thursday, June 05, 2014

Euthanasia and the Slippery Slope

Normally, I hate slippery slope arguments. But in this case, I think it's warranted.

I'm OK with euthanasia being an option for terminally ill patients who are suffering a great deal. My problem with euthanasia is that, with our society's attitudes to disability, it will not stop there.

And I have evidence to back this up. Look at pets.

For pets, euthanasia is an accepted option - no controversy about whether or not it should be allowed. My own parents have euthanized several of our pets, when they were terminally ill and in a lot of pain.

For example, my dog Sasha, at age 12, was found to have breast cancer that had travelled all along her stomach and partly down one leg. Doctors told us there was little they could do, her condition was pretty much certain to kill her even if we tried aggressive treatment. They were willing to surgically remove some of the tumors, but if they removed them all, they'd cause such extensive damage that she'd probably die simply from shock. We chose to euthanize her.

Another pet we euthanized was my 20 year old cat Timmy. He'd been bleeding from the mouth and meowing while trying to eat, and it turned out half of his jaw was one big tumor. Doctors told us that in other cases, when they'd removed a tumor like this, the cats had refused to eat and starved themselves to death. If they didn't remove it, it would keep growing and causing more and more pain until Timmy no longer could eat. We chose to euthanize him.

These are both cases where, if they'd been humans with the same issues, I would be in favour of allowing them the option of euthanasia. (Timmy's issues are unlikely to occur in any human, because part of his problem was a quirk of cat behavior that isn't present in humans, but Sasha's illness occurs in humans and, if not caught early enough, can cause the serious problems she had.) Unlike animals, most humans can tell us whether they want to fight the illness or not, and the decision should be up to the patient. But I don't have a problem with a woman with very advanced metastatic cancer choosing to die a bit earlier in a more comfortable way, when her death is pretty much guaranteed either way.

But we've also had some animals that vets counselled euthanasia for, that we refused to euthanize. Most people, in our position, would have euthanized these pets, and missed out on the happy years they had left.

Charlie was a 15 year old cat with diabetes. She'd been getting skinnier and skinnier, and then she got frostbite on her ear when it shouldn't have been cold enough for frostbite, so we took her in. We were expecting either 'she's fine, nothing to worry about' or 'there's nothing we can do, she's terminally ill'. Instead, we got a diagnosis of diabetes - a condition we knew full well was manageable with medication. The doctors taught us how to give her injections. At first, Charlie hated them, but over time we got better at giving them and she realized they made her feel better, so she tolerated them. And we had two more years of cuddling and purring and bumping against my Dad's recorder as he played. Her diabetes had no impact on her quality of life. At least, not until it killed her kidneys, and she died on the way to the vet.

Anja was a rat, about a year old. (Rats live around 2-3 years.) We're not sure exactly what happened, but our best guess is that one of the toys in her cage fell on her and broke her back. In any case, her hindquarters were paralyzed, and vets recommended we put her down. We refused, and they gave us advice on how to care for her. They told me to keep her isolated in a restricted area for awhile so she could heal, and gave me advice on softer bedding that wouldn't hurt her as she dragged herself along it. But over a couple weeks, her mobility improved dramatically, until her only impairment was an inability to jump or climb. We didn't bother changing to softer bedding, just put her back in her cage with her friend (rats are social, and get depressed if kept alone too long). She went on to live a happy life, filled with treats, teeth grinding and cuddles, until she died suddenly, most likely from old age.

Charlie and Anja had lives that were worth living, just as humans with diabetes or spinal cord injuries do. Even if Anja's recovery hadn't been so dramatic, we could've given her a good life. Rat advice websites state that some male rats develop progressive hindquarter paralysis in later life, and these rats still live a good life when their back legs can't move at all.

But I'm pretty certain that many people, if they'd had Charlie or Anja, would have put them down. Similarly, people often put down cats with cerebellar hypoplasia, but Youtube abounds with videos of happy CH kitties wobbling around. (Buddy, for example.) Our society has the attitude that disability, any disability, is a horrible fate. And if euthanasia was available, many people would approve of it even for minor conditions. Worse yet, many newly-disabled people, without giving themselves time to see if they can adapt and live well, would jump to the conclusion that their good life is over and seek euthanasia.

Another example of how many people will choose death over disability, even for very minor conditions, can be seen in abortion rates for prenatally diagnosed conditions. Most babies prenatally diagnosed with a disability, any disability, are aborted. In one study, out of 40 prenatally-detected cases of sex chromosome aneuploidy, 25 (63%) were aborted. To give some background, there are four types of common sex chromosome aneuploidies - XXX, XYY, XXY and monosomy X.

XXX and XXY are very mild, causing a slight drop in IQ (around 5-10 points) and a higher risk of learning disabilities and ADHD, as well as making kids a bit taller than expected. Many people with these two conditions are never diagnosed, because they have few or no symptoms and no one thinks to test their chromosomes.

XXY, also known as Klinefelter's Syndrome, is a bit more significant. In addition to the same traits seen in XXX and XYY, Klinefelter boys sometimes experience feminine body changes at puberty (breast growth, getting curves). These changes can be readily prevented by testosterone treatment. In addition, Klinefelter Syndrome usually causes infertility, which can't be prevented. Even so, many men are never diagnosed, or are only diagnosed in adulthood due to infertility.

Monosomy X, also called Turner Syndrome, is the only sex chromosome aneuploidy often detected at birth. It causes a distinctive set of minor physical changes, such as extra skin around the neck, which have no significant impact but allow doctors to spot the condition. In addition, Turner girls are infertile, shorter than expected, often don't go through puberty unless given estrogen treatments, and have an increased risk of congenital heart defects. Turner Syndrome also causes nonverbal learning disability and difficulty reading nonverbal cues.

Even the most severe of these conditions is easily managed, and poses no real impediment to a full and happy life. And two of these conditions are barely detectable at all. Yet when parents are given the option to abort, two-thirds of these kids will be aborted. Even a condition as mild as Turner Syndrome is seen as a serious enough problem to make not living at all preferable in their eyes.

And until this changes, I don't want yet another way for disability prejudice to kill us off.


Blogger BayesianSpoon said...

This comment has been removed by the author.

8:07 AM  
Blogger Kaminiwa said...

The Netherlands has legalized euthanasia for the terminally ill, and by all accounts the "slippery slope" hasn't materialized at all.

To Quote the Remmelink Report:
"In 96% of instances of euthanasia and assisted suicide the physicians stated that the request of the patient was explicit and persistent. (The finding that there always was a request of some sort is circular since such a request is at the core of the definition of euthanasia in the Netherlands.) In 94% the request had been made repeatedly; in 99% the physicians felt sure that the request had not been made under pressure from others; and in all cases they were convinced that the patient had sufficient insight and knowledge of the course of disease"

I'll totally admit my understanding of this is entirely secondhand. Even the quote is from , but... the evidence seems to say humans treat other humans (even disabled ones) very differently than they treat pets and fetuses.

8:08 AM  
Blogger Ettina said...

"and in all cases they were convinced that the patient had sufficient insight and knowledge of the course of disease"

Here's where I have a problem. Physicians don't have a clue. They know the facts, like that most people with Duchenne's Muscular Dystrophy will be ventilator-dependent at some point in their twenties, but when it comes to how it feels for the patient to live like that, doctors and non-disabled/newly-disabled people are equally clueless. Both groups vastly underestimate the quality of life of so many different kinds of disabled people. When the patient themselves has no clue what life with a disability is like (because they've only just become disabled), and when doctors don't know to tell them any different, then people who could've adjusted and went on to live happy lives might seek euthanasia because they mistake a temporary grief reaction for eternal unhappiness. (Same problem with non-disabled suicide, incidentally.)

Unfortunately, that post you gave didn't discuss which conditions the patients had, except to throw out the suggestion that many had cancer. And if they were all terminal, then I'm fine with that. But I don't know if they are, and I know there have been non-terminal people seeking euthanasia in the past.

4:36 AM  
Blogger Ettina said...

Also what about this:

22 newborns with spina bifida and hydrocephalus were euthanized, with parents' consent, but obviously not with their own since they were newborns. Meanwhile, both conditions can be treated and are only terminal if untreated, and many individuals with both conditions go on to live happy lives with disabilities.

4:47 AM  

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