Is there any debate on this?

I have to rush out to go to a wedding reception so apologies for this post being short and rubbish but quickly, here’s a story on the Daily Mail website about a twenty six year old woman who swallowed anti-freeze and arrived at hospital with a note requesting her wish to die.  Which was honoured.

It has the usual hysterical Daily Mail title of,

What kind of country have we become if doctors and lawyers allow a disturbed young woman to die?

The coroner’s verdict was unequivocal. Dr Alexander Heaton, he said, ‘went over and above what was required of him’ when Kerrie Wooltorton was admitted to the Norfolk and Norwich University Hospital.

She had swallowed anti-freeze, but insisted she didn’t want to be saved. In her hand was a note which began: ‘To whom it may concern, if I come into hospital regarding taking an overdose or any attempt on my life, I would like for NO lifesaving treatment to be given.

‘I would appreciate if you could continue to give medicines to help relieve my discomfort, painkillers, oxygen etc. I would hope these wishes will be carried out.’

Kerrie Wooltorton who died at the Norfolk and Norwich University hospital after drinking anti freeze and leaving written instructions not to revive her
Kerrie Wooltorton, pictured with her godson George Miller, died at the Norfolk and Norwich University hospital after drinking anti freeze and leaving written instructions not to revive her

Those wishes were eventually carried out, to the letter – throughout the 37 agonising hours it took for Kerrie to slip away. But, initially, a second opinion about Kerrie’s mental state was sought by Dr Heaton as to what he should do: in other words, should he save this young woman’s life or not?

The medical director of the hospital was contacted. The hospital lawyer was consulted. Then, and only then, was the decision not to treat Kerrie taken, the Greater Norfolk Coroner William Armstrong told me this week.

In other words, as far as Dr Heaton and his colleagues were concerned, all the boxes had been ticked. Legally, anyway.

Had he and his team not respected Kerrie’s wishes, Dr Heaton argued, they could have opened themselves up to charges of assault. That’s the law, apparently – one which, to all intents and purposes, has now resulted in lawyers sitting in judgment on life-and-death cases in A&E departments.

Such cataclysmic developments should give us all cause for concern, and this special investigation into the circumstances surrounding Kerrie’s death will do little to allay the fears of those who believe a culture of ‘medicine by lawyer’ is beginning to prevail.

The case has provoked fears that ‘civilised’ Britain is moving insidiously into an era of euthanasia on demand. All but forgotten, it seems, by those at the centre of this tragedy is the central principle of the Hippocratic oath, which has guided doctors for the past 2,000 years. It is: ‘Never do harm to anyone.’

She requested pain-killing treatment and explained she had called an ambulance because she didn’t want to die at home alone.

The problem here is that she was young and physically healthy and her illness was a mental one.  There is a prevailing attitude that anybody with a mental illness who is suicidal isn’t in their right mind.  In fact, having a mental illness at all- which invariably clouds your judgment (as does pain in the case of terminal illness, but that’s different because death is imminent)- means that their wish to die shouldn’t be respected.  That people are always treated, always eventually saved, will always look back and say, “I’m so glad I didn’t end my life then”.

But that isn’t always the case and sometimes, ending your life is the rational decision you take, not the irrational one.  And as far as someone can demonstrate that they know what they’re doing, then their wishes should be respected.

The Hippocratic Oath is the tenet of practice in modern medicine but medical intervention can just be a sticking plaster prolonging the process of life without any consideration as to which quality of life the person has.  It’s the whole, “sanctity of life” idea, that, “Hey, at least you’re alive!”, without thinking if that life is worth living to that person.  Not everyone would choose life over death.  If they had intervened in this case, Kerrie might have just been on dialysis for the rest of her life, and possibly would have made another suicide attempt.

I know it’s all well and good saying, “might have been”, by the way. Likewise, you could argue she might have been okay, might have been happy. But she wanted to die, the doctors honoured her wishes and they shouldn’t be attacked for it as harbingers of moral doom.  It is far more respectful to actually give a thought to the individual person’s desires than to just treat them with the vague, hypothetical, “first do no harm”. And I think it’s everyone’s right to end their own life if they want.  It is their life, after all.

Anyway, excuse the lack of proper intelligent commentary here but I mostly just wanted to bring this story to your attention- what do you think?  Should the doctors have intervened and tried to save her life?  Should suicidal people be allowed to die if you can’t prove that they’re in their “right mind”?

30 Responses

  1. I think people do have a right to life which also means they have a right to die. As you say, it’s their life.

    However, if someone I knew was to take an overdose intending to kill themselves, and then telephone me to tell me and apologise for any wrongs they’d done to me, I would do everything possible to save their life. Even though I might be wrong in this and would be going against their expressed wishes, I’d do this because I’d think there was a possibility that part of them unconsciously wanted to be saved. When there’s a possibility, I think it’s worth pursuing. So I wonder if part of the woman in the newspaper story didn’t want to die. So I think maybe the doctors should have saved her life.

    The times I’ve been suicidal, I’ve been most angry and upset with myself when I’ve realised I’m not actually going to go through with it (however close I’d come). I’ve come up with a plan to ensure a speedy exit with little pain and with very little chance of being able to be medically saved. But I’ve hated myself for not having the will to overcome the last unconscious part of me that seems to want to live. It has reached the stage when there are no rational reasons remaining for wanting to live, yet this stubborn part of me still wants to, and I can’t will myself to overcome this. And it’s this part of me that eventually makes me reach for the phone and ring my Psychiatrist.

    So I think maybe it’s this same part of someone, like the woman in the newspaper, that makes them make contact with someone else – while unconsciously I think they might know they could be saved medically and want to be.

    So the only situation in which I think someone should NOT intervene in a suicide, is when the person concerned has, as far as is possible, eliminated all possible chances of surviving and being stopped. If by fluke or random chance, someone still could stop them or save them, I think they should NOT intervene. This is where I would be convinced that no part of the person concerned wanted to live – where their right to die is able to be exercised.

    Wow, that’s the first time I’ve articulated all that. I hope it makes sense!

  2. A rather unsurprising bit of lazy journalism from the Mail.

    The actual text of the Hippocratic oath, varies according to the translation but it generally talks about not administering poison, not performing abortions & generally not doing anything “mischievous or deleterious” to a patient.

    However, there are a number of different, modern versions, which take into account contemporary ethical & legal issues. The oath is not even compulsory in the UK, instead the GMC publishes guidelines for “Good medical Practice”.
    They make it very clear that “A sane adult is permitted to refuse effective treatment”.
    I suppose much of the debate centres around whether or not Kerrie Wooltorton was making a rational decision or if her judgment was clouded by her illness.
    Personally I don’t think that suicide can ever be a rational decision, but then I’m not sure what a “rational” decision is. Human beings are capable of rational methodologies but it is absurd to think that we are motivated by rationality (it’s also an absurd use of language).

    I have made a number of suicide attempts & there have been many times in my life when i have not wanted to live because of the depth of my depression, though when the depression has eased, I’ve always been glad that I didn’t die.
    However, my illness is episodic in nature. If I was facing a lifetime of unremitting depression, I don’t think I could cope & I’m pretty sure that I would eventually kill myself. I don’t see why this should be judged differently than a person suffering from a chronic, physical disease, making the same decision.

    It is the right of the individual to take their own life if they wish but we should remember that the individual only exists as part of society. Those close to us posses their own little piece of our existence. They will have to deal with our ghosts when we are gone.

  3. Whether in her right mind or not, who are we to judge if a life is worth sticking around for. As sufferers of mental illnesses we should be the first to understand that those around us, non-sufferers if you will, have no idea in the slightest what it’s like to have a mental illness.

    A while back my non-mentally ill wife had a bout of clinical depression. It lasted a couple months. It was a rough time. When she finally got out of it she cried for me. She had a glimpse of what I go through, have been going through, and will go through for the rest of my life. She barely made it out.

    I think we forget sometimes how different our experience of the world can be at times compared to others.

    This woman had lost hope, was probably tired and simply didn’t want to go on. It was her choice and I can and do support that. The doctor’s made the right choice.

    It would be hard for me to honor such wishes if it involved a close friend or family. I don’t know what I would do. I would hope that I wouldn’t be selfish and force someone to continue living a life that isn’t really a life.

  4. Sometimes I think the Daily Mail can GO TO HELL

    %-/…

  5. When my friend took an overdose recently she asked not to be saved but they did it anyway. Obviously, from my point of view I’m glad they saved her, but I can see her point, and she still doesn’t want to be alive. However, as her liver is severely damaged (functioning at 40% and she’s still drinking heavily) it will probably fail one day. When she was in the hospital, she came very close to needing a transplant, and I think it may come to that one day, which I think would be utterly pointless. If her mental health improved, fair enough, but as it is she has no desire to be alive, hence the fact that she’s making no effort to stop drinking. If they gave her a new liver, she would only destroy (unless they final get her on a ward, and they don’t seem to be trying very hard). If she didn’t get a new liver, it would be with holding life saving treatment. I have a feeling that in this circumstance the DM would be appalled if she got it though.

  6. If that’s what she wanted then why continue such agonizing deteriorations. I think the doctors did the right thing . here in the states any type of attempt at suicide or even saying I wish I was dead will eventually get you a free room in the local insane asylumn for a extended period of time . Of course life is precious but in the eventuality of it all one should have the right to a final sucession of over an done . without furthur degredations. As in a thoughtful attempt I wrote the above link to one of my blogs after an attempt at suicidal tendancies . Beyond the ledge can also be found here > http://beyondtheledge.blogspot.com/
    Feel free to tell me what you think in the comments at the bottom of my blog thanks to all for viewing an your thoughts an comments are appreciated .
    Sincerely Dirtdog

  7. I think people think of ‘unbearable suffering’ in physical terms only and more respect should be given to physically healthy people who consider their mental suffering unbearable to the point that they don’t wish to live any more. Also, serious questions need to be asked with regard to what can be done by the wider community to remove many of the reasons people with mental illnesses find life unbearable in the first place.

    Sad thing is, the very people who are going to be vocal on this issue are (as always with issues regarding personal choice) the ones who have no clue what they are talking about.

    I think there is a discussion to be had about this but it has to be a discussion with people talking and listening to those with mental health problems, not just assuming that mentally healthy people know best all the time.

  8. Here’s a legal/ethical opinion in the BMJ on the rights and wrongs of the case:

    http://blogs.bmj.com/bmj/2009/10/01/sheila-mclean-on-advance-directives-and-the-case-of-kerrie-wooltorton/

    I’d disagree with some of the points in that analysis (for one thing, I don’t regard personality disorders as necessarily “untreatable”) but it also makes a lot of good points about how the fact that she had a personality disorder doesn’t mean she wasn’t competent to make a decision.

  9. General consensus is that a person should be allowed to choose to die if they are ‘of sound mind’ – a phrase that in itself seems to imply ‘not suffering from a mental illness’. But wanting to die is so often seen as a symptom of a mental illness, or at least, a sign that you’re not of sound mind, for whatever reason, which means that a logical result of wanting to die is being deemed unfit to choose your death. Which is the kind of logic that Joseph Heller would be particularly proud of.

    From Catch-22:
    “Orr was crazy and could be grounded. All he had to do was ask; and as soon as he did, he would no longer be crazy and would have to fly more missions. Orr would be crazy to fly more missions and sane if he didn’t, but if he was sane he had to fly them. If he flew them he was crazy and didn’t have to; but if he didn’t want to he was sane and had to.”

    Translated to this scenario: You can die if you want to, as long as you’re ‘of sound mind’. But wanting to die makes you NOT ‘of sound mind’, so you’re not allowed to die.

    Some people support euthanasia, but get very irate about news items like this – wanting to die is all very well if you’re going to die soon anyway, and imminent death seems to be the only acceptable reason to want to die.

    That said, I do feel, instinctively, that there’s an inherent distinction between a) being so depressed that you want to die, and b) wanting to die because you find your life, which may or may not include periods of depression, unbearable. I’d be more willing to respect a person’s wish to die in the second case than in the first. Perhaps that’s just a different form of the same hypocrisy, but from a personal point of view:-

    – an episode of depression ends. It always goes away, however long it takes. And however hellish it is when I’m depressed, it DOES go away. And it’s such a relief to get out of it, and I don’t want to die anymore. During the depression, I want so badly to die, and when it goes away, I’m so glad that I didn’t die, so glad I didn’t make that decision. An episode of depression is a temporary thing – the thoughts and feelings of it go away (even if they come back).

    – at the same time, I know how it feels to not currently be depressed, but to hate what depression has done to my life, and to find it difficult, a real struggle to keep doing everything I have to do, because I’m so behind with everything, and depression has made everything harder, even when I’m no longer depressed. And in times like those, I’m not depressed, I just hate what depression has done to me, and I’m terrified of the depression coming back, and because everything seems so impossible, I sometimes want to die – and I can imagine this happening more often and more strongly, the more times I get depressed.

    I’d say that in the first instance, wanting to die is the result of a temporary state. Depression colours your thoughts, makes everything feel hopeless. And I’d say that in that case, suicidal thoughts are a direct result of a temporary problem, and so, in that case, wanting to commit suicide is perhaps ‘irrational’ – or at least, they are thoughts that are caused by an illness, and will stop when the depression inevitably ends. But in the second instance, the suicidal thoughts are a direct result of looking at your life and analysing it and coming to the conclusion that you don’t want to live. And whilst you are still ‘a person who suffers from depression’, your depression is not at that time directly affecting your thoughts, and you have to be said to be ‘of sound mind’. But perhaps the line between the two examples I gave is not as clear as perhaps I’ve made it seem.

    I agree that, if a person wants to die, they should be allowed to. People should be allowed to make decisions about their own lives. But I don’t think that those decisions should be made in the middle of a depressive episode, because those thoughts so rarely coincide with a person’s thoughts outside of that episode.

    It’s as if depressed me and not-depressed me are two people – a decision as permanent as suicide shouldn’t be made by depressed me alone, because it’s not just depressed me who’s affected by it. If not-depressed me wants to die as well, then I’m in agreement with myself, and can make a real judgement, based on the feelings I have both when I’m depressed and when I’m not.

    Gaah, this is a bit rambly. Sorry about that.

    Laura.

  10. I wonder how the doctors can know for certain that the patient is in fact the author of the note.

  11. Seriously, this just made me cry. With sadness. With empathy. And none of us can say for sure what exactly this woman was going through. A good decision or a bad one? I don’t know. I just hope Kerrie found the peace she was looking for.

  12. Anti-freeze is usually fatal if not caught soon enough. Unfortunately, It is not quick and is painful. Usually if a person survives the initial insult, liver failure will get them.

  13. I both agree and disagree with you. I agree because if someone who is in there right mind decides to die, then they should be have that option.

    However, scribbling a note, to me, tells of a hasty decision. And hasty decisions of such grandeur don’t exactly speak of someone in there right mind. Now, if she had actually went out and gotten a proper DNR, then that would be a different story. But, that is not the case. Similarly, for her chosen method of death.

    I also have a gigantic problem with lawyers being involved here. The choice of whether or not to help someone should be a ethical/medical question, not a legal one. In fact, the law should protect that. I find it really *really* disturbing that a lawyer was involved in this decision. Not to mention that this sets a dangerous precedence.

    (seriousprofessor) has a great point as well.

  14. “Should suicidal people be allowed to die if you can’t prove that they’re in their “right mind”?”

    Absolutely not, under no circumstances. The doctors at that hospital should be struck off and prosecuted. This is why euthenasia is wrong – it slides into letting mentally ill people kill themselves, and from there it’s just a hops skip and a jump to helping and even encouraging such “drains on the system” to do away with themselves.

  15. “Tony Blair’s Labour government passed the Mental Capacity Act in 2005”

    Is there no end to that bastard’s evil?

  16. Being bipolar and working in MH and corrections, so many times I have to remind my co-workers — hey y’all — being mentally ill is NOT illegal.

    I rather enjoy your blog and have been ever-so-quietly stalking you for some time. Just thought it was time that I say something worth saying. 🙂

  17. It’s my belief that people should be allowed to choose to end their lives if they so wish. The problem is that it’s human nature to want to ‘help’ someone in distress and sometimes people get it wrong and help someone to live when it was a rational choice for them to die and vice versa. For the hospital the morality was obviously complicated by legal implications.

    I have to say I didn’t understand why she called the ambulance – it seems unnecessary to involve other people in her choice (not wanting to die alone, she could have called the samaritans, who would have respected her wishes). She could also have chosen to die in a manner that wouldn’t require painkilling treatment. I know this sounds harsh, but I do feel for the staff forced to stand by whilst she died painfully.

    I respect her decision, just a bit concerned about the way it all went down.

    Aethelread had a good take on this subject (fairly close to your point of view) here: http://aethelreadtheunread.wordpress.com/2009/10/03/the-right-to-die/

  18. I wouldn’t like to comment on this particular case because I think one would have to know more about her and her history.

    I’ve tried to commit suicide four times and, right at this moment, I am glad I failed. However, had I succeeded I’m very “meh” about it; I mean I don’t think it would have been a tragedy had I succeeded.

    In the last year I’ve started to smoke more than I have in times past. So there is a danger of cancer. If I get cancer I would like to be only treated for pain, not to be treated to remove or try to beat it.

    If I were to get cancer I may live in prolonged and agonising pain because doctors will often hold back on pain killers due to “double effect” whereby the pain killers shorten a person’s life even though they make that end period bearable. I think that’s disgusting. I’d rather have my life shortened or even ended than live in terrible pain and I think it should be my decision as to whether I wish to risk death by taking more pain killers.

    I absolutely support euthanasia. I loathe the argument that euthanasia may lead to exploitation of people because safeguards could be set up to make sure that didn’t happen.

    They could follow the model of people who request a sex change. People asking for that treatment are given a number of interviews to ensure they really need the surgery to feel fulfilled and happy. Euthanasia could be administered only after a succession of assessments that demonstrate that it isn’t just a phase or rash decision.

  19. I have to admit, when I saw the details of this – that a person could be allowed to take their life, and that their wishes could be respected by the medical profession – I felt it was a very civilised outcome.

  20. I also feel if she really wanted to die she could have avoided putting all those staff in the position where they had to stand by and watch her suffer. I think that was a hateful thing to do to them.

  21. Very worrying, the note sounds rushed and spur of the moment, i didn’t know the hospital can be charged with assault if they ignore a patients request…The doctor was probably very torn …i don’t think a lawyer should be involved …this seems just plain wrong morally and ethically & really only to benefit the hosptal and protect them against a possible future claim from the family…Frighening times we are living in…i agree we should allow people to choose for themselves however a duty of care should cover all life to ensure as was said earlier the individual is of sound mind…

  22. I agree with the sentiments of the post and agree that people should be able to choose whether to live or die. There is a stigma still around suicide (and indeed the usage of the phrase, ‘committing suicide’ is still used and yet it was decriminalised in 1961…and before that suicide was a sin based on religious morality… see the likes of Thomas Acquinas and Augustine). I think the hospital did the right thing and obeyed the woman’s decision.

    I worked on a helpline some years ago and there was a discussion about what to do if someone contacts the helpline having resorted to a suicide. My own response would be to listen to the person and not to elicit information to pass onto the cops/ambulance services etc (some people said they would do that) because that would be an ultimate betrayal of trust. I know if I was in that the position I would be feel betrayed if I saw and heard the siren with professionals ready to ‘save my life’….

    Someone in this meeting said why would the person have rung up if not to be saved? Maybe because they are lonely and don’t want to die alone. I can understand that.

  23. Maybe they were more willing to let this young woman take her own life because she had ‘an untreatable personality disorder’. If she’d been bipolar they’d probably have pulled out all the stops to save her. I guess the life of an individual suffering from a ‘personality disorder’ is worth less than the life of some one suffering from bipolar affective disorder.

  24. I certainly hope I’d be treated like that.

    And yes, I could see myself pushing assault charges on a physician after. I suspect that’s true – we were taught in med school that treating against someone’s will could be brought against us as assault charges.

  25. If she really wanted to die, why did she call the hospital? I think deep down she wanted to live. A hospital is a place where they do everything in their power to save someone’s life. I think they should have tried.

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