Thoughts of a Lord on the eve of a debate

— Announcement —

Welcome to the blog. Here you will find 100 posts exploring aspects of medicine that have preoccupied or challenged me during training and the first 3 or 4 years as a consultant.

I began to write in August 2012, and managed, against expectation, to produce one post a week for two years. I am now giving it a rest, although I’m sure I will come back to the blog when an observation, scandal or ethical dilemma grabs my attention.

I have collected and published these posts in three volumes, the most recent of which is ‘A Face to Meet the Faces’.

Thank-you for your support. I’ll announce any new posts via Twitter as usual.

 

 

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oOo

 

 

thoughts of a lord

Forgive the impersonation.

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I’m not a true expert on assisted dying, but have become something of one with all the petitions, emails, personal representations and evidence summaries (collated by my excellent assistant). Recognising that care and compassion are abundant on both sides of the argument, I began to focus on the objective. Harrowing and personal stories are persuasive, and cannot be dismissed, but it is my duty to look up from individual tragedies and forward to the future where harms may arise. But what harms?

 

I am persuaded that there has been creep in the most liberal nations, where euthanasia is practised. I am persuaded that life may have become a little cheaper, and, dare I say it, a little less sacred in those places. But Falconer’s Bill isn’t about euthanasia, it is about patients taking fatal doses at the time of their own choosing. Doctors will do nothing more than facilitate the getting of the drugs, and sometimes the administration. Am I being naive here?

 

Can I be sure that the system will protect those who might not have requested AD if were not for the vulnerability of their position or the nudges and comments initiated by relatives, carers or unscrupulous others? Will there be a risk of subtle coercion over many weeks or months that ultimately drives a patient to request AD? I am not persuaded of that. A doctor involved in the assessment should question hard a patient, or a family unit, when a request seems to come out of the blue or appears inconsistent with prior impressions. Can I be sure that not one single such instance will occur? I cannot. There are no certainties in law, medicine or human behaviour.

 

And what of those doctors? They will be involved early on, when assessing a patient’s ‘settled intention to end his or her own life’, and when looking around the patient to ensure that there has been no familial coercion. Can we trust them? They are not perfect. Some are downright poor. But I do not see poor doctors leading to a lack of safety here; more likely, the poor doctor would fail to allow a patient the opportunity to discuss AD at all.

 

Will patients feel ‘guilted’ into choosing AD? I know of no evidence that they have done elsewhere, although I did read something to suggest that depressed patients are more likely to choose it. Depression, they say, is treatable. I might counter that depression is not surprising, and is not likely to be reversed in this context. I don’t mind that part of a patient’s motivation might be the fear of becoming or continuing to be a burden…that is part of the personal burden of illness, in my view. But the drive to have an assisted death has to come from the patient.

 

I seem to be talking myself out a Yes vote.

 

But wait. We must move forward. The supreme court has told us as much – admittedly in relation a different group of patients, those without terminal illness who actually require the physical assistance of a doctor or carer to do the deed. Nevertheless, we cannot stay where we are. The line, which has hitherto stopped doctors facilitating death in any circumstances, must be crossed at some point. If not this year then next, or the year after that. That much is clear to me. I am not comfortable with it, I would expect no-one to be comfortable with it, but to resist the move to patients being assisted in the organisation of their own life and death seems over-dogmatic to me.

 

Unencumbered by religious faith, I do not have to factor in the intentions or opinions of a overseeing creator. I feel for those of my colleagues who do, but am interested by the intervention of a retired archbishop. The ranks of the religious are by no means aligned. I am far more alarmed by the ranks of palliative care specialists. These doctors have dedicated their professional lives to the care of the dying, and their opinion must be respected. I don’t know any who support AD. Perhaps some do but are nervous about being seen to support something that seems contrary to the prime purpose of providing comfort and quality in life. But I am a little frustrated too, because I don’t see why palliative care cannot segue into AD if comfort cannot be provided. Why should a patient lose the option of AD just because they submitted themselves to the care of a group of doctors who are strongly opposed? I do not like the thought that a patient in a hospice might be barred from seeking AD, or might have be discharged in order to pursue the option away from the disapproving eyes of his or her palliative care team.

 

So it seems I’m in favour after all. But I will listen to the arguments, even though I have probably heard them before. There will be emotion, which must be allowed to touch one, but I will try to maintain the objectivity of the law maker. There will be thinly disguised religious motivation, which I must try to respect because I respect the people who are speaking. And there will be reassurances, that the slippery slope is illusory and the safeguards are adequate. I will vote in favour…but, on the threshold, I cannot guarantee that something will not hold me back. A sudden chill that I am belittling the value of existence and shattering the previously inviolate principle that human life should not be taken. I cannot guarantee that as I act to vote in favour, glimpses of other lives, wasted due to mankind’s failure to recognise life’s value – in battle, in innocent planes over war zones, on Middle Eastern beaches – will hold me fast and change my intention. I just can’t say. A vote like this is, for all the evidence one hears, is an instinctive affair.

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