An evening in the Dutch Centre: on euthanasia

‘Medicine didn’t work until 1850,’ says Dr Bert Keizer (72), who works in the Dutch Levenseindekliniek (End of Life Clinic). And truly effective, life-prolonging treatments only really developed after the 1950’s. In his opinion, modern doctors commonly ‘misbehave’ when faced with patients who are clearly near the end of life, but for whom there are... Continue Reading →

Would you? The RCP Assisted Dying survey

  Doctors in England are being asked to answer a survey on their attitudes to assisted dying (AD). The Daily Mirror led on it on their front page today (Monday 14th Jan). The Royal College of Physicians wants to be sure that it current oppositional stance is a true representation of members' views, and is prepared... Continue Reading →

Introduction to ‘From Every Angle’

  In this the 6th collection of posts from Illusions of Autonomy I have explored complex situations through the perceptions and voices of those involved. This exercise is creative, and was inspired by William Faulkner’s 1930 novel As I Lay Dying. In this he describes the final days of Addie Bundren in the voices of... Continue Reading →


  My first midnight ward round in the intensive care unit, and still pretty inexperienced. The patient in cubicle 4 was deteriorating. His oxygen requirement was maximal, the pressure settings on the ventilator had crept up. His lungs were stiffening, be it due to infection, fluid overload or a tense abdomen... I could not be... Continue Reading →

Resilience – from within or without?

  I have been confused about resilience. To me, it always seemed very sensible to focus on it, this ability to 'bounce back from tough times, or even triumph in the face of adversity'. It surely is part of the ‘hidden curriculum’, as Horne and Peters refer to it in their BMJ article, ‘Ensuring our... Continue Reading →


On this blog I have explored the challenges involved for doctors who engage patients in conversations about resuscitation. I have written about the emotional energy consumed in initiating them, and in The Hill, a series of 7 episodes, I described the spectrum of reactions seen in patients and relatives. Recently I gave a lecture that... Continue Reading →

Asymptote: answering the dreadful question

Working in a specialty that is almost overwhelmed by '2 week wait' referrals (patients who are sent by their GPs with a suspicion of cancer), I am often asked, 'How long?' For some patients, inevitably, are found to have incurable disease. It is the job of me and my colleagues to provide an answer. Frequently,... Continue Reading →

The problem of late-stage consent in Assisted Dying

Assisted-dying law in Canada requires the person to be alert and able to provide consent just before their death. The Government of Canada website on Medical Assistance in Dying (MAiD) says, You must be able to give informed consent both: at the time of your request immediately before medical assistance in dying is provided This seemingly... Continue Reading →

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