Saturday, 11 July 2015

The Case for Assisted Dying

The progress of the Assisted Dying Bill through parliament is a ponderous one. Lord Falconer’s bill intends that ‘competent adults who are terminally ill be provided at their request with specified assistance to end their own life; and for connected purposes’.

It passage seems unlikely to be easy or straightforward, and will be further hampered by the fact that in this country we have the somewhat arcane system whereby members of the established church (bishops) sit in the House of Lords. Hasten the day when that lot will be booted out. Yet it is hard to see how, in the end, some sort of facility for assisted dying will not be enshrined in law. Unfortunately it may be a very watered down one. Already sufferers from Alzheimer’s Disease and other progressive dementing processes are virtually excluded as a consequence of so many not being deemed to be competent to make such an informed request in their circumstances.

The medical profession has proved itself adept at prolonging life to an ever greater extent. I know, from having worked many years in the National Health Service, that quantity – length of life – has a far higher value set upon it than its ultimate quality among those who determine treatment regimes for patients. When it was suggested to me, in my late 60s, that taking a statin would reduce my risk of stroke or heart attack I asked the question ‘so, what would be my likely mode of dying in the end?’ The response, from a nurse who was acting upon the directive of a protocol on her desk, was a vague answer that was little more than a brush-off. No matter – from my experience of caring for people in extreme old age I had a pretty good idea of it in any event. Pneumonia if I was lucky, recurrent and chronic urinary infection from an indwelling catheter if I was not – indeed were I actually to be permitted to die of these illnesses rather than have yet another course of unpleasant antibiotics, quite probably administered intravenously.

But I want none of it. Not if I were afforded any choice in the matter, which seems unlikely.

The counter-arguments to assisted dying are several and include the wonderful quality of terminal and palliative care. Tosh. Or at least in far too many situations (not all, I grant you) - tosh. But this is what the public is fed in the press and the other media. So long as people are condemned to die ‘naturally’ there will always be suffering to one degree or another, and far too often appalling suffering in terms of pain and other symptoms, and loss of dignity. Worse – as we all know – deliberate and callous abuse by those charged with their ‘care’. People may try to tell you otherwise but they are either deluded or less than truthful.

Another powerful argument is the claimed potential for abuse of the law – as has happened with the Abortion Act which was never intended to create a facility for abortion on demand as has certainly happened in most parts of England. But that is a consequence of laxity, and collusion between health service workers and their patients. The demand for assisted dying is going to be far less than that for termination of pregnancy, and the decision could quite properly involve a judge as well as a medical expert, the family and – most importantly – the patient her/himself. So the fear that granny will be bumped off in order that her bungalow may be sold and the family go off round the world on a cruise ship on the proceeds should hardly be taken seriously.

When I was a GP I lost count of the number of times I was asked by people in extreme old age to be helped to die, or at least not to be treated in the event of serious illness. They had lost all their friends. Their families might be hundreds, if not thousands of miles away. And they lived constantly in the fear of ‘being sent to a home’. Of course I could not – and would not while the law does not exist – do anything that could be seen as acceding to their request, and I gently told them so. But they were very special patients to me and I gave them my best, which I know might have made their predicament a little more easy to bear. Yet still they longed for it all to be over. And almost always their parting took place in when they were alone, or – worse – in a busy hospital acute ward or on a trolley in A&E.

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