Medical perspectives on the ‘End of Life’ bill

‘If we have the right to live the way we want to why can’t we choose when and how we die’

Vinod Kathuria, consultant surgeon; clinical director, Tula Medical Experts

 

As a medic dealing with life and death, we constantly deal with choices. We all are taught, right from early years, to look at options and make decisions. The life is full of choices, and we make them. Some good and some we wish we had not made.

 

The question is, if we have the right to live the way we want to why can’t we choose when and how we die, under certain circumstances.

 

The proposed bill has come at a welcome time to help make that decision, for those who need to. ‘To live life with dignity is desirable. To die with dignity must become a human right.’

 

Doctors and nurses see a lot of suffering and do whatever they can to alleviate it. Patients rely on medicine to make them better or at least feel better. With terminal illness, when there is no light at the end of the tunnel, it turns into chaos. A confused state where patient, family and doctors are all hoping for and trying to do the right thing.

 

There is physical suffering and then there is significant psychological aspects of it too. It usually leads to despondency, sadness and most of the patients want to slide away into nothingness without pain and suffering.

 

Some want to put up a brave front and fight it. Then there is the reaction of the family and friends. Some of them have already supported and looked after the patient for years, having put their own life on hold. There comes the question of how this final lap affects them.

 

The end-of-life bill goes a fair way to help end suffering for the patient. The bill is not much different from other countries and addresses the issue of safeguarding the dying patient, with two independent doctors approving the wish and the independence and mental capacity of the patient has been taken into consideration.

 

From legal point of view, this seems to be a well thought out and researched proposal. However, it is much more complex and difficult from individual human point of view.

 

Whilst the proposal is protecting the patient and is offering the patient a choice to end their life, it may not be providing the support that a patient in that situation would need to make that decision.

 

These are vulnerable patients and have probably suffered for years. They are frail. They are usually fed up with life. There is pressure from the family and friends, mostly supportive. Pressure to fight, to live on. To put it harshly, mostly for personal gratification of the family because they want to hold on to their loved ones for as long as they can.

 

There is a story that I read long time ago. The father is very ill. He is fed up and depressed with pain and suffering. His son is a doctor, and he begs his son to help relieve him of the suffering. And the son helps!

 

Move forwards a few decades and the son is now in a similar position and asks his own son if he would help him die, and the son spends time discussing openly various aspects of the situation, talks him out of it and the father is greatly relieved and wants to live on for some more time. He had become cautiously aware of his perception that he may have become a burden on the family, the son was able to alleviate his fears.

 

The story brings out the point that it is the most difficult decision one would have to make in their life if they were unfortunate to be in that position. They will need all the mental, emotional, and psychological support they can get, to help them make that decision. The understanding that the patient will make that decision without ‘coercion’ is a utopia.

 

The proposed bill presumes that every patient in that position will be completely independent in their thought process and the family that they want to rely on, will have unanimous support to uphold the patient’s decision.

 

Unfortunately, that is not the reality. The patient needs professional support. There must be a provision of a counsellor. Not in an advisory but purely in a supportive role to help steer the patient through the muddle of their own thought and the surrounding noise.

 

We have mandatory training for all doctors including safeguarding our children and the elderly/vulnerable. There must be mandatory training for all hospital doctors and GPs in procedural requirements and understanding of the proposed ‘End-of-Life’ bill.

 

Without the additional support, I feel that we are throwing all the responsibility for this huge decision at the patient without offering the support that we would have offered if they wanted to live.

‘As much morphine as they request to keep them comfortable’

Dr Finola O’Neill, GP

 

I am against [assisted dying legislation] and the community nurses that look after dying patients that I spoke to are too.

 

In our experience if community services are well funded enough no one should die in pain. We can give enough medication to keep someone comfortable and if it shortens their life, but that is what they want but the purpose is to control their symptoms/pain etc, then it is entirely legal.

 

Most of the celebrities, like Esther Rantzen, are talking up horror stories, are talking about individual accounts, which were probably not optimally managed.

 

If you give enough diamorphine it is always possible to control pain.

 

Now is the wrong time to be debating this while the NHS is failing so badly and services are so poor. I will refuse to be involved if the bill is passed as will a lot of my colleagues.

 

In Canada it has slipped over time to allow assisted dying for people who are not terminal and have problems like depression or disability.

 

I don’t have any concerns about assessing capacity. We are always assessing that, for example around power of attorney applications. We assess capacity in elderly people all the time.

 

Capacity has to be situation and time specific. But one of the nurses I spoke to said she does have families that push to speed up death when the patient themself is not uncomfortable and she worried that people may be influenced by family who struggle to see them suffering.

 

My mum always said you will have to give me lethal morphine when I get too incapacitated (she had Parkinsons). I always said no, apart from it being illegal the majority of frail people get an infection and you can refuse active treatment (ie antibiotics, etc) if you get ill when you are frail, and it will do the same job.

 

It turned out in the end she had a stroke and then wanted all active treatment. She very much wanted to continue as long as possible and in the end she was in hospital with a chest infection and got the morphine once my sister arrived - she held off as she wanted to see her.

 

She agreed to every single dose and we kept asking her, and she died comfortable at exactly the pace she wanted.

 

Essentially if a patient is given as much morphine as they request to keep them comfortable I can’t see when assisted dying would ever be needed. And the only thing standing in the way of that is good enough end of life care in the community. That needs a lot more funding.

 

I think the assisted dying law is a very bad idea and a slippery slope. Canada is the failed experiment.