Suicide by Duress

A stroke recoverer friend in his 60s recently visited a new GP for the first time.

‘Have you ever considered suicide?’ she asked as she went through his notes.

‘No’, he replied.

‘Why not?’ she asked.

He was so thrown by her question (and having lost his ability to react spontaneously anyway through stroke damage) that he did not reply.

I suggested to him that he should complain to the surgery and get to the bottom of whether this was professional misconduct or she simply didn’t explain herself properly.

However he has so many battles to fight on a daily basis, he has to choose them carefully and is thinking of just requesting a different doctor in future.

It set me thinking about how not so long ago suicide was considered ‘a sin’ to the point that a suicide could not be buried in consecrated ground, yet somehow suicide has now become socially acceptable and even touted as ‘a human right’.

I particularly find it disturbing that this is bound to affect and influence those who might have challenging lives or health issues but who don’t necessarily want to die – they just want proper compassionate care and to be able to trust their health professionals to provide it.

To read that NHS hospitals got a ‘bonus’ for each patient they put onto the ‘Liverpool Care Pathway’ to bring their lives to an end (even if their lives were nowhere near their natural end) is frankly chilling. Some patients on the LCP have not even been old but cancer sufferers in their 40s and 50s and many it now transpires were being placed on the LCP without their consent or their next of kin’s consent.

Moreover, since when did food and fluids come to be termed ‘treatment’ to be withdrawn, rather than basic sustenance required as an essential human right?

What next? A posthumous award to Dr Harold Shipman for his humanitarian works? It seems to me there is little difference between what he was doing and what the Liverpool Care Pathway has been doing.

If we have an over-population problem, there must surely be better ways of solving it than manslaughter at worst and societal coercion for those who've served their economic purpose at best.

Dying for Compassion

Anyone who considers that Assisted Dying can be legislated for with the subsequent legislation faithfully adhered to without dilution or abuse has only to look to the British Abortion Act of 1967 which stipulated:

‘Abortion is legal when a pregnancy is terminated by a doctor, and where two doctors certify that one of the following conditions is met:

a) risk to the woman's health or the health of any existing children of her family (within a 24 week time limit)

b) risk of grave permanent injury to the physical or mental health of the pregnant woman (no time limit)

c) risk to the life of the pregnant woman (no time limit)

d) substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped (no time limit).’

and observe how abortion has subsequently degenerated into a ‘woman’s right to choose’, despite no great change in the Abortion Act, bar the termination time limit moving back and forth as technology advances and more is discovered about foetal viability at each developmental stage, and despite a smorgasbord of contraceptive options available to the modern female which were largely unavailable to the 1960s female.

A former neighbour of mine worked in an abortion clinic where it was not uncommon to have clients walking in for their 4th or 5th abortion. Some were unusually fecund, it is true, and no contraceptive seemed to work for them. Others were so casual about the subject of contraception, they simply shrugged when they found themselves pregnant again and no amount of education or free contraceptives seemed to change that, even though they were not seemingly educationally-challenged. One particularly memorable case involved a high-earning woman who demanded an abortion because being pregnant would interfere with her skiing holiday which would then cause her emotional distress!

So if it is seemingly impossible to get the populace to observe the rules of the Abortion Act and maintain a high level of respect for human life, why would they pay any more heed to an Assisted Dying Act?

While something undoubtedly had to be legalised regarding abortion owing to the estimated 15% of maternal deaths caused by back street abortionists, Assisted Dying is something that many people are requesting through fear of infirmity in one of the most ageist societies in the world and where many still have no access to full palliative care or anyone capable of allaying those fears. These individuals may or may not end up in the physical state of decline they most dread or in the hands of uncaring carers who malnourish them, but increasing numbers are taking no chances and killing themselves or flying to Switzerland whilst still in good health. Is this to be encouraged?

These are the issues that need to be addressed first before we even think of making Assisted Dying legal. Moreover doctors are not trained to kill but trained to treat. There is something deeply wrong about asking them to turn into assisted killers, not least if they have sworn the Hippocratic oath; ‘First do no harm.’

And there really aren’t enough Harold Shipmans (thank goodness) to spawn such a perverse twist in the medical profession.

In the real world, doctors unofficially up the morphine/equivalent on a regular basis in a dying patient in the full knowledge that this will probably hasten the end, but the compassionate thing to do is ease the patients’ pain to the best of their ability. However they will seldom act against the wishes of the patient or their families (ie keep them alive at any cost), unless keeping them alive at any cost is the patient’s or familys' wish, particularly in a terminal case.

In many instances, it is plain for all to see, not just doctors, that the patient is fading away literally and losing their interest in the world and the dying is a natural process when someone reaches a certain point in a terminal illness, a natural process of letting go made easier by being as pain-free as possible in calm and caring surroundings.

However if we cannot guarantee the calmness and caringness of the surroundings or the total pain management, I believe that’s where a lot of the fear creeps in, whether rational or irrational. This society also seems to have lost its ability to deal with death and dying per se. Hence palliative and geriatric care units are often under-resourced, compared to children’s or heart departments, where there are higher chances of happier outcomes and greater success rates. Cottage hospitals – ideal for the dying – continue to be closed in their droves with their human contents transferred to vast impersonal general hospital blocks where they are more likely to be ignored or overlooked rather than properly nursed and comforted.

Finally there will never be a shortage of greedy relations out there, not to mention insecure elderly people (sometimes in the same family) who fear they are ‘a burden’, whether or not that is a figment of their imagination. Who will protect the vulnerable patient from having assisted dying foisted upon them or being scared or coerced into it as being ‘for the best’, whether or not they are competent or confident enough to express their own true wishes?

More outrageously we might even begin to hear of the loving grandparent suffering no more than the usual minor ailments of ageing who knows that the only way for their grandchild to afford to go to university would be for the grandparent to die and pass on their inheritance early and because Assisted Suicide has become legally and socially acceptable by then, no one bats an eyelid when they request medical assistance. As for the grandchild, they wouldn’t even have to send a thank you letter for this supreme act of sacrifice! You do get parents and grandparents who will go to extraordinary lengths to ensure their offspring never hear the word ‘No’ these days.

So my message to the government is to hold fire on an Assisted Dying Act until all of the above are fully considered and debated, not to mention the moral and religious angles. For now the law is far better left to judge on a case-by-case basis where a loved one has helped another loved one die, and use their discretion as to whether each case is murder, coercion-in-disguise or a genuine act of compassion in accordance with their late loved one’s wishes

23/02/12 Breaking news: Doctors agree to abort babies of the 'wrong sex'

The Right To Why

A major debate currently rages over whether legalised euthanasia should be introduced for those with 'life-limiting' illnesses (other than life itself, that is!)

It strikes me as quite shocking that what should be a last resort is blatantly being advocated as a first resort, in view of the fact that at least half the country has no access to proper palliative care, let alone in the speciality of geriatrics (a vastly understaffed field to begin with). Therefore the majority of patients in extreme pain have no effective means of pain management in order to gain the mental equilibrium necessary to arrive at such an irreversible decision. Still others are simply depressed and may not realise it, so this too needs to be ruled out as a factor in their decision making, particularly if treatable.

And no one in the country seems to have access to such a thing as cognitive therapy specialising in the treatment of those with dementia (many of whom couldn't give their consent in any case, even if the highly vocal author Terry Pratchett is choosing to give his ahead of time.) But if there is such a thing as the Peto Institute in Hungary to aid neurologically-impaired children into becoming more functional using conductive education, why not an equivalent rehabilitation system for dementia utilising this, perhaps combined with cognitive therapy? And why are drugs such as Aricept costing only £2.50 per day - considerably cheaper than 24/7 nursing care if it retards or plateaus the condition - being stinted on or outright refused to save money because the patient 'is not yet ill enough'?

Now we hear that for every £144 spent on cancer research, a mere £12 is spent on dementia research, no matter that dementia actually costs the nation a great deal more in care costs. Furthermore 60% of dementia has actually been linked to vitamin deficiency if an older person suffers from mild to severe malnutrition owing to their diet narrowing and liquid intake falling due to an inability to cook once widowed or lack of appetite owing to pre-existing medical conditions. Even long term hospitalisation where nursing care is inadequate is proven to leave patients malnourished, which means dementia could theoretically be a temporary and reversible condition for many sufferers, not least those who go into hospital with their marbles and come out without.

And even if a patient has had the luxury of being able to exhaust every alternative there is and has met every last legal and good practice criteria decided upon to be passed fit for assisted suicide, what right does he or she have to ask of a medic trained to heal rather than harm, to become a killer? There is no right to die, merely a perception that there is. Although not religious myself I still acknowledge that life is a gift and therefore not necessarily mine to take, however dire it may become.

My father (although not malnourished) has dementia but is lucky enough to live in Northern Ireland where you basically get whatever you ask for when you enter a Doctor's surgery and they don't seem to have heard of drug budgets. My mother requested Aricept for him and within the day was holding his first prescription of the stuff. It is early days in terms of knowing whether it is doing anything yet, but at least he has been given the chance and has not suffered any adverse side-effects. Meanwhile I have sent my mother a hypnosis CD on developing a better memory which I have suggested she tries playing softly under the bed as he sleeps and have also found a book optimistically entitled The Alzheimers Prevention Plan, which looks like it might be quite useful for people of any age. Though having been a bit of a late developer in life, I'm rather hoping I will be a late developer re my diseases as well!

Though just in case you thought life was becoming a little too disposable, at the opposite end of the spectrum you can always take this,solving all your health problems and living to 100 at a stroke.