Assisted Dying

[SteveT]

PGC wrote:I do know some medics collude in the practice

I know for a fact that almost any doctor who is worth their salt, has killed by drugs.

If they never have, they cannot be called an active doctor.

I do not hold a flag for harold shipman, but I do for all the doctors who are sensible enough to recognise the 'no hope' position that many of us eventually slide into.

I have watched several ageing relatives die recently and must say that their last six months of their lives would have been better terminated that much earlier.

One uncle 85 years had no future he was twelve stone it was only when he had reached 6 stones that he was 'released' and had the pleasurable ride out via drugs. I always felt it would have been more humane had he been allowed to 'go' earlier rather than 6 miserable months sipping water and almost no food intake.

[lozzyloz]

My wife and I have an unwritten understanding that if either one of us is horrendously incapacitated, both physically and mentally, then one would humanely assist the other out. Trouble is, I'm not sure if I could actually do it in reality, ffor fear of making things worse and creating more suffering. I think I'd prefer the help of someone understanding in the profession.

This debate reminds me that some animals will kill their brood rather than let another predator get to them. Also the story of Keyser S?ze in The Usual Suspects. Hungarian gangsters invade his house while he is away, raping his wife and holding his children hostage. When S?ze arrives they kill one of the children to show him that they mean business. They then threaten to kill his wife and remaining children if he does not surrender his business to them. Rather than give in to their demands, and to prevent his loved ones from having to live with the memory of what has happened, he murders his family and all but one of the Hungarians, whom he spares knowing that the survivor would tell the mafia what has transpired.

[citizenED]

As a few posts on here have pointed out this is one where there will always bit a theory/practice split. What sounds fine when you are pondering the problem sitting in your living room with a glass of Chablis suddenly gets far more urgent and taxing when you are sitting on the ward next to your dying relative. There is a sense of humanist bravardo in some people's hardline assumption that they would switch off the machine or administer the fatal dose. I suspect, in reality, being cruel to be kind is not such an easy option.

[*Bob*]

Some rather bizarre analogies floating around here ha ha.

My fave so far: "I do not hold a flag for harold shipman".

More often than not, I would say the higher the level of 'humanist bravado' (or whatever you want to call it) - the greater the level of personal experience - and the more matter-of-fact.

There's nothing like you Mum calling for a chat about the preparations for Christmas this year, and musing in a humdrum and lighthearted fashion about the best way to go if need be. "I'm wondering if the lethal overdose of barbs will be ok on its own or if I should use a plastic bag secured with a rubber band as well? Anyway, we'll be there on Christmas Eve as usual, so we'll see you when we see you".

[annaj]

I have been holding off getting involved in the thread, because it is such an emotive subject and bound to have affected some people reading.

*Bob* the tone of your posts suggest you are speaking from experience and you have my sympathy for any suffering or loss you have endured.

However, I have to agree with BN5 (and not for the obvious reason)and contradict SteveT. I've been qualified for 9 years and have worked in oncology and palliative care, although I don't any longer. The practice being alluded to here is a form of palliative care. As BN5 said, when an illness is terminal the focus of treatment changes from cure or management of the disaese to control of symptoms in order to maintain comfort and dignity. There is a school of thought that says in palliative care control of the symptoms should be acheived at any cost. So, for example, if the symptom is pain and the treatment morphine and the dose necessary to control the pain would also reduced breathing, then some would say that dose is justified. As I say, I'm aware of it as a theory and have heard it discussed, but have never seen it done and have never done it myself.

In my chosen specialty the part of this debate that I have most experience of is the decision to stop resucitation or not to attempt resuscitation. This is a decision I have to make at least weekly and I never take it lightly. PeckhamRose, whilst I respect you view, Bookworm's post very eloquently expresses why these are not decisions that should be made by families. Of course the wishes of the patient and their family are taken into account, but ultimately this is a medical decision based on the likelihood of resuscitation being sucessful and the likely condition of the patient if resuscitated sucessfully. In reality attempted resuscitation is nothing like it looks on television, it is brutal, undignified and traumatic and in the majority of cases unsucessful. It is my job to decide whether it is, in medical terms, worth putting someone through that. I don't relish this part of my job or see it as playing God, I see it as part of my resoponsibity as a doctor to use my training and experience to decide rather than inflict the pressure and guilt of deciding on a distressed family.

Finally, I agree entirely with citizenED that this is a situation that's completely different in reality to theoretical discussion and none of us know how we would feel or react unless we have been unfortunate enough to be faced with it. My thoughts are with anyone reading who has a seen a loved one suffer and anyone who has ever had to consider these subjects as anything other than an interesting debate.

[annaj]

Ok *Bob* serious cross-posting, I was typing my long ramble when you posted.

Can I say once again, I'm so sorry for anything you've suffered.

[mockney piers]

As it goes *Bob* I had a disturbingly similarly surreal conversation with my own dad about 5 years ago at christmas. He was in Madrid and I went down to see him. He was suffering from a pretty severe depression and had convinced himself (he thinks himself a very rational man) that he was a drain on resources and had decided to end it all.

Over our crackers and crimbo paella I had to say that method a would be terribly unfair on the train driver. Method b was too messy, imagine the poor chap who finally had to find you. No no we can't possibly have c, too much risk of fire and killing a neighbour etc, to which he'd sagely nod, and say "I always said you should have been a lawyer Piers".

Fortunately I persuaded him to hold on long enough for him to pull through (or at least the drugs to kick in).

[*Bob*]

Really, there's no need to apologise, tread lightly or tippy-toe round.

C'est la vie. C'est la mort.

[SteveT]

When I suffered from renal cholic er kidney stones, the pain was so unbearable that if some one had offered me a 'death pill' I would have taken it unquestioningly without hesitation.

In the future as I age, I expect more of that type of misery during my bodily decline, when the pain becomes that bad, I can see no reason why I cannot make the decision to 'go'.

I hope I get an 'active' doctor on my side when I most need it.

[Peckhamgatecrasher]

No Chelthenham today, and I've got fags, so here goes.

I do think that life is sacrosanct and God-given and hold as a basic premise that I have no right to take life away from anyone (why doesn't she give up smoking, I hear you cry? For another post). I appreciate that many of you will think this is bollocks and that's cool, these are my ramblings.

Apart from that I also think that we have to protect the weaker members of society, something Moos touched on. Unless there is a central law that forbids taking life, I think that sometimes the decision to end someone's life, even from the best of motives, could be abused.

I also think that at some point, life does have to end and we need to embrace that and help the passage with dignity, not cling to it. I saw this with my aunt who tried every hocus pocus cure for cancer under the sun to no avail. I have also witnessed a very brave man who died a couple of years ago, after discussion with his family, who decided to end the invasive radiation/chemotherapy that had little chance of success who died with joy and peace. I appreciate that if one has a faith, it is easier to make this choice. I also agree with annaj that resucitation for resucitation's sake is not good.

My aunt, who lived in America so I think we'll risk the prosecution angle, eventually died at home with accelerated morphine doses. The doctor hinted to my grandmother, mother and uncle what dose would be too much. They chose to take this route because they couldn't bear to see her struggle and they have to live with the consequence of that choice. It wasn't taken lightly and they did it out of love, but I do think it was the wrong decision.

I believe the hospice movement was created to help people die with dignity and good palliative care - not to hasten death, but to make the patient as comfortable as possible and in the case of Marie Curie nurses, this takes place at home. I would favour this route over actively killing someone.

I now have no idea how to end this post but I will try and make sense if anyone wants to ask anything.

[*Bob*]

Would doing yourself in (unassisted) be an option?

I think that's the only part you haven't covered..

[Peckhamgatecrasher]

Suicide (pause while I hum the Mash theme tune) is killing, so not an option for me, which as a depressive, is a bit of a bummer.

[mockney piers]

I wouldn't let it get you down PGC.

i'll get my coat

[Peckhamgatecrasher]

:))

[bignumber5]

mockney piers Wrote:

-------------------------------------------------------

> method a would be terribly unfair on the

> train driver.

The dad of a friend of ours is a train driver and never really got over the time someone threw themself in front of his train...

[mockney piers]

A friend of mine used said method. Must be terrible for the driver, but I can't really blame him, he was suffering pretty severe psychosis, paranoia and depression. Pity no one was able to help him in time.

Ever the way I suppose.

[SteveT]

mockney piers wrote: he was suffering pretty severe psychosis, paranoia and depression.

Yeah, but apart from that, what was his beef?

[annaj]

Steve, perhaps I'm being overly sensitive again, I know mockney's fairly hard to offend, but I think that's in pretty poor taste.

[SteveT]

My apologies to Mockney Piers, I had no intention of offending him it was supposed to be wickedly humorous, more masculine, drinking at the bar, kind of humour.

Annaj thank you for your correction, I shall try harder to be more tasteful in future, and my apologies once more.

[annaj]

A very gracious apology Steve.

Although, just to be clear I wasn't saying mockney was offended, I wouldn't dream of speaking for anyone else on here, it just went a bit far for me.

[SteveT]

Come in Mockney I want your side of the story.

Do I tone it down in future(?)

Have I offended you(?)

Does it fit into masculine, drinking at the bar, humour,.... we must be told.

[Asset]

Timely article

[mockney piers]

It was a long time ago, ain't going to get offended. Nowt wrong with gallows humour, a bit of memento mori never hurt anyone I suppose.

Don't going saying that to his brother though, he was a psycho of an entirely different ilk!

[mockney piers]

and i haven't been sulking, i've been at an Irish wedding all weekend, just got back from Luton, having pretty much gone straight from the wedding, and feeling very much the worse for wear.

Huge dose of The Fear, leading to excess memento in my mori.

[annaj]

Two days without posting mockney, is that a record?

Since you're definitely not offended it had better be me who apologises next.

Clearly I'm much too sensitive for all this "masculine humour" Steve, do forgive my feminine weakness!