Monday, March 06, 2006

Physician assisted suicide.

This evening I attended a seminar on physician assisted suicide. Lord Joffe's Bill is due to be debated in the House of Lords in May.

I am against the Bill for the following reasons:

It negates what doctors are there for. I went into medicine to save lives not to dispense with them. Although there would be an opt out clause for concientious objectors, the Bill would fundementally change the relationship between doctors and their patients.

It underestimates the ability of palliative medicine. The Hospice movement begun by Cicely Saunders (whose Memorial Service in tomorrow in Westminster Abbey) has had remarkable success in aleviating suffering. there is no reason why anybody should be in pain.

It is a slippery slope. In 1967 I fought a losing battle against the Abortion Act. The propaganda told us it was to prevent back-street abortions of which there were supposedly 100,000 a year. When the Bill was enacted the British birth rate fell by the number of legal abortions. How could it have done do if it was simply replacing the back-street abortions? In fact today 20% of all pregnancies end in legal abortions; virtually none because the life of the mother is threatened; virtually none because the mother has already had 7 pregnancies and she can't manage an eighth; virtually all because it is not the woman's choice to have a baby now. Once the door is open a chink, experience tells us that it will be forced wide open.

It is not safeguarded by having two doctors agreeing to do it. It was necessary for two doctors to sign a cremation form, but this did not stop Dr Harold Shipman from murdering more than 250 of his heartsink patients and then covering up his crime by having the body burnt.

It puts unfair pressure on the old and sick. Old people may feel that their lives are useless and opt for a pill to end it all simply because they are lonely.

It assumes that doctors know when patients are about to die. This is plain arrogance. Predicting death is like the weather forecast; you can be fairly accurate about today's outlook, less so about tomorrow's and after that it's largely guesswork.

It takes no account of medical discoveries. I have been continually surprised by medical advances that have turned terminal ilnesses into treatable conditions. A good example would be the treatment of pulmonary hypertension in babies. Previously it was rapidly fatal. Now we know it responds to Viagra. Who'd have thunk it?

It puts intolerable temptation in the hands of relatives. I have never been asked by a patient if I would kill her/him. But relatives have asked me to put gran out of her misery. With many having to sell the family house in order to pay nursing home fees, it doesn't take much to persuade a frail old lady that she would be doing everybody a favor by popping her clogs.

It devalues human life and dignity. I wouldn't allow a dog to suffer like that. You hear it said all the time. But a human being is not a dog. All human lives mean more than that. Just as the real response to an unwanted pregnancy should be care and support for the mother, so the correct response to the old and the dying should be care and support. Everybody has to die. But nobody should die alone, in pain and in sorrow. Shame on us that some should do so.

It smacks to me as a cost saving measure by a government strapped for cash. A famous "Yes Minister" TV program had the civil servants insisting that the most efficient hospital was one that didn't open to patients who would undoubtedly spoil the place. It may be a cheap way out to bump off these difficult patients, but that rather misses the point about what doctors are for.

I guess I could think of more reasons, but that should do.


Anonymous said...

Good God, morals in medicine and morals of which we can be proud! We are not puppies! Thank you TH for recognizing publicly that we are people and different from the animals my daughter treats!

Charles Stearns
"Today is God's gift to me. What I choose to do with it is my gift to God."

Anonymous said...

Thank you, Dr., for voicing that. I'm a liberal progressive who also believes in the basic sanctity of human life. I, like you, do not want any slippery slopes. However, I think that in my country, this issue will never be resolved because it provides 40 million votes for the politicians who give lip service only to the issue. Once the issue is resolved, folks will start to look at what the politician REALLY stands for and kick him out on his/her keester!

Vance said...

Well, you know where I stand on this issue -- right along beside you!

We who deal with sick and dying patients walk too closely to the line already. I sometimes have concerns that hospice workers step over that line in the name of "comfort" though I cannot be certain.

But we surely do not need that line moved so as to make it any easier to get rid of the infirm and unwanted.

Like you, I have had family members all but ask for a parent to be put down because the family has grown tired or run out of money.

Someone has to stick up for life, and we are sometimes the last line of defense.

Anonymous said...

On the other hand...

We recently put our wonderful dog to sleep. She had slipped into a coma, and she was not going to come out of it. I felt then and now that it was the right thing to do. Should we have put a feeding tube in just to keep her alive?

She also had recurring urinary tract infections, and a progressive myelopathy.

I love(d) that dog as much as I have loved any human. I felt it was a humane thing to do.

Should I not treat my family member as well as I treat my dog?

BTW, my grandfather was in a similar situation. He had Alzheimer's and pnuemona. He also slipped into a coma. We could not end his life, so he died of starvation and of thirst.

Which is the better way to go?

Anonymous said...

My Grandfather, a burly, strong, hands on man, was always doing and going. He was a hard working man all his days on earth, until one day took that away.

In his younger years while working in an auto manufacturing plant and in an accident had a car fall on him and he lost a lung.

He was of the generation who knew nothing of the dangers of smoking and smoked, like all my grandparents did; but he developed emphysema in his one lung.

That still didn't stop him, he never complained. He just dealt with it on continued on and took oxygen when he had to.

Then his prostate turned ugly on him and he had to have it removed, back then it was a grusome surgery, not like the laser precision of today.

Still, he marched on. Always tinkering, fixing and putting a smile on everyones face. He was the rock no matter what.

Then he had a stroke. Not enough to kill him, but bad enough to completely paralyze him. Took his speech, his ability to walk, his smile, he couldn't lift a fork or even go to the bathroom on his own.

We didn't care. We loved him as he was. The entire family. It was our turn to take care of him. We read to him, kept him company, took him for drives, wiped his drool, held his parakeet close so he could kiss him, snuck out back and held his tobacco pipe for him so he could sneak a puff every now and then as he had given up cigarettes after the onset of the emphsymea but still loved to smoke.

We all spent lots of time with him and all it did was make things worse. He was so humiliated that he could no longer not only care for himself, but moreso, he could not provide anything for the woman and family he loved.

We watched my Grandfather cry all the time. But we still, all, took turns working with him as his speech and therapist, to teach him to talk again.

And do you know what his first words were? Kill me. Gun. Shoot me. God not hear me. God not take me. God not want me. I want to die.

Poor Pop lingered in misery for a couple years while slowly everything shut down.

Until he ended-up in a hospital bed because he decided to quit eating. Back then, my parents had to fight to NOT have a feeding tube inserted.

It was a hard fight for my Dad and his Mom to fight, but they knew Pop wanted to die. And we had to watch him starve and thirst himself to death.

It was horrible.

No, Pop wasn't a dog, but I wouldn't even treat a dog like that. I envy that we have the choice to help our pets move on peacefully with a simple shot of the pink stuff.

I won't get into the details of my other grandparents, there was mercy for them, and I can only hope the same kind of death angel will visit me when my life remains as nothing more than waiting in a hospital bed.

Choosing life is one thing, having mercy and compassion for someone who wants and needs it is something entirely else.