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Electing when we die is the ultimate choice. It must be ours and ours alone Electing when we die is the ultimate choice. It must be ours and ours alone
(about 1 hour later)
Last year my brother killed himself. He was 60 and suffering from terminal cancer. He had been exceptionally fit and strong until the disease struck, but by the time of his death he was breathless and the spread of the cancer to his spine meant he could only crawl around the house. He knew the end was near and, despite the support of an excellent palliative care team, he felt he'd had enough. He wanted control over his death and, in the absence of assisted dying legislation, he knew he would have none. He took the only way out that he could see. He was found at the bottom of a flight of stairs, having unsuccessfully tried to hang himself.Last year my brother killed himself. He was 60 and suffering from terminal cancer. He had been exceptionally fit and strong until the disease struck, but by the time of his death he was breathless and the spread of the cancer to his spine meant he could only crawl around the house. He knew the end was near and, despite the support of an excellent palliative care team, he felt he'd had enough. He wanted control over his death and, in the absence of assisted dying legislation, he knew he would have none. He took the only way out that he could see. He was found at the bottom of a flight of stairs, having unsuccessfully tried to hang himself.
Soon Lord Falconer's bill will come before the House of Lords. With upfront safeguards, it would allow assisted dying for those of sound mind who are terminally ill, and have a settled wish to die, a change that many feel is long overdue. Norman Lamb, Liberal Democrat care minister, is just the latest high-profile politician to say he will support this change.Soon Lord Falconer's bill will come before the House of Lords. With upfront safeguards, it would allow assisted dying for those of sound mind who are terminally ill, and have a settled wish to die, a change that many feel is long overdue. Norman Lamb, Liberal Democrat care minister, is just the latest high-profile politician to say he will support this change.
The law needs to change because not all suffering can be adequately relieved. Dying can still be messy, painful and undignified, despite what the palliative care physicians tell us. The availability of assisted dying is not just about relieving the unbearable physical suffering of some patients in their final days; it will also address the fear many will experience as they anticipate those final days.The law needs to change because not all suffering can be adequately relieved. Dying can still be messy, painful and undignified, despite what the palliative care physicians tell us. The availability of assisted dying is not just about relieving the unbearable physical suffering of some patients in their final days; it will also address the fear many will experience as they anticipate those final days.
As the law stands, terminally ill patients know they will have no control over their own death and live with the very real fear of uncontrolled symptoms and loss of dignity. Assisted dying would help by giving patients the prospect of control and choice when it really mattered so that they could face death with greater equanimity. In Oregon, where assisted dying is legal, only one in 200 of those who inquire about it avail themselves of it. The knowledge that it is available is usually comfort enough.As the law stands, terminally ill patients know they will have no control over their own death and live with the very real fear of uncontrolled symptoms and loss of dignity. Assisted dying would help by giving patients the prospect of control and choice when it really mattered so that they could face death with greater equanimity. In Oregon, where assisted dying is legal, only one in 200 of those who inquire about it avail themselves of it. The knowledge that it is available is usually comfort enough.
Some reject the idea of legislation on assisted dying because they believe the matter should be left in the hands of the patient's GP, who will discreetly deliver the required dose of pain relief when the time comes. I know a GP who gave a terminally ill patient an appropriate dose of morphine to get him through the night. The patient died shortly thereafter and the relatives accused the GP of killing him. He was arrested, taken to the police station and formally charged. The story was in the local papers, and it took him more than a year to clear his name. Many GPs are understandably afraid to give adequate doses of pain relief, and it is not fair to fudge the issue by exposing them in this way.Some reject the idea of legislation on assisted dying because they believe the matter should be left in the hands of the patient's GP, who will discreetly deliver the required dose of pain relief when the time comes. I know a GP who gave a terminally ill patient an appropriate dose of morphine to get him through the night. The patient died shortly thereafter and the relatives accused the GP of killing him. He was arrested, taken to the police station and formally charged. The story was in the local papers, and it took him more than a year to clear his name. Many GPs are understandably afraid to give adequate doses of pain relief, and it is not fair to fudge the issue by exposing them in this way.
But at the heart of the debate over assisted dying is respect for patient autonomy. I have seen a profound change in the relationship between patients and doctors since I qualified. Benign paternalism has gone and doctors are taught to respect the right of patients to choose even when we don't agree with their choice. So why in the matter of death and dying do we revert back to that old paternalism – the "doctor knows best" attitude of my medical youth? We do something we never do otherwise – we assume we know better than the patient. Why should we doctors have the right to deny patients their ultimate patient choice?But at the heart of the debate over assisted dying is respect for patient autonomy. I have seen a profound change in the relationship between patients and doctors since I qualified. Benign paternalism has gone and doctors are taught to respect the right of patients to choose even when we don't agree with their choice. So why in the matter of death and dying do we revert back to that old paternalism – the "doctor knows best" attitude of my medical youth? We do something we never do otherwise – we assume we know better than the patient. Why should we doctors have the right to deny patients their ultimate patient choice?
My brother was exceptionally brave. He did not wish to suffer as he had seen others suffer, and he found his own escape from an intolerable situation. But in doing so he died alone and afraid. He could have died at a time of his choosing with his family around him but the law did not allow him that choice. That law is cruel and barbaric, and we now have an opportunity to change it.My brother was exceptionally brave. He did not wish to suffer as he had seen others suffer, and he found his own escape from an intolerable situation. But in doing so he died alone and afraid. He could have died at a time of his choosing with his family around him but the law did not allow him that choice. That law is cruel and barbaric, and we now have an opportunity to change it.
A bad death means not only suffering for the patient but a cruel legacy for those left behind. Out of respect for my brother's memory and for the sake of the many facing the same situation, let us legislate for assisted dying for the mentally competent, terminally ill patient. It may even be ourselves one of these days.A bad death means not only suffering for the patient but a cruel legacy for those left behind. Out of respect for my brother's memory and for the sake of the many facing the same situation, let us legislate for assisted dying for the mentally competent, terminally ill patient. It may even be ourselves one of these days.
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