Copperfield on the assisted dying bill
The thing about the assisted dying debate is that it’s just not funny. Which is a shame, because I do generally like to introduce a tone of self-effacing levity into these blogs, as my regular reader knows.
Maybe there’s some potential in the issue of assisted dying waiting lists. Supply and demand for this new service might mean such endless queues that, by the time you get seen, you could be… you know…
Also, there’s the slippery slope concept. That amuses me. According to the naysayers, one minute we’ll be euthanasing the terminally ill, the next it’ll be those with TATT or lists. Come on. There’s a big difference between what we secretly think versus what we’d actually do. Also, there would be a thing called the law.
And that’s it. Assisted dying into light-hearted blog doesn’t go. So I have no choice but to be completely serious from this point. Two points, in fact.
1. LDL cholesterol. Bear with me. I had an epiphany recently as I ploughed through a QOF-out-of-target list and found myself pondering whether to recall a patient with an LDL of 2.01 for statintensification. What I realised is this: medicine has lost its way. Its obsession with prevention, targets and arbitrary disease labels mean we have totally forgotten what we’re supposed to be doing. We’re so busy biochemically micromanaging that we’re overlooking the fact that there’s a person attached to all the numbers.
And this leads to an utterly perverse situation: doctors are perfectly happy to repeatedly interfere and impose on peoples’ lives for marginal benefit when they’re not ill, yet are reluctant or too squeamish to step in with a gracious, compassionate and effective intervention when those lives are coming to an end. Is that cowardice, stupidity or moral blindness? Or maybe all three?
2. I don’t buy the argument that palliative care, properly done and adequately resourced, can solve all end of life issues. It can certainly help, but I’ve seen enough palliative horror-shows to know it’s no panacea. One case in particular: a man whose mental anguish was so great as he lost all control of body, comfort and destiny that he would weep whenever he woke from his opioid sleep because of the simple fact that he was still alive and didn’t want to be. Where’s the ‘management of psychical’ pain section in the BNF’s palliative chapter?
So you can see which mast my colours are nailed to. And if my arguments don’t convince you, try some cliches next time you’re mulling over an LDL. Like, treat the patient, not the blood result. And cure sometimes, relieve often, comfort always. And above all else, whose death is it, anyway?
No. it’s not funny. But given the right care, I might die laughing.
Dr Tony Copperfield is a GP in Essex.
Someone talking sense, at last.
We are not meant to be in the business of extending suffering, but alleviating it and the next person who quotes “primum non nocere” at me will get thumped (joke!)
May sound cynical and selfish but before making too much noise about this, GPs ought to think this through. It won’t be long before people who could perfectly be managed in a palliative setting will be discharged at 3am from hospital with instructions to relatives to speak to GP in the morning to arrange ‘ease of suffering’ or such some pathway.
Similarly, this will be imposed as a part of the contract as unresourced care as people would wish to pass away in their homes. We will only be too happy to do this seeing it as our duty without a strong united voice to argue ours and ultimately the patients POV. But that’s okay folks, either AI or financial pressures will finish us off first while the big funeral care companies sell their packages as the data will have been handed over to Palantir et al.
A well balanced article.
Tip to through the minefield
Finally….some sense.
This blog is actually quite moving when you think deeply about it.
Doctor: Assisted death?
Patient: Yes.
Doctor: Good. Down the corridor, bay on the left, one pill each….
Doctor: Assisted death?
Patient: No, assisted life please..
Doctor: Oh, err, let’s see..we’ll need to get you on eol path, need your house valued, look at your savings, fill forms for UB, home care, OT….
Patient: Oh, just give me assisted death.
Doctor: Good. Down the corridor, bay on the left, one pill each….
(thanks to Life of Brian)
Not sure about the logical fallacy 1. GPs do lots of Useless things, Therefore 2. Let’s do something Useful like fulfilling requests for legal suicide.
After Shipman, at social do’s people would joke “didn’t know you drs were supposed to kill your patients”…..a prophecy in joke form??
Nor a big fan of the Westminster elite deciding this. In view of our (ie UK, not Canada or Australia or Switzerland..) cultural, religious, historical, and philosophical factors (not merely the legislative and medical) being airbrushed from the debate, a referendum would be better.
And prior to catching Keir’s ear, the only thing I remember Esther for, is 40 odd years ago getting a dog to say “shozziges” on her show. Oh how we laughed…..
Come on stbfw, that dog saying sausages was bloody funny…
https://m.youtube.com/shorts/g5qLcjcJ3UQ
😂
Do you think assisting suicide because someone is worried about being a burden is ok? No pain or suffering, but patient worried about how they will cope/ will they need care/ who will do it? Main reason people cite for AD in Oregon is not wishing to be a burden. Is this compassion? I also struggle with the principle of safeguarding vulnerable adults. How will we? A suicidal alcoholic with decompensated cirrhosis? Or someone who has had a terminal diagnosis and is scared, depressed and overwhelmed? We may all be vulnerable adults one day. And my last (overriding) concern is around the state of our health and social care system. The NHS loves the path of least resistance. A discharge to death pathway from hospital?. I completely agree it is not a laughing matter- it is frankly terrifying how this is likely to be abused given the socio-economic factors in the U.K. I give it 5 years before we have a Panorama investigation, and 10 years before there is a public inquiry into deaths from abuse of this flawed system. Too many huge conflicts of interest for it to be anywhere near safe here. And it will have been on our watch. I want absolutely no part of the impending ‘show’.
Couldn’t disagree more. Yes often EOL care works well. Sometimes it doesn’t or cannot, despite everyone’s best efforts. I watched one of my patients die a horrible death this year, with full palliative care input. Other countries manage this without fanfare or contention. Why is the UK yet again an exception? It may be the last compassionate act I can bring to a select group of patients.
@david.mummery, 40 odd years later and I’m laughing louder at the dog owner’s quiff 😂 – how the times have a-changed….
Respect the views expressed in the article. Yes, LDL micromanagement is murder of remaining sense.
But…call me mentally weak, selfish, short sighted, but I will not be able to sign a prescription of a lethal drug. Something prescribed with intention to end life?- Not by me.
If you were George, would you have shot Lenny?
very well said, and moving too. Those of us who have experienced many deaths and seen some awful ones tend to be supportive. Its disappointing that the hospice movement is so set against this. The research coming from countries where this is legal shows that 80% of requests for assisted dying are from patients already under hospice care. They are frankly being dishonest when they claim there is no need for a law change were they to have enough resources. I’m sorry but the hospice movment is quite shamefully deceiving the public on this.
100% in favour of assisted dying.
It is not about palliative care. Yes palliative care should be improved, but it plays no part in this debate at all.
This is about the right to self determination of competent adults.
To those who oppose this:
Nobody is forcing you into assisted dying, but just because you don’t want this, you have no right to deny it to those of us who do.
Thank you DT for finally cutting through all the BS around this debate and hitting the nail right on the head. This is about the right to self-determination and nothing else. It’s quite extraordinary the sheer number of people who think it’s absolutely fine to deny me self-determination because THEY don’t believe in it.
@So the bird flew away
I’m not sure there is a need for a formal referendum given the results of the yougov poll:
“Our study shows that 73% of Britons believe that – in principle – assisted dying should be legal in the UK, compared to only 13% who say it should not.”
https://yougov.co.uk/politics/articles/50989-three-quarters-support-assisted-dying-law
Excellent article. Medicine has lost it’s way and so has the country. The sheer amount of ADHD, personality disorders and neurodiversity etc coming through. One has to start asking if it is now a variant of “normal” by sheer numbers or someone trying to take unfair advantage.