Dr Katie Musgrave on the assisted dying bill being introduced to parliament this week
I’ve been mulling over how to develop a portfolio career over the coming years, and I think I’ve happened upon the perfect opportunity. I’ll train to become a GP with a special interest in death. I’m convinced there could be real scope for higher-end private practice. And living in a well-heeled, rural part of South Devon, it seems I am ideally placed.
Very soon, assisting with death may become part of my day-to-day NHS work. Alongside requests to visit our frail and elderly patients, there will be requests to ‘sign off’ patients on the assisted dying pathway. Maybe this will come with an £82 fee? It could prove light-relief from more complex medical appointments. We’ll soon be falling over ourselves to sign up for the death rounds.
Realistically, it will be impossible to argue that someone is ineligible; anything from quiescent prostate cancer to chronic alcoholism should tick the box. Before long, fibromyalgia and ADHD will suffice. Since, who are we to determine whose suffering is more unbearable?
I’m not sure how our local palliative care team will engage with the pathway. I expect it will be a case of giving patients the option: if the waiting list for palliative care is too long, or there’s no hospice bed, then there’s always assisted dying. Thinking about it, syringe drivers are so 20th century; as big pharma have developed brilliant new drugs that are far slicker.
It may – just occasionally – prove tricky to navigate safeguarding issues. For example, Mrs Jones – whose niece is determined should stay in her dilapidated bungalow, without carers or cleaners – might suddenly find herself put forward. Or Mr Thomas who remarried a much younger lady – perhaps she might enthusiastically support his desire for assisted suicide, but how will his children feel about it? Or that sad situation with a mentally ill 20 year old, who gets admitted every few months following an overdose. Maybe A&E will provide a walk in death clinic for the repeatedly suicidal? Second overdose with a chronic mental illness, and you could go there? Or two GP appointments followed by a direct referral to level 7?
In terms of resource use, assisted dying is a complete no brainer. All those years of chronic disease monitoring, and the social care costs. Not to mention the burden of home visits, or care home rounds, on the hard-pressed GP. Our housebound list might become a thing of the past! And when there’s an eight hour wait for an ambulance, I could probably get to a patient’s house to assist with suicide during my lunch break. I expect I’ll receive calls from paramedics advising that some of my patients would prefer this option over a trip to A&E. They are always under pressure to reduce admissions.
The hospitals would love it too. No more ‘bed blocking’ with patients waiting for social care packages. Secondary care will need to swiftly assemble an in-hospital death service, and likely a ‘discharge to death’ team. The cost and efficiency savings would be extraordinary. In fact, this has the potential to completely revolutionise the NHS!
The only possible fly in the ointment for me, might be that assisted dying would be the perfect, defined scope of practice that NHS England needs to provide for the now infamous physician associates. If they can’t reliably distinguish a systolic murmur from a ventricular heave, then what does it matter: since the patient is dying anyway. In fact, I think our social prescribers might be best placed, and would have the highest take up. Hmm, maybe I need to develop a plan B…
I hope you don’t feel I’m being flippant – because seriously, there are so many arguments in favour of this law change, I’m truly astonished it hasn’t been pushed through parliament sooner. I mean, what could possibly go wrong?
Dr Katie Musgrave is a GP in Devon
Hahaha….excellent. Hilarious, I nearly died laughing. Sold, I’m putting my name down before a 10 year NHS waiting list develops!!
We have so many diseases of affluence, we might as well add “life” to the list…..This Govt’s given up on “assisted living”…
Can we convince any of the current crop of politicians to be the beta test subjects for this new service.
flippant, offensive and uncharitable I’m sorry to say.
How can anyone who has witnessed the miserable death a few poor individuals have suffered show so little sympathy or compassion. In none of the countries where an assisted death has been allowed is there any desire to reverse the law change. The cross party investigation of the subject came out in favour of a law change. The one finding that particularly struck me was that of those requesting an assisted death 80% were already under hospice care. This exposes the hospice’s claim that given enough resourses there would be no need for a change in the law to allow an assisted death (in strictly limited circumstances).
we, as caring doctors should concentrate on the relief of suffering. It will only affect a small number of patients and anyone whether patient or doctor is entirely at liberty to have nothing to do with it.
This is a flippant article. Assisted dying is about patient choice when facing a slow and inevitable death. It is not for the reasons suggested in this article. Given the failures to change the law in the past it is not a topic for humour yet.
Couldn’t disagree with you more Gordon. Death is part of life. Its the ultimate inevitability for every one of us. We are all going to die. Everbody
To me palliate care is to doctoring what Wales and Scotland were to the Romans – the last refuge of the GP
Life’s a piece of shit (hoo-hoo)
When you look at it (hoo-hoo)
Life’s a laugh and death’s a joke, it’s true (hoo-hoo-hoo)
You’ll see it’s all a show (hoo-hoo)
Keep ’em laughin’ as you go (hoo-hoo)
Just remember that the last laugh is on you (hoo-hoo-hoo)
https://www.poetryfoundation.org/poems/46569/do-not-go-gentle-into-that-good-night
Enjoy yourself ..its later than you think!
A sadly cynical article. Easy points to raise a wry smile.
If we argue that we can’t make changes because sometimes we might get it wrong, well, we will. Isn’t the point that there are cases where we are getting it wrong for some people now? Are we listening? Are we open to challenge?
Fully agree with Jonathan on this . There are times for Medic humour and this is not one of them.
This article is disappointing. It’s not that assisted dying is too upsetting or serious a subject to be treated humorously. It’s that satire is an unsatisfactory response to a decision that has been so carefully and cautiously taken.
When some insane new directive drops out of a clear blue sky (anyone remember GPs ideally placed to do boiler checks?) then satire is the perfect way to skewer the arrogance of whoever apparently spent six whole seconds thinking up a “policy”.
But here, the assisted dying bill is the careful result of DECADES of debate and negotiation between well-informed and morally serious contributors.
I’m “pro-choice” on this matter but I would never ridicule the “pro-life” arguments because pro-lifers raise important and serious questions. Neither side in this debate deserves to be satirised.
I have no problem with the humour in this article, even though I passionately support the right of terminally ill patients to be assisted in ending their own lives.
The author makes perfectly valid and serious points about the slippery slope to widespread euthanasia using wit and satire. Anyone familiar with Jonathan Swift’s “A Modest Proposal” (essentially, eat the poor to reduce population growth) will know that there is a proud tradition of using satire to skewer even the most sensitive topics.
I agree, David
Black humour is a coping mechanism, very relevant to our job
Sometimes, as Oscar said, “you would need a heart of stone not to laugh”
I agree with Jonathan Heatley’s inital remark, that this “article” is flippant , offensive and uncharitable.
Assisted dying as a concept needs to be dealt with on a much, much more mature level than Dr Musgrave seems capable. It must be considered with a compassionate, vocational and sympathetic manner, and the patient themselves and the family treated with far greater dignity than Dr Musgrave seems to believe.
Assisted dying will be a potential minefield of problems, that must be dealt with holistically; and not merely as a “nice little earner” reserved for the wealthy in affluent areas.
I understand that Dr Musgrave might well have been clumsy in her grammar, but if a doctor is not very careful about not just what they say, but also how they express themselves, then miscommunication, misunderstanding and terrible errors will inevitably ensue.
The health profession is not there to polish off inconvenient terminal disease patiebts.
I believe in the concept of assisted dying, but if we appear gungho about it, then error and great trouble will occur.
I don’t agree with ad hominem attacks. Surely it’s clear to anybody that Dr Musgrave is an experienced caring GP and raises concerns re assisted dying and, in a venerable tradition, wittily uses satire to make her point. Whichever side of this longstanding debate we’re on, we all know the seriousness of the arguments, for and against, and we’ve all been involved in death and dying of our patients, and in our families.
Slippery slope but serious moral question – if the bill is passed, down the line do you think people will also want The Choice of the manner of their assisted dying – eg by injection, or say by hanging. Or is this just more gallows humour?
Incidentally, my Palestinian doctor friend argues that while the West have the luxury of discussing this, he wishes the Gaza people also had some choice in the manner of their “assisted” dying… Difficult topic, death, you can’t avoid it…
It seems the medical profession is behind the curve of public opinion on this one. To put the opposing view, I for one would consider it an solemn honour to be involved in this last act of medical kindness.
Brilliant!!!!!!!!
I hope you never see a loved one die a long, miserable, undignified and painful death.
Perhaps GPs would be best sticking to GP care?
Avoid potential conflicts of interest perhaps?
Not at all clear why assisting death would require ten years of training, and that assisting death is the most effective use of those who complete training.
The Captain of the merchant’s of death has spoken