doctors and dignity

Just seen this link – ‘UK doctors consistently oppose euthanasia and assisted suicide‘. It describes a literature review of doctors’ attitudes to assisted suicide over the last 20 years, confirming that the medical profession as a whole remains reassuringly unconvinced of the value of modifying a doctor’s role to include intentionally ending their patients’ lives.

It jumped out as I’ve just recently read Against Physician Assisted Suicide: A Palliative Care Perspective, by David Jeffrey (2009).  (Amazon)

Jeffrey points out that palliative care and physician assisted suicide are fundamentally incompatible, and the perceived need for the latter arises only in the absence of the former. The UK is currently the world leader in palliative care, the approach which seeks to improve the patient’s quality of life through the prevention and relief of suffering.

It’s only a short book (120 page paperback)  but it covers a huge amount of ground – ethical, legal, and practical issues surrounding the care of the dying, with a helpful analysis of the failed Joffe Bill and the situation in Oregon and the Netherlands, where forms of assisted suicide have been legalised.

Most usefully of all, it calmly, gently, and thoroughly dismantles the myth that dying can only be dignified if it happens at a time and in a way under your own control. The ‘suffering’ component of any illness is much more of a psychological and social problem than medical, and once patients have their pain controlled, if they are assisted to address their fears and feelings of hopelessness, whatever attractiveness they had seen in ending their life prematurely seems to quietly disappear.

Scaring people about the horrors of old age and illness is a great way of instilling the idea that life is not worth living unless you’re young and fit, but it’s really just an unrealistic and defeatist attitude which treats human life with vastly less of the dignity it pretends to – as untold numbers of disabled and older people can testify.

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5 thoughts on “doctors and dignity

  1. I posted this on wur blog a while back – a comment by Paulinus on Fr Ray Blake’s blog (a post about the NHS):
    Interestingly, although most doctors are opposed to euthanasia, when you look at the figures by specialty, those who are most likely to support it are precisely those furthest from frontline practice (lab doctors, pathologists, radiologists) and those who oppose it have most frontline experience of death (palliative physicians, oncologists, geriatricians).

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  2. That’s interesting. Corroborates what this wee book says –
    “Over 90% of doctors working within palliative care oppose euthanasia and PAS. Why do those most involved in the care of dying patients believe that PAS is an inappropriate response to suffering, whereas the general public seem to support a change in the law to permit hastened death?”

    Again – “Lawyers and philosophers, who have little or no experience in the care of dying patients, have been prominent supporters of the legalisation of euthanasia and PAS, whereas those directly involved in the medical and nursing care of the dying are intuitively opposed to any change in the law to allow intentional killing. The practical aspects of caring for dying patients have been neglected in the debate, yet they are of central importance.”

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  3. A very good lenten reflection.

    These are issues which tend to attract doubtful ethics from many religious groups. While welcoming a debate on death and dying, it appears that death and dying has been made part of the core curriculum of any art installation, radio programme, tv programme, reality ‘planning your death’ programme, waiting for the ultimate exit. While it’s true in the recent past death and dying had been swept under the carpet, we’re now beginning to recreate the death and service industry with all its invented ritual, ceremonies and expense. Did you know that funeral directors study demography and it’s in their interest to anticipate ‘trends’ in death, dying, bereavement counselling, lonely hearts, spiritualism and such like. I might be a cynic …

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  4. Hi, Cath,

    My aunt spent six weeks at my house while I gave her palliative care (cancer IV). She died about a month ago, in the spare bedroom, while I held her hand.

    Since I’ve just been through this, I am absolutely certain that the push for PAS is much more about carers wanting to be free of the burden than it is about any idea that PAS gives more dignity to the dying.

    I was comparatively lightly burdened, since I loved my aunt dearly, have faith in Christ, and came in as a carer very late in the game (because my aunt refused to make arrangements earlier in her illness). I still found the going very tough.

    I felt very much the meat in the sandwich between the hospice movement, whose emphasis was patient comfort, and the doctor, whose emphasis was prolonging life to the last instant. Because of this tension, I wished desperately that someone would take over and solve the puzzle as to whether my aunt’s remaining days should be comfortable or long.

    In the end, the puzzle solved itself pretty quickly, but I didn’t know that would be the case – I was prepared for six months of care, which included sleeping in the same room as my aunt (since she persistently tried to get to the toilet by herself and would fall.)

    Because of this experience, I have deep pity for those carers, especially elderly spouses, who hint to doctors that the dose of morphine might be increased, and who find themselves eyeing soft pillows. I’d be hard put to explain to anyone what was the value of my aunt’s death, conscious pretty well to the last, and groaning at one point, “Oh, I hate this.” I do, however, pray that there was and is an eternal value that is now known to my aunt and will one day be known to me.

    I’m pretty sure that PAS will be universal, soon, and its use normalized to the point of expectation. At that point, if the Lord does not return, I can only hope that He so reduces Western living standards that, precluding long end-games, we all die, early and quickly, of the ailments that took our forefathers . It would be no more than we deserved.

    Best

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  5. Thanks for writing this. Everybody’s circumstances are different and it’s impossible not to feel for people who see no alternative but to bring life to an end, and yet everyone from medics to family members know that something has gone wrong when that’s how things look.

    People in favour of PAS like to give the impression that it’s inevitable, only a matter of time, and perhaps not even hugely different from what many doctors/patients already experience. David Jeffrey mentions this in his book too. Experiences like yours show that it’s not even desirable, far less inevitable.

    Sorry for the slow reply.

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