I have refrained from discussing the assisted dying bill, but in the light of the decision made on Friday, very largely by Labour and LibDem MPs, to approve the second reading of this bill, I think it appropriate to do so.
I can see why, on rare occasions, assisted dying might be an appropriate option within a care system. In principle, I think this option should exist.
In practice, I do not trust this government with that option. Nor would I have trusted the Tories with it. The reason why is straightforward. I think legitimised suicide has always to be a last resort. My fear is that it will become anything but that because of government pressure to normalise it.
The problems are easy to identify.
We do not spend enough on health care to prevent people from dying in pain. We should spend what is required.
We do not spend enough on social care to support those towards the end of their lives. We should spend what is required.
As a state, we spend very little on palliative care or support for hospice care. We should spend what is required.
We do not support research into how to help people have a good death. We should spend what is required.
There is too little research into pain management for the dying and how the problem of double-effect (that the pain killers issued for this purpose might themselves hasten death) can be managed both medically and legally, with protection being provided for patients and doctors alike. That should happen.
And far too many find managing the process of securing care within the NHS an administrative nightmare. There is, in particular, a lot of evidence that those who are not used to managing bureaucracy find this very hard, and there is, as a result, a clear class bias in accessing care because the middle classes are usually most experienced in this way. This then leads to issues around economic access to care, which is decidedly unequal at present.
Put all these, I think undeniable, facts together, and we have to ask how assisted dying might work when we have a government that is indifferent to at least one-quarter of all children living in poverty and tens of thousands of pensioners dying from hypothermia each year because they will not provide the financial assistance that either group need. What will happen, in that case, when assisted dying is permitted?
Coercion by relatives will, I hope, be unlikely because I expect safeguards to prevent this will be made available. But the risk of coercion from a state that is not willing to fund palliative care - and claims it has to balance its books at all costs - seems likely to me. I can imagine a care institution saying in the future that it cannot fund a dying person's care, but they can fund their assisted dying, believing that is the option they can afford within the budget limits provided by the government.
For that reason, I cannot support assisted dying until the NHS is properly funded, social care is properly funded, palliative care is provided to all who need it, and doctors are provided with all the support they need to provide the care a person needs and wants.
Right now, there is no chance of that, and in that case, the risk of state-sanctioned killing to ensure budgets are balanced is something I cannot support but which I fear will happen.
To be blunt, this government cannot be trusted on issues like this. They are too indifferent to the reality of life in the UK for that to be the case.
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I agree wholeheartedly with your proposition. When the Liverpool Care Pathway was brought into being, it was intended to be a merciful way of ending a life of unbearable suffering. But government interfered in what should have been an ethical and medical matter, and, unbelievably, introduced target numbers and financial incentives. It was then largely abandoned, for the obvious reason that it was now involuntary euthanasia. But the Pathway itself is still used (as I personally know), and is a great mercy for those who need it. I now ask why the government is withdrawing finance from Hospices.
I`ve recently received a rebuff from you, Richard, implying that you think I`m sort of imbecilic in discussing the recent demise of my wife with one of your correspondents named Cyndi, about the death of our loved ones, in a topic that you yourself raised, on the most significant decision that some humans are allowed to make, if they are lucky. I assume that you have not fully read my meagre submissions, which is understandable, as you are a busy man. I`ve always enjoyed your exposition of mmt, which makes complete sense, but I regret I have to finish any observation of your blog, as it seems to show you up in rather a poor light
You wrote contemptuous nonsense about the state that implied a loathing for what it does and what those who work for it do. I know such opinions exist, but I do not tolerate them here.
I can mistrust neoliberal politicians, for good reason, but not your views, which I associate with the far-right.
If I may…………….there might have been a genuine mistake here.
P – your contribution was a bit muddled (as I can be at times when thinking and writing cannot keep up with each other) because it seems to me that you were both acknowledging that palliative care was underfunded but at the same time the ‘grasping tendrils of the state’ statement seemed to imply that you either thought that it was the State charging handsomely for such care or you meant to imply that to you government involvement is just a negative thing. I’m not sure really what you are saying and given Richard’s role as the moderator moderating everything – and lots of it – the uncertainty of your message is amplified.
I would say that here many see the State as a force for good, as well as having the best means – sovereignty and money sovereignty- to address these issues if only the politicians who have this means at their disposal and care were to use it!
Thanks
The trouble is that the follow up comments from P have added no clarity, so I stand by my opinion.
I understand the concerns. I think this is one of those issues where reasonable people can reasonably disagree for moral or practical reasons.
But it feels to me a little perverse to deny an adult, with full capacity and within six months of death, the option to choose the time when they may die with dignity until we have a health system that delivers perfect palliative care for everyone. That is never going to happen. The ugly truth is that palliative care is no panacea. For some conditions there is no relief.
This bill is also no panacea, as it does not provide the option of a dignified death to those living with conditions that make their lives intolerable but won’t kill them. But we should not let the perfect become an obstacle to the good.
And meanwhile we allow those with the ability and the resources to get themselves to Dignitas, even if that exposes their relatives to the possibility of prosecution for aiding an act that is not a crime.
You are, I think, avoiding my argument. That is about government coercion, not personal choice. My fear is choice is going to be taken away.
And, end of life is almost impossible to predict. That makes a mockery of this approach.
A few more questions.
In an NHS where it can take 7-10 days to even get a GP appointment, how much time will the doctors concerned be able to devote to exploring the various medical aspects of the process?
What wider effect will assisted dyeing have on the first professional ‘golden rule’ for doctors (‘Do no harm’) ?
What are going to be the legal complications of assisted dying cases before a judge, especially if there are ‘competing’ parties to be heard?
Having seen pics of large ads on the Tube ‘promoting’ assisted dying, who is paying for these and what are their motives?
The Independent recently carried an article regarding an American doctor (who it was said had be involved in many assisted dying instances) will this area, in time, become a privatised medical consultancy ‘specialism’?
1) Most doctors will want nothing to do with this. They must have the right to say no to any patient.
2) The real question is, will legal aid be available for this?
3) I have no idea who is paying for ads.
4) In the Netherlands some doctors are amnesty setting up to be specialists in this – for the right fee.
Nothing feels good about much of this.
As you know from my comment on a previous blog you wrote on this subject I’m a strong supporter of assisted dying. But while I share your suspicion of this government – and indeed any other – with regard to the potential to abuse policy, I seriously doubt whether it’s going to happen on this occasion.
Why? Because as with abortion, those who have a religious objection to assisted dying – and they are many, though most hide their religious objections behind arguments about the need for ‘safeguards’ (which when offered are always then insufficient) – will be all over the actual application of assisted dying (if we ever actually get it implemented, which I have some doubt over) like a rash. Thus, should any person, group, organisation, health body, doctor, nurse, government, or indeed any entity, try to in any way misuse or abuse the policy we can expect an almighty din of ‘told you so’ from said religious and other objectors. So, on this occasion I think your political radar is off kilter.
I wish it was
I am noting what is already happening in Canada
In Canada assisted suicide is seen as an option for young people with severe depression – when I read about this I was really shocked. In the times we live in – with a failing health service under pressure – I think there is a real concern that that the UK might eventually follow Canada in allowing assisted suicide for a wider range of health conditions and circumstances.
I share your concern – because of what is happening in Canada.
Ivan
I’m with Richard on this.
Your biggest threats are not just from religion my friend but the fact that government is inculcated with short term-ism which it gets from the market thinking it has adopted, which includes a model of economic viability that is based on ‘invest or divest’ (cows and dogs – the BCG Matrix for example). The fact that such reductionist thinking might be involved in dealing with such a human problem terrifies me and we might be grateful for the intervention of a religious POV.
For the record I am also accepting that in certain situations, allowing a person to humanely die is acceptable because that person could be me or someone I love who wants that and wants me to help and ‘let go’.
And again – religious matters aside – as a society for me this is a the right thing to consider at the wrong time. Unless that is that you think that being rich, you pay for everything that society has (for some stupid reason or other). What would happen if this idea was being floated during a Labour government actually behaving like a Labour government, for example?
Thank you, Thank you, Thank you.
100% agreed. Some observations of my own that I wrote down on the train to work the other day – they are very conflicting:
A decent idea in indecent times?
A cruel idea in a time of culturally reinforced cruelty in the absence of any sensible ideas about how to solve our problems (how long before we have assisted dying events on TV?);
A triumph of individuality against humanity in an age of the cult of the individual?;
Deeply dangerous;
A system that will demand safeguards that we are not prepared to pay for, and even flies in the face of the the current policies to push back the frontiers of the state?;
A system that requires regulation in a world that does not know what regulation is anymore (that is addicted to this false notion that man is rational and self regulating);
A proposal whose parameters should not ever be decided by the market (thinking of the ‘dead pheasant’ insurance that operates in America, where companies can insure staff against death and get huge pay outs when they die);
A proposal that has the potential to improve palliative and other high dependence care;
Should we not rescue the NHS first, making sure it is functioning before we even take this into law? How can you impose it on an already failing system?;
We constantly obsess about money being short when in fact we can make as much of as it as we need – is not the will of someone who wishes to die and ‘not be a burden’ merely a symptom of a society that has decided to not only limit state support and money but uses it so unwisely?;
Why are people still dying of diseases when all that money was spent on developing drugs like Viagra and other drugs and things like surveillance capitalism that help us consume stuff without actually solving our underlying problems? Why can we not invest in a concept of ‘life’ for once that is not related to us consuming something?;
Should the state not in the first instance explore how markets and their products already assist people to die with their unhealthy products and pollution? We could call it the ‘Assisted Living Bill’. Currently, all the markets want from us is our income, the state wants our taxes but it seems that when we as ‘units of consumption’ need to consume something we actually need – we are just encouraged to slip off our mortal coil and go quietly into the night – ‘Now piss off and die will you old chap, you’re no use to my bottom line’;
Is the assisted dying bill not just driven by fear alone, arising from the awareness of lowering standards in health care and poor research funding in the management of these diseases (care, pain management, surgery etc)? This fear needs to be plainly spoken of by both sides of the argument and continuously because fear IS there;
My last point is a bit harder to clarify but is based on my observations of Right To Buy (RTB) policy over the years in housing. So, the Tories launched RTB and off it went and a whole section of society benefited from it that met a certain amount of need. But what was left behind? Well, less housing stock for a start; not enough replacements to even sustain RTB; people who bought homes could not afford to maintain them due to the distortion of the subsidy and the market entrance cost or because their wages dropped or their work dried up (a sure fire indication that Thatcher had no idea what she was really doing – ‘property owning democracy’ my arse). There was also a lot of short term greed among buyers to seize an opportunity and bugger the long term view (can I afford to won it)? Also, RTB was very London’South East-centric initially.
So, once all those currently pushing for assisted dying have used this utility – what will happen then? What will be the state’s involvement and commitment to assisted dying be going forward? How will it play out? Will those pushing for this make it fit for purpose or just meet their own short-term goals at a loss to those who follow on and may be benefiting from advances in the care of certain conditions? Who will be watching when their is potential to actually improve the management and survival rates of these morbidity inducing conditions? Which brings me to my final and most worrying point;
Will the assisted dying bill be taken as a signal to stop any investment in the management and cure even of serious/terminal diseases? Will someone argue that that money can go elsewhere, be spent on something more ‘extractive’ for capital because people are seemingly happy to die once they can no longer consume as an economically viable unit? Or, how about what we are seeing in NHS dentistry where you can have a top class clinical experience – if you can afford it?
When a pall of silence fell over parliament after the vote, did they really understand what they might have kicked off?
I don’t know…………to me we seem to have ‘caved in’ and chosen death. Again.
Much appreciated
Excellent points, many thanks.
Much to agree on.
As someone who is opposed to the assisted dying bill, I am very disappointed with it’s passing, as I share the exact concerns of Richard, plus I do not trust the safeguards – there will be people (despite the laws in place) who would want to take advantage come what may, and the potential for a slippery slope is all too real.
I was so proud of Diane Abbott in so eloquently and vocally voicing her concerns, and why she was against, along with many others against.
Britain has been a pioneer in palliative care and the hospice movement. If any positives can come out of this, surely improvements in end of life care (not killing) needs to be central.
I stress, in principle I agree with assisted dying.
One of my father’s last questions of me was “Have you brought the gun?”
My problem is with the failure to provide real choice.
Both my parents died of cancer, my mother in 1977 and my father in 1993.
Both died in the local hospital without, as far as I could tell, much physical pain, but both certainly were in distress. I am convinced that they both died earlier than they might have done, as their doctors increased their morphine levels to ensure they were not in pain. For that, I am grateful to the doctors. I believe this used to be normal practice. Assisted dying without acknowledgment.
I also believe it is a great deal harder for doctors to act in this way now. For me, that is a shame but people should still be able to choose their time to go without relying on the personal beliefs of their doctor.
Much to agree with
Cyndy, I do sympathise with your losses. I believe I can relate to your feelings, as my wife died of an intractible brain tumour last year. She was a CNS, district nurse, and had witnessed and participated in the painless and longed-for death of some terminal patients, by means of appropriate medication by their GP. It used to be the way. Knowing what was coming, she asked to be euthanased by her medical carers, and in effect, they did . I`ve mentioned my thoughts in the comments above. However, there is a big problem. The government has invested enough in the Hospice movement to ensure that they have control, and of course they insist on efficiency, do more with less. I would maintain that the government has a duty to support generously the end of life needs of our people, but when essential services such as lifeboats and air ambulances are supported by charities, basically to keep out the grasping tendrils of government control, what are we reduced to except begging?
The gasping tendrils of government control?
What the heck are you talking about?
Do you really think that is what public employees do?
Richard, it was `grasping`, sort of like bindweed. I hadn`t expected you to be so unkind.
I hadn’t expected you to be so intolerant. I was not unkind. I wouldn’t tolerate someone offering such opinion in my home. If you think the NHS is being killed by something like bindweed, you are utterly mistaken. It is being killed by indifference and contempt from people most likely sharing your views.
Why should I tolerate such opinion here?
p paints a picture of hospice finances and government control that I can’t reconcile with the public record.
Here is just one of a swathe of available articles which point in the opposite direction.
https://www.bbc.co.uk/news/articles/c9rzdnl6315o
Having just buried my 93 year old stepfather two weeks ago and at this moment awaiting the death of my 90 year old father-in-law, I side with the argument of Abbott and Corbyn – let’s get social, community and palliative care sorted first. My stepdad would’ve taken assisted dying – he’d had enough, was suffering and still of sound mind. F-i-L wanted to die at home, with home-based care, before strokes removed his awareness and he was removed to hospital (no DNR so paramedics had no choice). There has to be a full, professional service in place long before impending death may offer a choice.
Thanks
We don’t spend enough on palliative care, adult social care etc…
Someone recently observed that if we didn’t spend some vast sum (£205 billion comes to mind but I can’t find the source to check) on replacing Trident then 30 thousand people would lose their jobs. Alternatively we could give each of them £1million and still have £175 billion for those care services.
🙂
I think the figures might be overstated but the idea is not.
Has anyone talked about numbers here? There seem to be a lot of different categories in people’s minds, both in terms of
1- those wanting and needing provision,
2- those currently being offered it, and
3- those in fear of it (the combined effects of austeriry, prejudice and discrimination verging on fascism, affecting disabled, seriously and terminally ill).
In times gone by, there was the “double effect” rule with opiates, mentioned by Richard which gave many people a gentle passage out of this life (but Harold Shipman rather spoiled that).
There was the development of the hospice movement, a uniquely homegrown UK phenomenon, arising from religious conviction but serving everyone without dogma, and the technical advances they made in their very positive, humane approach to end of life care – but they are now a shadow of what they once were because of austerity, and they never were properly supported by government in the first place. Will we have palliative care in 10 yrs time?
There remain hard cases, every one, humans suffering, some for ethical, some for scientific, some for social reasons. But how many?
How many intractable central nervous pain cases?
How many terminal illness cases where the end cannot be humanely managed?
I genuinely do not know the numbers or examples. And no one seems to discuss it openly. How many die avoidably very unpleasant deaths? How many can we still do nothing for?
In a post without answers, I would simply say, one person’s death should not have to yield to either the state’s or their family’s or society’s convenience. We will never be able to sanitise death to suit those who remain alive and that must never be allowed to be a motivation. Like Richard I don’t trust the state at this time to dischrage this sacred trust, and with good reason. But if not now, when?
What luxury we have here, to discuss the ethics and humanity of individual United Kingdom deaths, while all over the climate-ravaged global south and in the war zones of South Sudan, Gaza, West Bank, Syria, Lebanon, Yemen, Libya, Ukraine, Nigeria, people will die by the thousands every day, in great pain and prolonged despair, by the deliberate murderous actions of others, partly because our governments want it that way and refuse to change direction. We musn’t let them off the hook.
Thank you
I like this sort of challenging contribution
These are good thoughtful points from Robert J.
One of the best self-help books that I ever read was by Stephen R Covey ‘The 7 Habits of Effective People’ (1989).
One of the things I pulled out of the book was that we in these times are obsessed with with independence – marketing drives a lot of this – and that we increasingly look down our noses at forms of perceived ‘dependence’.
What Covey revealed to me was that we should actually consider ourselves to be inter-dependent creatures – the two polar opposites previously mentioned being merely unhealthy extremes – we humans are inter-dependent surely in life and at death? It is a fundamental refutation of what the likes of von Hayek and others have said said so arrogantly about ‘rational self-interest’.
And this interdependence is wide ranging, ranging from families, friends, to national and international forms if only we realised it.
‘Atlas shrugged’ eh?
Only if we let him.
I was birdwatching this afternoon, and we were discussing the randomness of this – whilst watching a marsh harrier. Given where we were, that bird was not a surprise sometine in the day – but we reflected on the fact that in birdwatching we can increase our probabilities but have no control – we are dependent on the birds for what happens. That just makes your point – it is our interaction with nature that matters – but it is an interdependency and we are not in control. We need to realise that much more often than we do.
Apologies to everyone.
But the country is in a mess.
Labour have been in power for nearly five months and has not produced any policy that might remotely start to fix the problems.
Yet gives parliamentary time to assisted dying. Is this government by focus group?
Now no steer Starmer is announcing a “reset” with big targets?
In my view this Labour government is absolutely clueless.
I was born during the 2nd World War (towards the end of it), so am ‘elderly’. I watched my Mother dying with pain and suffering, but she did have a ‘Living Will’. My Father, at almost 94 went very quickly – just a matter of hours after requesting me to cancel the table for lunch as he felt unwell – one member of the Clergy called it a ‘good death’ and I agree. My Father also had a ‘Living Will. Last year I was severely ill and not expected to live on a couple of occasions. At that time I had only a ‘Living Will’, but have since completed DNR and Advance Decision as I certainly do not want to go through what I went through last year again. My illness has taken a toll on my body but my mind is still, in my opinion, active, and my daily enjoyment, other than listening to music, reading books, reading newspapers on-line, is Richard, reading your blogs and the resulting discussions – I am in awe of your knowledge and thought processes and of the knowledge and thought process of many who join in with your discussions. Your blog does stimulate my mind, and those who speak against your blog are, I believe envious of your extensive skills and which leads to good and refreshibg discussion – thank you.
Many thanks Susan.
As I like to say, go well.
I believe this topic was last discussed in Parliament roughly 10 years ago and about 10 years before that and so on. Over these years where was the research and thinking by the slippery-slope brigade et al and the charity money poured into palliative care development etc?
It’s reported the churches – Christian and non-Christian – quietly collaborated and poured £60,000 in to a campaign to kill the bill. Without exception church holders opposed the bill they universally referred to throughout as suicide.
The cherry on the cake were the groundless fears whipped up that the passing of this incredibly restricted bill would open the floodgates for state enforced euthanasia of the handicapped!
Amazingly, a good majority of MPs saw through this fog of hysteria and reflected the 73 per cent public opinion that we each deserve the right to decide and control our own deaths.
Do you have an argument? There is no hint of one in that comment.
Well Richard, I disagree with you on this one! Apparently the Canadian example has been held up as a terrible example of where this legislation could go.. I don’t know why and as a Canadian I 100% support this legislation and only wish it could be further expanded to allow those who may fear dementia in their future to make advanced requests. This was supposed to come about this year but to many peoples disappointment it has been delayed again for another couple of years, and with a possible conservative gov. coming in it will probably be delayed even further. Its not just about unrelenting pain but an end of life where you are maybe confined to your bed, unaware of what’s going on.. what’s the point? I don’t think governments are the ones pushing this, but ordinary people who have experienced family members lingering in pain or just lingering pointlessly.. once again.. what’s the point? Personally I don’t want to hang about for months or years in a state where there is very little enjoyment in life and when I get to a certain point I will certainly sign up for a medically assisted death. The Canadian figureds right now are 9,664 or 2.4% of the Canadian population signed up in 2020, and in 2021 3.3% or 12,689 did so. In a population of 30 million or so this is not exactly a death cult in operation and there are plenty of safeguards and you can change your mind at any point. Relax people; if you don’t agree with it, you don’t have to do it! And as for being pressured into it by relatives the couple of cases I have heard about are about upset relatives who were not informed that their family member had signed up for the service, probably because they ( the about to be deceased)knew they were going to get pushback so they went ahead on their own.
There is clear evidence that state pressure is being brought to bear on people in Canada.
I think those expressing concerns do so appropriately.
Might you engage with the concerns I raised? You have not in any meaningful way.
I have no evidence of “state pressure” being put towards “pushing” medically assisted death in Canada. That doesn’t mean to say its not happening, but what is this “clear evidence” ? If anything, the government keeps backing off.
I think you can use Google as easily as I can.
I understand that you and most of your commenters have genuine concerns and reservations. I don’t trust the government either. But you seem to be demanding, and are content to wait for a more perfect NHS and social care system, something which I have no confidence will come about in my lifetime. Indeed I can only see it getting steadily worse.
And meanwhile, unfortunate people will continue to die horrific and undignified deaths despite having the capacity to express their heartfelt desire for their life to be ended.
That’s cruel.
People are demanding choice.
I am too, but a realistic one, and not just between death or pain. I want a choice of death and dignity, and to suggest that option cannot be provided is an indication of political resignation to which I will not subscribe. We can deliver dignified death without suicide (which will always be exceedingly stressful) and to pretend otherwise is to concede to a political system that just does not care.
I retired in 2011after 40 years in both hospital medicine and general practice. I have followed events in healthcare closely since. I will do my best to be succinct:
From my practice numbers (out of date but probably valid) only about 4% die in a hospice, 20% at home and the rest split about equally between hospitals and care homes.
Hospice care was a non-issue in 1948 and came on the scene in the 60’s. The reliance on the charity sector and the adverse effects of austerity have resulted in a hospice crisis that should make all politicians, particularly Starmer, deeply ashamed.
When I was a GP, the Primary Care Team with personal lists and everyday communication with district nurses and other care workers made care of those dying at home a crucial part of my work. Regular home visits, discussions with relatives and the patients, advice from secondary care and careful medication monitoring were all the accepted way of working.
A combination of ideologically driven market based policies with totally incompetent workforce planning and chronic underfunding has resulted in the destruction of the kind of family and patient oriented medicine that I used to practice. Successive GP contracts have meant that practice is about meeting targets to maximise income and meet centrally driven objectives. Looking after the dying at home doesn’t increase income.
Secondary care is broken up into subspecialties with advantages for expertise but problems when a wholistic approach is needed in older patients dying with multiple pathologies. Dying of heart and renal failure on an orthopaedic ward when you’ve broken your hip may not give you hospice care you need.
The care home sector has been privatised so the quality of care is patchy and extremely difficult to evaluate. Again, market ideology has resulted in care quality being subject to profit motive and market forces. See recent BMJ article
So, in the light of this, do I support assisted dying? On balance, no. Do I think that Starmer and all the politicians giving impassioned speeches about the need for good deaths are a bunch of hypocrites – yes. Do I think that dying is not well managed in the NHS – yes. Do I think that the crisis in the care of the dying is the direct result of a whole series of misguided policies, both Labour and Conservative.
Do I think that Streeting, with his obsession with hi-tech, targets, league tables and efficiency will make our dying any better- no.
Do I think that we are having the right debate- absolutely not.
All very depressing after a life in the NHS
I think you and my wife would get on well.
Thank you for this comment.
Difficult to disagree with Richard’s mistrust of the State’s ability/ to protect the vulnerable, the old etc.
So many instances of DNR ‘let them die’ notices – on those who could have been / were eventually saved
Many of those in favour of assisted suicide seemed to assume palliative care would not be available – so a painful end would be inevitable.
Surely assisted suicide and palliative care should be discussed together – and A.S. should not be an option, or indeed would not need to be discussed, if P.C. was available?
As I understand it the medication, and other treatments to relieve pain under a fully functioning palliative care system might ultimately mean a person descending into uncosciousness and then maybe the the end of life. And that is still allowed – without the need for the extra provision of assisted dying?
I think this is roughly what Richard is saying.
Robertj’s comments put all this into perspective.
You get it.
Did I need palliative care? Was I end of life?- my family were warned of such. I certainly needed post hospital support having been admitted via A&E , followed by emergency surgery x 2 and then several weeks in hospital (NHS were brilliant) , I was not conscious much of the time and when, after a few weeks, I was discharged from hospital on condition that I had support at home, there was no support – it was Friday afternoon so there was no support but l was stiil discharged as the bed was needed – no support – nothing! was I frightened = yes . (I suffered from Caecal Volvulus with compications for any medical experts!) – I urge anyone who has, as I did, insufficient legal documents, to ensure that all is in order – I had no warning of this illness, and indeed had just become a new Mum to a (very) lively puppy – and she now lives (very) happily on a farm in the Peak District and I have visitation rights ! (moral = there is a good side to everything!). Moral also is to have have all the papers in place and to make one’s wishes fully known – the NHS were brilliant but there were huge limitations – until these services are fully and properly funded, people such as I will suffer. There was no NHS when I was born, but it must be fully funded including paliative care, and efficiently run. The best part of my illness was the young doctors and trainee nurses who came to talk to me in hospital – they were fantastic as were the more senior staff – but funding is needed, and effectice management. Would I have welcomed assisted dying ? yes at times – but, thanks to the NHS Staff I lived.
Thanks for relating your story, Susan.
Rachel Clarke from the front line puts it very well
https://www.theguardian.com/society/2024/nov/30/good-palliative-care-can-alleviate-the-pain-of-dying-this-bill-means-labour-must-fund-it?CMP=Share_iOSApp_Other
Agreed
I trust her
No one has spoken about what happens when a person dies, from a scientific point of view. I have read not so long ago, that brain activity increases dramatically. Why? Does the same thing happen to people who die of illness as those who die naturally of old age? I don’t know, does anyone? What if the law is encouraging the stifling of natural processes? We with our limited consciousnesses don’t know the workings of all the laws of nature, we can only wonder at the red kite as it swoops from the sky.
I also think about survivors of coercive control, of which there are probably more than people imagine. What choice will they have? We don’t have enough doctors, nurses or care assistants for the living, never mind the dying! According to a friend of mine who was trained by and volunteered for the Samaritans, people in vulnerable situations, especially the elderly are prone to saying the opposite of what they really want. Who will speak on their behalf?
During Covid the NHS was routinely adding Do Not Resuscitate (DNR) notices on elderly patients records with no consultation. Now we have the US import NHS Managed Care, (also known as Accountable Care or Integrated Care) doctors will be placed in a very tricky situation. I am thinking of Linda Peeno’s testimony in Michael Moore’s film Sicko. At first she viewed using her medical skills to deny funding for patients, as a game. Then she came to the realisation of what she was really doing. How many doctors jobs will be on the line if they don’t promote this option?
I took advice on this one.
Technically you can say death happens because the organs fail, but it is apparently a bit more complex than that. Death happens because mitochondria, which are the cells that distribute energy – literally, electric charge – around the body cease to be charged. The battery fails. Mitochondria degenerate throughout life. Violent death creates this consequence in a different way. But the batteries always run out, is how it was put to me. I pass that on.
Thank you, Richard, for a well-argued discussion.
Regarding the concerns over the ‘direction of travel’ and state action as a matter of economics, I was reminded of the Japanese film Plan 75 – which I’ve not seen, but was chilled by this review last year:
https://www.theguardian.com/film/2023/may/08/plan-75-ageing-japan-euthanasia-suicide
I have heard of too many who have far out-lived the doctors’ expectations by years, (some I know personally very well, the others a more passing acquaintance), to feel in any way comfortable with this bill. I share Richard’s concerns, together with many of those expressed here in the comments.
I am really not sure that the medical profession will ever be able to predict an individuals future life span well enough for me to believe that this is a satisfactory change to our law, irrespective of the safeguards that are put in place. If passed into law, there will be the inevitable doubtful and highly disturbing decisions, all irreversible. How can the individuals involved ever be held to account?
Those who will bear the cost will be the relatives and friends of the diseased who may have disagreed with the decision of outsiders to shorten someone’s life, and for them it will be a lifetime sentence. I suggest that MPs do not have the right to impose such a burden on others.
How will MPs, who vote for the bill who start to have doubts about the wisdom of this decision, feel?
Can those who voted for the bill be 100% sure forever and a day know that they are absolutely right to have given this bill their support? What if they have doubts? They personally have no way back.
I wish it had never been put to the House in the first place. In all, highly disturbing.
The medical profession cannot predict life expectancy, and don’t.
All they can say is they would not be surprised if someone was dead after X months or years. Over 70 it gets a lot easier to sy that of a great many people, but it doesn’t mean they know.
I asked fur advice on this.
Thank you Richard.
You wrote “The medical profession cannot predict life expectancy, and don’t. All they can say is they would not be surprised if someone was dead after X months or years”
The implications of this have firmed up my views against this bill. The opinion of a doctor now must surely be based on their experience over their years post-qualification. I find it difficult to believe that a doctor who has, say 5-10 years experience, can be given the same weight as one with 35-40 years.
It must also depend on how often their work has brought them into contact with a particular problem. Rare conditions exist, so how can any doctor given a reliable opinion. It becomes, what in other areas, would be called guess work.
So now, I am even more of the opinion that this bill should not be passed into law.
We should not play God.
Spot on Richard!!! I think in principle humans should have a say in how and when they pass over, but in practice I’m fairly sure it will be abused. A lot of people, regardless of age, will be driven to an early end.
I do not trust the government to handle this either for exactly the reasons you specify. My fear is that this may legitimise DNACPR where the patient hasn’t necessarily asked for it. As has been the case with some neurodiverse individuals during the covid pandemic. I do worry.
Until yesterday I supported the Assisted Dying Bill on balance.
Having read your reasonings as to why the Bill is so dangerous, and also just watched Dr John Campbell’s similar reasoning in his latest YouTube video, I have changed my mind.
I can no longer support the Bill.
Thankyou Richard (& Dr J C).
Thanks
Leaving ethics on one side for a moment (although I could write & debate reams on it)…
Legislation is one thing, providing the service is another.
How to find 2 GPs when finding a GP nowadays is such a struggle?
How to access the court system when there are such huge court backlogs?
How to get the drugs required when pharmacies are overstretched, and supplies of therapeutic drugs sometimes uncertain?
Who will oversee/regulate this process given that the potential for legal and medical abuse is high, and UK regulators do not have a good track record?
Finally, the question that asks who these new freedoms are FOR. Who will pay for this service? Will it be free (available for all on the basis of need, not ability to pay) or charged at the full economic cost of drugs, documentation and professional time?
These questions are not in themselves an argument to block the legislation, but passing it, without answering them satsfactorily, would be highly irresponsible, and very cynical.
Wirh respect to palliative care, we already know what is happening, the services, the staff, the beds, the drugs, the finance, are all drying up because the state “can’t” (won’t) afford it and charities no longer have the income.
Has the state suddenly found a funding stream for an assisted suicide service, free to all at the point of need? I wish they would do something about the assisted living service, because round here, its falling apart (new notice at our GP surgery, we can only mention ONE THING during our 10 minute consultation).
All excellent questions
And remember, you will only get 10 minutes to persuade the GP you want to die
To PSR, thank you for your generous view of my inadequately-expressed comment. I have a loathing of all that the Right says and does. My opinion of politicians has been informed by observation of their actions over a long period. Perhaps this contempt has coloured my view of the State as such, it was not my intention to let this form any part of an argument. I seem to have given offence where none was intended, which I sincerely regret. Any criticism I express is directed at people who want to destroy a communal effort towards making life and indeed death better for all of us. The State is a collection of people, after all, and I am actually in awe of the vast majority who give their time and talent to us all.
OK
It looks like I misinterpreted you.
Apologies.
It happens sometimes.
Thank you. My fault entirely. I think I left out a word, which entirely changed what I was trying to say. Not up there with `Thou shalt commit adultery` (The Bible, 1631), but obviously enough to cause unintended offence. Sincere best wishes.
Thanks
@p
Perhaps “the State” carries the meaning of the establishment, authority, power – and can be negative and brutal, whether of the left OR the right.
Whereas “government” is more of a term that divides right and left, where the left see a role for the state in investing in infrastructure for the public good, whereas the right doesn’t really believe in that function of government, because it thinks (or tells us) that markets can do everything, it wants v small government (but it still wants a powerful state to protect the wealthy).