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DYING FOR A CHANGE IN THE LAW (Part Two)

19-06-2007

The recent release of Jack Kervorkian, America's so-called "Doctor Death" has re-ignited the debate about euthanasia. Barbara Panvel (link to article) recently argued on The Stirrer that helping those in pain to peacefully pass away was the mark of a civilised society. Dr David Nicholl explains why so many doctors disagree.

Euthanasia is a subject which arouses strong passions on both sides of the debate and Barbara Panvel's posting prompted me to give the other side of this debate.

Why is it then that when the subject comes up the majority of doctors are against the idea of 'physician assisted suicide' or 'assisted dying'?

When the Lord Joffe's attempt to change the law failed, surveys from both the Royal College of Physicians and the Royal College of General Practitioners opposed Joffe's bill by roughly 70% (the exact opposite of the level of support amongst the general public).

The level of opposition for Joffe's bill amongstdoctors involved in palliative care was even higher at 95%.

Why the difference in opinion between the medics and the public? What follows is a personal opinion and for obvious medico-legal reasons some details have been deliberately left vague.

Death and illness are the time of our life when we are at our most vulnerable and therefore most in need of protection from the law.

All of us are eventually going to die, but I suspect most of us, whatever our beliefs fear a death that is undignified, painful and distressing, rather than death itself. Thus the issue is not usually a fear of death but a fear of suffering.

In addition, I think that there is a misperception amongst some that all doctors want to do is keep the patient alive whatever the cost. Some time ago, I was made aware of a particularly tragic case somewhere in the UK where the patient was in a vegetative state not dissimilar to that of Hillsborough victim, Tony Bland.

Every single clinician and nurse involved felt that further supportive treatment was futile- the patient was not capable of feeling pain or any response and was reliant on a ventilator.

A decision was made to withdraw treatment but on several occasions the family threatened to place murder charges against any member of staff who stopped the ventilator.

The case ultimately had to be heard in court and the courts backed the medical staff in their view that further treatment was not in the patient's best interests. As a result, ventilatory support was withdrawn and the patient subsequently passed away painlessly.

This however was not before a number of invasive medical and surgical procedures had to be performed in order to keep her alive pending the court's judgement. Was this 'assisted dying' or was this 'defensive medicine'?

I would say neither, but appropriate medical treatment in a tragic case where the courts' opinions were only sought when there was a difference of opinion between the clinicans and the family concerned.

This case illustrates the extremely complex ethical and legal dilemmas that are dealt with in hospitals all over the land using the existing legislation but for confidentiality reasons the public would not normally have any inkling of the issues involved.

The most controversial figure in the pro-euthanasia movement is Dr Jack Kevorkian in the US (aka Dr Death) who was recently released from prison. Several of the people he was involved with had mental health problems, or problems with drug and alcohol abuse.

For example, Rebecca Badger, a single mother with a long history of depression was thought by Kevorkian to have multiple sclerosis but no evidence was found at post mortem. Judith Curren had chronic fatigue syndrome, not exactly a terminal illness.

So the issue, for many doctors, is ensuring that there is adequate palliative care to ensure that death is pain-free. I believe that the current law and its implementation are appropriately balanced in protecting the rights of both patients and staff.

I would strongly recommend patients consider taking out a 'living will' to help patients and their families communicate their wishes to medical staff. We do try to listen (although I probably draw the line at a murder charge!).

A change in the law would open up society to the abuse of vulnerable patients by, for lack of a better term, quacks like Dr Kevorkian. The bigger issue is whether there are enough resources for palliative care, pain relief and good nursing care.

That, I believe, is where the focus of debate should be, because that is where, so often patients and their families feel let down hugely.

(To see Barbara Panvel's article which kicked off the discussion, click here)

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