“A Die-Lemma”

Dying is not a subject most people want to contemplate.  It engenders sad emotions and fearful prospects.  Nonetheless, it is a subject which we will all have to face more frequently as our population ages.

What prompted me to write this blog was a short three paragraph piece in The Daily Telegraph on the 19 April – just a page filler – not a big news story.  The report covered the fact that a Primary Care Trust in North Essex had suggested to care homes that they should not dial 999 when an elderly person was dying, providing they held a “do not resuscitate” form from a resident, their family or a doctor.  The suggestion was that care homes were ignoring such requests and dialing the emergency services anyway.

I am sure this policy is well intended.  It is certainly true that most people would prefer to die at home.  Whereas currently the majority of people die in hospital, all too often in desperate circumstances.  Therefore you can sympathise with GPs / PCTs who are trying to enable more people to die in their own homes.

The problem as ever is in the detail:-

Who decides when someone is dying ?

  • An unqualified care assistant on duty alone in the middle of the night ?
  • An about-to-be-bereaved relative in a late night phone call ?
  • A local doctor covering the night shift who has never met the resident before ?

Who waits in the wings to pass judgement ?

  • The care home owners rightly fearful of ending up in a court action over negligent care ?
  • The Care Quality Commission every ready to be holier than thou with the benefit of hindsight ?
  • The coroner at an inquest weighing the opinions of all the people who weren’t there ?
  • The no-win-no-fee lawyers ever eager for the next lucrative case which can be made to drag on for months / years ?

With these witnesses and prosecutors behind you, it is a very bold person who can make a compassionate decision on life or death.

The medical profession is more and more able to prolong life at all costs, while the legal profession is increasingly geared to assigning blame at great expense.  An unholy alliance accidentally designed to ensure elderly people do not die with dignity in their own homes.


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4 Responses to “A Die-Lemma”

  1. david freeman says:

    A very emotive and well put pitch. Everything has been rolled up into a small time frame I believe of dying at a moment? I can see your point and feel your empathy for all the good intentions: However I would propose how to die well!
    In and unforseen circumstance death is in the hands of ones god, or beliefs. I would suggest that as we approach that age of senility and the bibles 3 score years and ten that maybe we discuss with our loved ones the likehood of a terminal illness, ailment or progreesive decline in one facalties the most proberble out come, of what we as individuals would want in the case of a sudden demise and debilitating condition, and advice we may offer to our loved ones and carers in the shape or form of a living will.
    I believe that as I have watched my senior members of my greater family reach the crescendo of their personal life on this earth. They have, while they have the wit and ability to realise that they are facing death, and that they wish to make their own personal peace, so I do believe my time will not in the end be controlled by me personally, by by a loved one (Relative or not), and I do not wish to burden them with a decsion, that I will have to face and I am sure in time will make.
    Be sure here I am in no way advocating euphenasia, but a sensible way to the future.

  2. Maureen O'Neill says:

    I cannot comment on care homes but I can comment on hospitals.When my husband was so very ill they asked me if I wanted him resuscitated if necessary and I said no. I also said I wanted him to be kept free of pain. The doctors and nurses were so very kind and he was kept free of pain.
    The other day I thought I would use his camera and I found on it a photo of him when he was in hospital – I had visited everyday for nearly 5 months and as he grew weaker and unable to even turn or sit himself up I had become used to seeing him like this although it was upsetting. His brain was working very well though. When I saw this photo I was shocked and as I looked at it I realised that although I miss him I am glad he died. He would have hated lying in bed, fed with a tube and unable to do anything for himself.
    When one is younger one hears about the quality of life but it is only when the quality disappears that the reality is apparant.
    An aquaintance of mine is dying from terminal cancer and has very little time left. If he suffers as it reaches his brain the hospital won’t take him in because he will block a bed and they can do nothing to help. They do help of course to keep him free from pain. This leaves a very willing hospice with no room at the moment. It seems to me that dying is sometimes in the hands of the hospital,at times in the hands of carers but that what ever happens God will decide.

    • john graham says:

      Thank you for this.
      It adds a powerfull insight into some of the issues that relatives have to face with end of life care. They can be eased by support from doctors and nurses with specialist skills, particularly in a hospice.
      My concern is that they are life and death matters that should not be left to care staff , who may be subject to all sorts of other pressures.

  3. begethers says:

    Thank you for writing about death. My mum is a lifelong nurse and one of her patients recently said to her:- “I wish i could die in your arms.” – she emobodies compassion and kindness.
    Recommended reading on the subject of dying and compassion (whether of a buddist persuasion or not) – The Tibetan book of Living and Dying.
    Sogyal Rinpoche

    thank you
    Andy Bradley

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