A couple of months ago on the 20th June 2011, I wrote about assisting early death and the apparently more liberal attitudes to euthanasia in Holland, albeit with some safeguards.
A graphic illustration of the issues is shown in a recently reported case at a General Medical Council tribunal, where a Shropshire GP is facing a misconduct hearing for allegedly hastening the death of a 65-year-old man, terminally ill with lung cancer. The patient had been given a large dose of pain relief drugs in the knowledge that this may hasten his death. The family were informed and a specialist was also in attendance. The man had recently been discharged from hospital, presumably to allow him to die in his own home. The doctor had visited regularly and on his fourth visit in 24 hours, he administered the final drugs. Over the years this must have happened quietly in the night to many other people, where a caring doctor has eased the painful end to a life.
Now in these more judgemental days, that’s not the end of the story or the distress. A worried nurse reported this incident as a “serious deviation from end-of-life care standards”. Thereafter the due process of retrospective assessment takes over, the police become involved followed by the lawyers, then there is no turning back. What may well have started out as a compassionate and caring act, becomes a potentially criminal act.
It is not my intention to judge the rights and wrongs of this case, merely to highlight the difficulties:-
- If the patient had been kept in hospital, no doubt the hospital doctor would have had more support at hand but it is the desire of most people to die at home.
- If the GP and the nurse were able to discuss the options more openly between each other and with the family, they may have reached a consensus decision and the death would have been accepted by all involved. But it is not easy to have these conversations, especially with relatives, in such stressful situations.
- If the patient had made a living will expressing his wishes in such circumstances, the decision might have been easier – although not necessarily legal. However, few people like to think ahead to their death and cancer can arrive with great speed.
- If there were a more substantial range of home care for the terminally ill, such as “hospice at home”. This situation may have been resolved differently. Specialist services like McMillan Nurses have a great reputation in this field.
- In the year and a half following the patients’ death, the relatives will have found it a very difficult bereavement; the police will have spent time investigating whether they have another Harold Shipman case to deal with; and the GP will have endured the anguish of not knowing if he will be struck off and maybe prosecuted.
These examples and others like it will be repeated many times in the years to come. If a climate of fear and blame is created, it can only result in doctors trying to keep patients alive at all costs. More patients will be sent back to hospital to end their lives in a prolonged period of ill-health and pain before they are allowed to die.