A really difficult issue this, touching on the deepest aspects of what it is to be human. I certainly don't want to go out screaming or panicking, but I'm not at all sure that's where we are right now in most cases. Let me explain.
I have been present at the deaths of all four of mine and Mrs D's parents. One of them (at 88) was completely out of it already. Of the others, all in their 90s, two positively wanted to go and the third was taciturn on the subject, but didn't seem overly fretful. All were quite ill.
Here's the thing. At the end, they all went "peacefully" with a legful of morphine (in case you don't know, UK "palliative care" includes having a morphine-cocktail[1] pump strapped to your thigh) - administered by a senior nursing Sister and, (since the pump is authorised by a doctor) evidently approved a few days earlier by a doctor.
These four were in three different establishments: two hospitals and a nursing home (private, but which is qualified to administer end-of-life treatment in house[2]). It was, quite obviously, the standard procedure, or "pathway" as everything in the NHS is termed these days. I don't know if it's universal across the whole service.
This seems to me to be humane, and pretty satisfactory for very many circumstances. I might even say: that's how I want to go. It almost seems like the old system of legend, where at some point a doctor would "take a view" and quietly do whatever he did.
What would happen, though, if it all becomes formalised - two doctors, a panel, lawyers or whatever? You might argue that formality is necessary for cases where people are not already on their deathbeds, but are Definitely Doomed under whatever are the definitions of an assisted dying law (MND and other ghastly cases); and declare that Now is the Time. But what about the poor old person who at present can be eased out humanely at the end by Sister, as in my family's experiences, and for whom a big loop through paperwork and multiple sign-offs is not going to be remotely possible? Will the duty doctor be obliged to refuse the morphine because it's just not allowed any more?
I haven't listened to the Parliamentary proceedings: but does anyone in debate dare to mention the rather satisfactory (IMHO) status quo? None of us fancy MND - but which of us wants to be deprived of the morphine at the end?
All very difficult. What do we realistic grown-ups think?
ND
UPDATE I forgot to add: the morphine pump is an 'and/or' with that other traditional expedient - allowing pneumonia to set in ("the old man's friend"), which is well-nigh inevitable when the antibiotics are withheld from a very sick / old person. I am never clear whether this badly distorts reported health statistics, if some vast proportion of deaths are attributed to pneumonia. Do they in practice just always read past the first line of the list of 'causes' on the certificate, and focus the top one of the co-morbidities listed below?
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[1] There's more than just morphine involved: there is tranquiliser, plus choking and vomiting suppressants.
[2] Which is why one of my Aged Ps chose that particular home, having had their fill of NHS corridors.
9 comments:
"What do we realistic grown-ups think?" I think that's a very decent piece of reflective writing.
But I would because my thinking is pretty similar. I want to be able to opt for a morphine blast when I've had enough of pain or anguish. What's harder to work out is what to do with poor sods who are obviously distressed but unable - by reason of dementia, for instance - to explain their own wishes. Putting them, undefended, into the bureaucracy of the lanyard-wearing classes may well be bloody cruel.
Just about relevant: my wife was involved years ago in some research which turned up a fact that took her interest. It involved part of the country where home births had been the habit until a nice new maternity hospital was built so that almost all births happened there.
The number of handicapped/defective/euphemism-of-your-choice babies increased. The cause, it was reckoned, is that with home births the parents/midwives/doctors would often let such a newborn perish. In the hospital the bureaucracy made that unsafe so the poor wee mites had to be "saved".
In the 70s and 80s our local GP was well known for his "end of life" cocktail. Only to be administered by a close member of the family, and the remainder flushed down the lavatory.
I'm not against assisted dying per se , but looking at the alarming statistics in Canada, they seem remarkably keen on offing people, and not neccesarily those of advanced age and in poor health.
The slippery slope is real, and `medically assisted dying` in Canada now accounts for 1 in 20 deaths.
That >96% just happen to be white is also purely coincidental I'm sure.
I have just completed my Advanced decision to refuse Treatment and previously a 'do not resuscitate' on advice of my consultant.
We have family story of 'accidental' morphine overdose by nurse ancestor.
Also story of end of King George 5 is interesting
Think that existence of of Advanced decision and DNR should be clear evidence to back up request for relieved end .
Interesting point about 'still births' in past - again this is well held belief
It happened in our family in the 1930s. The GP attending left the badly deformed newborn by an open window.
There's a description in Sons And Lovers of the family dosing their dying mother with all of her pain relief at once.
I think the current system generally seems ok, Shiptons excepted. Having seen my mother die at 2 am I'm sure the morphine may have hastened her end, but it's a balance against pain relief. I certainly didn't rush to call a nurse and perhaps prolong things for another day or two (untreatable cancer). You just hope you did the right thing.
Seems the old ways worked pretty well......until Harold Shipman.
Reckon you've seen this one already;
https://marginalrevolution.com/marginalrevolution/2026/03/tracing-the-genetic-footprints-of-the-uk-national-health-service.html
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