Coffee House

Why should doctors override patients’ wishes on assisted dying?

13 July 2013

I chaired the Steering Committee of Healthcare Professionals for Assisted Dying (HPAD). This group was co-founded by an immensely brave and visionary general practitioner, Ann McPherson, when she was seriously ill with pancreatic cancer.

She was outraged that the so-called representative bodies of the medical profession such as the BMA and the Royal College of Physicians overrode both public opinion (80 per cent in favour, 75 per cent of those with religious beliefs) and the views of 30-40 per cent of their members, by opposing legalisation of physician-assisted dying for terminally ill people with unendurable symptoms.

Claim your gift

Anyone who believes that good palliative care renders such a law unnecessary should read the account of Ann’s death (written by her daughter Tess, herself a hospital consultant). It makes harrowing reading.

GoveThis is an extract from Raymond Tallis’ diary in this week’s magazine. Click here to read for free with a trial of The Spectator app for iPad and iPhone. You can also subscribe with a free trial on the Kindle Fire.

Give the perfect gift this Christmas. Buy a subscription for a friend for just £75 and you’ll receive a free gift too. Buy now.

Show comments
  • Terence Hale

    Why should doctors override patients’ wishes on assisted
    dying? This is a complicated subject that tangates’s medicine, morel, religion
    and law. Working in hospitals I’ve seen every death is a sacrifice for the
    living in that we learn to find solutions to why such a person has died. Assisted
    dying is and should be a complicated procedure a patients view is one of shock,
    end it all and and, the relations, be it pity or inheritance factors are
    determinate. One of the ironies of modern life is why do we put so much research
    and effort in to prolonging life when at the end we kill it.

  • 2trueblue

    It is all academic posturing. Talk of pressure, dignity, the wishes of the individual, family, all whilst the agenda is already set. The disgusting fact is that whilst we were told that over the past 15yrs the NHS had huge investment, both financially and training, and what do we now find……. that it was all a sham.
    CARE, that is what it should be all about. It is not rocket science. Good basic care, given by those who have chosen that as a career/job. It should be present throughout the NHS and be fundamental in all areas, from the time you cross the threshold, and practiced by every person who works in any area of the NHS. Perhaps it is in short supply in our present day society?

    • HookesLaw

      Not the last 15 years, just the 13 years of tick box target led labour management.
      Labour failed the nation economically
      Labour failed the nation in respect of the way it created a million jobs for immigrants.
      Labour failed the nation in the way it managed the NHS.
      My own local trust is moving to values based interviewing (pioneered by the NSPCC) to improve standards. So its wrong to think that nothing is being done. And what is being done is the result of the Francis Report commissioned by a tory.

      • 2trueblue

        And also thanks to Liebore we will end up with a Rationed Health service.

  • Austin Barry

    The NHS is designed to kill us, with some fleeting dignity, hopefully, but to kill us without compunction or hesitation. One’s only wish is to spit in its gimlet eye before the white tunnel which never ends envelopes one’s soul.

  • McClane

    Who is Raymond Tallis anyway? His career is a blank (according to Wikipedia) between Oxford and St Thomas’s in 1970 and his post as Consultant Adviser in Care of the Elderly to the Chief Medical Officer in 1996. His degree in animal physiology from Keble links to Physiology on Wikipedia which has references to various types of physiology but appears to exclude animal physiology.

    Since then he’s been on any number of committees and steering groups.

    He’s just one more person telling me what I think and what I know is wrong because he knows better.

    And what I think is the ‘legalisation of physician-assisted dying for terminally ill people with unendurable symptoms’ is the thin end of a very wide wedge.

    I am sorry that Ann McPherson suffered from pancreatic cancer. She was lucky to have a daughter who was a hospital consultant and who could give an account of it.

    I will have to be grateful for what the NHS gives me. Death through neglect, possibly, but never, ever, physician-assisted dying. Never euthanasia.

    CiF is a better place for this blog post. I buy the Spectator on paper when I can but I will never subscribe while Tallis has a diary there.

    • HookesLaw

      He is telling you what he thinks. If you think he is telling you what to think then I can only suggest you are becoming a wee bit paranoid.

      • McClane

        I think you’ve missed the point of Tallis’s argument and my reply.

        • HookesLaw

          He is just one person sitting on whatever committee he might be involved in. He is a qualified doctor. With a modicum of research…
          ‘…clinical res fell Wessex Neurological Centre 1977-80, sr lectr in geriatric med Univ of Liverpool 1982-87, prof of geriatric med Univ of Manchester 1987-2006, conslt physician Salford Royal Hosps Tst 1987-2006; numerous visiting professorships…’

          I have no idea of the quality of his intellect some regard him as one of the worlds greatest living polymaths. According to Amazon he has written 28 books.
          Its absurd to decry him but perfectly legitimate to disagree with him. This is where I came in.
          Over and again on here we see people surrendering to their prejudices and warping their view of the world.

          • Fergus Pickering

            He has written one truly great book which has nothing at all to do with medicine. ‘Not Saussure’ is a book everybody should read.

    • Fergus Pickering

      Raymond Tallis is a man of great distinction and I would give any opinion of his house room. However, I don’t have to agree with him, and in this occasion I think I do not.

    • Colonel Mustard

      Agreed. His diary piece in this week’s magazine was pretty insufferable and the buzzword attacks against the Tories in it, even if the editor should want a “contrary” view, tedious and predictable. He came across as a smug, complacent prig of the privileged leftist quangocracy who uses the same cod-Pepys turn of phrase of a certain troll hereabouts – “And so to the weekend, sitting in the sun” writing a Guardian obituary. . oh, spare me, do! Check your privilege Mr Tallis! The fact that he and his wife run “Stockport NHS Watch” tells you everything you need to know. The proliferation of “Watch” organisations staffed by arrogant busybodies who think their judgements are somehow necessary and indispensable makes me wonder how we ever did without them in the “bad old days” of an England I remember so blissfully. Full of gentleman comfortable in their skin with the emphasis on ‘gentle’ and ‘men’. Now we have ‘men’ who aren’t much who boast about their ‘caring’ that doesn’t much.

      One thing is certain you wouldn’t have died of dehydration, starvation or neglect in an NHS hospital then, watch or no watch. The nurses might not have had degrees, baggy boiler suits or inflated ideas of their own importance but they kept the wards spotlessly clean and cared for their patients in a no-nonsense but effective way. “Progress”, lefties? Don’t make me laugh.

      • Alexsandr

        I believe caring went out of nursing when it became a degree entry job. so academia id more important than caring to nurses now. and caring is keeping patients clean, fed given drinks, and holding their hands when they are frightened. and – god forbid- -taking to them.

  • Portendorfer

    There are 2 major problems, Raymond with your proposition

    First and most important no doctor, however much he knows the patient and however many second opinions he takes cannot be sure that the patient is not subject to pressure however subtle. I addition the patients apparent terminal condition may not be actually terminal (Remember even childhood diabetes was terminal before two Candians-I think-showed insulin could treat it).
    Second any doctor participating however much protected by law does not have a conscience fully protected from dark thoughts after the event.
    This is a dangerous road down which we must not go.

    • Dan Grover

      With regards to the former argument, I’m not sure it holds much water. Sure, they *may* be influenced by pressure, but that’s life. That’s everything. There isn’t a facet of our lives which is not influenced by some pressure from somewhere, whether it’s where to send our children to school or which vacuum cleaner to buy – or, indeed, when to turn off a loved one’s life support machine when it becomes sufficiently unlikely that they will ever wake up. It seems to me somewhat odd that in general the right tends to be in favour of the individual taking responsibility for their situation rather than the state (and it’s the reason I am, myself, on the right) but not on this issue.

      With regards to the second point, doctor’s having dark thoughts over their own actions have long been a part of medicine. The aforementioned example of turning off a life support machine even when there is still a degree of hope is one example. Boards decide who shall live and who shall die via their decisions on who gets donated organs and rare blood types. Sadly, death is a very real and almost routine part of the science of keeping people alive. Besides which, I suppose it depends on the legislation, but I don’t really see why doctor’s couldn’t opt out of performing a function like this if they were morally uncomfortable with it – the more important element is that the family members that help are no longer criminalised for doing so.

  • paulus

    The weak and the vulnerable will be susceptible to persuasion, Doctors already make decisions we all know that and tacitly approve. What we will not do is enshrine it in Law and take it out of the hands and judgement of Drs on a case by case basis. So long as they always know there judgement must stand in a Court of law and lay their before twelve of their peers.

    HL do you have to have a contrary position to everyone, Al laid out a reasoned argument, but didn’t disclose how personal this issue is to her. You intervene with a strange stain type of comment and force her to disclose something very personal. We don’t mind. But when you start bullying women your moving beyond the pail.

    I think you might of had a stroke unawares apart from your apparent incontinence, you need to think what people are trying to say.

    • Alexsandr

      if Al is me, I am a bloke!

      But thanks for your support
      I dont mind puttng personal stuff in if it helps with the argument.
      Mum is fine by the way! But some of them in the home were distressed by the heat I think.

    • HookesLaw

      The issue can be discussed without referring to the people who have to make decisions to murderers. And I reserve the right to say so. As I said it was a fair argument but not well made.

      I am a contrarian so would dispute that I take a different decision to every one.

      I speak as someone who has seen a brother and a father linger for several weeks in a coma before dying – so I know all about strokes as it happens. I give up my time as a member of the public to contribute to our local gerontology and stroke dept and only recently we had a discussion about the problems of dementia.
      I also speak as someone who saw life support turned off for his mother.

      I would say that every case needs to be treated on its merits and I would say that in life there are many occasions where there is no correct solution and its probably futile to try to legislate for them.

      • Alexsandr

        I felt the original piece was arrogant. sort of ‘if you dont beleive in euthanasia you are some sort of luddite’ attitude. That is why i made the shipman comment.
        I am sure some have been upset by people dying slowly and in pain. But that does not mean we don’t need very well thought out safeguards, with serious criminal proceedings for those that break them. And I am not convinced these have been proposed.

        • HookesLaw

          Well the original piece was an extract and gave a particular example. I am not sure the author was suggesting there should be no safeguards.

          I don’t support euthanasia as a policy and I don’t think I support it as a principle. Right at the outset I said you made a fair point.
          Quite frankly though I am not sure. Do any of us have plans to manage our death?
          For all the continuing hysteria from others on this subject a hysteria which I cannot help but think is in support of their prejudices, we have to face the fact of the difficulties we will inevitably meet from both sides of the issue.

  • Alexsandr

    Pity they dont understand some people are very vulnerable. Many old lades have been subservient to their fathers and then their husbands. So when asked if they think they should be killed they will always say what they think the questioner wants to hear. ‘If you think so, dear’ I can hear them saying.

    Until I hear workable proposals to protect people like this then these pro-euthansia lot are no better than Shipman IMHO

    • HookesLaw

      A not unreasonable, though not very well presented, view totally ruined by a final hysterical paragraph.
      You can’t keep away from the hysteria can you.

      The whole issue turns on what are the genuine feelings of the patient and their understanding of their condition.

      • Alexsandr

        But how do you know what the genuine feeling of the patient are?

        Sorry if i sound hysterical to you. I am going to visit my Mum in a while. She wont know how long it was since I last saw her (last monday), but she knows who I am. But talk to her about stuff over 20 years ago and she knows it all.
        But she has always been subservient. it was her upbringing in the 1920’s.

        Suggesting euthanasia to someone like that is just plain wrong.

        perhaps you can see why Richards piece made me angry.

        This stuff is easy when talking generally. but becomes a lot harder when talking about your own flesh and blood.

        • HookesLaw

          I do not say these issues are not difficult. Sadly your mother may have some form of dementia and that certainly is not a case for euthanasia (if in deed there is any case).

          The other case is where someone only has a life, a relative short life, of pain misery and suffering and /or the clearly terminally ill.

          • Alexsandr

            but where do you draw the line? who decides? what safeguards? how do you stop scope creep? how do you write this into law? Who says dementia is not a reason for euthanasia? How do you cope with someone in paid with dementia?
            The manager of the home, a geriatric nurse of some years, thinks its a bad idea too.
            Yes we have these sad cases where people are obviously have a poor quality of life where it seems obvious, but we cant start killing people without it being properly thought through.

            • HookesLaw

              Dementia is not a reason for euthanasia. My mother in laws partner lived to 94. He was clearly suffering form dementia for at least the last 3 years of his life and was in a home for 2 years. It was only in the last 6 to 9 months when he became bedridden and totally befuddled. But right to the end he would eat a biscuit and banana with us and liked the tot of whisky we fed him.
              Just as we wondered how long he could go on he died of heart failure.

              Did we do him any favours for the last 6 months of his life? Who knows.

              • HenryWood

                A very difficult question to answer, HookesLaw, but at least it seemed to be one you and your family answered together.

                I am more concerned about the elderly who belong to families who cannot consider such questions for many and various reasons and go along with “doctors know best”.

                I suspect that not many elderly patients from families like yours would ever be put on the Liverpool Care Pathway, and especially never without much deep thought and total family consideration.

                However, to put it bluntly, think of the elderly relations of Wayne and Waynetta Slob … “Yes, doctor … thank you, doctor … it’s all for the best innit doctor? … ”

                Doctor smiles comfortingly and reassuringly, gets relations to sign forms, co-signs forms, and goes off to report to “The Management” that another bed has been freed and the hospital can expect another “bonus”.
                Trebles all round!

                • HookesLaw

                  Yes families are imperfect as are doctors and patients and sadly all are placed in difficult moral dilemmas. Sometimes they watch people linger suffer and die. In time you me… anybody is quite likely to be on both sides of the equation.

                  Just how much criminality does anybody really think goes on in these circumstances?

                • HenryWood

                  When I have read some of the cases reported in some of the national press, to me, it ends up not so much as criminality, i.e. no doctors/medics ever thought for a moment that what they were doing was against the law, and indeed it *probably* was not, but I do think quite a bit of unthinking cruelty went on in some of those circumstances. (e.g. Literally dying of thirst and drinking from a flower vase!) If this truly only happened in even just one single case, then it was cruelty of the absolute worst kind; cruelty which a doctor would have been prosecuted for if it was shown he had treated a dog in this way. Cruelty which was either totally ignored, or swept to one side in the interests of ‘medical efficiency’. This is what disturbs me – a lack of compassion.

                  Whatever was the reason for *deliberately killing* many elderly patients by using the methods now in dispute, those medical practitioners who ever used that “Care Pathway” c have kind of proven themselves unfit to practice.

                  For why? Because now other medical practitioners are saying it was wrong, had always been wrong, and must now “be phased out” – i.e. STOPPED!

                  If it never crossed the minds of those “carers” putting elderly patients on this *certain death* route was wrong, then I suggest they are not fit to be medics/carers?

                  Just My opinion.

                • Colonel Mustard

                  Of course it was criminality. We live in a society which deploys the offence of “corporate manslaughter” and “causing death by criminal negligence” to punish those organisations it disapproves of – usually ones associated with the Tories. Why should the NHS be immune from that? Because the fundamental basis behind it meant well?

                  Ignoring an elderly patient dying of dehydration, starvation and neglect is every bit as criminal as failing to maintain railway lines, especially for a nurse charged directly with that patient’s care and in proximity to them. There can be no excuses for that, except those deployed in mitigation against a prosecution in a court of law.

                • Fergus Pickering

                  You mean breaking of the law? Probably lots. The law is imprfect and needs to be broken on many occasions.

                • Tom Tom

                  You really need to educate medical practitioners in Criminal Law and Mens Rea then. I think it is not part of their training sadly. There are procedures carried out by a clinician that hasten death but unless you are aware of them you will simply think the medic is being “kind”. The Medic has no thought that he is “criminal” because you have told him/her how “kind” they are

            • HenryWood

              “How do you stop scope creep?” I’m not too sure what scope creep is but there have been many well publicised examples of the Liverpool “Care” Pathway creep, and in many cases, “*Care*” was the last thing on some of the medics’ minds. Was there not money (bonuses!) paid to hospitals who pushed “patients” onto this “pathway”? If those reports were true, I doubt if the medics could ever sink any lower. A “bonus” for every death, eh? How about time-and-half for abortions, eh?
              Catch ’em young, catch ’em old, but catch ’em anyway and certain hospitals/medics will be rewarded.

              It was not caring at all in some cases. As you well ask, “Where do you draw the line? Who decides?”

            • Dan Grover

              Well assisted suicide – which is what this is actually discussing – is purely for those *physically* incapable of killing themselves. I think concerns about creep and pressure are very real, but the worry that someone will get bumped off for dementia seems a bit much when there’s nothing physically wrong with the person. To any such physical able people, whether they’re vulnerable people born in the 20’s that were subservient or not, there’s nothing you can do to stop people’s pressuring these people to take their own lives. The only people to whom this legislation is relevant are those that *can’t* take their own lives, and so need someone else to help them or do it. That’s why I don’t think references to dementia et al are particularly useful relevant. Encouraging suicide is something that’s both very different and basically impossible to legislate against – that genie has been out of the bottle more or less forever.

          • Fergus Pickering

            She may have some form of dementia, eh. My father was in exactly his mother’s condition. It was my opinion that he had little left to live for but that was only my opinion. What did I know about it? Somewhat later he was in great pain and morphine was administered in huge doses which, again in my opinion, killed him, as those administering it knew it would. Again in my opinion. And that was all right.Yet again in my opinion. Perhaps things are best left as they are. What would I wish were I in his condition? I don’t know. I hope I never have to find out.

            • HookesLaw

              I agree with your sentiments. I think there is a strong likelihood that most of us will indeed find out.
              As I think I said right at the beginning there is often no right solution. Circumstances are often different.

              • Alexsandr

                Hooky and Fergus:-
                Yes, dementia is not a reason for euthanasia. but old people don’t usually have one condition. Consider someone with dementia, needs dialysis and also needs expensive drugs. That’s when this becomes dangerous.
                henrywood. scope creep is management babble for when a project starts to take on work outside the original specification. In this context I meant it to mean that if this were made law, then there would be clearly defined circumstances when it could be used. But my worry is as case law developed, the circumstances when it could be used could be watered down over time.

                • Alexsandr

                  and remember – there are relatives who would consider bumping off Nana to get their hands on her loot.

                • HookesLaw

                  if you look up to the article the issue at play is ‘opposing legalisation of physician-assisted dying for terminally ill people with unendurable symptoms’
                  Being in need of dialysis is not terminal and it it not an unendurable condition.

                • Alexsandr

                  the point I was making is the expense to the NHS, and scope creep. Once we have established the principle of killing people, then i am sure there will be calls to make it more widely available.

      • Andy

        You might think it is ‘hysterical’, but I can assure you it is not. Shipman was a shocking case but as we have seen at Mid Staffs things are hardly perfect. The elderly need to be protected just as much as the young.

        • HookesLaw

          And we can discuss it without hysteria.

    • Tom Tom

      Having waded through NHS notes after a relative’s death I am amazed at how inaccurate they are, how many lies are stated, and how much “error” is covered up. Asking elderly relatives dosed to the eyeballs on Tramadol if they “want to go home” is a nice side-stepping of Fast Track procedures and NOT explaining that death is imminent. We need to save Medical Staff from themselves ! Under T-4 in Germany doctors thought they were getting extra resources for patients when filling out the forms which had their patients terminated at Hadamar, Grafeneck, Sonnenstein

Can't find your Web ID? Click here