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Working in a semi-rural community we have looked after a number of farmers, and this is a sentiment we have heard on occasion.
It was hard to argue – he was a man in his 40s with a particularly nasty sarcoma involving his arm causing pretty much complete loss of function. He also had neuropathic pain which was proving challenging to manage.
More often, the form of request to die I get is euphemistically phrased as, ‘can’t you just give me a little blue pill, doctor?’ to which I’ll reply: ‘What, you mean Viagra?’ before gently reminding them that this is something we cannot do, but reassuring them that in the hospice we are not in the business of prolonging things. Our ethos is to add life to days rather than days to life.
And that’s the rub. When people ask this question they are usually being admitted following a difficult time at home with uncontrolled symptoms, possibly the indignity of incontinence, often feeling they are a burden to their family.
The relatives also feel a failure for not having managed to care for their loved one at home when this may have been an express wish. Some patients are clinically depressed, but more often it is a knee jerk reaction to things being pretty awful and not seeing any other way out.
One of the many things that make palliative medicine particularly satisfying is the ability to Do Something.
A lot of those things aren’t rocket science — sorting out pain and constipation isn’t difficult in the majority of cases, although I concede they are easier in the inpatient setting of the hospice when combined with our cheerful, caring nurses and complementary therapists.
We’ll put together care packages and sort out equipment, all the time talking to patients and their families to work out a way forward together.
I revisit the wish to die with these patients down the line, reminding them of what they said and asking if this is still the case.
In 15 years in the specialty (gosh, can it really be that long?) I can honestly only recall a couple of cases where people have persistently asked to die. Mostly, people articulate how desperate they felt when we first saw them, how they felt so dreadful and had lost all hope.
And how now their symptoms were better controlled, they were gaining great pleasure from small things — sitting in the garden, time with young grandchildren — and they were starting to set simple, achievable goals.
For there is always hope, it’s just that one has to change what one hopes for, until what remains is hope of a dignified death.
Our farmer had a fancy schmancy nerve block from the anaesthetists and got home. He was out and about on the farm, though his son was driving the tractor. I suspect he continued to feel that cow versus man was a double standard, though.
Becky Hirst is a consultant in palliative medicine in Barnsley
The BMA has been conducting a major project into end-of-life care and physician-assisted dying.
Read the third and final report, reflections and recommendations from the project, and join the discussion on our dedicated community.
You have failed to answer the question that you posed yourself. At my age I haven't got time or sympathy with plans. I would need effective action now if I had severe pain now. At 84 I still have plans and hopes for the future. One hope is that I get a rapidly fatal stroke or cardiac arrest and no first aider near. Half a grain (30mg) of heroin eases most folk in their tribulations, at little cost to the management.
I fear that if people demand to be treated like animals, they will be. Cheaper. And reduces emotional cost too. So many "best interests" assessments are veterinary in outlook; we appear to have lost the ability to view the sick, particularly the elderly or demented as people, no less deserving of respect as our own family members. We must also strongly question the extremely weak assumption hard-wired into most Pall Care initiatives these last 10 years or so, that it is possible to “predict” death over the coming 12 months or more, and that "generalist" palliative care is anything other than a cheap alternative to the specialist kind. No-one with a serious organ-based illness would willingly accept being under an almost untrained carer, why should those who are dying? These are all examples of rationing gone mad.
My father had fantastic care in the hospice and significant improvement in the quality of his life.
His case, of metastatic prostate cancer, is different form someone with eg motor neurone disease or similar.
In a society that supports freedom of choice and provides termination (of healthy foetuses) on demand, it is hypocricy to deny a person of sound mind freedom of choice about their quality of life and their right to end it.
Personally I do not support either abortion or euthanasia, I do however believe it is a personal decision and doctors should respect their patients choice
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