Thursday 26 June 2014

Death By Killing –The Assisted Dying Bill

Archbishop Peter Smith has asked us to place a notice in our Bulletins this weekend encouraging us to write to the House of Lords and express our views on the ‘Assisted Dying’ Bill. Having sat for a month by the bedside of my mother following a subarachnoid bleed, and observing the care given and the rationale behind the medical and nursing interventions, I shall be saying that the dying person does not require killing (or assistance to take their own life) but complete and dedicated care. We should not measure our care of the terminally ill by how easy it is to bring about their death, but against the criteria of “is this going to delay natural death (in which case it is wrong) or sustain comfort while moving towards a natural death?” 

In the UK, Pathways for the dying routinely remove food and fluids while increasing drugs which sedate the patient, achieving a calmness in the patient that may prevent the dying person from being unaware they are thirsty, with the family thinking their loved one’s death is simply ‘peaceful’ rather than procured. In the situation with my mother, the physician said they were going to remove mums subcutaneous infusion (500mls N/S per 24hrs) as it was life-extending. I had to challenge this to have it noted as -at most- life-sustaining, and certainly not life-extending. In that we all lose around 450mls per day just by breathing, never mind the insensible loss (loss of which we are generally unaware, as in sweating) and the sensible (obvious) loss in passing urine, there seems no good reason for removing all fluids. Even in congestive heart failure, removing the infusion may do little to relieve the pulmonary congestion since circulating fluid ‘seeps’ into the lungs whether fluids are given or not -and it is, after all, simply replacing only one daily ‘insensible loss’. This is not to say there are no occasions in which infusions can be removed in the last few hours of life, but whether infusions are present or not, frequent mouth care by nurses and relatives must be a priority intervention for reasons of comfort.

Many anxieties arise in those who are dying, mainly concerning pain and dignity during the dying process. It is this pain and distress that needs to be ended, not the patient, while their dignity and enjoyments are to be retained. If the dying person can retain their dignity (by respectful cleansing after passing urine or stools etc); have their anxieties relieved (by adequate but not excessive use of anxiolytics), their pain relieved (by such as morphine); any muscle spasm relieved (by such as Baclofen or Clonazepam); and if their enjoyments (TV programmes, reading or music etc) can be provided along with comforting, human-touch therapies (such as massage and aromatherapy), many who think they should end their life might be happy to have more time with their loved ones. This kind of care requires more and better funded hospices. We must strive to provide such care because the human person alone walks the earth with a dignity that does not have a sliding scale based upon whether one is rich or poor, black or white, male or female, sick or well. We are not mere animals; we have a mind which produces concepts; a mind which brings us to understand and master the world in ways that animals with their basic instincts cannot. We may euthanize the arthritic dog, but people require other than killing –they require compassionate caring and respect.

It is said that the Assisted Dying Bill will result in fewer dying adults facing unnecessary suffering at the end of their lives and bring clarity to the law, thus providing safety and security for the terminally ill and for medical professionals. This is a poor argument, since suffering can be relieved by medications and having pleasures retained as I outlined above. Nor do we need a clarity in the law that brings physicians, nurses and loved ones to become killers rather than carers; the clarity we need is on the protection of human life and the provision of proper care.

It is said the Bill will not legalise voluntary euthanasia, or act as a slippery slope to do so, only give dying adults peace of mind that the choice of assisted dying is available if their suffering becomes too great for them to handle. That the Bill would not legalise euthanasia is nonsense; the procuring of death in the dying person is exactly that: euthanasia.

It is said that the Assisted Dying Bill would only apply to adults with ‘mental capacity’ both at the time of their request and at the time of their death. This does not lessen the reality that this Bill is seeking to procure death before one’s natural time. Further, the issue of consent is very problematic: when given a long time in advance it cannot be relied upon since it is given when the person cannot actually know how well they would cope if complete and expert care were given. If consent is given in the immediate situation it is hampered by fears, and if anxiolytics are given to relieve that fear then the consent is given while under the influence of drugs. The Bill would certainly NOT protect against unscrupulous relatives or physicians from pressurising the dying person into requesting euthanasia by engendering feelings of guilt, fear etc. 

To conclude: what is required is not procured death by killing but dedicated, complete care of the person’s physical, mental, social and spiritual well-being, which can be achieved through more and well funded, fully staffed hospices. The dignity of the human person demands this; the capacity for compassion for one’s fellow man delivers it, since compassion naturally inspires devoted care, not killing. 


  1. Dear Father

    Thank you for these posts about your mother when she was dying in hospital. I've found them comforting.

    My aged father died two years ago in hospital. I'll never forget when the doctor phoned me up to tell me what had happened, that he had been admitted etc, and the first thing she asked me was if he had an "end of life plan". I said no, but felt like giving her a whole spiel about how he had fought in WWII etc, but then thought better of it, thinking that it would just be wasted on her. So much for bedside manner. When my father was admitted to Intensive Care later that night, I was horrified to see the doctor prepping him, putting the tubes in him etc, with absolutely no gloves on. This was mentioned to the doctor in front of me by an Intensive Care nurse who had come over from there. Essentially, I think they thought that Dad was going to die, so I guess they treated him like a piece of meat. Also, one of the nurses in Intensive Care said that "it was just the drugs that are keeping him alive...". Dad developed breathing difficulties and was transferred to another hospital. My father would sometimes just lay in his bed, and just wouldn't wake up. I didn't ask why that was, perhaps I should have done. Perhaps I should have been more confident and asked questions like you had. Daddy was 89 when he died, and he had a liver infection and they said it his liver had started to shut down. Problem is, I don't think I really wanted to believe he was dying because he had gone into hospital a number of times before and come out. In fact, he loved hospital puddings!

    It can feel like a sinister experience though. One previous time, Dad had had a minor stroke, one side of his face relaxed, and one male nurse told me straight that my father was going to die, no decorum about it. He had trouble walking and his jug of water was forever far from his bed. I remember long awaited test results seemed to take ages to arrive... Of course Dad pulled through. I remember there was a very old man on his ward and he drew my attention wanting something, so I went to find a nurse for him and found them all on tea-break. They dismissed the old man's needs. You'd have thought they'd have a staggered tea-break.

    Another time my father was on yet another ward, and there were a number of old patients there and a nurse told us that hospital management will shove the old patients into any ward. The nurses on ward are not specialist geriatric nurses and these type of old patients take the time away from them dealing with the other patients, say for instance they've been put in a ward dealing with urinary or heart patients. I have seen for myself that some elderly patients can be very time consuming, sometimes they're difficult or very ill.

    It's as you say, there needs to be more better funded hospices and old people's homes (perhaps specialist ones).

    I do think we are moving towards killing the elderly. This is compounded by the breakdown of the family and single-parent families. A man who dumps the woman who's carrying his child, does he not consider who will look after him when he is an old man - seems the government has...

    Another great problem is that we are dealing increasingly with an era with a lower set of values, morality. I remember seeing documentaries about trainee doctors in hospital getting hopelessly drunk and then working on the wards the next day. I don't know how these people live in their private lives, perhaps they're living vacuous lives. Certainly when they're students, some of them become drunk enough. But they will end up making life and death decisions about our lives in hospital when we're old.

    I do regret that I didn't make an official complaint against the doctor who unhygenically prepped my father, perhaps I still could?

    1. Dear Damask Rose,

      Thank you for allowing us to share your experience, which sounds to have been a very trying and difficult time.

      I truly think the answer is to have many more, well-funded, and fully-staffed hospices for those who are dying, and clear packages of care for those dying in the community. Sadly, any 'Pathway', like all paths and road, leads to a predetermined goal.
      God bless.

  2. I would have hoped bishop Peter Smith would have done something more active than asking us to write aletter to the house of Lords. This is a rather limp wristed approach that will hardly have any impact. He should be in the front line of a demonstration.

    1. Thank you, Paul.
      I think a more aggressive stand is required too, but with the letters to support it. I hope many, if not all, parishioners write to the peers and indeed their MP's.
      God Bless.


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