Thursday also turned out to be an interesting day.
The consultant affiliated to our hospice organised a seminar workshop for the staff to explore and discuss the law relating to assisted suicide within the health care setting and had organised for an Australian medic who was a specialist in Voluntary Assisted Dying to lecture us on the subject via zoom
For those that don’t know
Voluntary assisted dying (VAD) refers to the assistance provided to a person by a health practitioner to end their life. It includes:
- 'self-administration', where the person takes the VAD medication themselves (this is sometimes called physician-assisted suicide or dying), and
- 'practitioner administration', where the person is given the medication by a doctor (or in some Australian States, a nurse practitioner or registered nurse) (this is sometimes called voluntary euthanasia).
‘Voluntary’ indicates that the practice is a voluntary choice of the person, and that they are competent (have capacity) to decide to access VAD.
As you can see the law in Australia seems a million miles away from ours in the Uk, however the criteria for VAD is precise and can only be used with a diagnosis of conditions that are life limiting of only a few months . Conditions such as MND, disabilities or mental health do not fit the criteria.
It was a fascinating workshop and I felt that the Australian consultant was rather intrigued that he had been approached by a tiny Welsh Hospice to discuss his role rather than by a UK palliative care centre based in say London.
All of our hospice doctors, a good cross section of the nurses and support workers and a smattering of managers and Board Members turned up and on reflection I still am not sure how I feel about the whole subject.
Of course the positives seem humane and client focused but when I asked the Australia doctor what situations had “ gone wrong” for want of a better phrase he discussed two cases that were sobering.
One situation had a patient who had vomited after she had taken the medication and so didn’t die as was expected, while another had another patient taking his medication which was brought into him by a relative whilst he was an inpatient of a general hospital being looked after by nurses who had no clue he was about to take his own life.
The ethical implications from both situations hung heavy in the air.
Anyhow it’s Saturday today.
It’s early and we have all been out for a walk. Roger is almost fully housetrained now. He walks well on the lead and sits politely in the car, unlike Dorothy who is now always crated in Bluebell and who remains vociferously loud during any journey.
He’s eating better and is less frightened of anything he doesn’t know.
But he is a chewer.
I think we will all go to the beach this afternoon.
I’m meeting up with Gorgeous Dave later and we are going to The Storyhouse to see a one woman show with the title How to be Amazingly Happy
John I found your discussion on VAD most interesting. At 90 this October I have no wish to hang about and should the opportunity arise and the circumstances be right I would opt for Dignitas. As for that fluffball in the photograph - adorable.
ReplyDeleteDignitas has its downside as there have been several successful prosecutions of relatives who have accompanied their loved ones to Switzerland only to arrested on the wayhome
DeleteSuch an interesting, brave and appropriate post, decisions occurring for which we all need the judgment of Solomon. Humanity should rule, but rarely does. But as with other medical crises and conditions, such as abortion, the decision should belong to the patient, when mentally capable. No other person should enforce control onto the physical body and the life of another. A broad principle perhaps, but one that should be the basis to work from, not work round.
ReplyDeleteI remain ambivalent even though I have worked for Samaritans and been a nurse …
DeleteJohn isn’t it interesting that those who work in Palliative Care have very mixed feelings about assisted feelings . After working in pal care for 14 years and a Dn fir 25 yrs before that it still feels uncomfortable. Xxx Bernie
ReplyDeleteYes see above. Xx
DeleteSorry assisted dying ! Not feeling!
ReplyDeleteI think that it is kind and caring to help another human to go early when they have expressed a desire to be assisted. After all, it is in this spirit that we put down very poorly or aged animals. What makes us different?
ReplyDeleteThe difference is subtle …hummm or is it ?
DeleteMany people I have nursed are just plain tired of being ill and want to go. Others feel a burden to go.
I see Ursula’s benign comment has been deleted ..why is that?
DeleteSigh.Ursula has been previously asked not to comment here , as she has been requested not to do so on several other blogs.
DeleteThis comment has been removed by a blog administrator.
DeleteAn interesting read, John, thank you. As time goes on can you see the need to go to Dignitas for the inevitable end, or will voluntary assisted become more relaxed here? I saw a video once which followed a patient and his family go to Switzerland, right up to the moment of his death. It was fascinating but I am still in two minds about it.
ReplyDeleteI think it will eventually come to the UK
DeleteBut again I feel that the people who may need the change in the law the most, the locked in syndrome patients, the motor neurone patients, the post stokes, the severe MS will lose out
Thank you for a comprehensive breakdown of assisted dying. It needs to be talked about even though it is a frightening concept for many people.
ReplyDeleteThe laws are much more relaxed in the Netherlands who are pushing for the age limit to be lowered to children levels ….
DeleteThe countries in which some sort of medically assisted suicide occur include parts of the states, New Zealand , Colombia , Spain ( surprisingly given its catholic background)
The sticking to rigid rules in order to protect the vulnerable has produced a dilemma for people who are supposed to be helping the terminally ill. Not so long ago it was taken for granted that a doctor would deliver what could be lethal doses of painkiller if it was deemed needed, and it was not discussed for legal reasons. Now, everything has to be discussed. When my father was dying, my sister asked the doctor - in the presence of our father - if he would do something like that, and he said 'I will help him on his way if needed'. It wasn't needed.
ReplyDeleteIn all my years of nursing , the prescribing of meds have always been done to make the patient comfortable. Often death happens when the patient is no longer struggling, for breath, or with delirium , or with hypoxia
DeleteI remember when I was a very, very junior student nurse, we had a patient on a general surgical ward dying of bowel cancer. He was in agony and I asked the doctor if he could increase his pain meds. His reply? "No. They're addictive." The patient died that night. That was one incident which made me in favour of assisted dying. x
DeleteGood palliative care for all is, sadly, a rarity .
DeleteIt’s. Not seen as apriority.
Sad some of the best palliative care is from charities like ours
That’s what we are finding too John
DeleteAnd as a society we are not encouraged to talk about death ( what’s the line about death and taxes…..). My husband Tony doesn’t want to dwell on his death , he wants to concentrate on the now, but he says he is comforted by the discussion and plans we have .
Siobhan
If all the necessary safeguards are in place, then I can see nothing wrong. We'd be prosecuted if we let an animal suffer the way some humans have to. Sadly, though, assisted dying wouldn't have helped my parents with dementia. They were both in favour of it, but at the end, lacked mental capacity to make that decision, even if it was available. One day, living wills and assisted dying will be legal. Not for everyone, I know, but we can't put ourselves in someone else's shoes. What is bearable for one person, isn't necessarily bearable for another. xx
ReplyDeleteGood point well made.
DeleteAs it stands the medics in Australia have to make a clear case the patient is actively dying ,
I just recently had a discussion about this with a friend who surprised me by insisting no one has the right to assist in their own death nor should hospice stop feeding a person who has days, hours, or minutes to live. Emotionally, he said, he just couldn’t imagine that. I know it’s not simple, but I’m a strong believer in dying with dignity.
ReplyDeleteInteresting
DeletePatients are often given sub cut fluids in hospice care if it will make the patient more comfortable. This sounds incredibly subjective but skilled palliative care workers know when this is applicable .
As it stands in this country anyone with capacity can implement suicide but only if they choose their own hand todo it. This precludes many conditions such as MND who, it could be argued have that right too but who don’t have the “ ability” except to passively stop eating , which is a sad and inhuman way to die
The second case mentioned by the Australian doctor is interesting. The drug must have come into Australia from overseas illegally. You must know that medical people already assist in dying by increasing pain medication to the point... well, I don't think it is something lay people should interfere with. Doctor knows best. Euthaniser is not Australian wide as in some states it is illegal.
ReplyDeleteI have always believed in quality of life over quantity of life. Although I do think until you've walked in their shoes you, will never know what you would do
ReplyDeleteEvery time you post a picture of Roger I fall more deeply in love.
ReplyDeleteHe works his 'spell' on me too.
DeleteHe’s a delightful dog
DeleteI wanted to help my mum - Instead she passed in agony - I was there and no nurse or doctor helped us in the hospital x
ReplyDeleteIt’s. More common than you think, I’m sorry flis
DeleteA really complicated issue. For me the tipping point is the ability to self administer, beyond that point it shifts the ethical burden to someone else.
ReplyDeleteI get that , but I can understand the dilemma of paralysed patients who want to take the drug, fill the criteria except the holding of the cup
DeleteMy first husband died at 41 after a prolonged illness. He was able to adjust and thrive during the four years of decline knowing that he had clearly defined limits and would act if he was totally bedridden. His doctor prescribed painkillers with instructions to not take too many. I know that a burden was lifted with direct impact to the quality of his life once this was sorted out. For some, this option is truly a gift.
ReplyDeleteAnnie
Understood x
DeleteI especially feel for those in intense pain or illness who are alone. I had a somewhat lengthy and horrible illness last year which had me hospitalized during Covid. I could only have one visitor a day and that showed me how important having someone by your side is when you are ill. I can't imagine being alone when you are that ill. It would seem pointless to go on.
ReplyDeleteYes Linda . And that worries me too about patients who don’t fight their illness because they don’t feel strong enough or don’t feel worthy as they are alone
DeleteIt is in place in Canada. I personally know of two people who chose assisted dying. -Jenn
ReplyDeleteCan you tell me more jenn
DeleteWhat an interesting topic! As a retired nurse, I and for people having the option to end their lives rather than to stay for years of suffering. Interesting to me is that, dcades ago, VAD referred to Ventricular Assistance Device before heart transplants were possible.
ReplyDeleteRoger is utterly charming, but you know that!
Hugs!
Thank you babs
DeleteHe is a charming dog and oh so like my old terrier William .
He’s polite and gentle and polite
Dear Roger - such a comfort to see him. I hope he loves the beach - our little dog on her first blissful beach visit found a long dead seagull to roll in, chased a seal into the surf and was matted with sand and seagull yuck such that we had to wade in and try to clean her off. In retrospect we should have kept her more closely leashed, but she did have fun.
ReplyDeletececi
The vastness threw him. He just sat on my knee and looked
DeleteThe territory in which I live has been (for the last twenty five years) denied the right to even consider passing legislation about assisted dying. I hope that will change under our current Federal Government. It isn't an easy decision but...
ReplyDeleteCompletely agree
DeleteBut it’s amongst the most important decisions we will make in life , so you are right to see the complexities. It is not an easy decision to make , and it’s very emotive as well
But thank you for providing safe place to talk about it
Siobhan x
Such an interesting topic John, I can see why to some it's controversial. I can also see how such a thing could, potentially, be abused.
ReplyDeleteIn saying that, I have a condition that is exceptionally painful and debilitating and a few years ago I had come to the end of the road of possible treatments. The difficulty was it's not a condition that will kill me or even shorten my life. I was at the time of diagnosis 23. It was a lot to process and there were days when all I knew was pain, I couldn't really function to any qualitative degree and things felt very bleak. Made worse by an inability to be around my family and it was quite isolating for all that I am usually not that sociable. I was watching life pass me by and was helpless, an awful feeling.
Medical advancements and a wonderful doctor would eventually see a new treatment that, thankfully, works and gives me a quality of life again. However if that had not happened, I cannot say with any degree of certainty that I would have lasted a natural lifespan - as awful as that possibility now seems to me because I have a young child that was only possible because now my pain is almost none existent.
I feel, personally, because of my experience that if it were allowed in Britain I would support it and be glad for all of those who face a death that they either fear or just plain want to be different. But I could never argue passionately over anyone who has the other view, we are all our own people and what is an ideal solution for some is a horror to others. I think it's a case of damned if you do and damned if you don't really, there will always be campaigners for and against it and I can't see that changing even if it became legal here.
You make a good point and one that the MND patients would scream at , as no medical innovation it would seem would be available to change their suffering
DeleteYour post underlines hope x
Do you cover Roger's crate? Try a blanket over it so he can't see out at all. Worked for all my dogs.
ReplyDeleteSorry I meant Dorothy's crate not Rogers.
ReplyDeleteYes I’ve tried that
DeleteShe gets louder
In Canada the rules are similar to those in Australia , ithink.
ReplyDeleteI will go and look this up.
Thank you
Interesting post today. I would say that I cannot speak or make any decisions for anyone else no matter their condition or state of mind. However, I am of the mind that I had no say over my birth but I certainly would want some say over my death whether assisted or not. I hope I continue to be well apart from aches and pains of the inevitable aging process but I am prepared should the needs be. My decision no one else is involved.
ReplyDeleteJo in Auckland
Jo
Roger is gorgeous♥️
ReplyDeleteSince Roger is coming out as a chewer, make sure you have a variety of chew toys for him ... toys that everyone can gnaw on! Reward the good behavior and be firm about the "No Chew" items!
ReplyDeleteLOL ... everyone has an answer, don't we!?
I hope you have some good tips after the show for how to be amazingly happy. I would say mainly.....suit yourself. :)
ReplyDeleteI guess, in the end, what matters is the patient's wishes, imho. I live in a country where everyone seems to believe that their opinion matters in private medical decisions. Maybe that is just too simplistic. It is just how I see it.
ReplyDeleteTina in Oz here. I'm part of the vod movement here. I absolutely want the right to end my life on my terms, and I would never force my opinions on another in this, so I would prefer that others don't do that to me. I am not afraid to die but I am afraid of how I will die, and that is largely because I could end up in the hands of people who won't ease my dying pain "in case it kills me." I also am horrified that our Oz laws stop someone with dementia being able to make that choice legally, even while they are still sound of mind. In my opinion we are being cruel to be kind in a way we would never do to our dear pets. I've read some lovely stories of vod occasions of peace and love with family around.
ReplyDeletePeople kill themselves alone and ineffectively because the law won't allow anything else.
The whole subject is a minefield and I just wish we could all able to have the type of death we wish. I too fear a slow and painful death or terrible quality of life without any end to it. It feels to be too much to ask someone to take the responsibility to actively help you to end it, but I wish there was an opportunity for all to make the decision themselves and have it carried out. If not, then good palliative care for all is so needed.
ReplyDelete