Patrick Stewart on assisted dying

This is subject that tends to polarise for understandable reasons. I agree that medicine should be about the relief of suffering, but have no experience of the judicious taking of life when loved ones have died. On the contrary, I have found medical staff committed to preserving life. Quality of life is key and many of us would not want to be kept alive by tube feeding, on a hospital ward when we are no longer able to move or make our wishes known.

Maries, I acknowledge your painful experiences, but found the way in which you responded to posters who support some form of assisted death a bit unpleasant. I didn't find earlier posts to be from a smug, self satisfied, mutually supportive group of individuals. Given the age group of contributors, it's likely many of us have been with loved ones at the end of their lives. It's not easy, and compassion and tolerance for the views of others are so important in my view.

Perhaps so, river. I'll rephrase what I want then. Do Not Rescusitate. That's one instruction. So if I collapse from a heart attack and appear to be dead (not breathing, heart stopped), then leave me be. janea mentioed above the possibility that members of my family might want to rescusitate me. My answer to that is: it's not their choice. My life, my choice.

Second one is, if I have a terminal illness and I decide I want to end my life before it becomes completely intolerable or out of my control, then I want to be assisted to die when I choose. My death, my choice.

Hear hear bags- and I am very privileged to live in a country where this choice will be mine, at the time of my choosing, in the comfort of my own home- and there palliative care is also available and excellent for those who make that choice. It is really not a question of either, or- but choice.

Both my inlaws chose when to die, in S Wales. FiL kept pulling out the drips in his arm. Eventually he managed to put his hand on the doctor's to stop the drips from being reinserted. Doc accepted this as patient's decision.

MiL, six months later, refused food and drink in hospital.

Both in their eighties. Both had had years of ill health. Both were ready to die. I'm glad that whoever was looking after them honoured their wishes instead of forcing on them treatment (including feeding) they didn't want.

Good hospital care is not simply about keeping people alive, especially people who "have had a good innings". In my view good hospital care includes giving people a good death if that is what they want, when they want it. What relatives may want is a separate issue. Good health care is not just about preventing death as much as possible.

My sister died after 18 months of horrible operations, chemotherapy and round the clock nursing at home, then in the local hospice. She couldn't eat at all for the last six months so was tube fed. The unpleasant side-effects of her illness were completely alleviated in the last two weeks when she was on the LCP, and her pain relief was adjusted daily so that she was not being mithered by observations, blood tests, injections and all the other things that make a fading life miserable. Nurses were there to comfort her, stroke her hand, chat with the family, make sure her mouth wasn't dry and keep her and her bedding fresh. The LCP was discussed with her before she chose to go into the hospice, when Macmillan nurses were visiting. She raised the issue first.

Any doubts we had about being helped to die were relieved by being part of this process. There was nothing to benefit her from trying to prolong her life for a few more days or weeks. She wanted to be allowed to die peacefully, with her loving family there beside her, and her wishes were met. She knew, so did we, that increasing her drugs would mean her dying in due course - those drugs stopped pain, calmed and sedated so she would no longer have moments of panic, and they affected her memory so she was not distressed about anything that had happened to bring her to her last few days. She occasionally woke, squeezed a hand or smiled, knew we were there. She lived for a week longer than expected, and there was no sense of undue haste. In the weeks before she died, she planned her funeral and her will had been done long before. She was ready to die.

We need much more support across the board so palliative care is as good as that provided by hospices, and the independent choice to die with assistance in our own homes, if we decide that is what we want.

That was the important thing for my husband, he did not want to be fed by tube. The disease he had meant that he would not eventually be able to swallow at all.
My mother in law has asked her son to pull out the drip, but because she was not considered in her right mind, he cannot do it, as it hasn't been in writing.
Hopefully, with the opening of cottage hospitals there will be better palliative care for us when it's our turn, although the care that my husband had was exemplary. He was 65.

Dignity in Dying AGM Image
Dignity in Dying AGM - Tuesday 3rd June 2014
(Queen Elizabeth II Conference Centre, Westminster)

Dignity in Dying's AGM is taking place next Tuesday (3rd June 2014) at the Queen Elizabeth II Conference Centre in Westminster and we'd love you to join us there if you can. For more details about the event please visit our AGM 2014 page on our website.

Please feel free to attend (we will be accepting walk-ins).

Report shows lack of patient involvement in key decisions about their end-of-life care

An audit on the provision of care for terminally ill people in hospitals has found that experience varies significantly across hospitals in England. Worryingly the audit found significant variation in the quality and provision of services and training across the country, and a need for major improvement.

Read more on our blog.

Dignity in Dying Event Image
Faith and Assisted Dying - Wednesday 11th June 2014
(Emmanuel Centre, Westminster)

This important event, taking place in the run-up to Lord Falconer’s Assisted Dying Bill being debated in the House of Lords, will bring together faith leaders and religious commentators on both sides of the debate on assisted dying.

Book your free place here.

Thanks to When for talking about her sister's death, and the LCP. A very close friend was supported so well by our local hospice, and then brought home where the LCP helped him and his loved ones.

Article in today's Express. The url wrongly calls Lord Falconer's assisted dying bill a euthanasia bill. Assisted dying is not euthanasia. Euthanasia is not chosen by those who die but by someone else who does or orders the killing. Assisted dying is a choice the dying person makes, no-one else! Reporters using the correct words in cases like this might eliminate a good deal of misunderstanding. Words matter.

If this legislation goes through, I wonder how long it will be before 'assisted dying' turns into euthanasia? We already see legal abortions carried out on the grounds of the sex of the baby, and very late abortions because of quite minor birth defects. It seems illogical to continue to prosecute individuals for infanticide because the baby has been through the process of birth. And after all, if Granny were in her right mind, she wouldn't want to still be alive, would she?

I agree Lilygran
As the spokesman fro Care not Killing out it,
"this Bill sends a dangerous message about how we value the most disadvantaged and vulnerable people in society".

Individual choice is one thing, but due consideration should be given to how any change in legislation will ramify throughout society.
As When and others have described, it is possible within the present legal framework for people to have a dignified death with as little pain and discomfort as possible. I would like to see the LCP re-introduced, without the NHS imposed targets that led to its abuse.

But the whole point of the proposed bill is to ensure that granny is in her right mind when she makes her choice and to make it impossible for someone else to make that decision for her.

As previous posts have said, it works in other parts of the world and there is no evidence of the 'slippery slope' so many seem to fear and expect.

Good end of life care is essential if we are to call ourselves civilized. This might take the form of a rational choice to request the withdrawal of treatment, or of excellent pain and other symptom relief at the end. The fact that any system might be open to abuse is what concerns most people.

At present, elderly or vulnerable patients are asked when they go into hospital what their wishes might be in the event of cardiac arrest; but this does not cover other situations of slow and inevitable decline.

Like many others, I support the idea of personal choice in principle, but the safeguards need to be very stringent indeed, so that scenario outlined by "maries" becomes impossible.

Yes, it is possible to be alloved to die peacefully within the present legal framework, but when you aren't in accord with the views of medics, I wonder whether your choice can be exercised? The legal framework needs to be amended to encompass assusted dying. My father had had enough a few years before he died and would have willingly gone to Dignitas if it hadn't involved going out of the country. When hospitalised, he refused food and would remove tubes and lines as soon as they were put back. He kept saying he wanted to be left to die and was consistently clear in his mind about it, never waivering. It was a battle, and distressing for family to be caught in the middle of these disagreements. He had terminal illnesses from which he would not recover, and which some people would choose to accept treatment to prolong their lives.

Who's to say which was the better course of action? Choice is what we need, at home and under medical care, whether that be in hospital or elsewhere. So many elderly people dread going into hospital and having their choice removed. It's interesting to hear the argument that vulnerable and elderly people could be bumped off with haste, but the counter-argument is that many are not being listened to anyway.

Where do GPs stand at the moment in all this? The NHS says that they ought to identify the one percent of patients who they think will die this year and have a conversation with them about how and where they would like to die.

Assisted dying isn't one of the options available to them, however.

jen the Royal College of General Practitioners are opposed to any change
www.rcgp.org.uk/news/2014/february/rcgp-remains-opposed-to-any-change-in-the-law-on-assisted-dying.aspx
"Although a minority of respondents put forward cases to shift the College’s collective position to ‘neutral’ or ‘in favour’ of a change in law on assisted dying, most respondents were against a change in the law for a range of reasons, including that a change in the legislation would:
be detrimental to the doctor-patient relationship
put the most vulnerable groups in society at risk
be impossible to implement without eliminating the possibility that patients may be in some way coerced into the decision to die
shift the focus away from investing in palliative care and treatments for terminal illnesses
instigate a ‘slippery slope’ whereby it would only be a matter of time before assisted dying was extended to those who could not consent due to reasons of incapacity and the severely disabled.
In addition, some respondents thought that the possibility of a wrong decision being made was too high to take the risk.
The GP-patient relationship, with GPs often attending patients in the final days and hours of their lives, means that GPs would be one of the professional groups most affected by any change in the law on assisted dying."

Difficult for GPs, isn't it?
Unless you have been in this situation, it's impossible to know whether the patient has been coerced or not, so how does a GP know?
My husband had a living will for many years before he died, using it to make sure his wishes were known. He changed the wording quite often when something occurred that he had not thought of.
However, a GP had to be there to tell us what to do, i.e., only give him food or drink if he asked for it. There was also a Macmillan nurse there as two professionals had to agree.
The hardest thing was not to ask him over those last three days. I assume the carers did not ask him. When they were here that was the only time I left the room, to get something to eat and drink myself.

Thanks, jane. The GPs have summed up all my reasons for being alarmed! And as for the people who say assisted dying is working perfectly where it has been introduced, I would answer that it is hard to be sure that any information is unbiased. There is such a strong lobby in favour and I have yet to see what I would call a really objective analysis. And as jen says how can anyone know if there has been any coercion? And who are these doctors who know which of their patients is likely to die in the next 12 months?

dyingmatters.org/gp_page/identifying-end-life-patients

Read this, Lily.
It's impossible to expect anyone to be objective about a close one's death.

If you never saw it, do watch the 2012 Dimbleby Lecture, written by the author Terry Pratchett, and read by his friend Tony Robinson - really though provoking and moving.

youtu.be/90b1MBwnEHM

Totally agree that GPs should be kept out of this equation. Although, most doctors in the past have been involved with possibly increasing the dose of morphine in latter stages of terminal illness, to aleviate the pain and at the same time knowing it may hasten the end. It is well recorded that King George's life was shortened by more and more morphine. And it was totally accepted and acceptable- until very recently when the culture of life by any means without any quality, became an obsession and also the suing culture. Shipman was also a tragic turning point.

Exit in Switzerland only involves the GP in determining the severity of illness, and check that the patient has registered their Exit membership with them, and their living will. Trained volunteers are the ones to assist- some are retire doctors and nurses, most of them are not.

Hope that some of you will take time to watch the Dimbleby lecture on the subject, full of touching humour and humanity. Whichever way you feel about the issue.

Can GPs be kept out of the equation? A living will has to be signed by your GP, and a copy left with him/her and anyone else concerned with your health, just to make sure they know what you want.

of course- I meant in the final act.

Ooops, such a shame it is not possible to edit anything here.

In Switzerland, a living will does NOT have to be signed by GP and registered with them. it is advisable, but not compulsory. If you are a member of EXIT, then they will assist you (on the provisos explained in previous posts)- and your living will can help confirm how you feel - but no more.