Summer 2010 - The British Pain Society

advice in uncertain or complex
cases.
• Use case history examples
of good and poor practice to
illustrate your points (some
examples will be available
from BPS this year)
• Contact the Accountable
Officer in your Trust or PCT
• Work with your pharmacy
department to promote good
practice.
These are some simple practical
ideas; good practice is explained
in the guidance. As pain specialists
we are also opioid specialists,
referred to by NICE in this context
in both the Low Back Pain guidance
(CG88) 4 and Neuropathic Pain:
pharmacological management in a
non-specialist setting (CG96) 5 .
This is our opportunity to
disseminate our knowledge and
to prevent problems for future
generations.
PROFESSIONAL PERSPECTIVES
References
End of Life Choices?
Following the attempt by Jeremy
Purvis to introduce a Member’s
Bill on assisted dying interest in
Scotland, prominent MSP Margo
MacDonald has introduced an
“End of Life Choices (Scotland)
Bill” into Scottish Parliament. Ms
MacDonald with the assistance
of Christina Chen, Peter Warren
1. Opioids for persistent pain:
good practice. http://www.
britishpainsociety.org/
pub_professional.htm#opioids
2. Katz N, Mazer N. The
impact of opioids on the
endocrine system. Clin J Pain
2009;25(2):170-175
3. McCracken L, Vellerman
SC, Eccleston C. Patterns of
prescription and concerns
about opioid analgesics for
chronic non-malignant pain
in general practice. Primary
Health Care Research and
Development 9 (2008):146-156
4. Early management of persistent
non specific low back pain.
http://guidance.nice.org.uk/
CG88
5. Neuropathic pain: the
pharmacological management
of neuropathic pain in adults in
non-specialist settings
http://guidance.nice.org.uk/
CG96
and the Scottish Parliament’s
Non-Executive Bills Unit, has the
support of 18 MSPs to introduce
this bill. The Bill is currently being
investigated and scrutinised by the
Scottish Parliament but may have
wider implications for the greater
NHS.
The proposal of the bill is that
persons who wish to decide when
to end their lives should be able to
do so, legally, with the assistance
of a registered physician. This
has come about because of
the experiences of people with
degenerative conditions, terminal
illnesses and those who become
entirely dependent on others
following a trauma.
Of interest is the fact that all of the
examples given in the consultation
document are patients who have
non malignant illnesses, terminal
or not. It is not unreasonable to
assume that some of the illnesses
will chronic non malignant pain
and distress. As such it is probable
that this issue will become more
and more likely to be in the
domain of all multidisciplinary
pain professionals.
What follows are articles by both
Ms Margo MacDonald MSP and
Baroness Ilora Finlay, a prominent
palliative care physician and
Professor of Palliative Medicine,
presenting opposing views of
the key points of this important
debate.
Margo MacDonald MSP puts
forward the arguments for
the End of Life Assistance
Bill Scotland
“Recently, one of the faith-based
groups opposed to the End of Life
Assistance Bill (Scotland) assured
people there is no need for the
Bill currently being considered by
the Scottish Parliament because
“up to 95%” of those who might
suffer a painful death avoid such
a distressing end to their lives
because of the much improved
understanding of pain relieving
drugs.
Even taken at face value, that’s
hardly reassurance for the 5%. In
Scotland, the calculation is that
between 50 and 60 deaths per
year might be assisted, because
the people concerned are unlikely
to see any benefit in prolonging
their agony at the very end of
life. It should also be stated
that people with irreversible,
progressive degenerative
conditions tend not to cite their
fear of pain as the reason for
wanting the legal right to seek
assistance to end their lives, but
emphasise instead their fear of
losing dignity, and their ability to
exercise choice over the last acts
of their lives.
The End of Life Assistance
Scotland Bill, (“The Bill”), is
now into the most important
part of the process whereby it
may become law in Scotland,
and possibly, influence the law
on assisted suicide south of the
border. From the start, it should be
emphasised that the Bill has not
been constructed as a ubiquitous
answer to the dilemmas posed
by people going to Switzerland
to bring about their own deaths.
Nor has it been conceived out of
sympathy for people such as Dr
Anne Turner who brought about
her own death perhaps earlier
than she might have in order to
comply with Swiss law. Neither
was it prompted by the experience
of two mothers, each of whom
helped a much-loved child to die,
but whose actions were judged
quite differently by the English
courts.
PAI N N E W S S U M M E R 2010 39