The Parish Magazine July and August 2021

The Parish Magazine - July/August 2021 31
HEALTH — 1
Dr Simon Ruffle grasps the nettle . . . of dying
One of the most controversial subjects to discuss in any
community is how people die. It is the inevitable and an
unescapable end of life, as much as birth is the beginning.
Too long, as a nation, we have filed the discussion in the ‘to
do’ cabinet.
Rarely in discussing other issues do we ignore the full scope
of an argument. 60% of people in the UK have no will when
they die.1
Compare our attitude to South America. Día de Muertos
(day of the dead) is celebrated. Anyone watching James
Bond Spectre (2015)2 could not fail to see the scale of the
celebrations of the dead that coincides with All Saints and All
Souls days — the first two days of November.
Depending on which surveys you read between 70%
and 80% of the public are in favour of assisted dying, yet
parliament allows a free vote on this subject, leaving it to
the individual MP. This is not an easy decision for anyone
to contemplate making; and I doubt any MP wishes to go
against their constituents' wishes. Strangely, we can have a
referendum to decide to choose our European status but not
on our own choices about our lives.
The issue is so personal to everyone and many different
influencing factors lead a person to their own decision. I
doubt I could list everything but personal experience, legal,
professional, religious and societal factors are some of these.
TERMINOLOGY
However, I am not certain that everyone is aware of the
terminology used. While researching this topic, I found that
the House of Lords voted against changing the Assisted
Dying Bill to have the title Assisted Suicide.
Wanting to die and wanting to determine your death are
two totally different issues. Choosing a method to die when
your life expectancy is determined does not mean someone
is actively suicidal. The definition of suicide does not help.
Intentionally taking action to end your life is suicide. A lot of
suicidal attempts are not intentional. The person often lacks
the capacity to make a rational decision due to the
effects of drugs, alcohol, financial issues and mental
health problems. This problem gets projected onto
someone who wishes to choose when and how to die
when they have been given a terminal diagnosis, even
if not a totally determinable time to live.
Euthanasia is a step beyond this. This is someone
else ending your life.
In some countries and USA states, notably
Oregon, the term favoured is physician assisted
suicide. Only 0.4% of deaths in Oregon, USA are
from assisted dying. It was legalised and since
then hospice use has increased and the numbers
using the legislation remains small, but the
fear, anxiety and pain scores associated
with dying have decreased.
The figures from Oregon also show that the
slippery slope and exploitation arguments are not
valid. Louis Theroux made a hard watching but
sympathetic documentary on this.4
The religious argument is out of my remit as are the
legal aspects and the argument that we have to extend the
protection of the law to those who are dying is irrefutable,
but it is parliament that chooses legislation.
Among the medical profession surveyed in 2020,3 50%
believed there should be a change in the law. 39% were
opposed to physician assisted dying but only 36% of doctors
were prepared to be involved, 45% would not participate and
11% were undecided. This poses really thorny questions —
Who is going to prescribe medicines to take a life? Who is
capable of deciding whether a terminal illness is correct, or
the patient has capacity and is not being coerced?
When I was at medical school palliative care education
was pretty pathetic, fuelling the belief that if something can
be done it must be done. Palliative care services were seen as
a Cinderella service — neglected, underfunded, and poor.
QUALITY OF LIFE
In the last few years palliative care services have
improved. This is mainly through the use of the third sectorcharity.
Research into palliation has increased.
Receiving palliative care is not an immediate sentence of
death. It is an acknowledgment that the disease process has
a life limiting aspect to it, but it doesn’t just mean length of
life. Palliation is the treatment of symptoms that remove
quality of life.
It is time that this Cinderella service got it’s happy ending
(no pun intended) and is elevated to its rightful position and
funding.
Patient choice has been high on the health services
agenda for many years now but sometimes it’s a choice
between a kilo of mud and 2.2lb of mud, no real choice. I
mention this because a huge question for me is if palliative
care services were of ‘gold standard’ would people want to
choose differently?
At the moment we have the unacceptable legal/moral
position of ‘turning a blind eye’ to those who assist
someone to travel to a foreign country with the sole
purpose of dying. It is a criminal act whereas
suicide was decriminalised in 1961. Doctors in our
country are not allowed to aid dying or provide
material or information that may lead to it. They
face prison and their licence to practice to be
removed. We cannot provide an opinion on whether
someone is capable of making the decision.
People in their most needed time of life are faced with so
many decisions. Palliative care and assisted dying
are not binary choices and correctly used,
together, could offer peace at the end of life; a
choice.
Even with the best care and the support
and love of family, friends and the community
around them, some people suffer in their final
days and there are alternatives to being rendered
confused and sedated, which just prolongs the
inevitable decline and death.
I hope I haven’t offended or hurt anyone by
discussing this topic and indeed hope that some
may take comfort in knowing that with correct help
the end of life can be well managed; but that needs
not only the medical profession but all of society,
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