Dying – assisted by whom?

I felt relief to hear of the vote in favour of “assisted dying” last week. If you are pushing seventy and have listened to a stream of stories about the potential agonies of the process of death, you can only feel relief that there might be some possibility of a slightly early escape. But like Jonathan Sumption, writing in the Sunday Times, I hardly felt “jubilant”. On a close read, the whole tone of the proposals seemed dispassionate and impersonal. Maybe it has to be. But as Sumption put it, “parts of [the bill] read like a protocol for an execution”.

Like Sumption, I observed in a recent post that “we” (that is, the medical profession, dying patients and their relatives) have lost the ability to exploit the fuzzy boundary between life and death, between relieving suffering and hastening the end. In part, we have Harold Shipman to thank for that. I strongly suspect that no medic now can risk prescribing any more morphine than is strictly necessary to control the worst pain (and many no doubt err on the side of caution and prescribe a little less).

I am also conscious that small advances in life-extending treatments have come at the cost of more protracted deaths. Of course, I don’t for a moment begrudge those at the end of life a few more weeks or months (and I have no idea what choices I myself will make in those circumstances). But I do think we ought to be less naively celebratory when we cheer some new medical advance that claims to offer precisely those few weeks, and we spare no thought for what happens when the new wonder drug stops working. (How about we insist that research funding for new medical treatments should always include an element to be earmarked for palliative care?)

Overall, I guess that palliative care will benefit from whatever legislation about assisted dying finally gets passed. The idea that we will offer people an early death, but no alternative humane treatment at the end of their lives, will seem little short of sadism. But we will need an even bigger, and costlier, shake-up in medical provision than merely a raft of new hospices, welcome as they would be. Who do we imagine, in the NHS, is going to be doing all the talking and the listening that assisted dying must surely demand. My hunch is that hovering in the background of this debate has been the nostalgic image of a “Dr Finlay’s Casebook” style GP (someone who has known his patients for decades, who has time to sit and chat … we all know the fiction). But general practice doesn’t often involve that personal relationship anymore.

I changed GPs about five years ago, and since then I have never been to my “new” doctor. I don’t even know their name (though I occasionally spot on the NHS app. that I have been “re-allocated”). I confess that if I am ill, I am lucky enough to be able to pay up front and go to the local private GP, where you can get an appointment tomorrow for more than ten minutes, without hanging on the phone for ages at 8 AM. Friends and relations who (more obediently than I) respond to centralized NHS text messages to get a health check, tell me that it usually involves sitting down with a nurse while s/he reads questions off a computer screen (that you might as well have answered off your own screen at home).

So which part of the medical profession will be providing the infrastructure for assisted dying. I can’t imagine that it will be the private GP (though, in some ways, it might be a good signal if end-of-life care did interest them). But, in whatever way the system starts off, in due course I fear it will become closer to the online option (with or without the nurse). “Please tick the box to confirm that you understand …”. Don’t get me wrong, I still think that the House of Commons’ decision was the right one. But do let’s hope that it kickstarts some bigger changes in the Health Service.

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