13:04, February 28 157 0 theguardian.com

2020-02-28 13:04:03
The right to a dignified and less painful death

As someone who cared for their terminally ill partner, Helen, for her last eight years of life, and who felt the force of the law after her death at the Dignitas clinic in 2016, I found Dr Matthew Davis’s letter (25 February) on assisted dying deeply disturbing. Dr Davis appears to imply that calls for changing existing legislation are morally motivated. As a moral issue, the public has the right to make its voice heard and to be respected.

The confusion exemplified in Dr Davis’s letter continues in relation to that slippery notion of “harm”. Rightly, Dr Davis points out that protection of the “weak and vulnerable” is of paramount importance in any medical scenario. What I find difficult is that medically intervening to extend a life near its end, or passively withdrawing treatment to allow a so-called “natural” death, can itself constitute a harm, particularly where the chances of intense pain and suffering are considered by all as a reasonable expectation. This is not just a moral harm, it condemns those whom do not wish it to physical harm as well.

Further harm is also constituted when, due to existing legislation, the dying attempt to take issues into their own hands, which frequently ends disastrously. Likewise those who are able to afford it are compelled to travel aboard when they are weak and frail. So too all the families that have been affected by unwarranted and emotionally distressing police investigations after a loved one has died abroad.

James Howley

West Bromwich, West Midlands

Who can disagree with Dr Matthew Davis when he refers to the duty of respecting the Hippocratic oath? The oath promises to “abstain from causing harm” rather than “first do no harm”, but let’s leave semantics aside.

I spent my career trying to respect the oath, but it is not as simple as it sounds. Please advise me what harm I am invoking by respecting the carefully articulated, legally protected, autonomous wishes of a dying patient. Particularly when the alternative – palliative care, regretfully, having limitations – is to lose the patient’s trust by condemning the sick to greater suffering, greater distress and, I maintain, subsequent harm.

I understand the discomfort of many, but I would be more understanding of their opposition if they desisted in basing it, primarily, on obviously and overly simplistic words that are two millennia old.

Dr Richard Clubb

London

I’m not sure if my husband, who died at 62 from bulbar onset motor neurone disease, would count as a member of one of the “vested interest groups” referred to by Dr Matthew Davis, but my children and I have to act as his voice now. He decided not to go to Dignitas as that would have meant ending his life before he felt ready, and we supported his decision. He chose to die in the Mountbatten hospice to make it easier for the family, and he was treated there with care and compassion, but we all found the long wait for death agonising.

I bitterly regret not fighting harder to keep him at home, where there was access to all his medication and where I could have assisted him to die when he asked, instead of having to witness his despair at continuing to live. Smothering him with his pillow in the hospice did cross my mind, but I couldn’t bring myself to do it.

Bob was awarded his PhD a month before his diagnosis and died 15 months later. He had mental capacity and was clear that he wanted to die when and where he (and we) chose. His vulnerability during his last weeks was made more acute by this lack of control over his destiny. A 2019 Dignity in Dying poll carried out by Populous found that 84% of people in the UK would support assisted dying proposals. My daughters and I are among them.

Helen Keats

Kingston, Shorwell

Speaking as someone who accompanied my husband to Switzerland for an assisted death, I have found it extremely disappointing that, despite the Royal College of GPs’ survey having 51% of voters preferring a neutral or supportive stance, its council has decided to remain opposed to assisted dying. One can only conclude that the council has decided to ignore the opinions of its members.

The only fair position for the RCGP to take would be neutrality, as the Royal College of Physicians did last year when its survey showed a similar split in views. Meanwhile, the BMA’s own assisted dying survey closed on 27 February. I hope members opted for neutrality, which would allow everyone’s views – patients’ and doctors’ – to be respected.

Sara Fenton

Hungerford, Berkshire

As a 52-year-old with incurable breast cancer, I can’t tell you how devastated I am with the RCGP’s decision to remain opposed to the choice of assisted dying. I live every day knowing that it is highly likely I will become terminally ill in the next few years. I am scared of dying, the pain and the indignity. The choice of an assisted death would mean that I could use what energy I have living my life, rather than worrying about the end of my life. Where is the compassion I crave, to know that I don’t have to be afraid? Doctors and GPs, this question is about the wishes of dying people. Please listen to your patients.

Christie Arntsen

Black Bourton, Oxfordshire

Wednesday 26 February would have been my daughter’s 33rd birthday. However, after two-and-a-half years of gruelling cancer treatment, we were advised that nothing further could be done. Fiona’s last few weeks were spent in a hospice receiving palliative care intended to reduce her pain. Despite huge amounts of drugs, she still suffered excruciating pain and this was devastating as a mother to witness. The medication was increased daily and she was advised that she would be sedated and eventually pass away, and it was, by this time, her wish to do so. Every time she fell asleep we thought it was for the last time, as did she. However, she kept waking and the pain was constant. Distress was obvious for all concerned, including the wonderful health professionals.

Eventually the large doses of pain relief resulted in her death, but it was a slow and painful process. I fail to see the difference in gradually increasing the medication daily, to administering a large dose, which would have the same outcome but would have lessened her suffering. There was no hope of recovery for Fiona but I feel she was entitled to a quick and peaceful death and should have not been made to endure this barbaric protracted process.

We are all going to die, and should be able to do so in a dignified and as peaceful way as humanly possible.

Susan Strong

Epsom, Surrey

In 2018 I accompanied my husband of 45 years to Switzerland, where he ended his own life. It took tremendous determination on his part to fulfil the rigorous procedures of Dignitas and Swiss law, and then to make the difficult journey to a foreign country. He had suffered from Parkinson’s for nearly 20 years and he was facing a brutal decline when he would be totally dependent on the care of others. He died peacefully and with great dignity, at a time of his own choosing. There is no need for scaremongering. Switzerland and several other enlightened countries can provide a careful model, which the UK could use or adapt. I speak from personal experience when I say that the safeguarding procedures of Dignitas and Swiss law are rigorously adhered to.

A huge percentage of our population is in favour of a change in our outdated law. Doctors, like any other group, represent a range of opinions. No doctor would be required to act against her personal ethical stance. But sometimes “doing no harm” can mean a refusal to act upon the ultimate in compassion.

Jan Vallance

Dore, Sheffield

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