Dying with Dignity

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Dying with Dignity. Susan Wilson GPVTS 24/01/2008 With acknowledgment to Elaine Murphy’s presentation at RCGP Annual Conference. Introduction. Suicide Act 1961 decriminalised suicide Failed attempt could no longer be prosecuted - PowerPoint PPT Presentation

Transcript of Dying with Dignity

  • Dying with DignitySusan WilsonGPVTS 24/01/2008With acknowledgment to Elaine Murphys presentation at RCGP Annual Conference

  • IntroductionSuicide Act 1961 decriminalised suicideFailed attempt could no longer be prosecutedHowever a person who aids, abets, counsels or procures the suicide of another, or attempt by another to commit suicide, shall be liable on conviction to imprisonment of a term of up to 14 years

  • IntroductionHuman rights Act 1998 states that everyones right to life should be protected by law.No one shall be deprived of his life intentionally save in the execution of a sentence of a courtChallenge by Mrs Pretty lost as refusal to consent to treatment even if death will ensue is not the same as ending ones life

  • ValuesAll patients are intrinsically valuable, no matter how disabled. A doctors role is to strive to improve the quality of life

    A request to die is a communication that has many different meanings

    A doctors primary role is to relieve suffering, not to preserve life at all costs

  • Choice at the End of LifeEveryone should have a choice at the end of life. Palliative care should be patient-led.

    End-of-life decision making should be open and honest. Under control of patient.

    Choice for terminally ill people should include medically assisted dying within strict legal safeguards

  • British Social Attitudes Survey 2006 82% Support ADTI

    GP Net 2005 62% doctors say yes to intentionally hasten death

  • Other CountriesSwitzerland has loophole in suicide laws and includes non-residentsOregon, USA has death with dignity act. Only permits assisted suicide and only for residents.Holland and Belgium allow voluntary euthanasia as well as assisted suicide. Also only for residents.

  • What is legal in UK now?

    Suicide have to be able to do itAdvance directive to refuse treatmentDouble effectTerminal sedation

  • Dignity in DyingCampaign organisation (formerly VES) seeking greater choice for patients at the end of their life

    Feel that choice of when and how to die should be a basic human right

  • Dignity in DyingThis year [2007] has seen some terrible cases of people's wishes at the end of life not being respected. The fact that over one half of all complaints about the NHS are about end-of-life care is unsurprising. Access to palliative care is a postcode lottery and the service you receive depends on where you live. People with a terminal illness and who are unbearable suffering are denied the right to an assisted death and have to consider an unacceptable, morbid pilgrimage acrossEurope.

    Ashley Riley, Head of Campaigns

  • Dignity in Dying

    "The implementation of the Mental Capacity Act in October was a positive step forward in ensuring greater patient choice at the end of life, but theUK still has a very long way to go. Assisted dying should be a basic right for terminally ill, mentally competent adults who are suffering unbearably. Excellent palliative care should be available to all those who need it. More awareness of the importance of advance decisions is vital to ensure everyone has the best death possible."

  • DignitasFounded May 1998 Ludwig MinelliFirst assisted suicide took place in Oct 1998Clinic in Switzerland but accept non-residentsIn 2007, 70 Britons travelled there to end their lives

  • Swiss Law"Whoever lures someone into suicide or provides assistance to commit suicide out of a self-interested motivation will, on completion of the suicide, be punished with up to five years' imprisonment". Dignitas interprets this to mean that anyone who assists suicide altruistically cannot be punished. Its specialist staff all work as volunteers to ensure there can be no conflict of interest.

  • Steps to TakeJoin Dignitas as a member (registration fee plus annual membership)Send personal letter of request explaining reasons. Need to include medical file containing diagnosis, therapies and prognosis (medical examination within 2 months) and CV

  • Steps to TakeDignitas finds a Swiss physician willing to prescribe lethal medication (phenobarbital)Obtain recent copies of all documents (birth cert, marriage cert, divorce decree etc)Once documents are with Dignitas an appointment can be made

  • Steps to TakeMember will meet physician who must assess capacity and explore any other possibilities eg analgesiaIndividual must be capable of making final act himself (drinking barbiturate solution, self-injecting prepared solution etc)Retain control of the act to the endAverage time scale is 77 days

  • A nurse sits with the patient, but cannot actually help

  • Assisted Dying for the Terminally Ill BillLord Joel JoffeBill to enable an adult who has capacity and who is suffering unbearably as a result of terminal illness to receive medical assistance to die at his own considered and persistent request

  • ADTI BillWould be lawful for a doctor to prescribe medication and provide a means of self-administration (if oral not possible or appropriate)Members of healthcare team to work with the doctorCertain conditions must be satisfied

  • ConditionsDoctor must be informed in a written request, signed by patient, that he/she wishes to be assisted to dieSatisfied that patient does not lack capacityDetermined that patient has a terminal illnessConcluded unbearable sufferingInformed the patientEnsured palliative care availableRecommend patient notifies next of kinSatisfied that request is made voluntarilyRefer to consultant

  • Problems with the BillUnwieldy? Too much hassle?Which doctors? Remove illegality of assisted suicide insteadReview illegality of intention to kill by double effect if patient states wish to die

  • Who wants to die?Unusual few?

    The 2900 annual double effect deaths (Seale 2004)

    The Ive had enough doc thousandsDiane PrettyKelly Taylor

  • OutcomeLords select committee reported April 2005Called for a debate in next parliamentary session (2004/5 session cut short by election)Report recommended changes to the bill

  • Changes Assisted suicide and euthanasia dealt with separatelyTerm unbearable suffering changed to unrelievable sufferingConditions for assisted dying should be specific to clinical practiceActual procedures doctors should follow must be clearly statedLord Joffe to draft a new bill after full House debate

  • Against the BillSanctity of lifeDying is a part of lifeErodes doctor-patient relationshipRelationship should be open and honestNeed to assess capacityMCA requires us to assess capacity anywaySlippery slopeNot the experience from other countriesEffect on vulnerable groupsPatients in Oregon and Holland aged 50s and 60sPalliative care would be betterPart of palliative care, provides reassurance

  • ?

  • SummaryEnd-of-life choice is still a contentious issue

    Not yet in statutes in UK

    Other countries have different legislation