Wes Streeting informed backbenchers this week that he is voting against the assisted dying Bill on 29 November, saying that ‘end-of-life care is not good enough for patients to make an informed choice.’
Experience of an issue, and I have too much on this one, can both cloud and inform opinion. I’m glad I don’t have to vote on the Bill but I do know that if palliative care was reliably good many people, myself included, wouldn’t fear the end as they do now.
The current Bill, if passed, would allow terminally ill adults with less than six months to live to end their lives with medical help. Six months is a long time. Many terminally ill cancer patients are still going to the shops and out for dinner at this stage. It’s difficult to predict how long a terminally ill person will live. A woman here in the village was suddenly, with no previous symptoms, diagnosed with cancer in August and died six weeks later. She was 61, looked like Sharon Stone and led a blameless and healthy life.
Others linger for years. Jeremy, diagnosed in 2013, asked me in October 2022 how long I thought he’d got. One of my daughters was having her first baby and I was leaving him for two weeks to go and help. He’d stopped driving by then, had an awful pallor and a faraway look in his eyes but could still stagger down the hill a bit to help me up from the car park with shopping. I hesitated –how could I know – but he pressed me. He wanted to live to see his grandsons the following February. I told him I hoped it would be longer but I thought perhaps he had six months left. By chance I was almost right, he died the following May.
The last few days or weeks are easier to predict. In most cases appetite diminishes, bodily functions slow, oxygen levels decrease, breathing changes, pallor deepens and pulse becomes thready. If a terminally ill patient was, at this stage suffering intractable pain (unrelieved by usual doses of medication), doctors used to administer what they knew would be a fatal dose but since the Shipman case this has all but ceased. Nowadays palliative teams use ‘twilight sedation’ to ease the patient through the last painful days. Although this isn’t euthanasia, medication may inhibit breathing and cause death sooner. This makes doctors fearful of litigation and sometimes they under-prescribe which can cause unnecessary suffering. Hospices don’t always have full medical cover, leaving patients waiting painful hours for relief. Liver metabolism varies – as I recounted in the column I wrote here in February – and this also leads to under-prescribing.
Wes Streeting is right that palliative care isn’t good enough at the moment. Improvements could definitely be made, and much of it needn’t involve huge expenditure.
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