Thursday, 26 June 2014
Death By Killing –The Assisted Dying Bill
Archbishop Peter Smith has asked us to place a notice in our Bulletins this weekend encouraging us to write to the House of Lords and express our views on the ‘Assisted Dying’ Bill. Having sat for a month by the bedside of my mother following a subarachnoid bleed, and observing the care given and the rationale behind the medical and nursing interventions, I shall be saying that the dying person does not require killing (or assistance to take their own life) but complete and dedicated care. We should not measure our care of the terminally ill by how easy it is to bring about their death, but against the criteria of “is this going to delay natural death (in which case it is wrong) or sustain comfort while moving towards a natural death?”
In the UK, Pathways for the dying routinely remove food and fluids while increasing drugs which sedate the patient, achieving a calmness in the patient that may prevent the dying person from being unaware they are thirsty, with the family thinking their loved one’s death is simply ‘peaceful’ rather than procured. In the situation with my mother, the physician said they were going to remove mums subcutaneous infusion (500mls N/S per 24hrs) as it was life-extending. I had to challenge this to have it noted as -at most- life-sustaining, and certainly not life-extending. In that we all lose around 450mls per day just by breathing, never mind the insensible loss (loss of which we are generally unaware, as in sweating) and the sensible (obvious) loss in passing urine, there seems no good reason for removing all fluids. Even in congestive heart failure, removing the infusion may do little to relieve the pulmonary congestion since circulating fluid ‘seeps’ into the lungs whether fluids are given or not -and it is, after all, simply replacing only one daily ‘insensible loss’. This is not to say there are no occasions in which infusions can be removed in the last few hours of life, but whether infusions are present or not, frequent mouth care by nurses and relatives must be a priority intervention for reasons of comfort.
Many anxieties arise in those who are dying, mainly concerning pain and dignity during the dying process. It is this pain and distress that needs to be ended, not the patient, while their dignity and enjoyments are to be retained. If the dying person can retain their dignity (by respectful cleansing after passing urine or stools etc); have their anxieties relieved (by adequate but not excessive use of anxiolytics), their pain relieved (by such as morphine); any muscle spasm relieved (by such as Baclofen or Clonazepam); and if their enjoyments (TV programmes, reading or music etc) can be provided along with comforting, human-touch therapies (such as massage and aromatherapy), many who think they should end their life might be happy to have more time with their loved ones. This kind of care requires more and better funded hospices. We must strive to provide such care because the human person alone walks the earth with a dignity that does not have a sliding scale based upon whether one is rich or poor, black or white, male or female, sick or well. We are not mere animals; we have a mind which produces concepts; a mind which brings us to understand and master the world in ways that animals with their basic instincts cannot. We may euthanize the arthritic dog, but people require other than killing –they require compassionate caring and respect.
It is said that the Assisted Dying Bill will result in fewer dying adults facing unnecessary suffering at the end of their lives and bring clarity to the law, thus providing safety and security for the terminally ill and for medical professionals. This is a poor argument, since suffering can be relieved by medications and having pleasures retained as I outlined above. Nor do we need a clarity in the law that brings physicians, nurses and loved ones to become killers rather than carers; the clarity we need is on the protection of human life and the provision of proper care.
It is said the Bill will not legalise voluntary euthanasia, or act as a slippery slope to do so, only give dying adults peace of mind that the choice of assisted dying is available if their suffering becomes too great for them to handle. That the Bill would not legalise euthanasia is nonsense; the procuring of death in the dying person is exactly that: euthanasia.
It is said that the Assisted Dying Bill would only apply to adults with ‘mental capacity’ both at the time of their request and at the time of their death. This does not lessen the reality that this Bill is seeking to procure death before one’s natural time. Further, the issue of consent is very problematic: when given a long time in advance it cannot be relied upon since it is given when the person cannot actually know how well they would cope if complete and expert care were given. If consent is given in the immediate situation it is hampered by fears, and if anxiolytics are given to relieve that fear then the consent is given while under the influence of drugs. The Bill would certainly NOT protect against unscrupulous relatives or physicians from pressurising the dying person into requesting euthanasia by engendering feelings of guilt, fear etc.
To conclude: what is required is not procured death by killing but dedicated, complete care of the person’s physical, mental, social and spiritual well-being, which can be achieved through more and well funded, fully staffed hospices. The dignity of the human person demands this; the capacity for compassion for one’s fellow man delivers it, since compassion naturally inspires devoted care, not killing.