Friday, 18 July 2014

Assissted dying debate

This from Telegraph website.  Greatly admire this lady.
1252 The most personal intervention so far came from Baroness Campbell of Surbiton, who suffers from severe spinal muscular atrophy and spoke through a ventilator. Here is a text of what she said:
“My Lords, I have fought for autonomy the whole of my life.
“I have fought it for myself and I have fought it for others. I do not want this bill.
“My Lords, first I must declare a very important interest: this bill is about me. I did not ask for it and do not want it but it is about me nevertheless.
“Before anyone disputes this imagine it is already law and that I asked for assistance to die – do your lordships think that I will be refused?
“No. You can be sure there will be doctors and lawyers willing to support my right to die. Certainly many would put their energies into that without … helping me to change my mind.
“This bill offers no comfort to me, it frightens me because in periods of greatest difficulty I know I might be tempted to use it.
“It only adds to the burdens and challenges life holds for me.
“But it is not just about me, my story is echoed by the majority of disabled and terminally ill people in Britain today many of whom are outside this House protesting against this bill I urge you to go and talk to them. Many more have written to Your Lordships.
“Supporters of this bill argue that there is a hard and fast distinction between terminal illness and disability – I can tell you absolutely there is not.
“We the folk this bill claims to serve know that.
“The bill purports to offer choice, the option of premature death instead of pain, suffering and disempowerment.
“But it is a false choice – it is the burglar who offers to mugs you instead.
“That is not choice: pain, suffering and disempowerment are treatable, I have to believe that and it should always be treated. My own experience of progressive deterioration has taught me that there is no situation that cannot be improved.
“My Lords I have spent my life developing ways to prevent people in vulnerable situations from feeling powerless and burdensome. They do get cajoled, they do feel a burden, especially when they are at home with no one to come and assist them to go to the toilet, to have dignity.
“I have seen this transformation … those who society once saw as totally dependent become active and valued human beings.
“Assisted dying, I’m afraid will bring back outdated beliefs that devalue disabled and terminally ill people and we have tried so hard to get away from that.
“Small wonder then if some succumb to those beliefs and see premature [death] as the only answer.
“Small wonder then if family, friends, doctors and others see their duty to support that goal. It does appear easier, cheaper and quicker – and it is. 
“My Lords is motivated by fear and pity but, as the great words of the greatest French novelist Balzac observed, pity is death to us it makes our weakness weaker still.
“Death is seen as a release from pity for both giver and receiver but there are far better ways but there are far better ways of responding … we are no way near there yet.”
She went on: “This bill has become a runaway train, all the more frightening because of that.
“Please my Lords let us pause, let us find ways to reflect further. The bill is not the answer.”

Tuesday, 15 July 2014

Assisted suicide

I'm very concerned by the prospect of assisted suicide becoming law, and the forthcoming 2nd reading in the House of Lords that comes up this Friday, July 18th. For once the Daily Mail is helpful (I have to say its usually a bit of pain generally for the average GP). So catch this, http://www.dailymail.co.uk/news/article-2686711/Dont-make-mistake-As-assisted-suicide-bill-goes-Lords-Dutch-regulator-backed-euthanasia-warns-Britain-leads-mass-killing.html

There are so many reasons why the law should be left alone. The vulnerable need protection. The value of human life needs to be constantly upheld. The research and effort for palliative care needs to be maintained and even increased, doctors should not become partners in assisted dying-it changes the trajectory of the whole history of medicine and doctor-patients relations.

Insistent on assisted dying

The national newspapers are lining up. The Guardian is in favour of assisted dying, but columnist Andrew Brown has this tucked away in yesterday's piece.

A central objection – which seems to me completely inarguable – is that this really is an extremely slippery slope. Once the principle of autonomy has been conceded as a moral one, it becomes immoral to interfere with it.
There is no line to be drawn. Once we concede the principle that it is up to the patient to determine whether his life is worth living, and that the doctor's duty is to facilitate this wish, no amount of safeguards in law will matter. The patient's right to choose will become an absolute, just as the woman's right to choose has done. And that will put huge pressure on doctors to act against their own consciences, just as abortion does.
What is more, opponents are correct that it isn't really the patient's right to choose. As Giles Fraser keeps saying, we are not as autonomous as we currently pretend. Old people and others are hugely influenced by those around them. And – let's be frank – when those others have a financial stake in an early, cheap death, they will value the patient's life less. So will the patient. The desire "not to be a burden" is pretty deep rooted in social animals like us.,

Monday, 14 July 2014

Listening


Just recently I joined the rest of the human race and had some fraudulent payments exit my bank account. I cannot deny that it was stressful although the sums of money involved were not too great. The source of the stress was the way my bank dealt with me.

I totalled eight different ‘customer specialists’ (heaven help those people who speak to customer generalists), before finally the matter was successfully resolved. The nub of the problem was that each of them failed to listen adequately to what I was saying.  I tried, I really did try to communicate, but it wasn't until ‘Matt’, that I was understood.  Ah listening, that old fashioned supremely powerful tool in the hands of all doctors.

Listening is difficult and it is very tiring. It may seem strange to the non-doctor, but 3-4 hours of listening to a variety of human stories, especially if listened to well, is exhausting. Active listening consumes considerable energy as one seeks to clarify, summarise, encourage and understand. But the gain is enormous.

The medical insurance companies tell us that when a patient feels listened to and understood the complaints are much reduced, and similarly the likelihood of the patient benefiting from the consultation (even where no firm diagnosis is made or treatment is prescribed) is considerably increased.

‘To give a patient the impression that you could spare him an hour and yet make him satisfied with 5 minutes is an invaluable gift, and of much more use than spending half an hour of which he is made to feel that he is encroaching on your time. I do not know if this sepical kind of unhurried placidity can be acquired purposely, but it is a most enviable faculty to possess.’ Richard Asher in Talking Sense

To do it well requires at least two commitments. A commitment to at least try to understand (the ideas, concerns and the expectations), and also one of unhurriedness.

In the vortex that is the modern NHS what a relief to realise that there are many things that don’t and needn’t change, the art of listening is surely one of them.

Tuesday, 8 July 2014

Half-baked

On our recent summer holiday Biddy and I read from Charles Spurgeon's daily readings. On one particular  occasion we were very struck by the perception of his comments on what at face value seemed a rather obscure Biblical text. If the cap fits....


"Ephraim is a cake not turned." 
A cake not turned is uncooked on one side; and so Ephraim was, in many respects, untouched by divine grace: though there was some partial obedience, there was very much rebellion left. My soul, I charge thee, see whether this be thy case. Art thou thorough in the things of God? Has grace gone through the very centre of thy being so as to be felt in its divine operations in all thy powers, thy actions, thy words, and thy thoughts? To be sanctified, spirit, soul, and body, should be thine aim and prayer; and although sanctification may not be perfect in thee anywhere in degree, yet it must be universal in its action; there must not be the appearance of holiness in one place and reigning sin in another, else thou, too, wilt be a cake not turned.
A cake not turned is soon burnt on the side nearest the fire, and although no man can have too much religion, there are some who seem burnt black with bigoted zeal for that part of truth which they have received, or are charred to a cinder with a vainglorious Pharisaic ostentation of those religious performances which suit their humour. The assumed appearance of superior sanctity frequently accompanies a total absence of all vital godliness. The saint in public is a devil in private. He deals in flour by day and in soot by night. The cake which is burned on one side, is dough on the other.
If it be so with me, O Lord, turn me! Turn my unsanctified nature to the fire of thy love and let it feel the sacred glow, and let my burnt side cool a little while I learn my own weakness and want of heat when I am removed from thy heavenly flame. Let me not be found a double-minded man, but one entirely under the powerful influence of reigning grace; for well I know if I am left like a cake unturned, and am not on both sides the subject of thy grace, I must be consumed for ever amid everlasting burnings.

Don't lose the shock!

I was talking to a patient this week who has worked in very senior positions in a number of companies. We were discussing how new employ...