I work as a renal physician, including on a transplant ward, so I will have had many of the same experiences as Zubir Ahmed, but I do not share his opinion about assisted dying (As a doctor, I say this: before we even consider assisted dying, fix how we care for the most vulnerable, 26 August).
It is universally agreed that patients with capacity should be able to make decisions about their treatment. Their decision is the one that matters if they have the ability to use and understand the relevant information and can communicate any decision they make. The doctor needs to explain possible options and their likely outcomes in as fair and balanced a manner as possible.
My daily reality, like that of just about everyone working in the NHS (and in other healthcare systems), involves doing the best I can within constrained resources. Palliative care provision and social services are not unique in being limited by the funding and staffing available. To say that patients should not be allowed to choose an assisted death until these reach some arbitrary standard defined as acceptable by Mr Ahmed or others begs many questions, and denies patients the ability to control their destiny now.
Kidney doctors such as me look after patients receiving artificial kidney (dialysis) treatment. This gives many years of good life to many, but when the burden of living has become too much, it is not uncommon for them to decide to stop their treatment. “Thank you for looking after me so well, and for letting me go,” is the most moving thing a patient has ever said to me.
It is essential that safeguards are incorporated into any legislation that allows a patient to choose an assisted death, but we must work out how to craft these safeguards, not deny patients a choice.
Dr John Firth
Cambridge
Zubir Ahmed is right: palliative care needs investment and development before any further debate on assisted dying. Fear of dying badly has increased as NHS services have been squeezed more than ever. Lauren Edwards’ bill would fund assisted dying from the NHS budget, further eroding other services. Specialist palliative care across the UK is patchy, and palliative care in generalist services varies widely.
When a doctor says “there’s nothing more that can be done”, few patients know to ask for a specialist opinion. Sadly, many clinicians are unaware of developments in specialist palliative care and what can be done to relieve distress.
Without access to adequate symptom relief and competent psychological support, you won’t have a real choice when an assisted death is both offered and delivered by the very clinicians who could and should be working to improve your quality of life.
Research reveals that abuse of older people is common, but Edwards’ proposals will do nothing to detect abuse and coercion. The bill does not even require cases of assisted dying to be referred to a coroner; there will be no scrutiny of what really happened. In the last 15 years, 209 cases of assisted suicide have been referred to the director of public prosecutions; eight were prosecuted for homicide or other serious crime (almost 4%). How will these be detected under the current proposals? Andy Burnham is right. This bill is an untimely distraction.
Sheila Hollins and Ilora Finlay
House of Lords
As a former nurse and NHS midwife of more than 30 years, and now a full-time unpaid carer for my 88-year-old mother with dementia, I agree that a choice is only meaningful when a viable alternative exists.
We rightly worry that seriously ill or disabled people may feel they have become a burden. But we must confront what creates that fear: social care that is rationed, unaffordable or unavailable, while relatives are expected to fill every gap regardless of the cost to their own health and future.
I did not freely choose between continuing my career and becoming a full-time carer. I chose not to abandon my mother when suitable, reliable and affordable support was unavailable. Those are not the same thing.
I now provide considerably more than 35 hours of care each week for carer’s allowance of £86.45 – no more than £2.47 an hour at the minimum qualifying hours. Caring has cost me my salary, occupational-pension growth, financial independence and much of my freedom. Yet the state treats family care as an almost limitless free resource.
A humane social-care system would guarantee appropriate professional support to anyone who needs it, including people without relatives. Families could then choose whether to provide care, how much they could safely manage and when they needed to stop. Carers would receive proper financial support, pension protection and meaningful respite.
Before parliament creates another choice at the end of life, it must provide genuine choices throughout life. No vulnerable person should fear being a burden because adequate care is missing – and no relative should have to sacrifice their entire future to prevent that from happening.
Jacqueline Hylton
Leeds
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