Improve End of Life Care before Assisted Dying - not before !

[Gladys]

The problem is that much of medicine really just postpones the inevitable.  You can see it more clearly in pets when the veterinary treatment has kept the animal alive for far longer than it would have survived without it.  With pets, it is our intervention that has prolonged the suffering and so euthanasia is the kindest option.  To a degree, we have created the problem. 

It is a hard one for humans though and any legislation must have rigorous safeguards. 

[Apple]

@Roxanne and @Gladys hit the nail on the head.

Legislation and then practices that arise from that have to be specific and unambiguous. There is no margin for corner cutting, expediency or political or economic strategy to influence people in their decision making.  This was discussed on the island some 10 or more years ago iirc and the professional organisations did not support the idea at that time. However the need for the debate and the consideration is apparent nowadays as developments in medical care and social conditions have continued. 

Unless and until we know that say for example DNR (do not resuscitate) notes on medical records have been fully discussed with the patient and / or family and are regularly updated (consent and agreement can always be withdrawn but that doesn't seem to apply in all cases) then we must pursue the Capacity and Consent issues before we even consider this.

As for the economic and political dimensions then this would be a good time for Manx Care to show how independent it is from both of those influences and base their approach on the public and clinical attitudes. One could almost say it is too important and a much more complex debate for Manx politicians to seriously engage with and should be part of the wider UK approach. 

[snowman]

is this the new tourism policy ?

[Annoymouse]

44 minutes ago, Gladys said:

The problem is that much of medicine really just postpones the inevitable.  You can see it more clearly in pets when the veterinary treatment has kept the animal alive for far longer than it would have survived without it.  With pets, it is our intervention that has prolonged the suffering and so euthanasia is the kindest option.  To a degree, we have created the problem. 

It is a hard one for humans though and any legislation must have rigorous safeguards. 

I think it’s very similar actually, we prolong pain and suffering in humans by administrating a vast array of drugs to delay the inevitable, but when a vet says to someone that their pet is beginning to suffer, the vast majority of people respect that opinion and put the animal down.

The difference being that doctors aren’t allowed to put humans down in the same circumstances, take a DNR as an example, unless one has been signed then CPR should be preformed regardless even when doctors/nurses know it’s a complete and utter waste of time and is only prolonging the inevitable.

For some reason people are insistent on keeping a life support machine beeping, I do see the occasional story of people suddenly coming around after being in a coma for years and I think it helps feed this selfish nonsense of keeping someone alive, I’m not sure at what point the line should be drawn, but we certainly shouldn’t be keeping people in a coma for years.

We treat animals better than we treat humans, fact.

[TheTeapot]

4 minutes ago, Annoymouse said:

 

We treat animals better than we treat humans, fact.

I dunno man, last time there was a major disease epidemic they burnt all the cows.

[Annoymouse]

Just now, TheTeapot said:

I dunno man, last time there was a major disease epidemic they burnt all the cows.

True, I should probably rephrase that and say the vast majority of people treat their pets better than they treat humans. Some people are obviously unhinged and hurt/abuse their animals on purpose.

[Gladys]

15 minutes ago, Annoymouse said:

I think it’s very similar actually, we prolong pain and suffering in humans by administrating a vast array of drugs to delay the inevitable, but when a vet says to someone that their pet is beginning to suffer, the vast majority of people respect that opinion and put the animal down.

The difference being that doctors aren’t allowed to put humans down in the same circumstances, take a DNR as an example, unless one has been signed then CPR should be preformed regardless even when doctors/nurses know it’s a complete and utter waste of time and is only prolonging the inevitable.

For some reason people are insistent on keeping a life support machine beeping, I do see the occasional story of people suddenly coming around after being in a coma for years and I think it helps feed this selfish nonsense of keeping someone alive, I’m not sure at what point the line should be drawn, but we certainly shouldn’t be keeping people in a coma for years.

We treat animals better than we treat humans, fact.

You have said exactly what I wanted to say, but so much more eloquently.  

[Annoymouse]

4 minutes ago, Gladys said:

You have said exactly what I wanted to say, but so much more eloquently.  

Thank you, I sometimes get frustrated as I feel I don’t explain myself particularly well and having a somewhat alternative view doesn’t always help, but this is a subject I feel particularly passionate about.

[pongo]

4 hours ago, wrighty said:

I know there have to be safeguards to stop people being coerced into suicide to avoid nursing home fees etc, 

I know that everyone is different. But  needing to be in a nursing home would for me mean that it was time to exit. Or, frankly, if I've just had enough.

[Apple]

3 hours ago, Annoymouse said:

we prolong pain and suffering in humans by administrating a vast array of drugs to delay the inevitable, 

Not necessarily but I don't think this what was meant. There is no reason in this day and age to have anyone suffer pain and suffering in hospital, or at home, or anywhere else. The conditions wherein those decisions are made has to be just, fair, and legal and must be overseen by those with no influence or benefit. That includes medical staff treating the patient. For example - DNR's should not be signed off or implemented by the members of the clinical team treating the patient at the time.

That is a Safeguard we need to introduce now. We do not need a new law to instigate what some would already consider best practice.

That is my whole point. Let's make what we have better before we go careering off down the assisted dying route. Once we do there will be no turning back. 

Edited June 23, 2021 by Apple
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[display name]

4 hours ago, snowman said:

is this the new tourism policy ?

All aboard the Ben-My-Croak for the dead centre of the Irish Sea-em-off.

[Annoymouse]

51 minutes ago, Apple said:

DNR's should not be signed off or implemented by the members of the clinical team treating the patient at the time.

That is a Safeguard we need to introduce now. We do not need a new law to instigate what some would already consider best practice.

I’ve heard enough stories from friends/family to know they use their best judgment wherever possible, they aren’t in the business to prolong suffering. The biggest issue however is liability/red tape and family members go looking for someone to blame for the death because they can’t come to terms with it.

A patient can say no to a blood transfusion even though it might save/prolong their life, assisted dying should work in a similar way.

I wouldn’t necessarily be happy with say one doctor making the decision to end my life but if it was a collective decision (best interest?) then go ahead.

[wrighty]

We need to stop conflating DNR orders with end of life care or euthanasia. My view, not necessarily mainstream admittedly, is that DNR should be the default position for most patients admitted with non-cardiac conditions. Re-starting the heart has a chance of working if the heart is the first thing to pack up, not when it’s the last. 
 

This may be a ridiculous argument, but it’s pertinent. We don’t discuss whether or not to send people for heart transplant and have them sign forms to say it’s ok that they’re not. Why therefore should we be obliged to discuss CPR, a treatment that is effective in about 5% of cases? It generally prolongs death, not preserves life. 

The public perception of CPR is generally derived from TV programmes like Casualty. In reality it’s not like that. Unless there’s a reversible cause for cardiac arrest it is futile. It doesn’t work for frail, elderly patients with dementia who have reached the end of their life. It needs to be used sparingly, and the public need to understand that it’s generally not indicated. 

[Annoymouse]

There is a lot of focus on CPR, because we’re told it can save someones life, the public are therefore actively encouraged to learn CPR and that itself leads to its own issues, it’s a fairly traumatic process trying to save someone when their body is trying to shut down but if you ever ring 999 after coming across someone unconscious that’s probably what will be expected.

Edited to add : i think there is definitely more of a expectation of survival if it’s a a doctor performing CPR, I didn’t realise it was as low as 5%

Edited June 23, 2021 by Annoymouse

[Apple]

Who and how DNR orders are arrived at is my concern, not on who they are applied to. If patients are. elderly, frail, and have a very low quality of life it is appropriate. 

They used to use the Liverpool pathway for End of Life care until it was done away with. 

The withdrawal of food and fluids does not constitute humane treatment but does the issue of letting nature take it's course probably better than high doses of morphine etc like they used to do regularly in the olden days. There are many ways. for patients to be kept comfortable especially if agitated.

Helping people to die peacefully is a skill, and art if you like. That why we have hospices where the knowledge and skill are available. A lot of people though do not die in a hospice. I have heard enough stories to say that sometimes the skills associated and available with dying patients in Nobles could be improved. We need that before more complex legislation is brought forward in my view.