A very British death

Published by Tom

September 3, 2009

I didn't know how to be more than vaguely uneasy about this story when I read it yesterday. Anna Raccoon (post linked above) explains from a position of knowledge and experience. If you are a British reader, there is a very high chance that she is describing how your life will end; put onto a "care pathway" (a euphemism for being deprived of food and water under sedation) by state employees as a form of healthcare rationing.

The Mental Capacity Act 2005 has been enlarged and updated to include
medical care for similar reasons – to provide legal cover for Doctors
and Nurses to take the actions they have always taken; but because we
wouldn’t allow an honest debate regarding euthanasia or assisted
suicide, it took the only route open to it – that of empowering Doctors
to follow the ‘Bland‘ formula, and starve you to death when you were no longer economically sustainable.

It is important to note that food and water administered by a doctor counts as "medical care." As Anna says;

Dying of malnutrition – starvation – or lack of hydration – extreme
thirst – is a painful and obscene manner in which to die. It has now
become the ‘gold standard’ in end of life care. It has come about
because as a nation we refuse to discuss euthanasia or assisted suicide
in a reasonable or responsible manner. We become both emotional and
obscurist, hiding our true views behind a cloak of carefully crafted
language.

These are not occasional hard cases making bad law. This is how 16.5% of Britain's deaths occurred last year. Since those statistics include premature deaths from accident and disease, it must be a higher percentage of deaths among the elderly. I agree with Anna. We need to face our fears and address this issue openly; like adults, not trusting children of a "benevolent" state. Don't listen to us "nut-job" libertarians (still believing crazily, as we do, what the majority of educated people have believed since the Enlightenment). Look at the signatories to yesterday's letter in the Daily Telegraph (reproduced in Anna's post, linked above and discussed here). Then listen to your own reason.

Our lives are our own. They belong neither to the state, nor to the medical profession. No matter how democratic, no government has the right to appropriate our own life and death decisions or delegate them to others. If doctors (under the direction of the Court of Protection or otherwise) are to be authorised to kill, let's have an open debate. Let's agree how and in what circumstances they may do so. Please however, don't throw me the bone of an opt-out. Those of you who have faith in the state's benevolence, feel free to opt in to the right to be starved/dehydrated to death.

Renaming killing as a "care pathway" and obfuscating the issue with talk of patient "empowerment" is revolting, cowardly and – it shames me to write – 100% typical of modern Britain.

11 responses to “A very British death”

jameshigham

September 3, 2009

Tom, you’ve got me shuddering now.

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deogolwulf

September 3, 2009

“. . .still believing crazily, as we do, what the majority of educated people have believed since the Enlightenment.”
You mean those crazy ideas which got us into this mess?

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Navigator

September 4, 2009

Tom, thanks very much for posting this. What a thing to see on return from a long vacation – the passionate and robust discussions several of us were having on this board about euthanasia a few weeks back were redundant, as this government had already put a law on the statute books that has state employees dispatching the old and weak.
What a disgrace this country is.

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Fay Levoir

September 4, 2009

I was happier before I read this post.
Not great to look forward to.

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Moggsy

September 4, 2009

I am not saying I don’t share your concerns on this one. I figure you couldn’t trust the state to (as the saying goes something like) “organise a binge in a brewery” just their incompetence and mediocrity guarantees that.
Then they need to fiddle the books to cover their failings up. This is what you are posting about here I guess.
I am not trying to be provocative, honestly, but I am harping back to previous posts on assisted suicide, a very different thing in my book.
I am doing it because in this post you say:
“Our lives are our own. They belong neither to the state, nor to the medical profession.”
I agree with that 100%
You more or less refuted, or more like sidelined, almost identical arguments when I used them in favour of getting a helping hand to bow out. It seemed to me you almost junked some of your libertarian values to do it.
Are you looking to have your cake and get to eat it too?

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Navigator

September 4, 2009

Moggsy,
I haven’t reviewed the earlier posts to confirm the nuances, and I can’t remember what Tom argued precisely, but to me the simplest response to your comment ‘You more or less refuted, or more like sidelined, almost identical arguments when I used them in favour of getting a helping hand to bow out. It seemed to me you almost junked some of your libertarian values to do it.’ is to relate back to a fundamental principle that human life is paramount. On this basis these two points are inextricably linked.
And once we let go of this basic principle, then it doesn’t matter what our views on government (although I share yours totally!); we are opening up our society to a place where personal liberty is at the whim of others.

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Tom Paine

September 4, 2009

Moggsy, you and I are are exploring the boundaries here, and I accept I am open to the charge of being ideologically impure. There are three propositions that I am able to support simultaneously without painful moral or intellectual conflict.
1. It’s my life and I decide what to do about it (libertarian).
2. No-one else is entitled to decide for me (libertarian).
3. I have no right to ask anyone to decide for me. A fortiori, I have no right to ask anyone else to kill me, even if they are willing to do it.
This last proposition may not be truly libertarian. Arguably, it interferes with freedom of contract. I feel strongly that it is correct however, for reasons discussed in detail in the these two posts (and the comments to them);
http://lastditch.typepad.com/lastditch/2009/07/the-right-to-die-or-the-right-to-kill.html
http://lastditch.typepad.com/lastditch/2009/08/shall-we-create-more-categories-of-lawful-killing.html
Far more strongly, certainly, than I care about being judged a “pure” libertarian.

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JMB

September 7, 2009

I’ll take your word for that Anna speaks from a position of knowledge and experience since it is not obvious in the linked article. In fact it reminds me of the kind of article one sees in the newspaper which throws around statistics (16.5% of all deaths occur from starvation during/after terminal sedation, yes I did follow the link to the letter, yes they are certainly more credible people although again they do not cite their source) without citation and is meant to shock its readers.
Yes, I have seen such terminal comas, if not natural, usually brought about as a side effect of pain control in end of life situations, not induced as a means to an end. In a hospital situation which included a nursing home facility as well, I have never seen patients left without hydration, always they were on dextrose intravenous solutions. Yes it is true that it is not enough nourishment to maintain life and it is true that if the patient does not die quickly they do indeed die of malnourishment as their body basically consumes itself. On the other hand I have seen patients deny themselves food and water in full lucidity as it is their only option in their mind to end their suffering.
Family and friends witness the denial of fluids and food to patients. It has always been my experience that these people are very involved in decision making regarding treatment. I can’t imagine it is different in the UK.
Syringe drivers (what an expression) are being used to give continuous terminal sedation without regard to the fact that the diagnosis could be wrong. I think the diagnosis being wrong is an extremely rare occurrence but of course these are the ones people like to highlight with great fanfare.
I’m just trying to give another point of view for the reality of life and death in these situations. If indeed the medical personnel are just trying to get rid of elderly people simply and quickly then that is indeed draconian. But people usually go into the medical profession because they wish to help people not harm them.
In highlighting this situation, it is good if it leads to investigation to see that appropriate treatment is being given to the elderly but the scaremongering rhetoric used in articles like this just creates anxiety in the majority of the public who feel they can do nothing about it.

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Anna Raccoon

September 8, 2009

JMB
You say ‘scaremongering rhetoric’ – that is not my intention at all – and yes I do speak from a position of considerable authority on this, although I regret I cannot tell you exactly what, since that would identify me. You will just have to take my word for it. I will respect your postion if you decide not to believe me.
My position on this has always been that the Court of Protection, which is now the decision making authority on these matters is less than transparent. It publishes no court records, not even anonymised records ala the Family Court, so no one can ever know the basis on which a decision was taken. That makes it extremely difficult for anyone to challenge a decsion, if not impossible; and I would point out that once the court has decided to employ your autonomy ‘by proxy’ you are actaully not in a position to employ a lawyer, you cannot ‘contract’ any longer. It would be for someone else to employ a lawyer on your behalf – a dangerous position to find yourself in, since it may well be that the very person, ie family member, that you might look to do so on your behalf was the very same person who had reasons not to want to argue with the decision. The court is not open for hearings, not even to journalists. This is one reason why there is so little in the MSM – they have no way of substantiating ‘hard cases’ or newsworthy cases’.
There are currently some 36,000 cases ploughing through the courts annually, and for this reason the Master (judge) is assisted by ‘two officers’ of the court – not trained legal brains, but civil servants. The work load is futher ameliorated by other civil servants ‘deciding’ which cases to bring to the attention of the Master. The only audit is the NAO, which takes a handful of cases each year to look at – and they have been highly critical in the past of the handling of those cases. There are also the Lord Chancellor’s Visitors, who visit some 800/900 cases a year, and then file their report via those same civil servants, who decide whether the report should be put in front of the Master. Since any ‘problems’ which are highlighted are likely to be problems occasioned by those same civil servants and their handling of the case – I leave it to your imagination.
So, obscurity of record, a pathetic audit trail, some 36,000 peoples lives being pronounced upon by untrained minds in jobs filled from the local job centre……..its not scaremongering, its trying to bring this to public attention without the aid of the mighty MSM who ignore the matter.
You also seem to be under the imression that this only affects elderly people – it doesn’t. It would be fairer to say that it affects those who are not ‘economically viable’. The Bland case was of a young man in his 20s, already this year there have been two cases involving chidlren under the age of 12. I’m sorry I can’t give you more details, but contempt of court and all that.

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Tom Paine

September 8, 2009

Thanks for this contribution and for your original post. I am amazed that these issues are not being more widely discussed. It seems our taboo about discussing death is almost as strong as our misplaced confidence in the state.

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JMB

September 8, 2009

Anna, obviously there is much more going on behind the article that you wrote which was highlighted on this blog.
You have introduced a legal layer to this end of life issue with which I am unfamiliar, since I do not live in the UK, but I am assuming, perhaps wrongly, this is a legal entity to make decisions on behalf of those who have no one else to do so.
As I said in my comment I am speaking only of what I saw during my 18 years working in 600 bed hospital in the Canadian nationalized health care system. Here the family is very much involved in decision making for health care, in fact must be in agreement with all decisions, and I have myself been legally responsible for decisions for an friend with Alzheimer’s disease for nine years up to his death as he had no relatives to assume this responsibility.
While, as you say, this does not affect only the elderly, but of course the reality is that by far the majority of people in this end of life situation are the elderly.
Anyway thank you for clarifying where you are coming from regards this issue.

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