Yves here. This article raises an important topic, not just societally but in terms of government responsibility. Richard Murphy below depicts the UK as having threadbare palliative care for the dying. US hospice care in theory is more robust. From Wikipedia:
Under hospice, medical and social services are supplied to patients and their families by an interdisciplinary team of professional providers and volunteers, who take a patient-directed approach to managing illness. Generally, treatment is not diagnostic or curative, although the patient may choose some treatment options intended to prolong life, such as CPR. Most hospice services are covered by Medicare or other providers, and many hospices can provide access to charitable resources for patients lacking such coverage.
With practices largely defined by the Medicare system, a social insurance program in the United States, and other health insurance providers, hospice care is made available in the United States to patients of any age with any terminal prognosis who are medically certified to have less than six months to live. In 2007, hospice treatment was used by 1.4 million people in the United States. More than one-third of dying Americans use the service.
I do know of two people who have used hospice care, in addition to Jimmy Carter. However, at least among my parent’s circle, it does not appear to have been recommended when warranted. My father has a terminal illness that took an extremely painful and debilitating turn. He kept his doctors informed and they gave him a treatment that accelerated his decline. He shot himself because he could not take it any more (and he had very high pain tolerance). A friend of my mother has had and successfully beaten back breast cancer a couple of time. In her late 70s, it came back and her lungs started filling with fluid. She was not willing to be repeatedly intubated and managed to accumulate enough meds (not sure it painkillers or sleeping pills) to kill herself. A third, who had a poor prognosis and was in a nursing home, refused food and medication.
My father was not referred to hospice care (which can be provided at home) and I am pretty confident neither of the other two examples above was either. So there seems to be a gap between the theoretical and actual level of hospice care in the US.
Needless to say, these examples also show that the lack of end of life care leads to suicides. So do we want formally assisted dying or death by the best readily available means? One of my friends joked that at least my father was a hunter, so he knew how to do the job. Only 85% of gun suicide attempts succeed. There have even been studies of the outcomes of failed suicide attempts via gunshot to the head. I will spare you details.
Of course, it is fair to worry that the availability of euthanasia will lead to even more covert and even overt implementation of Lambert’s Second Principle of Neoliberalism “Go Die!”. But people are plenty capable of responding to actual or perceived “Go Die!” pressures on their own. So there seem to be no neat or clean answers here.
By Richard Murphy, part-time Professor of Accounting Practice at Sheffield University Management School, director of the Corporate Accountability Network, member of Finance for the Future LLP, and director of Tax Research LLP. Originally published at Fund the Future
It was only a few weeks ago that the Telegraph reported that:
The state of end-of-life care in the UK means the country is not ready for assisted dying, Wes Streeting has suggested.
The Health and Social Care Secretary has previously voted in favour of having an “in principle” debate on the ethical question, but declared himself “conflicted” on the issue.
Now, the House of Commons is to have a free vote on the issue, and nothing has changed.
As a matter of fact UK hospice care is wholly inadequate, which is not a reflection on those charities seeking to provide it. What is absurd is that this is thought to be an issue for charities to deal with.
It is equally true that palliative care within hospitals is underfunded. It would seem as if the UK state is willing to invest in us as long as there is a chance of returning us to the workforce, but when the time comes that we will, inevitably, not do so, it no longer cares.
This worries me in itself. Without any discussion abiuyt assisted dying, palliative care needs much more investment. People should have the right to die as painlessly and with as much dignity as possible. When most of us will die over a period of time in our old age, that seems like a pretty basic thing for the NHS to do, and it does not do it well at present.
There is more to this than that, though. Nor do we have proper social care plans for the elderly either, and with Labour having abandoned plans to cap some social care costs for the elderly needing residential care, matters have made no progress there.
Now, there is a discussion of assisted dying. Excuse me for being cynical, but I do see a connection, and I do not like it. Pressure from some families on elderly relatives to consider this route when otherwise the value of any potential inheritance might fall, potentially significantly, will grow. Evidence from other countries suggests that this is what has happened. And that is decidedly unhealthy.
For once, Wes Streeting was right. When the option of a dignified natural death is available, then we might discuss assisted dying for those who want to consider it. But right now, austerity is denying us that opportunity. That means we cannot afford the risk from assisted dying. The required checks and balances are not just medical. It is also that real alternatives have to be available to those facing their own deaths, and right now, the economics of denial is preventing that. When that is sorted, there will be time for this debate. But we are not there yet.