THE P RTAL
September 2011 Page 10
Euthanasia – the personal view of a GP
by Dr Chris Davies
I am writing this short piece based on my own recollections of medical training in the late 1970 ’ s and my subsequent experience as a GP in a busy suburban Practice over the last 24yrs . For about twelve years , our Practice was involved , in part , in the running of our local hospice .
Background and introduction
Even in this short timescale , there have been many advances in medical management of a variety of conditions , new illnesses such as HIV [ Human immunodeficiency virus ] and several changes in the delivery of our health service both in the community and primary care settings .
What I have witnessed for patients in Practice is a considerable increase in life expectancy and many more choices and , consequently , a large increase in my workload !
It would be fair to say that , in my era , medical training had very little formal teaching regarding care of the dying patient – this subject was very much learnt from watching experienced colleagues in hospital wards and in subsequent jobs in the GP setting . Then , even terminology such as the use of the word ‘ cancer ’ in a conversation on the ward would have been considered unacceptable by some hospital clinicians .
This contrasts with what I believe is a much more open , patient centred exchange of information today
Duties of a doctor
The General Medical Council [ GMC ] has detailed guidance on this [ 1 ]. For example , as a registered doctor with the GMC , amongst your many duties , you must ‘ make the care of your patient your first concern ’ and you must ’ protect and promote the health of patients and the public ’.
Palliative care
This has developed rapidly over the past two decades . Typically hospice care used to mean care for just malignant disease only often in the format of being admitted for symptom control or the terminal part of the illness . Now , hospice care can mean ‘ hospice at home ’ as well as provision of psychological ,
No news from the Ordinary or his assistants this month as they are all relaxing in exotic locations !
Back next month
social and spiritual support for patients and their families – the illnesses covered can include advanced non-malignant diseases e . g . severe heart failure or chronic obstructive pulmonary disease .
Developments for GPs
There are new duties for doctors with reference to ‘ End of life ’. This term refers to ‘ patients who are expected to die within twelve months ’. Again , the GMC recommends these choices should be raised sensitively with patients . They need to be discussed before any deterioration of the patient ’ s condition causes any impairment of a patient ’ s capacity to decide . Such issues are ‘ preferred place of death ’ and what expectation of resuscitation they may desire .
All these developments hopefully provide better patient management by anticipating need thus avoiding uncontrolled symptoms , unnecessary treatments and inappropriate resuscitation .
What is a natural death ?
Clearly patients with advanced and incurable disease may have need for symptom relief usually in the form of potent pain relief such as morphine or other sedative drugs . By virtue of our training , we want to provide appropriate relief of pain and other distressing symptoms .
It is sometimes inferred that doctors are somehow actively engaged in ‘ assisted dying ’ by providing such relief . I would disagree by stating that , in a natural death , that the doses of such drugs are appropriate and only gradually increased as necessary .
Other forms of severely ill patients
There are other conditions stated where it is said a sufferer needs the choice of ‘ assisted dying ’ for example , severe multiple sclerosis , severe motor neurone disease , advanced Huntington ’ s disease , and