Monday, 20 October 2014

Dignity's own goal

Dignity in Dying (formerly The Voluntary Euthanasia Society) ensured that the story of retired Maths teacher, Jean Davies, starving herself to death got maximum media coverage. This 86-year-old euthanasia campaigner wasn't terminally ill, but had a number of underlying conditions. I listened to the live interview with her daughter, Bronwen, who's a nurse in Cardiff and who cared for her mum over the last few weeks of her life, on Radio 4's Today Programme this morning. Sarah Montague did the interview, which is headlined "My mother said she had had enough" on the audio clip.

Bronwen Davies was very honest - a refreshing change from the frequent fare of political prevarication heard on the programme. What had been her reaction when her mother had told her she intended to stop eating and drinking? "I was very angry because I wanted to spend more time with her, and I wanted to go on holiday with my husband! Then I realised I was being purely selfish." But she admits, "I didn't want her to die."

It was something Jean had been contemplating for a couple of years. "She'd read somewhere that it was possible for somebody to simply stop eating, stop drinking and you will eventually die.  And we all know that's true. Hunger strikers are the example that spring to my mind." In fact she stopped drinking just two weeks before she died. 

Was the decision to starve herself, rather some quicker means of ending her life, partly, effectively, a continuation of her campaign? "I think it occurred to her, after she had started her course of action, that this could be something which would attract attention - as indeed it has done - and she took the decision without consulting me or any other members of the family, as far as I know, to contact old colleagues from Dignity in Dying, to ask if her story might be one in which the press might be interested. So she sought publicity after her decision."

You've answered the point in a way, that she was aware of the campaigning. I wonder, do you think the law should be changed? "No. I have found that this process has made me realise - I mean… I'm not a member of the Voluntary Euthanasia Society, as my mother had been for many years - and I am of the view that it's perhaps not necessary to change the law in this country, because I think if people realised that they had the power to end their lives by stopping eating and drinking - you're still entitled to medical care to relieve any symptoms - my mother didn't need any painkillers, but they were prescribed for her had she needed them - I think that, if people realised they had the power to take matters into their own hands and to take responsibility for their lives and the end of their lives in that way, there may not need to be a change in the law."

I suspect that final answer was unexpected, but it reminded me of my conversation with Tony Nicklinson who complained that it was unfair because, he said, I could take my own life and he could not take his. It was untrue on a number of counts. For one thing, I told him, he could refuse treatment for any infection - which in the end he did, dying of pneumonia.

I take the position of Bronwen Davies, Jean's brave and honest daughter. The law doesn't need changing. As it is, people have the power to take responsibility for their lives and for the end of their lives. In publicising this case, Dignity in Dying have provided evidence against their own campaign to legalise assisted suicide.

Wednesday, 1 October 2014

"Keep your mitts off my NHS"

Last week there was a speech at the Labour Party conference which, in my opinion, knocked the spots off any I've ever heard from a politician of any colour. I know politicians usually enter politics out of conviction, but they nearly all seem to get sucked into the slimy world of focus groups and spin. Power,  or the love of power, does corrupt. It was beautifully constructed and delivered by 91-year old war veteran, Harry Smith. He described his childhood in depressed Barnsley and the death of his sister of TB, as the family couldn't afford treatment for her. "My childhood was not an episode from Downton Abbey." Watch it here: Harry Smith on the NHS

I was reminded of this when I went to our local surgery on Monday. I wanted to ask my GP some things, and I needed a regular blood test. First it was to the phlebotomist (the nurse who specialises in blood tests). Not only did she take it to test my drug level and liver function, but "Why not do these others while we're at it?" she said. I lost count of them. Then she said to Jane and me, "Have you had your flu injections yet?" The answer was no, although Jane had had her letter. "Would you like me to do them now - get them out of the way?" And so she did.  And saved us an expedition.

Then we sat in the waiting room for a bit, until the doctor came and summoned me. The major question I wanted to discuss was about the pneumococcal vaccine. As I'd written to my friends who have slow forms of MND, "I've received a letter from my local surgery, headed 'Pneumococcal Vaccination'. It says, 'Our records show that in the last month you had your 65th birthday, congratulations!' Then it goes on to explain it's usually a one-off jab to protect against a number of infections including pneumonia. 'We would like you to be vaccinated now....' In the old days, pneumonia used to be called 'the old man's friend'. (As Net Doctor puts it, 'pneumonia is called the old man's friend because, left untreated, the sufferer often lapses into a state of reduced consciousness, slipping peacefully away in their sleep, giving a dignified end to a period of often considerable suffering.') I'm not sure whether I want immunity from pneumonia. I wouldn't mind dying sometime. I'm inclined to say yes to the yearly flu jabs, but no to a lifetime pneumonia one. I wonder what others think about this." My GP listened and heard exactly what I was saying. I don't imagine she had ever had a patient with MND raising that dilemma before. She didn't hurry to reply. In the end her answer reassured me. The vaccine doesn't give complete immunity and by the time I'm ready to pop my clogs it will probably be even less effective. In the course of our conversation we talked about whether I would want treatment and resuscitation at the moment, were I to get an infection - to which the answer was Yes. Life may be limited and frustrating, but it's definitely good, and I'd like to enjoy this gift while I may. There will no doubt come a time when I say, "Don't interfere anymore, thank you," - which, you will appreciate, is entirely different from, "Please have me put down."

I also had three others things to ask her, including about respite care. At no point did I feel she was clock-watching. She was focused on me. We concluded at the end that I would have the pneumonia jab, and Jane had the good idea that I might have it then as well. So we asked the receptionist if there was a chance. And there was. She fitted me in with a nurse. Thus I left, after about an hour, having had blood tests, flu and pneumococcal jabs and a consultation with my GP. Now that's what I call service. And at the point of delivery, it cost me nothing. Of course I and my employers have contributed over the years. But it's worth it. That's the National Health Service. The practice, by the way, is Newbury Street Wantage.

I gather that one of tabloids had a leader comment today which started: "With dreary predictability, GPs’ leaders have raised objections to David Cameron’s hugely welcome plan to restore that most basic mark of a civilised society – the right to see a family doctor at any time, morning to evening, seven days a week...." Besides being transparently part of a policy of squeezing small practices out of existence - surely The Daily Mail looks back further than ten years to the golden days when one- and two-man practices were the norm? - , I reflected my elderly in-laws' experience over the past fortnight. Their sizeable GP practice lists 111 as its out-of-hours number. My mother-in-law has had resort to it three times in the past fortnight, and according to her the service has been excellent. It sounds as though it was in every way - keeping her informed, the doctors visiting, the follow-up and the quick coordinating with their GP. I recall receiving a visit from a lovely emergency doctor a few years back on Christmas Day. The system works now. I can see no way in which Mr Cameron's plan will not soak up any new money he offers - and more. Thus we shall end up with fewer resources spread more thinly, and worn-out doctors with even less time to spend with each patient.

As veteran Harry Smith ended, "Mr Cameron, keep your mitts off my NHS!" And that applies to all of you meddling politicians. Keep your mitts off our health service - and our education service.

PS I'm told I should have mentioned how nice our practice nurses are. They are very good. My second jab was quite pain free.