To ask why we apply end of life compassion logic to dogs but not humans

[NorthernRosie]

It struck me again today (whilst reading Tim Dowling's Guardian column!) that many people seem happy enough to believe that it's kinder to put down animals at the end of their lives to end suffering but when it comes to our own species the majority argue against people's right to make that decision.

After all an animal can't actually make the decision but a competent human adult can.

Why is this?

The withdrawl of nutrition really doesn't sit well with me, Thankfully my dad was not concious when he was dying and at the time it bugged me that he wasn't being given anything other than morphine but i had sort of shut down and wasn't asking the right questions. How does this make the end more comfortable for people? I know that whenever i am excessively hungry or thirsty i feel terrible, how is this going to be any different just because a person is dying?

Effectively it is a long drawn out euthanasia and i think most doctors would have to acknowledge this? This is ok but administration of a drug to end the person's life, quickly and peacefully like an animal when it is pts isn't ok? I don't understand this.

You can't force feed people who are feeling nauseous and extremely sleepy or sedated though. You can choke them or they'll aspirate.

'Starving people to death' is a highly emotive phrase and, in my experience (elderly care) it never happens. We give people food as long as they want it, but they usually refuse and just take sips of fluid or perhaps even just mouthcare towards the end.

The public have the wrong end of the stick.

you don't have to administer fluids and nutrients orally.

Hiddenhome - you are dealing with members of the public on this thread who have witnessed a loved one dying and been distressed by it. Which wrong end of the stick do you think they have?

If my breast cancer spreads to brain/bone and I want the option of a quick death - why can't I have one? Which 'wrong end of the stick' do I have?

But I am interested to see this exhibition in Bristol, which I think I will have to visit www.bristolmuseums.org.uk/blog/death-is-it-your-right-to-choose/

Spero I'm not saying that people shouldn't have the choice to have an assisted suicide. I'm referring the the nutrition and fluids element. I nursed my own husband through terminal cancer, so I know how tough it is and how distressing, but the public do misunderstand the issues of food and fluids.

People who are dying don't wish to eat - they have no appetite - and often don't want to drink either. It can cause discomfort and distress, regardless of how it's administered. We offer food and liquids until the person declines them. When a person's body starts to wind down, they can't process food and fluids in the usual way. The food doesn't get digested and will cause nausea and the kidneys often aren't functioning properly and won't deal with the fluids. Fluid retention in the body causes discomfort and difficulty breathing.

I would like people to know that nurses and medical staff don't withdraw nutrition or fluids for no good reason. We're not out to be cruel or cause distress to people.

LEM there are physiological changes when someone is dying. Giving fluids intravenously causes symptoms that are uncomfortable and distressing. Giving food through an NG tube can also cause issues. Withdrawing (forced) food and fluids is never for the convenience of staff.

I never thought it was for convenience of the staff, i just thought that it was to help things along, if you see what i mean. I take your point though. In all fairness my father wasn't concious while this was happening to him so he did not (please God) suffer.

This thread has really made me think, i have always been a little uncomfortable with assisted suicide but i think i am coming down on the pro side of the fence.

I was talking to a vet today about this subject and she said that if her parents (who both died from the bastard that is cancer) were animals in her care she would have been struck off for causing unecessary suffering through not pts.

Something definately needs to change.

Hiddenhome, you are right - the public do misunderstand what happens when you withdraw food and water, but given that the majority of the public are not medically trained and doctors (in my experience at least) are very poor communicators, this is hardly surprising.

But it isn't really the issue is it? The issue is about basic kindness, compassion and respect for the choices of others.

I am sorry you had to go through that with your husband - but if it was your choice to support him to the end, I hope that provided some comfort to both of you. I am sure it must be very comforting to know that someone you love will be by your side.

The problem is that many of us won't have that option. I am vanishingly unlikely to pick up a loving husband in the next five years. My mum is dead, my dad very frail. The only person I could ask to be with me is my daughter - and what if she is at college? Has a baby of her own? I think it would be very unfair to expect her to nurse me through a terminal illness. Maybe I would have a different view if I had a loving spouse to be by my side. Maybe not. I suspect not - but I would never dream of imposing my own views on a couple who had decided to support each other for how ever long it took.

It seems from what you are saying that doctors can easily predict when someone is close to death. If that person has signed an advance directive that they do not wish to be allowed to linger WHY do they have to?

the distinction between 'acts' and 'omissions' here seems to be without merit. Doctors are 'actively' deciding to withdraw nutrition and fluids which MUST surely hasten death? What is the moral or philosophical difference between that decision and the decision to administer morphine?

Withdrawing food and fluids doesn't hasten death, because food and fluids are only withdrawn once the patient has no desire to eat/drink (because they are dying and their bodily functions are shutting down) or when they are in such stupor that giving food or drink is unsafe. We're not talking about weeks before death, here. We're talking about the last day (s) and hours.

Eating food means that the blood flow has to go to the stomach/bowel to digest it. When someone is critically ill, they need the blood flow to their vital organs.

We're not allowed to hasten death, except for giving enough painkillers to combat pain, that may hasten death as a side effect. It doesn't matter what individual doctors or nurses think about it. It's the law.

Withdrawing food and fluid doesn't hasten death.

I'm in exactly the same position Spero I'll have no family either and I don't have any friends. I'll have to lodge an advance directive with my GP and solicitor when I start to go down the pan. If I can afford it, and I can get myself there I'll go to Dignitas.

It's a frightening and lonely prospect. Assisted suicide should be available to people in the UK, absolutely.

I always clear up misunderstandings about palliative care on threads though. People totally misunderstand what happens.

I nursed someone whos family objected to narcotic painkilling patches as they left the person feeling sleepy. Because they were sleepy, they couldn't eat or drink much and the family weren't happy. Countless staff, including the GP tried to reason with them, but they were adamant legally, they didn't have the right to do that, but they were educated and officious and the GP wouldn't stand up to them. We didn't know how to advocate without going down some unpleasant safeguarding route. With hindsight, we. should have.

The person inhaled the thickened fluids we had to give them and they developed a chest infection - we got the blame for this even though it was unavoidable, and the person was given antibiotics. Yet more prolonged suffering.

The person died in pain, discomfort, fear and with their lungs full of fluid. They pretty much drowned. It was horrible. Not many cases stay with me, but that one will.

People need to take control of their own care. Nobody should have the right to inflict that much suffering on another human being. People knock the medical staff, but in my experience, the relatives are far worse when it comes to managing care and, legally, it's not even down to them either, it's a clinical decision and the doctor can over rule.

hiddenhome

I think for some relatives a protective mechanism kicks in that gives a disconnect between the clear evidence before them, that their relative is dying, and the hope that it isn't true. I don't think it's a controllable reflex.

But in the end isn't this just about fear?

I don't believe any relative forces medical procedures on a dying person to hurt that person; its about the fear of the imminent death, perhaps mixed with guilt that they weren't more involved with the person whilst they were alive.

I quite appreciate doctors/nurses can't sit for hours hand holding and gently explaining all the alternatives.

But we need to be having these conversations NOW while we are still alive and have capacity - not at the hospital bed, facing a horrible reality for perhaps the first time.

I don't see any point in blaming either medics OR patients for the mess we are in now. We are all complicit. We all have to agree to have the necessary conversations; and not simply shut down discussion about assisted suicide because 'it might be used to murder rich relatives' 'dogs don't have money' 'we wouldn't shoot a human with a broken leg' etc, etc.

If you need any help getting to Dignitas - let me know. I'll help you. But I really hope it doesn't come to that. I hope you have a very quick, utterly painless death after a really happy day, many, many years from now. And by that time we will have laws about assisted suicide which are compassionate and humane. So you wouldn't need my help anyway.

Yes, I can appreciate the disconnect due to fear and grief, but I think medical professionals need to be more assertive at times. I think they need a mechanism by which they could do this as well without having to go down the safeguarding route which is just nasty and stressful for all concerned.

Making an advanced directive is as important as making a will in my opinion.

I'm hoping that assisted suicide is legalised soon. It's a disgrace that people from the UK have to go to Switzerland. It's expensive too, which will exclude so many people.

Get to the solicitors everyone, before others take charge!

Actually, Spero I'll gladly come with you as well if you need assistance and company

spero my experience is that doctors and nurses do spend hours hand holding and explaining. Often that explaining needs to happen in increments. For some families the 'we don't think he/she is going to survive' conversation has to happen in small stages.

It's a date! But I hope if we meet its not for that...

You have inspired me to consider more seriously my advance directive.

That's lots of advice and guidance online Spero

We sat for a week watching Mum die on an end of life pathway. It was dreadful and it haunts me. I said one night to my son that we should put a pillow on her face. I almost wish we had. We were told nothing about how this was "managed" At one point she woke up and said she'd like some ice cream. Now I don't know if this was some sort of drug induced delirium, but it haunts both me and my son - I will never forget that and I feel so guilty that she was hungry and thirsty. Mum always said she'd take an overdose - I wish we could have done that for her. Dignity in death - bullshit. Excellent palliative care - bullshit. How can people in this day and age be left in pain? Why is no one looking into better pain killers?

Lougle,

I won't debate what happens to people without the capacity to advocate for themselves as I have no expertise.

However, if a terminally ill person wants to drink (or eat), they should be allowed to. Equally, if they ask for intravenous fluid, they should be given them (after potential consequences explained). The lung filling up can take place in any event (as I sadly witnessed).

There are clearly cases when drink and food have been withheld when a patient was not anywhere near the last few days or hours, and even cases where they revived and went home after relatives insisted nutrition was given.

The best palliative care takes many factors into account and, I am sure, is excellent. However there is a shortage of palliative care specialists and done care is dreadful. Even with the best in care, patients should have autonomy over their fates. Where we are now, this should be urgently prioritised.

of course the point where an animal doesn't want to eat or drink anymore is often the key trigger to euthanasia. I certainly won't hang around to be treated as an object and patronised by the Macmillan noddy headed element. I'd rather throw myself out of a window than have someone think I could be comforted by hand holding.

If someone who is terminally ill wants to eat or drink, they can do. Nobody would dream of stopping them.

I'm sorry, but I've not seen any palliative care, in either my mothers case, or my cousins. Cousin died in pain, and mother hung round, as I say, for over a week, without food or water. www.bbc.co.uk/news/health-23698071
This is another case from the Liverpool pathway

The LCP was misused in hospital settings mainly. I never personally saw it misused (care home). We don't use the LCP paperwork any longer, but our practise has not fundamentally changed.

Some of our terminally ill clients can manage small amounts of ice cream or yoghurt and they wouldn't be denied whatever they asked for.

Hospital is the wrong setting for people who are dying. They don't have the time or the staff to do it properly.

Please could someone explain where the law stands on Do Not Ressucitate and on withholding of medical procedures which will not cause immediate death? I don't understand how the stance on ^ relates to the current law criminalising assisted suicide.......

For example, a relative of mine then aged 80 was told by the first consultant they saw that they should not have the heart bypass on offer as they 'probably didn't have long to go anyway' and 'would be fine just sitting at home without the bypass until the end'. There was no medical reason not to have it beyond risk of anaesthesia. They also had DNR written up. The relative told them to get stuffed and demanded the bypass and a new doctor and told them to remove the DNR instruction. (Relative is still alive almost 20 years later and when in their early 90's was still doing 10k charity walks!!).

Oh, and for the record, I'm pro assisted suicide law changes.