To think that we need to have an honest conversation about euthanasia and care costs

[Noras]

So there are some interesting stats published by the Gov about the cost of cares the end of life and whatever way you look at it, it’s expensive. Obviously the most expensive is hospital care at about £400 to £500 per day but also care in care homes is high.Most of that could be avoided with an injection.

I have watched both my parents die and I have been left traumatised by it. My mother died from starving to death due to dementia in a non nursing bed with no pay relief other than paracetamol. She was clutching the sheets and morning for 14 days. My father died of the most gruesome cancer. We nursed him at home but we still had one 24 hour carer at the end paid for by CHC ( he was plus 2 for eg the commode and washing hence we still did it).

Whilst my parents were dying I could not bear to let them go but now after several years I think ‘What on Earth was that?’ With the benefit of hindsight I regret every mouthful of food that I fed my mother. She did not even know who I was and was in a different World but yet she was my beautiful mother.

I regret every time that I carefully measured morphine for my dad because I did not want to give him an overdose

I am haunted by the prospect of getting dementia. I am scared sick of cancer and dying from it as the pain meds never kept uo with the pain. When we just had the pain patches they were always too weak and we were always behind the race to keep up with the pain. When we got the end of life kit, as a relative I was always too scared to give ( I think ) enough morphine to top up the pain patches so my dad would he in agony. I could not bear to let my dad go - it was so painful,

So this is the question; Do we need to grow up and really think about euthanasia?

Over two years of my life were consumed by the impending death of my parents ( I still visited and cared for my mum in a care home despite it costing my dad several hundred pounds weekly as I wanted to care for her).

And you wonder how traumatic this is for family members just given the morphine and told to give it as we see fit. This is why we probably give too little.

i work in care and i agree wholeheartedly. The suffering for so many is just unacceptable. Its almost we have eradicated people dying from old age . So many times they are rushed of to hospital literally on the cusp of death and they pump them with whatever and then return them to us another notch worse .
Why are we so afraid of letting people die 🤷🏻‍♀️

Self administration and administration by family involves oral medication only. A family member would never be expected to administer injectable morphine or sedation, because despite the narrative that some keep pushing, those drugs are carefully prescribed, monitored and managed.

It is virtually impossible for you to cause death by administering oral opiods or sedation if used as prescribed. If the dose titration is incorrect, you may cause the person to become sleepy, drowsy or confused. Unless your intentions were questionable it would be unlikely that you would be able to administer further oral medication to that person and instead would seek medical advice.

Family members and carers need significantly better support, education, information and advice on managing symptoms at end of life that what is currently available in the UK. That’s s priority for legislators IMO.

You’re using deliberately inflammatory language here which isn’t helpful to the discussion. No one is administering pain relief to ‘kill someone’ - the diseases or old age has already taken care of that. HCP’s are administering pain relief to relieve pain, as they should. The secondary impact of which is, in many cases, a faster death. I’m not sure what your problem is - if you’ve been anywhere near clinical practice at the end of life you know full well what I’m talking about but appear to exist in a parallel universe where we prolong the life and therefore the suffering of dying people to what end? More suffering? That’s not, in any way, what happens and you know it.

Of course I’ve witnessed rattling and in every case let someone know the inevitable is happening, do you even know how care at the end of life works? I cannot believe you’ve been anywhere near clinical practice because you seem so completely detached from the reality of the management of death in the majority of cases for elderly and dying people.

If you’re worried about yourself at the end of your life because of your parents, then have a look at advanced decisions to refuse treatment. If I was ever diagnosed with anything, I’d make one and let my family know.

Look at your life now and make the changes you need to be happy and fulfilled now, not try and control a process that it is impossible to control.

Yes I think so.

My dad had patches and oral morphine top up as required. He never got a pump driver.

I'd agree that's part of the issue. We are keeping people alive artificially, which makes the whole end process worse.
Maybe there should be agreements not to treat infections etc when people no longer have capacity.

Looking at an even bigger picture, people are having to work until nearly 70 because the average death age has gone up.
But are people in their 60s much healthier and fitter than people in their 60s were 50 years ago? Probably not.

If anything with obesity rates they are probably less fit. And office jobs have become even more sedentary with the advent of paperless offices, no getting up to get files or put them away.

I'm sure most people would prefer to have a retirement at 65 and a a few years of good health to enjoy rather than a few extra years loitering around in a care home at 90 getting you arse wiped for you and living on pills.

I'm sure most people would prefer to have a retirement at 65 and a a few years of good health to enjoy rather than a few extra years loitering around in a care home at 90 getting you arse wiped for you and living on pills

Seriously? You think people would rather die at 70?

Mumsnet really hates old people!

So your latest logic is that we shouldn’t prolong life if we can administer medication to end it? Therefore killing someone? You may find the wording and terminology uncomfortable but if that’s the practice you’re advocating, then at least have the courage to call it what it is.

I’ll give you the benefit of the doubt by assuming that you’re definitely not in a specialist palliative care role. But your attitude to end of life care and drug administration is troubling and may be something you need to explore further with a clinical supervisor.

Look at your life now and make the changes you need to be happy and fulfilled now, not try and control a process that it is impossible to control.

I’d be off to Switzerland, when I got a terminal diagnosis or dementia. In no account, do I want to go, the way I’ve seen older relatives go! My cats were much luckier. DS did work experience at two vet’s practices and he said, they regarded owners, who let their animals suffer for too long, as cruel.

It's very difficult and expensive to go to Dignitas. If you are serious then start saving.

I remember a patient I had when I was a student ODP on placement in recovery.
A chap in his 80s with advanced dementia. He was with us as he had to have a GA to take a biopsy of a potential cancer. As soon as he was awake, he was combative (more so towards women). He had no family or anything... and he absolutely lacked capacity.
As awful as it sounds, I did wonder what the point of a biopsy was. Would he have been put through cancer treatment too?

Yep, it costs £thousands... and if you have ever been sectioned under the mental health act, then it is even more difficult to be accepted by them.

He was a person.

Well, he was not a mineral or vegetable.
Of course he was a person (I am not sure what the gist of your comment was)... but my point was that he was in the stages of advanced dementia and would not be able to understand or consent to cancer treatment.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5719645/

This may come as a surprise to some.

I looked into this a few months back. £16,000 in today’s prices. The rules are that you have to find a place to stay for a while before they will consider you. The thought of doing that, possibly alone, whilst suicidal, hopeless and suffering mental health problems, seems impossible to me. Particularly if someone has agoraphobia.

That's not what I said or if that's how it comes across I'll make it clearer.

I think most people would rather die at 80 or 90 when ever their body starts to really fail than too be kept going for an extra few expensive years making it to 83 or 93, but relying on carers and homes to look after them.

Not alt all my logic and you are aware of that. Please conduct a proper conversation in good faith about this without hyperbole, we need to be able to discuss this sensibly without endless point scoring.

Donyou have any interest in an open conversation?

Exactly what's the point, in trying to treat someone with dementia for cancer. Dementia is a terminal illness.

Lots of dementia patients are aggressive too. It's only a few weeks since it was in the news about a man killing his wife. They'd been married for decades. He'd gone to a neighbour- there's a body in my kitchen - zero clue who it was or he'd killed her.
Tragic all round, both him the wife, and family.

Hi Everyone

Please can we keep this conversation pleasant as it means quite a lot to me. Everyone’s views have helped me a lot to process my emotions and try to make sense of my thoughts on what is a difficult topic. I thank everyone for adding to this.

You all have so much to give on this topic.

OP

I’ve seen a lot of elderly people living with no quality of life, in a way I’m not sure they would want to live. I certainly don’t want to get old like that.

Euthanasia for patient with dementia will be problematic though as they can’t consent for the procedure. Even if they have an advance directive I’m not sure many people would be that happy to perform it if they were agitated or uncooperative.

Im an anaesthetist and I don’t think I would want to part of the team delivering euthanasia if I’m being honest.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10919223/

I don’t think we as a society are ready for a conversation about clinical euthanasia further out than a few days from the expected date of death in all honesty. Much like abortion, I think the path to assisted dying is going to be incremental in reality and I think it will progress like this:

where we are now: DNAR’s, end of life pathway, withdrawal of life prolonging care being an entirely clinical decision.

next: clinical evaluation of suffering: in extremis, when patients have no hope of recovery and are hours or days away from a horrific death, a clinical decision can be made to OFFER euthanasia to end suffering. Decision can be accepted or declined by patient or family on explanation of the likely progression of the disease/ death.

later: advanced directive: Much like a DNAR, patients can sign a directive that in the case of progression of their disease, they either give permission for clinicians or their next of kin or trusted person to evaluate their quality of life and, when deterioration occurs in the weeks before death, choose to end their life on their behalf based on a set of criteria used to evaluate QOL.

much later: assisted dying. Anyone can choose to end their life legally much like the Swiss model.