Assisted dying bill (TW assisted suicide discussion)

[Onand]

I appreciate this is a divisive subject and a sensitive topic for many. Please avoid this thread if you find any discussion of suicide, death, trauma, terminal illness, cancer and faith triggering.

I’m curious to know how others are feeling about this subject, from what I can see there isn’t a lot of discussion, is this a MNHQ decision or an indifference from posters?

My opinion and views on this potential landmark decision are based on my horrifying experience of watching and waiting for my mum to pass from end stage cancer several years ago.

For over four years she fought advanced cancer, she took every treatment and trial offered to her. She endured major abdominal surgery, many blood transfusions, multiple rounds of chemo, lost her hair several times, her bones started to crumble causing excruciating back pain, severe abdominal swelling, double nephrostomy as her kidneys failed, multiple lesions on her brain that caused debilitating headaches and personality changes, her teeth and bones were decaying due to a calcium disorder, various hospital stays for infections, the list goes on.

Truly the most hideous nightmare cancer ‘journey’ anyone could ever imagine, it always felt like one step forward and two backwards and yet she carried on without much fuss or sign of fear to protect the family and herself from the true horrors of suffering.

She never wanted to die and so she never gave up or gave in- that was until the last few weeks of her life when she had no choice. The immense damage and toll cancer had done to her physical body was too much to survive any longer so the last infection she had took her consciousness and so began the final horrifying curveball that cancer has up its evil sleeve, this one is for the loved ones though, because now you have to wait and watch for the end to come. Anyone who has endured this knows exactly what I am talking about, a horror that truly brings home the meaning of hell of earth.

If the assisted dying bill was around whilst my mum was alive I know she would have never entertained an early death whilst she was still in control and able to fight, but I do know that her love for the family would have also meant she would never have wanted us to endure that final two weeks of watching and waiting for her body to shut down if it could have been avoided and she was able to specify what was to happen at the end. There was no possibility of her ever getting better or a miraculous recovery, death was very inevitable and a certainty but we still had to sit and watch, doing oral care and leaving the room as they checked for bed sores and did secretion suction. The only thing I could do to protect and help her was the make sure she was undoubtedly unaware of what was happening as she feared death and leaving us behind- the thought of her being remotely aware meant we were constantly asking the nurses for more and more sedation.

If this bill gives patients the choice to avoid the hideously evil ending of a terminal illness and the following ptsd that impacts the loved ones left behind then it is an opportunity I strongly agree with. Watching a loved one die an agonising death is soul destroying and something I hope no one has to ever endure if said loved one could choose to avoid.

How do others feel?

It needs more thought the slippery slope - many people not ideologically opposed in principle believe this bill should fail - there is a real risk that people with terminal cancer will go too soon to be sure they can consent and because many parents never stop trying to protect their children at any age.

It happens, it's happened in Canada. And the reality is that many people can live at stage 4 for much longer than before.

This.

Can you expand more about why treating an infection is absolutely crazy? Particularly with regards to the pain and delerium that infection can cause?

And tell me more about the authority you would have to ‘instruct’ an HCP. How far do you feel that authority to instruct should extend?

The infections caused severe hallucinations and she was slipping in and out of consciousness so as her next of kin the medical teams told us they had to treat the infection. None of them mentioned at any point that we could ask them not treat it?

At this stage the great mystery of what ‘dying’ can look like for terminally ill patients hadn’t been revealed to us. We naively presumed it would be like in the Macmillan leaflets where the patient lies peacefully in bed and they simply drift off to sleep and you say your goodbyes, have a weep then leave. It wasn’t like that at all.

No one warned us of the brutality a cancer death can entail. There’s a stigma attached to death which really does a disservice to the healthcare system, you’re not prepared for what can happen and it blindsided us as a family, one final evil trick up cancers sleeve, some extra suffering for everyone.

I'm very pro choice on this one. I've seen people deteriorate massively both mentally and/or physically and frankly you can sod that right off.

However, I'm under no illusion as to what utter cunts people can be.

If you're going to do this, you have to make sure the safeguarding procedure is long and subject to rigorous oversight at every single step.

The penalties for coercion and abuse of the system need to be punitive with sentencing on the level of murder because that's what it would be.

Can we balance dignity in the last days against potential abuse? That's sadly a very sticky issue.

Treating an infection in someone who is dying is crazy and actually unkind imo. Not terminally ill, obviously people can live full and active lives when terminally ill but once bedbound, in the final weeks then active treatment should desist and supportive measures only continue. Such as analgesia and hydration.

As a Next of Kin I would of course have authority to instruct a hcp to desist in active treatment and provide pain relief only. I'm surprised you are unaware of this. Hcps would discuss treatment with relatives and they do absolutely have involvement in what is appropriate.

I have seen excellent end of life care but it certainly isn't consistent.

I oppose the bill but support a massive light being shone on palliative care particularly provided by GP services.

This bill is not advocating for assisted dying leaflets to be handed to every stage 4 patient.

It’s about knowing you could if YOU choose to, avoid the final weeks of agonising prolonged dying that more often than not comes to those suffering terrible terminal illnesses, it’s about those diagnosed with MND being able to stipulate at what point they don’t want to reach, it’s about giving control to those who fear a terrible death In unimaginable circumstances.

Being able to say I don’t want to get to that state is a landmark shift in how we as humans navigate our lives, it avoids a messy disturbing end that so many people experience currently.

What potential complications arise from continuing hydration at end of life?

And what legal authority does a NOK have in the UK? You believe that you have the authority over clinical decisions when an HCP disagrees with you?

Gloriia
As a Next of Kin I would of course have authority to instruct a hcp to desist in active treatment and provide pain relief only. I'm surprised you are unaware of this. Hcps would discuss treatment with relatives and they do absolutely have involvement in what is appropriate.

While healthcare professionals do discuss treatment options with relatives, they do it as a pragmatic courtesy. Relatives do not have authority to give instructions. Healthcare professionals, doctors anyway, are required to act in the best interests of their patient. They can and do sometimes act contrary to relatives’ wishes.

I don't know that I believe that the understandable fear of a terrible death is best migrated by the option of killing your self though, although I can understand why people want it as an option.

I strongly feel this needs more thought by a range of experts and plans for all aspects of end of life.

I don't have any other points really and I'm sorry for all of us who've had to witness this and for the people that it happened to.

Like with many things there are opportunities for abuse, I think those who could abuse the system would more than likely already be looking to speed up their inheritance quicker with or without an assisted suicide bill. Also how many people are we assuming would be murderers or consider murder by using assisted suicide for nefarious reasons under coercion? I’d like to think we’re talking of a very tiny minority and not the millions of people this could potentially help.

We’re not going to suddenly see hoards of elderly folk being wheeled into their GP for the ‘end of life meds’ because the family are waiting for inheritance.

Probably not hoards as you say but we do have to look at the outliers on this one because it will happen.

It's almost impossible to control some pain, so you are being disingenuous.
Also, for me, the thought of being incontinent and unable to express my needs is worse than pain

My FIL was never suicidal for as long as I knew him, he was fully sound of mind and a logical reasonable person. His love for my MIL was undeniable, they both adored each other and had a beautiful home and lovely life together.

However the last few weeks of his terrible cancer suffering saw him constantly ask to let him die, I want to die, I can’t do this any more, I’m done with this, please let me go- screams of agony and tears of anguish. An off ramp to avoid that terror and fear would have meant he still had control until his very end on his terms and be able to say goodbye to his loved ones whilst he was lucid.

Instead he endured a hellish final few weeks as what can only be described as suicidal breathing corpse. Horrific.

I am a Paramedic. I am completely FOR this bill, BUT I also believe palliative / end of life care and mental health care needs significant improvement as part of it. People need options, choice and control over their own life.

Not legal authority no. However at the bedside of a dying loved one if a GP suggested prolonging suffering by prescribing antibiotics I believe they would listen to a NOK saying no, let's just keep them comfortable and up the opiates please. Well, a competent and empathetic GP would listen.

So the life of a child or adult who is incontinent and unable to communicate is seen as what? Not worthy? Inhumane? Who makes that judgement? We’ve already heard from people who believe they have the authority over healthcare decisions for others….

It’s no different to putting a dosage warning sign on oramorph, surely that drug is more open to abuse than a professional medical team or agreed legal body assessing and approving an assisted death due to irreversible incurable disease progression?

You said you would ‘instruct’ an HCP to act on YOUR wishes. How far does that go ?

And can you answer the question regarding hydration at end of life? What are the complications associated with that ?

Read my post again.
I said for me, this would be an issue.
I made no judgement on using these as a criteria for assisted dying

It’s not uncommon for hydration to be withdrawn at end of life- my mum had hers withdrawn 9 days before she died - a decision taken by her palliative care team who assured us it was normal to do so.

We had to do oral care for a few days and then they advised us to stop as it was too distressing for her.

The hardened lymphoedema swelling in her limbs all but disappeared by the time she died, her nefrostomy bags were full of dark brown fluid initially and then they stopped filling a few days before she finally passed.

Oh I would also discuss resuscitation and pain relief. I would suggest/instruct that a catheter be inserted in a bedbound, dying patient who is incontinent of urine rather than bizarrely worry about the associated risk of UTIs. Things like that.

I would definitely instruct them not to give antibiotics to someone with days or weeks to live. Antibiotics can also cause unpleasant side effects such as nausea and diarrhoea why on earth would anyone want to risk any GI upset just to tick the antibiotic box?

HCPs should work in partnership with NOK so instructing hopefully isn't always necessary.

Please provide some peer-reviwed articles that support this assertion

So in a discussion about assisted dying, it’s a reasonable assumption that by listing those criteria, you believe that those are reasons why YOU would potentially choose this route.
In order for you to do this, these criteria would have to be included in the legislation.

And could therefore be used by, or applied to anyone….

Yes it is normal to withdraw it as patients can aspirate if taken orally which is unpleasant.

My point about maintaining hydration was to highlight that while I think medication to actively treat should be stopped other supportive measures like hydration should continue where possible and able.

So sorry about your dm .