Tag: dying

Dying your way – support the Assisted Dying (No2) Bill

An important moment is coming and everyone needs to think quite hard about it. In just over two weeks time the Assisted Dying (No2) Bill is to have its Second Reading in the House of Commons.

The Bill aims to make medically assisted suicide legal in the UK.

This Bill was originally introduced in the House of Lords by Lord Falconer but it lapsed when Parliament was dissolved for the General Election. It is being revived by Mr Rob Marris MP, who won the lottery for Private Members Bills in the new House of Commons.

The Bill has been very carefully framed and negotiated. Remember that Lord Falconer is a lawyer and former Lord Chancellor. In the Lords there was quite strongly felt debate. It lasted over 9 hours, there were over 100 speakers and two attempts to amend it to worthlessness were resisted, being out-voted by quite substantial margins. It was passed by a majority of two-thirds of those voting.

The Bill is a simple piece of legislation. It has very clear safeguards to prevent misuse of the new provisions. The fear that some elderly people may be exploited and bullied into assisted suicide has been addressed very carefully. Every written application has to be approved by the High Court. Doctors are not obliged to help a patient even to make an application and at every step the patient has the absolute right of withdrawal. Someone seeking to use this as a route to bump off a relative opens the way to life imprisonment.

The Bill’s first real test comes in the House of Commons on Friday 11th September. There will be a debate and a vote. There will, no doubt, be some opposed to the Bill.

There are many cancer patients who would like to see the Bill enacted and to have the option of dying at a time of their own choice. Dying from cancer rarely has much dignity. Even when at home and properly supported by medical and caring staff, extremes of medication are often necessary to control pain and other symptoms. The new NICE Guidance on end-of-life care is explicit about what symptoms might be experienced. It details treatment for agitation, anxiety, breathlessness, nausea and vomiting, “noisy respiratory secretions” and pain. It is not a menu, a list of options from which you make a choice. You might suffer all of them. You will not be in control.

If you would like to see this Bill take its next step through the House of Commons and, hopefully, make its way through Parliament to reach Royal Assent, write to your MP and ask him to join those who will support Rob Marris on September 11th by voting in favour of the Assisted Dying (No2) Bill.

Drug approvals and age discrimination

Cancerworld recently published a debate between Professor Karol Sikora and Dr Ulrich Wedding on using age as a criterion of regulatory decisions on funding new drugs.

The push to use age as a determining factor in drug funding permissions is blatantly discriminatory. There are better methods and measures for discerning eligibility, if only someone researched them properly. The pharma industry is not interested in this research. Its business model (which determines its approach to pricing) is encouraged by the current inadequacy of HTA and political decisions such as England’s Cancer Drugs Fund. Indeed the latter encourages higher prices.

When the current UK government came to power in 2010 they vowed that by 2014 we would have a value-based approach to funding decisions. Its nearly 2015 and there is no sign of it but as there was no research into how value could be defined let alone measured, its no wonder we are back to simplistic thinking about age.

The core issues here are about the holistic treatment of a patient. Just looking at the disease (albeit hosted by a person) does not take into account the needs of the whole person. This debate should be about integrating supportive care into oncology practice, about losing the barriers between palliative care and oncology, about educating patients on the balance between cure and end-of-life care so that when disease is truly incurable patients make rational decisions themselves. Another cycle of chemo given to a dying patient is immoral.

Living and dying have to become palatable points for discussion. This will deliver benefits for individuals and society and could well cut drug costs. While politicians, healthcare administrators, academics and doctors are the main voices on this issue simplistic inward-looking solutions will result. Get patients involved, introduce some earthy common sense.