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Assisted dying - a medical view. Dr J Martin Leiper, Consultant in Palliative Medicine, NHS Tayside. Secret ballot 1. Should physician assisted suicide for terminal illness be legalised in Scotland? Please put “yes” or “no” or “not sure” on you paper.

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Assisted dying - a medical view

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Assisted dying a medical view l.jpg

Assisted dying- a medical view

Dr J Martin Leiper,

Consultant in Palliative Medicine,

NHS Tayside


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Secret ballot 1

  • Should physician assisted suicide for terminal illness be legalised in Scotland?

  • Please put “yes” or “no” or “not sure” on you paper.

  • Please fold paper in half and pop in box.


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  • Not all practising doctors are trained in ethics

Sept’05


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Basic ethical principles

  • Beneficence - doing the patient good

  • Non-maleficence - not doing harm

  • Respect for patient autonomy (patient’s wishes)

  • Respect for justice (to the patient and the community)

    (Beauchamp and Childress 1977)


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Withdrawal & withholding of medical treatment

Voluntary euthanasia

Assisted dying

Principle of double effect

Refusal of treatment

Advance statements (living wills)


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Palliative care - intends neither to hasten nor postpone death

“the closer their experience of end -of -life patients,

the less sure professionals are about he prospect

of a change in the law in favour of euthanasia”

House of Lords Select Committee Report 2005


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Cancer

Debility

Therapy

Non cancer

Friends gone

Bureaucracy

Delay

Unavailable doctors

Treatment failure Irritability

Somatic (body)

Loss of:

income

role

Fatigue

Helplessness

Disfigurement

Total

Suffering

Depression

Anger

Anxiety

Fear of pain,

hospital, death

Spiritual unrest

Finance, Uncertainty


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How often requested?


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“Euthanasia is already happening” – eh no.

  • “…..we looked at allegations that doctors were already ending the lives of patients prematurely, though we found no reliable evidence of that.”

    Lord Mackay of Clashfern, 10th Oct 05

    (select committee member) - Hansard


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“Joffe” bill

  • Competent adult

  • Terminal illness

  • Suffering unbearably

  • “Assistance to die” – prescription to self administer.


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Lords Select Committee

  • Mandatory psychiatric assessment?

  • “Unbearable suffering” vs. “unrelievable” or “intractable”

  • Could patients experience palliative care before taking a decision?


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Select Committee Report

  • Do doctors need to be involved?

  • Future bill should distinguish between assisted suicide and voluntary euthanasia – “responsibility for the ultimate act rests with the patient”


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“Joffe” Bill (revised 05)

  • Verbal and written request to 1st Dr

  • 2nd opinion from consulting Dr

  • Psychiatric review if doubt as to competence

  • Compulsory meeting with palliative care

  • Witnessed written declaration

  • Dr prescribes lethal dose and patient self administers - assisted suicide


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Joffe Bill

Competent adult

Terminal illness - “months”

“Unbearable suffering”

Verbal and written request

2nd Dr opinion

Compulsory pall care consult

Assisted suicide

Dying with Dignity

Scotland

Competent adult

Terminal illness < 6 months

Verbal and written request

2nd Dr opinion

Assisted suicide

Failed Feb 2006

Failed Mar 2006


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Doctor - patient relationship

  • Trust

  • Testing the water

“just gim me the wee blue peel - doc”


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Competence

  • Adults With Incapacity Act


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Prognosis


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Understanding palliative care

Patients often say

  • “I wish I had known earlier”

  • “I wish I had come here earlier”


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Public awareness of palliative care

Report of the findings of the first national survey

in Scotland into public knowledge and understanding of

palliative care

December 2003 Jennifer Wallace


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Palliative care

Assisted dying


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Assisted dying

Palliative care


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Robert Pope


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Who is in control?

  • Young man, divorced, depressed – life no longer worth living

  • Older man – widower, depressed, frail, incontinent – life no longer worth living


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Oregon

  • Massive dose of oral barbiturate

  • After ingestion may live 30hrs or even wake up

  • 60% had to change doctor to get drugs

  • Only 20% of hospitals have pal care programme

  • Palliative medicine is not a speciality

  • No central register of prescriptions

  • 5% patients get psychiatric consult (was 30%)

    Baroness Finlay of Llandaff (Prof. of Pal Med)


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Role of palliative care professional in Joffe proposals

  • To encourage?

  • To discourage?

  • A duty to offer euthanasia?

Just tick the box!


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UK Professional Bodies

  • Association for Palliative Medicineagainst

  • Royal College of GPsagainst

  • British Medical Assocnow against

  • Royal College of Physicians (Lon) neutral

  • Royal College of Physicians (Edin)hesitant

  • British Geriatric Society against

  • Pharmaceutical Socthinking

  • Royal College of Nursingagainst

  • GMCno comment

  • Scottish Partnership for Pal Careagainst

  • Help the Hospicesmore pal care


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carenotkilling.org.uk


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Palliative Medicine

  • Acknowledges suffering

  • Cannot always relieve suffering

  • Realises pal. care is not always acceptable

  • Does not perform euthanasia

  • Not supportive of proposals

  • Feels “used” in as second opinion

  • May opt out of any proposals in future


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Who suffers in the end?

  • Person with chronic illness in nursing home

    VS

  • Human freedom and right to die (be killed)


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  • Volume III of our report has evidence from Dutch physician Bert Keizer, who wrote:

  • "I would rather die in a country where euthanasia is forbidden but where doctors do know how to look after a dying patient in a humane manner than I would in a country where palliative medicine is ignored but euthanasia can be easily arranged".

    Baroness Finlay of Llandaff (Prof. of Pal Med)


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Secret ballot 2

  • Should physician assisted suicide for terminal illness be legalised in Scotland?

  • Please put “yes” or “no” or “not sure” on you paper.

  • Please fold paper in half and pop in box.


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