Hazel McHaffie

mental competence

Marriage, death and blueberry muffins

I’m frequently amazed at how many articles in the newspaper touch on my subject area on a daily basis. Sensationalised often. Distorted even. But drawing attention to important issues nevertheless. Take yesterday’s edition for example.

A judge has just ruled that a 67 year old man who has had Motor Neurone Disease for 10 years, may be allowed to end his life peacefully by declining treatment. So? you might be asking, I thought any mentally competent patient had the right to refuse medical treatment. Indeedy. But in this case the patient has been unable to communicate his wishes directly for some time; he can only use eye movements. An advance decision was formally drawn up last November after several discussions and with all the important people present. Watertight you might think, but apparently a carer who wasn’t there, cast doubt on the nature of the patient’s consent, hence the case went to the High Court for clarification. Sad that the family needed to endure this additional delay and burden. The question is: Would you consent to this for yourself or your loved one? As a professional, would you have allowed it to go ahead unchallenged?

Still with death, an American study (published in Personality and Social Psychology Review) has discovered that awareness of mortality can have positive effects. Really?!! The headline put it: ‘Save your marriage by thinking of death’. Not surprisingly, it makes people value the finer things of life more. But, how ready would you be to clutch at this particular straw?

The social network site Facebook has just launched a new feature to encourage users to sign up as organ donors. It’s reported that 6,000 signed up to Donate Life America by the end of the first day. A ‘health and well-being button’ allows users to register with the optional extra of telling their friends (or the world if they prefer) that they have become potential donors. Question is: Are you a registered donor? If not, would you be more inclined to join up this way?

Me, I’ve been in the business long enough to have registered as a donor online years ago, and to have drafted a formal advance directive which has been duly signed and witnessed, and to have notified my family of all these wishes and intentions. But I’m only too pleased the media are raising the nations’ consciousness of the issues.

But to end of a lighter note … also in the newspaper this week a survey carried out by a food company, actually reported that one youngster in six regarded a blueberry muffin as ‘fruit’ that counted as part of their five-a-day recommended intake. As they say: You’re avin a larf!

Seems to me journalism could be fun!

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Right to die

The subject of suicide (assisted or otherwise) just won’t – pardon the pun – lie down and die. Even in a week where I’ve discovered internet sites devoted to book reviews, (eg. www.dovegreyreader.co.uk and www.meandmybigmouth.typepad.com) had a phonecall out of the blue from Angela Rippon’s agent, and had a big breakthrough for the next book, Remember Remember, I’m moved to devote another blog to this persistent subject. Somehow in the face of tragic deaths other mundane happenings hurtle down the scale of priorities. But of course, given my obsession with medical ethics, and especially having agonised over Right to Die, my personal interest is ongoing anyway. So sorry, folks, it’s serious time again.

The life and death of Kerrie Wooltorton has been haunting me – and filling column inches in the papers, two years after her death. Please note: long before the DPP guidelines on assisted dying for the terminally ill came out last month. Unfortunately the press have tended to confuse the facts by linking this case to the recent debate and wagging I-told-you-so fingers. But the Wooltorton story happened two years ago; it’s hit the headlines now because the coroner has just pronounced his verdict on the rights and wrongs of the decision.

How desperate was this 26-year-old woman to choose to swallow anti-freeze, ring for an ambulance, and hold a piece of paper out to ambulance men asking them not to intervene to save her life? Oh yes, she wanted to die, she was sure about that; she just didn’t want to die alone and in pain.

What torment possessed the minds and hearts of the doctors in A&E who had to decide how to respond? What would you/I have done in their shoes? Surely the foundation of medical care – to ’do good’ and ‘not to do harm’ – must have compelled them to intervene to save this young life … but, hang on a minute … legally it would be deemed an assault to give treatment which the patient herself expressly refused. That’s a criminal offence. And anyway, backing up her claim, there was the tried and tested basic ethical principle that says every rational human being should have the right to self-determination … but then, with her history, how could she be judged mentally competent to decide to die? It was a no-win situation.

There have been innumerable letters, strong opinions, expert analyses, expressed in support of both arguments. From psychiatrists and lawyers as well as from lay people. Wheeling out the law and ethical guidelines; roundly castigating both law-makers and care-givers; consigning society as we know it to a very slippery slope. But as for me, my heart goes out to the Wooltorton family and the professionals intimately involved in this tragedy.

I’ve worked in an A&E department myself. I’ve been instrumental in saving the lives of potential suicidees, bringing them back from the brink, only to face their personal demons all over again. In a few harrowing cases I’ve learned subsequently of the far-worse-than-death things that happened to them afterwards. I still carry a burden of doubt and guilt decades after the events. And back then dignity-in-dying and advance directives hadn’t even been invented.

By all means let’s keep talking about the issues, addressing the anomalies, learning from experience. But let’s not belittle the tragedy for all concerned by pretending that we only need to feed the facts into a moral guidelines machine to get black-and-white answers. Every case is personal and unique. These people need our understanding and support, not our semi-detached criticism.

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