Hazel McHaffie

When is a spade not a spade?

Phew. What a week! We might have seen history in the making but I for one will be devoutly thankful when the dust settles from this jolly old general election. And rest assured, I have absolutely no intention of extending the agony here.

But I do want to talk about one particular politician, Independent MSP Margo MacDonald. Last week, in the midst of all the election hype, I was invited to go and hear her in person talking about her proposed End of Life Choices (Scotland) Bill. Of course I leapt at the chance. It’s a subject dear to my heart, as you folks know.

On this occasion she stoutly maintained that having Parkinson’s Disease herself hasn’t influenced her in taking up this Bill, but I have to admit her personal circumstances give her a certain edge in my estimation. Anyone who campaigns so tirelessly when they’re battling personally commands my respect.

But here she was, asking for comment and questions about her proposed Bill from a largely medical audience, which included lots of psychiatrists and some palliative care specialists, both of whom have a lot riding on this. Of course, they challenged her. And why not? She wasn’t seeking any latitude because she has an illness herself. And more importantly, by her own admission, she’s asking an awful lot of doctors: viz to end the lives of human beings. Quite deliberately.

Now, if you’ve read my novel on this subject, Right to DieRight to Die, you’ll know that I fully understand the dilemmas for those people who suffer horrific degenerative neurological diseases. You might detect that I have a lot of sympathy for those who want to end their lives ahead of nature’s schedule. But what you won’t know from that book, is that I personally have very mixed feelings on the subject of assisted death. Depends where I’m standing what it looks like, I guess. But because I feel honour bound to try to present the picture fairly and honestly (well, I’m not a politician), Margo’s debate with the doctors compels me to spell out a few angles thrown up in the discussion that made me think, even though some at least appear in the novel in one guise or another. (Incidentally the book predated Margo’s Bill by a couple of years.)

Here’s roughly how it went (my paraphrasing).

MMacD: This is a Bill to help a small number of people with intolerable or terminal conditions have the kind of dignified death they wish for.
Audience: Let’s call a spade a spade. It’s euthanasia.

MMacD: Ending a life is too big a responsibility for families who, in any case aren’t knowledgeable enough about medical matters; they might guff it up and not know how to correct their mistakes. Ergo, doctors should do the deed.
Audience: Doctors aren’t trained in how to kill either. They wouldn’t know how to. And given the projected small numbers* eligible for this service it’s hard to see how they could be trained, or build up expertise.
*(Based on the Oregon experience, MMacD had projected 55 per annum in Scotland.)

MMacD: Doctors already end lives because of the double effect of the drugs they use: big doses of pain relief shorten lives.
Audience: This is a myth. Research shows that when medication is carefully titrated against pain by palliative care specialists it doesn’t shorten life. It’s only when non-experts panic this happens.

MMacD: The Bill requires psychiatrists to assess the patient’s definition of ‘an intolerable life’.
Audience: Assessments like this are notoriously difficult.

MMacD: The patient drives this. It’s what they personally find intolerable that counts.
Audience: So what are the doctors assessing?

MMacD: One of the rules for this Bill is that the patient isn’t being coerced or subjected to undue influence to die.
Audience: It’s incredibly hard to decide if they are. Pressure comes in many guises.

MMacD: Whilst she has no quibble with religious or moral objections to this Bill, MMacD gets annoyed by the people who make false claims about its risk to vulnerable people. But she also said she feels guilty she’s being too conservative about who would be eligible for this service.
Audience: No, they didn’t say a word!

It’s only fair to underline a couple of points.
– MMacD was inviting challenges. And she stated that she had every intention of having medical experts present at the discussion stage.
– the Bill is at a very early phase. It could change in lots of ways before it becomes law – if it ever does.
– the doctors who spoke are not necessarily representative of all medical opinion and she is not representative of all politicians.

Do add your comments either on the blog, or to me in confidence (see my contact page), I’d love to hear from you. Especially if you can help to clarify my own thinking on some of this. What a minefield!

In the midst of all this turmoil, it’s been a tonic to involve myself in Christian Aid week. The annual Book Sale at St Andrew’s and St George’s in Edinburgh’s George Street is a fantastic example of love in action. (It raised £101,000 last year!) And the people who go out of their way to be sure their donations get to me if I miss them in my door-to-door collecting – they restore my faith in human beings. As did the church I visited the previous week, who really reach out to their local community in practical ways as an integral part of their Christian service. These are the kind of folk who get my vote. Politicians please note!

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2 Responses to “When is a spade not a spade?”

  • Clare says:

    It’s a pretty big minefield this one!
    I don’t always agree with what Margo has to say but I do respect her for making a stand when so many of us would prefer to dodge such a controversial issue – she’s a brave lady.
    There’s no space here to go into the issue in depth but a couple of things do jump out at me.
    Would it necessarily be doctors who carry this out? I think there might be better alternatives.
    With regards to the idea of doctors already ending lives by prescribing big doses of painkillers, I don’t agree that that is a myth and I think it disingenuous of the audience to claim if this does happen it is a case of non-experts panicking. Caring is not the exclusive domain of palliative care specialists.
    I have heard many people in the media proclaim that palliative care can invariably ensure adequate pain relief and therefore no one need worry about their loved ones dying in pain – if only that were the case.
    Death is something that affects us all and while I am a great advocate of palliative care services they are not the whole answer (nor is there adequate provision and funding of such services to ensure equality of access to all.). I don’t pretend that I have any answers but I certainly think this is something that merits open and honest debate both within and, more importantly in my opinion, outwith, the medical profession.

    • Hazel says:

      Thank you so much for your comment, Clare. You’re right, it’s something that merits open and honest debate.
      It was Margo who said that in her opinion doctors should do this because they would be best qualified to get it right. I’d be most interested in which alternative you think would be preferable.
      I perhaps gave the wrong impression by putting ‘audience’ (attempting to clarify it later). It wasn’t the whole audience but a voice or voices from the audience who said these things. And it was a palliative care specialist who said that it was a myth that doctors were ending lives using big doses of painkillers. I think many people would share your opinion (?experience) on this point.
      You are absolutely right that palliative care doesn’t answer every case and is not available to all. But to be fair, as I understand it, Margo’s Bill is trying to offer a solution for those who fall outside the capacity of this form of care.
      There are no easy answers but it’s reassuring to have the subject at least debated so openly before anything irrevocable is done.

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