Recent research funded by the charity Marie Curie has discovered that each year in England around 170,000 people are suffering unnecessarily and dying in pain. That’s almost a third of total annual deaths. As it stands this shocking statistic can only fuel enthusiasm for the Assisted Dying Bill currently being debated in the House of Lords. But it needn’t be like this. There are lots of effective painkilling drugs, but some staff can’t believe the amount of morphine or other drugs patients need and so under-prescribe.
There are lots of effective painkilling drugs, but some staff can’t believe the amount of morphine or other drugs patients need and so under-prescribe
I know of one woman who had terminal breast cancer with painful bone metastases. A month or so before she died she was told she couldn’t have her morphine increased because, ‘she was getting too used to it.’ This came from a member of palliative care staff with inadequate training.
We all know that the speed at which people metabolise alcohol varies enormously; what we think of as a good head for drink is actually a good liver. But few of us realise that extends to drugs as well. Hospice and domiciliary palliative care staff should know this. In the last days of their life does it really matter if someone is ‘addicted’ to morphine?
Another factor is staffing levels. A young woman I knew died a couple of years ago. She died painfully of a brain tumour, drowning in lung secretions because there was no doctor on site in the hospice to prescribe drugs. This suffering was entirely preventable. Defeated, the nurse could only hold her hands in her face.
Post Harold Shipman, doctors have been wary of prescribing adequate – and in the event of extreme terminal suffering, possibly fatal doses – of analgesia, for fear of being accused of euthanasia. Yet none of the people standing round that young woman’s bed would have doubted the motives of a doctor who reduced, by minutes even, the duration of her agony.
Many people who support the Assisted Dying Bill do so out of fear. They’ve seen relatives and friends suffer. If we could ensure that everyone had access to excellent palliative care and had a say in how the very end of their life was managed, we would have no need for this poorly considered and inadequate Bill.
Could government for once do something decent and do it quickly, and sort this palliative care crisis? It needn’t take years of research and consultation and, unlike some projects, cripplingly expensive investment. Much of the information is there. We have the expertise.
The solutions are obvious. We need improved nationwide standards of care under effective, intelligent and empathetic leadership. This might include a 24 hour on-call team of two in every hospice, a doctor and nurse already on duty, trained to respond to palliative emergencies. That’s all it would take to fix this problem.
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