Thursday, 30 April 2015

Getting good at dying

This is a guest post by a local voter who has worked in a major London NHS hospital since 2011. He worked first as a Healthcare Assistant on the wards and is now an Emergency Department Assistant (EDA) in Accident & Emergency. 

He writes: 
As you're the Green Party candidate for Enfield North, I'm writing to you to ask you for your thoughts on recent attempts by organisations, such as Dignity in Dying, to legalise and enshrine an individual's right to choose to die under specific circumstances.

Obviously this is a sensitive and personal issue for all of us: we will all die at some point. I feel that as a nation we are prone to ignoring this very pertinent fact of life, to the detriment of our friends, family and loved ones. A more pragmatic reason for me to write to you about this is because I work in healthcare. I've seen people die, whether they were young or old, sick or (apparently) healthy. Death is indiscriminate and we do ourselves a disservice when we think of it as an enemy to be fended off at all costs.

I have looked after patients in the late stages of dementia, whose families have insisted that they be given feeding tubes when they are no longer capable of chewing and swallowing proper food. This is not a common occurrence, but it happens. These patients cannot communicate, move or control their bodily functions. Do they know what they're experiencing? Do they have a concept of time passing, as they lie there being drip-fed and hydrated by artificial means? I honestly couldn't tell you. What I can tell you is that being fed through a PEG feed gives a patient constant loose stool, which inevitably leads to them having to be turned and cleaned up with regularity, as well as extreme discomfort.

The NHS will proclaim an adherence to 'dignity in care' until they're blue in the face. Take a moment to consider the above scenario, to imagine what healthcare workers have to do to keep that individual clean, pressure-sore free and, for lack of a better word, 'healthy'. Perhaps I misunderstand the concept of dignity, but I cannot find any of it there. I can apply the word 'abuse' more readily to that situation than 'dignity'. The suffering is needless, sad and preventable.

This is an extreme example, but I want you to understand how the current attitudes towards death in our country have encouraged things to happen that are at best questionable, and at worst reprehensible. We do not die well in the UK, because most of us choose to reject the idea that death is inevitable. Many of us will die in hospital, surrounded by strangers and alone. Maybe in pain, maybe not. Maybe in our sleep, maybe not. I won't list the ways in which I've seen lives end, but you should understand that they are numerous and for the most part very unpleasant indeed.

We do our best in the NHS to look after those whose death is imminent, to give them relief from any pain or discomfort. Everything short of giving patients a choice. Sometimes a patient gets lucky and is able to go home and die, supported by their friends and relatives, but these instances are few and far between.

I'm 29-years-old and I don't take my life for granted. I never have. Before I worked in the NHS I was attempting to join the forces, and I certainly didn't assume that - in the event that I was successful and made it to combat zones overseas - I would survive because of my youth and physical fitness. After three and a half years in the NHS, I have seen enough to confirm it doesn't matter how young or healthy we are. We will all die of something. It is only right that we be given the means to choose, if possible and desirable, how we experience those final heartbeats.

A few weeks ago the well-loved and respected Sir Terry Pratchett died in his home, surrounded by his family. He was a leading voice in the campaign to change the law on Assisted Dying and was often quoted saying, "It's time we learned to get as good at dying as we are at living."

For those who would rather die when it is "their time", I endorse their decision and our current framework can cater to that. For those of us who want to choose when we die the current system is woefully inadequate. 

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