The right to die could become a burden
The onward march of medical progress has proven to be something of a mixed blessing. We may now live longer than ever, but the prospect that this might entail a melancholic older age, culminating in an undignified and distressing terminal illness, is not alluring. Hence the overwhelming public support – almost three quarters – for the legalisation of “assisted dying”. Yet it would seem many are under the mistaken impression this involves the (non-contentious) practice of discontinuing futile medical treatment.
Meanwhile, doctors increasingly favour a “neutral” stance – as reflected by the vote at last week’s BMA meeting – reflecting the conflicting views within the profession. But this stance is anything but neutral, being understandably interpreted by legislators as meaning that doctors are no longer opposed, or tacitly support, legalisation. Certainly, the adoption of this neutral stance by medical organisations in Canada and elsewhere was rapidly followed by a change in the law. Still, given the necessary safeguards, the autonomy argument – that the terminally ill should have the right to decide for themselves the manner and timing of their dying – is persuasive, were it not for the consistent opposition of specialists in palliative care medicine. Why? This is a complex matter, but perhaps they perceive more readily than most that the sanctioning of assisted dying can change perceptions in such a way that people feel under duress to exercise their right to die.
Twenty-five years ago, just prior to Oregon State’s pioneering legalisation, 12 per cent of patients in hospitals and care homes reported feeling they were a “burden” on their relatives – by 2018, it was 68 per cent.
GP flexibility is key
There has been ample testimony in this paper’s correspondence column to the failings of some family doctors during the pandemic. Still, this scarcely equates with consultant surgeon Meirion Thomas’s assertion of an “almost universal dissatisfaction with the performance of general practitioners”. The inevitable corollary of such hyperbole is the call for radical reforms – Mr Thomas favours imposing a contract specifying precisely the number of daily consultations and hours worked, a bureaucratic solution quite contrary to the ethos of traditional family doctoring. The more constructive approach would be to strengthen the role of Patient Participation Groups that now function in two thirds of practices in England.
Instituted back in 2011, their remit includes canvassing the views and experiences of patients and discussing significant issues with the practice staff. No doubt some are more active and effective than others, but Denys Williams, chairman of the Cross Keys Surgery PPT in Buckinghamshire, writes to tell how, despite the difficulties of the past year, they have successfully refashioned the appointments system to ensure that virtually all can consult a doctor on the day requested. This new method exploits the greater flexibility and convenience of telephone consultations while also allowing for face-to-face appointments for those requesting them. Rather than radical reforms, this would seem a much better and simpler way of correcting current discontents.
Help for arthritics
Finally, further to the elderly lady whose mobility – severely compromised by wear and tear arthritis of the knees – was restored by daily use of a rowing machine at home, a reader commends a most useful pamphlet from the Royal Orthopaedic Hospital, entitled “Exercises for Arthritis of the Knee”, which is available on the internet.
The purpose of these exercises is to improve the functioning of the two main groups of muscles responsible for respectively extending and flexing the joint, namely the quads at the front and the hamstrings at the back of the upper thigh.
The pain and impaired mobility in those with knee arthritis is much compounded by the synergistic adverse effects of weakened quads and tightening of the hamstrings – reversible with a series of simple exercises designed to strengthen the former and stretch the latter.
Doctors increasingly favour a ‘neutral’ stance reflecting the conflicting views in the profession