“How people die remains in the memory of those who live on.” – Dame Cecily Saunders, founder of the modern hospice movement.
During the last two months of my fifth year “Community Care” medical placement, I have had the precious opportunity to spend time with palliative care patients and physicians. It was an experience that not only gave me knowledge about this oft-forgotten kind of medical care, but also engaged my whole person, emotionally and spiritually, and left me with a new respect for the dying and those who care for them. I am thankful for the wisdom I gained from the experienced palliative care consultants, nurses, and chaplains at Sobell House hospice in Oxford, and Sue Ryder hospice in Nettlebed.
As a medical student, I have more opportunity than most to experience the hard realities of sickness and disease. But before this placement, I had spent little time with the dying, perhaps because I was more enthralled by the high tempo work of the emergency department, or the advanced interventions in cardiology.
Dr Adams, a wonderfully competent and compassionate palliative care consultant at Sobell House, taught me about the management of terminal patients: pain control, relief of nausea and constipation, and tending to emotional and spiritual needs. I learned about three of the big fears faced by the dying: fear of being in pain, of losing dignity, and of being a burden to loved ones. An elderly gentleman confided in me “I do love my family and I know they are all so busy, and I don’t want to burden them, so I hope I go soon.” I was told that it is not unusual to find patients concerned about becoming an unwanted burden on their relatives and carers.
Yet there were also those who took great delight in the time that they had left, and wished to stay alive as long as possible. “The thing that keeps me going is the only thing that makes me happy: spending time with my family”, one woman revealed. For some, a fear of the unknown in and after death, or a longing for forgiveness, was prominent. For others, a confidence in life after death brought peace. “I know where I am going”, reflected one man.
One of the most powerful lessons for me was the value of a good death. By a good death, I mean one in which a patient has had the chance to share memories with and say goodbye to loved ones, to set their affairs in order, to prepare themselves spiritually, and has been relieved from physical discomfort. Relatives, while grieving after a death, also shared their appreciation of the time spent together at the end. While many in our society may wish for a quick death, I think I would rather have this opportunity to spend my last days surrounded by family and friends, cared for by a team of experts.
Palliative care may begin to look very different to future medical students in the future. Next month MP Rob Marris will introduce a Private Members Bill into the House of Commons designed to allow doctors to assist in the suicide of patients with a terminal illness. At the moment, doctors are prohibited from killing and from assisting suicide, but under the proposed legislation they would be allowed to select a poison of their choice, advise the patient how to take the drug, and even insert an intravenous line for the drug to be given efficiently.
I’ve often heard people suggest that doctors currently use drugs to help people die, and that all is being proposed is regulation. But this is just not true: palliative care doctors use opioids and benzodiazepines to treat pain and anxiety, so that the precious last hours, days and weeks can be as valuable as possible. These drugs are used to improve one’s quality of life, not to end it altogether. The drugs used in assisted suicide, barbiturates in massive overdose, are completely different, designed to kill rapidly.
Of all the palliative care physicians that I spoke to, not a single one of them supported a change in the law on physician-assisted suicide. They recognise that the current law works, and that under the proposed law, pressure on terminally ill patients to end their lives may come from family members or medical professionals, but also may be self-imposed by those feeling they are a burden to others. I hope that the excellent work of the palliative care teams I joined can continue -without the threat of assisted suicide – for many years to come.
Josh Peppiatt is a 5th year medical student at Green Templeton College, Oxford