There has been too much focus on what is being called a ‘right to die’ and too little thought given to understanding what dying is and how we deal with it
Dying is something that most of us put firmly to the back of our minds. It only comes to front stage when something, like a worrying diagnosis, leaves us with no option but to think about it. While we accept as an intellectual proposition that we will die one day, we don’t, most of us, give dying any serious thought or make any plans for it happening.
“The debate around assisted dying”, writes Alice Thomson (The Times,4 February), “has centred so much on the right to die that we have forgotten the greater importance of how to die”. Dr Kathryn Mannix’s recent paper “What Happens When We Die”, published last month by Living and Dying Well (see below), makes a similar point. With most deaths now taking place in hospitals, she writes, “three generations of Britons have been prevented from observing the onset and progress of dying at first hand”.
This unfamiliarity with dying goes some way to explaining an interesting paradox. Two or three generations ago, when medical care at the end of life was in its infancy, it was not uncommon for people to die in pain or other distress. Yet there was no shouting about licensing doctors to supply dying patients with lethal drugs to kill themselves – what is being marketed these days under the euphemism of ‘assisted dying’. Today, by contrast, thanks to the huge strides that have been made in the science of palliative medicine, distressing deaths are much less common. Yet we are seeing strident calls for legalisation of assisted suicide.
Before we start talking of a ‘right to die’ – a right which already exists and is quite different from a right to involve someone else in bringing about our deaths – we need, as a society, to re-learn what our grandparents knew – that, to quote Dr Mannix again, “dying is part of life and we are richer if we understand it instead of fearing it”. To put it another way, we need a public debate about dying rather than about ‘assisted dying’.
Most of us say that we want to die at home. Alice Thomson draws attention to Spain, where she says more people die at home than in Britain and where home-based palliative care actually costs less than constantly rushing dying people to hospital. That should prompt us to support Baroness Finlay’s Access to Palliative Care Bill, which seeks to do just that – to ensure that the world-class end of life care that exists in hospices and in specialist hospital teams in this country is cascaded into community medicine and nursing.
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