Thursday 23 June 2011


Back from holiday and there's always mountains of stuff to sort. Busy busy busy. But the nuisances and inconveniences pale against that adversity that some patients endure. A number of patients presented with different backgrounds causing the same presentation and experience of wishing to die in an active intentional elective manner. Indulge me in merging details of several patients into one vignette.

A patient's got severe COPD and is breathless just sitting around doing nothing. He's got lungs full of coal dust. He's got knackered joints all over, he struggles to mobilise at all now. He's scalded himself, dropping cups of tea on himself through arthritic and somewhat numb hands (his GP reckons past machine use has caused vibration white finger). He's long standing angina, blood pressure and mild heart failure, he's getting older and renal function's starting to decline too but a recent diagnosis of Parkinson's Disease clinched it.

He described how he reckoned he'll get iller, frailer, more dependant, physically and mentally deteriorate and explained he'll die, "buggered, a cabbage." Those were his words. Grim. He'd been a proud man, proud of his working class roots and life, grafting to earn everything and asking nothing from anybody. When he came into hospital he'd not even allowed his family to look after his dog, he asks nothing and puts nobody out. Except inadvertently a social worker, who sorted kennels.

He feels it's not right for him to lose his dignity and independance, he's wishing to end it all before it comes to that. He's not awfully cheerful but he's not clinically depressed. Specifically, he's not mentally disordered (within the meaning of the MHA 1983) and he's a capacitated adult (within the meaning of the MCA 2005). His psychological wellbeing's not cheery, but there's no frank psychiatric condition to attend to. Mental wellbeing's supported, protective factors are explored, support's considered that may engender more hope and help him endure over the longer term. Or maybe it won't.

Killing himself won't be a happy ending for me. Or for his family. But it may be the ending he wants and needs, in the way and time he chooses. I don't want it to happen, but it's not my choice. I can't have a happy ending every time . . .


Alias Grace said...

That is grim. I wasn't sure if you meant that these patients have explicitly stated to you that they want to end their own life. If so, are they more likely to be open to discussion of ways it could be made more bearable than those who do not reveal their intent?

Either way, you're right that it isn't your choice to make. Given the circumstances, I personally would sympathise with the patient's attitude. Although it might not be what one would hope for, it certainly seems rational.

Difficult. But I do hope you enjoyed your holiday.

Eileen said...

My mother had chronic heart failure and, without saying anything to anyone, she stopped taking her medication when she came to the conclusion the coffee bar she was responsible for running for the WRVS at the local Court was going to be closed down. It was her life and the reason for getting up in the morning. She knew the meds would not work for ever and she would become gradually less and less able to do things for herself.

One morning she went to the coffee bar to tell everyone it was likely to end soon, went home and had lunch, did some shopping in the afternoon and spent the evening with her friend from upstairs. Later she called the friend as she didn't feel well and the OOH doctor was called - he asked if she knew she had heart failure. A little later she toppled forward off the dining chair she was sitting on, into his arms, and went to sleep, quietly and peacefully. The paramedics arrived a few minutes later. It was the way she wanted and I would like to think I will have such a painless and peaceful end. No heroic interventions.

The gentleman is presumably still on this earth because of interminable medication? When life is no longer worth living - why should we be forced to do so?

Dr Grumble said...

People like this are brought into hospital around the land every day and every night. If they are seen by a GP first it is a doctor in a taxi who doesn't know the wishes of the patient at a time when the patient is too ill to express them. They are then admitted where they are treated vigorously.

In some parts of the country all we have to communicate is a bottle in the fridge. In other areas even that has been abandoned. I hope you manage to get his wishes recorded reliably in as many places as possible.

The Shrink said...

He's on medication, he's vaciliating over whether to continue them (and prolong life) or not (and experience what he reckons will be catastrophic symptom burden).

The local acute Trust, their A&E, the hospice and Primary Care all are in the loop . . . but oft times in acute medical crisis such folk still get aggressively treated . . .

Anonymous said...

poor bloke. Are you not glad its not your choice though, of that at least you are absolved responsibility.