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Dying to talk about dying – or another heavy hint to the elderly?

Amid the Coronavirus pandemic, palliative care specialist Dr Kathryn Mannix urges people  to talk about dying; from her experience, most ‘very sick people’ – ‘[f]rom teenagers to pensioners’ – although  mostly ‘afraid that their illness and death will cast a shadow over the people they love’ find themselves ‘utterly unable to discuss this worry with their dearest people’; however, after such conversations, ‘[n]obody has ever said to me afterwards, “I wish we’d never talked about dying.”

But I’ve lost count of those who regret their silence.’ She says that ‘[m]aking an advance decision to refuse treatment (ADRT) is one way of ensuring that our decisions about treatment we don’t want are respected’, advising that guidance is needed to ‘make sure that the words we use are clear and legally enforceable’, and also the intricacies of completing and registering a lasting power of attorney  (‘Nobody has ever said to me afterwards, “I wish we’d never talked about dying”’, Sunday Telegraph, April 5, 2020).

All this is useful advice, but she also says: ‘Now, it has become even more important to be aware of people’s wishes, and GPs may get in touch to discuss “what if…”’ However, only yesterday it was reported that Labour MP for Hove Peter Kyle had expressed concern that the Coronavirus pandemic ‘crisis’ had prompted the blanket promotion of Do Not Resuscitate notices in care homes, with ‘elderly and frail residents … rushed to make decisions about their end of life care’ (‘Care homes “rushing into end of life decisions”’, Telegraph, April 4, 2020).

Dr Mannix maintains that ‘[d]uring the Covid-19 epidemic, GPs are trying to ensure that every patient’s wishes are explored and recorded’, a process called ‘advance care planning’ – ‘something that was encouraged for anyone with serious health problems long before this pandemic’, and that [m]any people have already decided that rather than risk dying in isolation in hospital, they would remain with loved ones at home’, and that both these options ‘are valid’ under ACP.

There is indeed a real risk that elderly patients will end up dying in hospital, unable to see or be seen by their closest family (Dr Rob Baskind, ‘I never got to say goodbye to my mum…’ Sunday Telegraph, April 5, 2020).  However, ‘remaining with loved ones at home’ is not such an easy option, requiring them to carry out round-the-clock personal and palliative care while taking the necessary precautions not to become infected, as well as dealing with the inevitable demise and related tasks.

Dr Mannix insists that any one of us could contract the virus, but adds: ‘If we are so sick that the doctors ask our families “Would he accept a ventilator?” or “I foresee that a period in ICU may leave her unable to live independently afterwards: would she accept that risk?”, will our families know what to say?’ Dr Mannix is not so blunt as Professor Sir David King, chief scientific advisor to Tony Blair and Gordon Brown, who warned that ‘[p]eople over 90 should think twice about going into hospital during the coronavirus outbreak to avoid “clogging up” the NHS’ (‘Patients in their 90s are “clogging up” the NHS, warns expert’, Telegraph, March 27, 2020).

More tactfully, ‘palliative care expert’ and Oxford-based clinician Dr Rachel Clarke ‘advised families to have an “advanced planning” conversation before infection’, because ‘if you had the conversation in advance, you may have concluded that you would rather have been at home”’ (‘Elderly urged to tell family where they want to die’, Telegraph, March 28, 2020). Elsewhere, the head of the Royal College of Physicians said that many health workers were off sick and they were having to purchase personal protective equipment from ‘“DIY shops”’, such that care was being compromised because of a lack of ‘“proper respirators and insufficient PPE”’, adding that ‘[c]onfused elderly patients who need constant monitoring because their oxgen masks slip off were at the great risk’ (‘Nurses “will not work” until they get protective equipment’, Telegraph, March 31, 2020).

All these heavy hints seem aimed at the older person and those with ‘underlying health conditions’ – the very people said to be most at risk from Coronavirus, who are now given to understand that they would be better off without receiving specialist treatment. With all the emphasis on patient ‘choice’, there is no legally binding ‘advance directive’ that we can sign to ensure that we receive treatment – only a legally binding document rejecting treatment – a self-imposed death sentence, influenced by the ‘experts’ insistence that for such people the Coronavirus is a death sentence,  therefore treatment is futile. And yet recently we have heard how even the very old have survived it – nonogenerians but also centenarians?

Despite this, it seems that the Coronavirus may succeed where the ‘right to die’ campaign has failed – to make old and disabled people so afraid of treatment that they will agree to forgo it – and yet the ‘right to die’ campaign never mentions the fact that anyone mentally competent can already refuse treatment. Could this strange omission be explained by a long-term aim of introducing euthanasia for those who are not mentally competent? This is already happening – and with no fanfare of publicity – although in some places the killing has been suspended, ironically because of Coronavirus ‘health and safety’ fears, as in the Euthanasia Expertise Centre in the Netherlands, which specialises in ‘euthanasia for psychiatric reasons’ and ‘for people with dementia or questionable competency’, and which last year killed 898 people.

Significantly, too, ‘the right to die’ campaign does not mention the role of faith or religion in life-and-death decisions, since such discussions might make people think twice about signing their lives away in advance. Neither is it a coincidence that killing the innocent is championed by the humanist movement and opposed by all the major religions. In all this ‘helpful advice’ to the frail and elderly, one vital thing is missing – any reference to what, if anything, happens after death – not information regarding the safe disposal of the deceased’s remains and advice about funeral arrangements, but the possibility that life may continue in the spiritual dimension.

We have heard much from doctors about how to avoid Coronavirus, and what – if anything – to do if we get it; but we need to hear more from doctors of the soul. As Easter approaches, it might be uplifting for all of us to hear that death is not, after all, the end, but the beginning; about how one man’s death split history in two and changed the world for ever. He died that we might live, and He did it out of love. Whether we live or die, let it be out of love and never out of economic expediency.

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