Death and dying
BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b5044 (Published 26 November 2009) Cite this as: BMJ 2009;339:b5044
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It can seem that there may be a minority of deaths in difficult
circumstances which, although posing upsetting dilemms,are causing a
general spread of anxiety. Surely most people who make an Advance
Directive are thoughtful individuals who die in fairly 'ordinary'
circumstances with some assistance from doctors and whose wishes should
be respected. Problem being that few members of the public are being
informed or advised by anybody to make a Directive. Despite the BMA has
published it's guidance which includes a speciment form, they are not
distributed; and many people do not realise that they may draw one up
themselves. It may come as a surprise to some who have made one years ago
though, that to be in any way binding, the Directive needs to have been
witnessed. Although understandable, that rather compromises the concept of
autonomy to some extent. Older people especially do give end of life
issues much thought and do express their wishes to family and friends. In
my experience though they do not as often put their wishes on record for
different reasons including embarrassment, needs for privacy, fear of
being perceived as over anxious. If putting wishes on record could be
normalised this could ease the situation. At the end of a life surely a
person should not have to concern themselves with others' feelings or
dilemmas. Most do know from experience that it is likely they will be
letting go when the time comes with probably the help of medication which
assists in letting the person slip away. (The euphamisms which are
sometimes avoided but are commonly used do soften the reality of such a
loss in a way which does not deny the realisty but emphasises compassion).
Reference; the Open University Open Learning Course (free on line)
Moral and Ethical Principles in End of Life Care; Living with Death and
Dying; Postponement and Promise
Competing interests:
Several friends have died in diferent circumstances. None were aware of Advance Directives
Competing interests: No competing interests
“The bringing about of a gentle and easy death” as euthanasia was
defined may have the same consequences as ‘letting go’ but is perceived
differently by the public.
Pointing out as the alternative to it that “no effort should be spared to
snatch life back from the jaws of death by death defying hospital staff,
no matter what quality of life and the wishes of the patient”, misses out
as a distinct alternative a ‘letting go’ policy which is a dignified
natural death something which most people would prefer.
Those who contemplate ‘assisted suicide’ are only the tip of an iceberg
cornered into such decisions by futile interventions that keep patients
alive but wishing they were dead.
Some therapy will be needed to alleviate the “distressing experience for
health care professionals to allow the patients to die, when a condition
is life threatening but treatable”, but this may be in the best interest
of patients.
Competing interests:
None declared
Competing interests: No competing interests
Human Nature & Ambivalence
Human nature is contradictory. We are all burdened with conflicting emotions
about life and death. At any given moment, we can feel positive and negative
emotions, which tear us in different directions. How can we cope with this? We
should accept the limitations of human nature, both in ourselves and others,
but
at the same time, we should also strive to retain control of our behavior.
Ultimately, our lives are determined by our behavior, not by our emotions.
Competing interests:
None declared
Competing interests: No competing interests