Lessons from GosportBMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k2923 (Published 05 July 2018) Cite this as: BMJ 2018;362:k2923
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The Gosport events need to be seen in context and perhaps reflect an end of an era. The scale and openness of what happened is surprising but it is unlikely that we will ever know the full extent of past practices which effectively shortened life, albeit on a less systemised scale, in a way that would be totally unacceptable now.
The year I started at University (1957) a book on medical ethics (1) gave practical advice on the use of opiates, and other options, for euthanasia to end suffering and not specifically for pain. Move on 20-25 years and in the Arthur case it was felt that allowing an unwanted baby with Down’s syndrome to die was within normal practice – death being made more peaceful with an opiate. In the early days of hospices we sometimes commented on how quickly some of our relatively fit patients died after transfer. Newspapers in the 1990s tried to highlight what could have been happening and one suspects that many of the public believed these stories to be true. Anecdotally (and how could these be published?) many doctors have admitted to having used opiates on occasion to try to ensure a peaceful death – again without specifying pain as the indication – and not always for patients who were terminally ill. For whatever reason the Profession chose to deny what might be happening
A central feature of the campaign for those wishing to change the law to allow assisted dying for the terminally ill was to try to ensure better protection from it happening without consent and without safeguards. VES (Voluntary Euthanasia Society, now Dignity in Dying) provided evidence in 2005 to the Lords’ Select Committee for covert euthanasia. The BMA and GMC seemed to fudge their responses and Lord Walton seemed dismissive, arguing that almost all the anecdotal evidence reflected “double-effect” prescriptions. A sense of paternalistic charity may have guided most of those involved in these overdoses but with growing pressure on beds a sense of distributive justice could well have come into play. Some of the anecdotes I have come across certainly suggest that as a factor. A peaceful and anticipated death can also be less stressful for staff on the ward.
It is easy to see how the option in a prescription to escalate doses “as necessary” could be misinterpreted. This was – perhaps it still is - a time when the lives of the very elderly were undervalued. Many of the Gosport victims were in this age group and perhaps seen as in some way “terminal”. In this they were reflecting a view of contemporary Society as well. In 2002, and without reference to Dr Barton, Mike Brogden, Professor of Criminal Justice in Belfast, published a challenging and very readable – and relatively short – book : “Geronticide” (2) , examining issues around how we see and treat the elderly.
We need to understand fully how the events at Gosport came about but equally we need to guard against an overreaction to events taking place at a time when audit, guidelines, appraisal and an emphasis on patient autonomy were in their relative infancy and resisted by many doctors. What we must now resist is overreacting and not giving drugs – including diamorphine – when appropriate for fear of repercussions.
1. Medical Ethics. A Guide to Students and Practitioners. 1957 p138 Edited by Maurice Davidson. London: Lloyd-Luke (Medical Books) Ltd. 1957.
2. Brogden, M. “Geronticide: Killing the Elderly” 2002 Publ . Jessica Kingsley 2002
Competing interests: No competing interests