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Improve End of Life Care before Assisted Dying - not before !


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We need to stop conflating DNR orders with end of life care or euthanasia. My view, not necessarily mainstream admittedly, is that DNR should be the default position for most patients admitted with non-cardiac conditions. Re-starting the heart has a chance of working if the heart is the first thing to pack up, not when it’s the last. 
 

This may be a ridiculous argument, but it’s pertinent. We don’t discuss whether or not to send people for heart transplant and have them sign forms to say it’s ok that they’re not. Why therefore should we be obliged to discuss CPR, a treatment that is effective in about 5% of cases? It generally prolongs death, not preserves life. 

The public perception of CPR is generally derived from TV programmes like Casualty. In reality it’s not like that. Unless there’s a reversible cause for cardiac arrest it is futile. It doesn’t work for frail, elderly patients with dementia who have reached the end of their life. It needs to be used sparingly, and the public need to understand that it’s generally not indicated. 

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There is a lot of focus on CPR, because we’re told it can save someones life, the public are therefore actively encouraged to learn CPR and that itself leads to its own issues, it’s a fairly traumatic process trying to save someone when their body is trying to shut down but if you ever ring 999 after coming across someone unconscious that’s probably what will be expected.

Edited to add : i think there is definitely more of a expectation of survival if it’s a a doctor performing CPR, I didn’t realise it was as low as 5%

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Who and how DNR orders are arrived at is my concern, not on who they are applied to. If patients are. elderly, frail, and have a very low quality of life it is appropriate. 

They used to use the Liverpool pathway for End of Life care until it was done away with. 

The withdrawal of food and fluids does not constitute humane treatment but does the issue of letting nature take it's course probably better than high doses of morphine etc like they used to do regularly in the olden days. There are many ways. for patients to be kept comfortable especially if agitated.

Helping people to die peacefully is a skill, and art if you like. That why we have hospices where the knowledge and skill are available. A lot of people though do not die in a hospice. I have heard enough stories to say that sometimes the skills associated and available with dying patients in Nobles could be improved. We need that before more complex legislation is brought forward in my view.

 

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  • 5 months later...

Jersey approves principle of legalising assisted dying https://www.bbc.co.uk/news/world-europe-jersey-59391501
 

Just saw this on the BBC news website. Jersey hope to vote things through for 2023. I’m sure it won’t be long before those on IOMNP Facebook page will be shouting and screaming for the island to copy Jersey. Meanwhile our esteemed politicos and civil servants at the Starship Enterprise will be looking intently on creating Suicide Tourism, our own version of Dignitas. Think of the potential - touch of sarcasm added.

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Too serious to joke about or try to score points, but if the UK doesn't introduce their own legislation and we do, I think the IOM would be preferable to many over Switzerland (or wherever).

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22 minutes ago, Stu Peters said:

Too serious to joke about or try to score points, but if the UK doesn't introduce their own legislation and we do, I think the IOM would be preferable to many over Switzerland (or wherever).

Yes  preferable to those living in the UK seeking legalized assisting dying( I assume you meant that?)

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2 hours ago, 2112 said:

Jersey approves principle of legalising assisted dying https://www.bbc.co.uk/news/world-europe-jersey-59391501
 

Just saw this on the BBC news website. Jersey hope to vote things through for 2023. I’m sure it won’t be long before those on IOMNP Facebook page will be shouting and screaming for the island to copy Jersey. Meanwhile our esteemed politicos and civil servants at the Starship Enterprise will be looking intently on creating Suicide Tourism, our own version of Dignitas. Think of the potential - touch of sarcasm added.

The question is, what is more human?

Allowing terminally ill people to end their suffering on their terms, or to keep their heart beating as long as possible, whilst much of the rest fades away, often in awful and painful circumstance.

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1 hour ago, Stu Peters said:

Too serious to joke about or try to score points, but if the UK doesn't introduce their own legislation and we do, I think the IOM would be preferable to many over Switzerland (or wherever).

be interesting to see what jersey do to get around  the medical profession and the hippocratic oath  and how that sits with medics who are regulated by the BMA , people may eventually have a choice ,but I think its many years off yet ,we have a first class palliative care service  thanks to hospice , 

 

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2 hours ago, Omobono said:

be interesting to see what jersey do to get around  the medical profession and the hippocratic oath  and how that sits with medics who are regulated by the BMA , people may eventually have a choice ,but I think its many years off yet ,we have a first class palliative care service  thanks to hospice , 

 

Medics aren’t regulated by the BMA, it is our trade union. (And has recently moved to a neutral position on assisted dying)

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3 hours ago, Stu Peters said:

Too serious to joke about or try to score points, but if the UK doesn't introduce their own legislation and we do, I think the IOM would be preferable to many over Switzerland (or wherever).

To be fair I may have read your post all wrong and I think you have chosen your words carefully.

But it's interesting that in potentially introducing a law which would end needless suffering of many of our own people, your motivation appears to be making money from the people who would come here to use it.

I hope Jersey's motivation was more honourable. 

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7 minutes ago, A fool and his money..... said:

To be fair I may have read your post all wrong and I think you have chosen your words carefully.

But it's interesting that in potentially introducing a law which would end needless suffering of many of our own people, your motivation appears to be making money from the people who would come here to use it.

I hope Jersey's motivation was more honourable. 

Believe me, my motives are completely honourable, having lost both parents to cancer and seeing that palliative care isn't always the best option for EOL patients.

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Just now, Stu Peters said:

Believe me, my motives are completely honourable, having lost both parents to cancer and seeing that palliative care isn't always the best option for EOL patients.

I would agree with you there, and for what it's worth I think it is to be applauded that a serving politician posts on here giving and explaining their opinion whatever that opinion is.

As a Manx politician though, I do find it strange that your first thought when weighing up a potential assisted dying law would be with the people of the UK. Not that I would be against them using it and would be delighted if it alleviated suffering there too. 

Perhaps you could explain why this was, and if you'd include the service as part of our reciprocal health agreement? 

 

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