Chronicle of a Death Foretold

Thursday, 05 February 2015


Suttie Centre

Professor Graeme Catto, Emeritus Professor of Medicine, University of Aberdeen

Professor Catto was a member of the Commission on Assisted Dying
"Assisted dying will be legal, why oppose patient choice?"
A thought provoking talk about an important but contentious subject.

Notes

Professor Mike GreavesMinute of meeting held in the Suttie Centre, Foresterhill on Thursday 5th February 2015

The President, Professor Mike Greaves, presided.

 

The meeting was open to the public.  91 people attended.

The President introduced the speaker, Professor Sir Graeme Catto who spoke about assisted dying, the title being Chronicle of a Death Foretold

Sir Graeme started by saying that most people wish to die at home but only 15% manage to do that with 70% dying in hospital and 10% in hospices.  There have been few audits of dying but there is evidence that care in hospices is best with care at home being variable and that in hospital the most difficult.  Although life expectancy has increased and medical care is generally good, many still die without dignity.

Professor Sir Graeme CattoWithin existing laws people can say what they do not want to happen to them but not what they do wish and in any case the medical profession does not always act on the requests, partly because senior staff often do not see admissions until a care plan has already been instigated.  People sometimes get admitted against their wishes for various reasons.

Sir Graeme said that doctors should be guided by society.  In the meantime he strongly suggested that everybody should have a 'living will' and recommended two websites:- compassionindying.org.uk  and polst.org, the latter being American.

As for changing the law, Sir Graeme believed that mentally competent adults with a life expectancy less than 6 months should be allowed to take their own lives by dosing themselves with a prescribed fatal dose of drugs.  Because they would self administer the drug, this would not be euthanasia.

He wondered why people were against this concept and offered some possible explanations.  Palliative care is said to be good but it is not universally so; some people see assisted dying as the start of a slippery slope to euthanasia but that has not been the experience in Oregon where assisted dying is allowed and the uptake has remained constant at less than 0.3%; one can debate what is insufferable suffering but that is for the person to decide; life expectancy is hard to estimate but doctors are usually too optimistic.  In Oregon, people do not take their own lives until they feel that their suffering is intolerable.

Another argument is that vulnerable people might be persuaded to take their own lives but Sir Graeme did not consider this to be a problem if life expectancy was less than 6 months and the experience in Oregon was that people taking up assisted dying were not vulnerable.

He pointed out that those against assisted dying tend to be very vociferous but 82% of the public support it.  He was against assisted dying being extended to disabled people since they may well change their minds in time.

It is said that GPs help people to die as it is, but Sir Graeme felt that was less likely these days because of the weakening of good personal relationships which formerly were more common.

There have been positive votes in the House of Lords and Sir Graeme felt that the law would eventually change in England.  He was less optimistic about Scotland since current proposals are broader and less likely to win wide support.

He pointed out that various bodies state that they are against a change in the law despite most of their members being in favour - he mentioned most of the Royal Colleges as well as religious organisations and bodies dealing with the disabled.  Some newspapers which were against a change in the law have changed their stance after listening to their readers and the Supreme Court has stated that the government should change the law.

Sir Graeme therefore expects that the law will eventually change and he favoured something close to the Oregon model, in which two specially trained medical professionals assess the situation and have to agree that the drugs can be prescribed.  In Oregon, palliative care services have not withered, the uptake is static and even those who do not utilise assisted dying are reassured that it is available if the require it.

There was a lengthy period of questions and discussion.  Some questions related to the process, others challenged some of Sir Graeme's statements about the Oregon experience.

 

The President brought the meeting to a close by thanking Sir Graeme for his thought provoking talk.

← back to listings