LettersThe BJGP welcomes letters of no more than 400
words,particularly when responding to material we have
published.Send them electronically to [email protected],
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and longones are likely to be cut. Authors should declare
competinginterests.
Assisted suicideLast time I wrote about dying at home, itwas my
personal view of my grandmotherseuthanasia in Holland.1 I have now
beeninvolved in a similar situation, a death fromcancer in Britain
and I was notimpressed. This time it was not a relativebut a friend
an 88-year-old gentlemanwho died of lung cancer. I am a
generalpractitioner in another city. I watched thingsunfold; I
wanted to be there for him and notget involved.
I visited him in hospital, walkingassertively onto the ward
outside visitinghours. He was discharged on a Friday andtold the
Macmillan nurses would contacthim on Monday. He was short of breath
atrest, but talking in sentences, mobile, andeating small meals.
His pleural effusion hadbeen drained and pleurodesis attempted.He
had been a very active man, walkingmiles a day with the dog until 6
weeksbefore admission. At home he lived with his84-year-old wife.
The family managed toarrange oxygen and sleeping tablets onFriday
afternoon from his GP surgery; hehad been comfortable on these in
hospital.They were not supplied with his discharge(there was a note
about not supplyingsleeping tablets long term). He
deterioratedquickly, became more breathless, stoppedeating, and
became bed bound. His wifehad difficulty getting him to the toilet
andthis was a problem at night when they werehome alone. The
Macmillan nurse arrivedon Wednesday, by which time the familywas
angry and had verbally complainedabout this delay. He was put on
oramorphas required, and the social worker came thesame day and
arranged a night sitter. Thesenice ladies were not nurses and
couldcome for 5 nights only. They could notadminister oral
medication. They did,however, agree to give morphine if his wifehad
drawn it up in advance but did notseem that confident about knowing
whento give it. By Thursday, my friend hadcalled out his GP and
asked him to end it
all with an injection. Like my grandmother,he was losing his
dignity and didnt want togo on anymore. His GP asked him if hewas
afraid to die, but with this remark thedoctor missed the point. My
friend wantedto die at that time and not suffer anymore.He was
prescribed oral diazepam. I toldhim he knew euthanasia was illegal,
but Iwould do my utmost to decrease hissuffering. One Saturday I
turned up early tofind him breathless, exhausted and indistress. I
gave him oramorph anddiazepam (he had not had any since 10oclock
the previous night) and he fell intoa peaceful sleep. His wife told
me shewished hed sleep like that until he died. Irang the district
nurses, and suggested asyringe driver because he was becomingunable
to take oral medication and needed24 hour symptom relief. Due to a
shortageof diamorphine, a low dose fentanyl patchwas tried. This
takes a long time to workand he was to be given oral morphine
untilit did work. By Sunday morning he couldbarely take anything
orally and again Iasked for a syringe driver. Now there
wasdiamorphine. The only problem was thatthe hospice had suggested
10 mgdiamorphine over 24 hours with the patch,and the on call
doctor prescribed 20 mg.The district nurse would not give myfriend
this dose and it took her 3 morehours to get the right dose. She
wasworried about suppressing his respiration,something the
relatives by that stagecould not understand. By 2 p.m. thesyringe
driver was up and at last my friendwas comfortable. He died
peacefully thatnight.
What shocked me was how much I hadto become involved. I wanted
to watch himdie peacefully at home with good palliativecare. If you
wont allow euthanasia, pleasegive people a good alternative.
F van Veen-ZwartGeneral practitioner, Upwell Street
Surgery,Sheffield S4 8ANE-mail: [email protected]
British Journal of General Practice, November 2005 883
REFERENCE1. Zwart F. A very special day. BMJ 1997; 315: 260.
Competing interestsNone.
I am writing in support of the viewsexpressed in the essay by
Ilora Finlay inthe September edition of the journal.1 Thearguments
against euthanasia andphysician-assisted suicide were
wellpresented, and I have felt motivated towrite to my MP about
this issue, in timefor the forthcoming Parliamentary debate.
Sandra Gordon8 Springhill Avenue, Crofton, Wakefield WF4
1HAE-mail: [email protected]
REFERENCE1. Finlay I. Assisted suicide: is this what we really
want?
Br J Gen Pract 2005; 55: 720721.
Congratulations to the RCGP for having thecourage and
determination to call for thelaw on euthanasia to remain as it
is.
I feel both proud and relieved that one ofthe professional
bodies to which I belonghas now stated so clearly its opposition
toeuthanasia; and embarrassed and ashamedthat the other (the BMA)
has not.
James GerrardMRCGP, Windmill Health Centre, Mill GreenView,
Leeds LS14 5JSE-mail: [email protected]
It is encouraging to find a stand beingtaken against assisted
suicide, somethingclearly repugnant to the majority of GPsand
elegantly discussed in the article byIlora Finlay.1
Over a long life in general practice I havenever found it
impossible to find pain relieffor patients either administered by
myself orthe practice nurse, or in one of ourexcellent hospices.
Moreover, it alwaysseemed to me that we did our best and
ifsometimes death was hastened by ourdrugs, that is surely a common
feature of
Letters
MagdalenaHighlight
