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LONDON, England /
The Daily Mail Debate / Health Boad / February 3, 2010
By Karol Sikora
The first time I helped someone to die is an occasion I will never forget. He was a 14-year-old boy who was suffering from leukaemia. I was a young cancer registrar at St Bartholomew's Hospital in London.
He was in such pain. Back in those days, we didn't tell people much about their illnesses - we never mentioned the word cancer, but the teenager had been fighting the disease for more than a year and didn't have long to live.
My consultant turned to me and said: 'Sikora, I don't want to see this boy again. Don't let him suffer.'
I understood. I doubled his dose of morphine, which I knew could suppress his respiration. The child died overnight, peacefully, with his family around him.
Karol Sikora: Against assisted death tribunals
That is what doctors used to do. We didn't call it assisted suicide or euthanasia. We called it 'easing suffering'.
Today, though, we are witnessing a concerted drive to formalise this process. The author Sir Terry Pratchett, who is suffering from Alzheimer's disease, gave a controversial lecture this week supporting assisted death, which he would like to be adjudicated on by a tribunal.
He envisages a system of 'death committees', which would rule on who should live and die.
Just how have we got to this point? This issue keeps coming up because society is evolving. We are living longer, and collecting more diseases as we go along.
Technology allows us to manage these illnesses thanks to bone marrow transplants, heart transplants or high-cost cancer treatment.
This is a triumph of modern medicine, a success story - but it means that more people are living into old age, often in ill health.
At the same time, we are seeing another change - a lack of family integrity. The village life structure of old England has all but disappeared.
The fact is that many families split up. In many cases, divorce and fractured families leave older people living alone in anonymous flats. No one even knows they exist.
Greater mobility means that an existing family is often widely dispersed. A 'me' culture has grown up, where we do voluntary work to show how caring we are and make ourselves feel better - but we fail to look after those closest to us.
But the biggest and most damaging social change of all for the elderly is the fact that so many more women no longer remain in the home.
The traditional matriarch who dealt with the health and well-being of the family has gone. Instead, she has become a professional, working woman.
As a result, she can't just drop everything and look after granny when she is ill. So granny has to go into a home.
Different viewpoint: Author Terry Pratchett, who has Alzheimer's disease, gave a controversial lecture this week supporting assisted death
The truth is that the elderly have become an inconvenience. From here, it's all too easy to see how we make that short leap from the old being a problem which needs a solution - and that solution is now perceived as assisted suicide.
In my work as a cancer specialist, I travel widely. In rural parts of the developing world, you see people dying at peace, tended by women and surrounded by family.
In Northern Thailand, for example, I saw patients who were suffering from cancer of the gall bladder, after ingesting fish parasites.
Their families were still intact and the extended family lived within a few hundred yards. The sick, therefore, were treated by their loved ones - using herbal potions similar to morphine - and were on hand when they died.
In such communities, a natural death is accepted. Yet here, in the West, we fight a natural death and want to control life's passage - meaning we don't know what to do with our growing elderly population. Enter Sir Terry Pratchett with his death squads.
Given that we find ourselves in this situation, what do we do? I am 60, the same age as Sir Terry. We are the baby-boomer generation, all approaching old age.
With the breakdown of the family, it is going to prove very difficult to look after us all - so Sir Terry is quite right: now is the time to ask: what do we want to do about this?
But my answer is most certainly not euthanasia by committee.
Ideally, for the last stage of our lives, all of us want something that the World Health Organisation calls 'compressed morbidity' - that is, we remain physically and mentally fit until we are 80. Then we might get ill, have a short period of bad health, and within a couple of weeks it's all over.
Fight: Multiple sclerosis sufferer Debbie Purdy, pictured with her husband Omar Puente, has campaigned for clarification of the law for those who help loved ones to die
You could say that euthanasia is a form of extremely compressed morbidity, speeding up nature. But the question is: who would deliver euthanasia? The idea really breaks down once you begin talking of death panels. Who wants their last moments divined by committee? Who would appoint such a panel? What sort of people would sit on them? Who would pay? How would they agree?
Last week, the novelist Martin Amis called for public euthanasia booths, where the elderly would be given a Martini and a medal. How preposterous. It is not for governments and politicians to sanction death.
As far as going to the ghastly Swiss clinic Dignitas: what an awful way to end your life. In any case, contrary to public perception, as a doctor, I know that there is very little desire for euthanasia.
This whole debate has become greatly exaggerated. There have been a few very distressing and sad cases in the public eye over the past few years, but in general, the sick want to live.
In all my 37 years as a cancer doctor, I have never had a patient who asked for euthanasia. In my line of work, it is not an issue. People don't want to die. And, usually, we can make patients comfortable, thanks to modern drugs.
Britain gave the world palliative care, after all: hospices were pioneered by Dame Cicely Saunders. She is widely regarded as the founder of the palliative care movement, and taught us that death is not something to be frightened of.
In order to see how deeply ingrained is the desire to live, you have only to go into the average old people's home and look around. Of course, some people there are depressed and miserable, but you would find that in any group of people. They may not be fighting fit - but that doesn't mean they want to die.
In Japan, I once had tea with a group of 25 people who were all over the age of 100. One of them played the grand piano; they all enjoyed life, albeit a sheltered and protected one, and were not ready to be put to death by a panel.
So wouldn't it be far better to revert to the old system, common 30 years ago in medicine. I remember as a young house doctor, seeing the now mythical Brompton cocktail - a mixture of morphine, brandy and a bit of cocaine - being given to patients who wanted to die.
Most doctors have been in a situation where a patient is in a lot of pain and the family is distressed, and it was then that we doctors would help a terminally ill patient slip over to the other side.
In the small hours of the night, it used to be that you exercised your own judgment. You didn't call a committee.
Now, however, medicine has been protocolised. If you don't follow the rules exactly, you get into trouble.
Young doctors are trained to follow these rules rigidly and unquestioningly.
That is wrong. So is assisted suicide. It is a dangerous path to take.
For my part, I know with certainty that when my time comes, I would rather be in the hands of a doctor than the next case on the agenda of a death committee.
rc]
© Associated Newspapers Ltd
The first time I helped someone to die is an occasion I will never forget. He was a 14-year-old boy who was suffering from leukaemia. I was a young cancer registrar at St Bartholomew's Hospital in London.
He was in such pain. Back in those days, we didn't tell people much about their illnesses - we never mentioned the word cancer, but the teenager had been fighting the disease for more than a year and didn't have long to live.
My consultant turned to me and said: 'Sikora, I don't want to see this boy again. Don't let him suffer.'
I understood. I doubled his dose of morphine, which I knew could suppress his respiration. The child died overnight, peacefully, with his family around him.
Karol Sikora: Against assisted death tribunals
That is what doctors used to do. We didn't call it assisted suicide or euthanasia. We called it 'easing suffering'.
Today, though, we are witnessing a concerted drive to formalise this process. The author Sir Terry Pratchett, who is suffering from Alzheimer's disease, gave a controversial lecture this week supporting assisted death, which he would like to be adjudicated on by a tribunal.
He envisages a system of 'death committees', which would rule on who should live and die.
Just how have we got to this point? This issue keeps coming up because society is evolving. We are living longer, and collecting more diseases as we go along.
Technology allows us to manage these illnesses thanks to bone marrow transplants, heart transplants or high-cost cancer treatment.
This is a triumph of modern medicine, a success story - but it means that more people are living into old age, often in ill health.
At the same time, we are seeing another change - a lack of family integrity. The village life structure of old England has all but disappeared.
The fact is that many families split up. In many cases, divorce and fractured families leave older people living alone in anonymous flats. No one even knows they exist.
Greater mobility means that an existing family is often widely dispersed. A 'me' culture has grown up, where we do voluntary work to show how caring we are and make ourselves feel better - but we fail to look after those closest to us.
But the biggest and most damaging social change of all for the elderly is the fact that so many more women no longer remain in the home.
The traditional matriarch who dealt with the health and well-being of the family has gone. Instead, she has become a professional, working woman.
As a result, she can't just drop everything and look after granny when she is ill. So granny has to go into a home.
Different viewpoint: Author Terry Pratchett, who has Alzheimer's disease, gave a controversial lecture this week supporting assisted death
The truth is that the elderly have become an inconvenience. From here, it's all too easy to see how we make that short leap from the old being a problem which needs a solution - and that solution is now perceived as assisted suicide.
In my work as a cancer specialist, I travel widely. In rural parts of the developing world, you see people dying at peace, tended by women and surrounded by family.
In Northern Thailand, for example, I saw patients who were suffering from cancer of the gall bladder, after ingesting fish parasites.
Their families were still intact and the extended family lived within a few hundred yards. The sick, therefore, were treated by their loved ones - using herbal potions similar to morphine - and were on hand when they died.
In such communities, a natural death is accepted. Yet here, in the West, we fight a natural death and want to control life's passage - meaning we don't know what to do with our growing elderly population. Enter Sir Terry Pratchett with his death squads.
Given that we find ourselves in this situation, what do we do? I am 60, the same age as Sir Terry. We are the baby-boomer generation, all approaching old age.
With the breakdown of the family, it is going to prove very difficult to look after us all - so Sir Terry is quite right: now is the time to ask: what do we want to do about this?
But my answer is most certainly not euthanasia by committee.
Ideally, for the last stage of our lives, all of us want something that the World Health Organisation calls 'compressed morbidity' - that is, we remain physically and mentally fit until we are 80. Then we might get ill, have a short period of bad health, and within a couple of weeks it's all over.
Fight: Multiple sclerosis sufferer Debbie Purdy, pictured with her husband Omar Puente, has campaigned for clarification of the law for those who help loved ones to die
You could say that euthanasia is a form of extremely compressed morbidity, speeding up nature. But the question is: who would deliver euthanasia? The idea really breaks down once you begin talking of death panels. Who wants their last moments divined by committee? Who would appoint such a panel? What sort of people would sit on them? Who would pay? How would they agree?
Last week, the novelist Martin Amis called for public euthanasia booths, where the elderly would be given a Martini and a medal. How preposterous. It is not for governments and politicians to sanction death.
As far as going to the ghastly Swiss clinic Dignitas: what an awful way to end your life. In any case, contrary to public perception, as a doctor, I know that there is very little desire for euthanasia.
This whole debate has become greatly exaggerated. There have been a few very distressing and sad cases in the public eye over the past few years, but in general, the sick want to live.
In all my 37 years as a cancer doctor, I have never had a patient who asked for euthanasia. In my line of work, it is not an issue. People don't want to die. And, usually, we can make patients comfortable, thanks to modern drugs.
Britain gave the world palliative care, after all: hospices were pioneered by Dame Cicely Saunders. She is widely regarded as the founder of the palliative care movement, and taught us that death is not something to be frightened of.
In order to see how deeply ingrained is the desire to live, you have only to go into the average old people's home and look around. Of course, some people there are depressed and miserable, but you would find that in any group of people. They may not be fighting fit - but that doesn't mean they want to die.
In Japan, I once had tea with a group of 25 people who were all over the age of 100. One of them played the grand piano; they all enjoyed life, albeit a sheltered and protected one, and were not ready to be put to death by a panel.
So wouldn't it be far better to revert to the old system, common 30 years ago in medicine. I remember as a young house doctor, seeing the now mythical Brompton cocktail - a mixture of morphine, brandy and a bit of cocaine - being given to patients who wanted to die.
Most doctors have been in a situation where a patient is in a lot of pain and the family is distressed, and it was then that we doctors would help a terminally ill patient slip over to the other side.
In the small hours of the night, it used to be that you exercised your own judgment. You didn't call a committee.
Now, however, medicine has been protocolised. If you don't follow the rules exactly, you get into trouble.
Young doctors are trained to follow these rules rigidly and unquestioningly.
That is wrong. So is assisted suicide. It is a dangerous path to take.
For my part, I know with certainty that when my time comes, I would rather be in the hands of a doctor than the next case on the agenda of a death committee. rc]
© Associated Newspapers Ltd
