ANOTHER VIEW : Signing your life away

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My peasant instinct is aroused by the contradiction in the very name "living wills". Wills come into force after death; probate is only granted following due process, and not when the deceased was under pressure from family or others at the time of signing.

Living wills, or advance directives, are very different: the signatory is still alive, although no longer able to communicate, and so deprived of the chance to indicate any change of mind. No inquiry will be made into the reasons for refusal of treatment, or whether the patient really knows what this would mean for him or her.

The instruction not to intervene can apply not only to "assisting breathing" but to treating a "curable" infection, or to providing assisted nutrition and hydration which, as the Royal College of Nursing told the House of Lords committee on medical ethics, is "part of nursing care".

Another constant propaganda theme is that doctors prolong the dying process by wiring people up to ventilators or inserting tubes into every orifice; and that even without us, many die in agony.

In fact, doctors have never been obliged to prolong the process of dying. In 31 years in my joint practice, families have never complained of "overtreatment". In these days of economic stringency, one fears the opposite - undertreatment.

As for pain control, there are more new drugs and techniques available than ever before. District hospitals now run courses on palliative care regularly to ensure that both interim staff and general practitioners and nurses are au fait with the most recent developments.

If, indeed, patients were not being given good palliative care then the onus is on our profession to correct any deficiency; we should not expect patients to sign their lives away because of our inadequacies.The latest empty slogan is "death with dignity". Anyone who has worked in a casualty department knows there is no dignity in the sight of a smashed-up individual; the dignity is in the attitude of the staff, in their care and concern for the injured person.

The thinking behind advance directives is wrong. It fosters a horror of old age, and of disability. We should not forget that we are all members of the same great human family. The propaganda emanating from the euthanasia promoters has played on the fear people have of the rejection which they think follows physical and mental imperfection.

But in this electronic age there is no disability that cannot be ameliorated. It is wrong to say, "sign an advance directive, you would be better off dead than alive". Remember, mistaken diagnosis is not uncommon. In 25 per cent of post mortems the diagnosis is completely wrong, and partially wrong in 50 per cent of cases. Sign an advance directive or a living will and you could be signing your life away.

Dr Peggy Norris is chairman of Alert, the anti-euthanasia education and research association.

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