Whose death is it anyway?

To refuse drugs to those in chronic pain for fear that they may get hooked or, God forbid, actually like them, is a terrible scandal
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The Independent Online
Some people leave their hearts in San Francisco. Unfortunately I just did my back in, with the result that by the time I got off the plane at Heathrow I had to be taken to hospital in an ambulance. Once inside the ambulance I immediately felt better, confident in the knowledge, because I watch ER, that by the time I got to casualty, 15 sex gods would jump up and down on me, forming deeply meaningful relationships with me and each other in the process. Mostly I thought that they would make the pain stop.

What actually happened of course was that I was left on a trolley in a corridor for three hours - "no porters today, love" - and treated as a wimp because the injection they eventually gave me did nothing to stop it hurting. I don't want to over-dramatise the situation. I know I was not going to die of back pain. I know that they probably had far more serious cases to deal with, yet it wasn't until I went into shock, partly because I couldn't move and partly because I realised I was not in an episode of ER, that anyone did anything. Even then, the doctors' attitude was that I had already had enough pain relief and that I must put up with it. This puritanical attitude to pain relief will not be news to anyone who has had to watch someone die in an NHS hospital. Individual doctors and nurses may be fantastic but many people are left to suffer when they don't need to, because of a fear of using narcotics.

This issue has been dramatised by Brookside, in which we see Mick and Elaine Johnson smother her mother, Gladys Charlton, with a pillow. Gladys has had terminal cancer for months and begs to be put out of her misery. Her GP has told her that he can only prescribe "so much morphine". Why? So far the issue that this drama has been said to raise is the one of euthanasia. The other spurious issue preoccupying the press as always is the "Do soaps go too far in their efforts to bust taboos and up the ratings?" issue. The real issue here though, I think, is the one of pain relief.

Unfortunately in real life, as Llora Finlay, professor of palliative medicine at the University of Wales, pointed out last week, the reluctance of many doctors to use morphine means that up to 30,000 cancer patients a year will die in unnecessary distress. There is a fear of addiction, as well as of hastening the patient's death. "You don't kill patients by relieving their pain. Morphine is a very safe drug for pain control," Finlay said, adding that effective pain control may extend life.

In Virginia, some doctors have been prevented from practising because they are thought to have over-prescribed narcotics to their patients. Two patients in chronic pain after car crashes have committed suicide as a result, yet the fear expressed is that these patients are somehow getting high or getting a rush off the drugs they need to maintain a tolerable life.

Certainly when my mother was dying of cancer I found this attitude intolerable. One had literally to beg doctors to up the dose of diamorphine in her syringe-driver (a kind of intravenous pump that means patients can administer their own dose of the drug). Once she was taken to a hospice we all felt a tremendous relief because the pretence of her getting better was finally gone, and pain relief was no longer such a problem. Even there, however, a kind of code was in practice whereby once she had slipped into unconsciousness we had to suggest to the doctors that she was still in pain, in order for them to increase the dosage of drugs that may in the end have helped her on her way. It is a cliche, I know, to say that we do not deal with death very well, but we don't. The training of medical staff often means that life-preserving measures have to be seen to be taken even with patients who are terminally ill. Thus smoking and drinking is frowned upon even if you have only got two weeks left in which to do it. In contrast, in the hospice my mum was in, a drinks trolley came round with the drugs trolley and we all needed a drink by then.

The sight of Dennis Potter swigging morphine from his hip flask and talking of the pleasures of smoking, in the last interview he gave, burst out of our television screens because it was in so many ways life-enhancing. The prevailing puritanism that says life must be extended at all costs is precisely what brings about the debate on euthanasia. Most people who feel strongly about euthanasia, and I count myself among them, feel so as a result of watching someone close to them die in agony. This position is reached through pragmatism rather than philosophical debates about rights and the meaning of life.

If giving birth and dying are among the most painful experiences we go through, perhaps we could learn a lot from the experiences of women in childbirth. Different ideologies and approaches in this area have meant that some women feel that because pain is in some way "natural" they must endure it no matter what, though, as is often pointed out, not many of us believe in "natural dentistry" anymore. Nor do we think that general anaesthesia for major surgery is somehow playing at being God.

At one ante-natal class I attended I was struck by a woman in a knit- your-own muesli jumper and earth shoes. "I bet she wants a natural childbirth," I thought. When the time came to ask the midwife questions, she said: "I've had a natural childbirth. This time I want the drugs in the lift before I even get on to the ward."

What matters, of course, is choice. Just as women should not be made to feel inadequate if they want pain relief in labour, then neither should anyone who is in chronic pain. The natural childbirth movement came about as a result of the over-medicalisation of childbirth, the handing over of midwifery skills to doctors, who often had less knowledge in this field. It was a way of wresting back control. Yet refusing episiotomies or caesareans or inductions because they suit the needs of some of the medical establishment should not be the same as refusing all medical advances in this area.

No one should be made to feel that they have failed at childbirth or that they are failing at dying because they cannot endure the level of suffering. We have still not discovered anything that is more effective at relieving pain than morphine, yet because of the associations with addiction we are still frightened of it. My mother controlled her own morphine intake because she did not want to lapse into unconsciousness, even though she was in pain. Many patients do this. She was also brought up to believe that she must endure a certain amount of suffering and not make a fuss. In the end her loved ones had to make a fuss for her.

In Brookside, Gladys Charlton's relatives suffocate her because they see no other way out. We cannot stop the pain of death, we cannot stop the pain of loss, but not to relieve the suffering of the dying is a gross inhumanity. Most of us would not let our pets suffer in this way. To refuse drugs to those who need them for fear that they may get hooked, or, God forbid, actually like them, is a terrible scandal but one that does on silently and behind closed doors every day of our lives. It is surely up to the living to extend the life-choices of everyone, even those at the very end of their lives.

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