Death and palliation – thoughts on Purdy.

A letter in The Times today considers the duty of doctors to ease the dying process, in the light of the Debbie Purdy case.


Dr MS Ali wonders why “people like Debbie Purdy and others have to fear that they will not get the necessary assistance from the medical profession to relieve their suffering when they need it”.  If it’s true that people fear this, that’s a bad thing.  And if their fear is warranted, then that’s worse.


Ali then asks whether

the medical profession [is] failing to reassure people like Ms Purdy that she will get all the necessary physical, emotional and spiritual care to have a natural and dignified death in her own home with her husband by her side, when her condition of MS becomes unbearable to her[.] Does not the medical profession have a duty of care to make sure that patients suffering from incurable diseases live well and also die well?

 Well – again – plausibly it does.  However, I wonder whether the point is much more than trivial.


What it lends itself to – which is non-trivial – is the “palliative care” objection to euthanasia and assisted dying.  It’s a line that’s fairly often adopted.  The gist is that people only seek death because the alternative – the kind of life that they’d otherwise lead – is intolerable.  The thought seems to be here that, if Purdy could be reassured about her future, she would not seek death.  Give people a better life for the rest of their lives, and they would no longer seek to die; therefore we ought to provide palliation rather than help someone to die.


But this is hokey thinking, it seems to me.  Importantly, it seems to be simply false that the only reason why a person might seek death actively is because they fear a lack of care.  It might be the case that a person simply decides that they’ve had enough, and they want no more of anything.  Along these lines, it might simply be that Purdy sees a time in which no amount of care will compensate for the fact that her life will be intolerable to her.  Maybe being cared for at all is exactly what is at the root of the problem.  And it’d be hard to tell her that she’s made a mistake in that evaluation – and, even if she has, there’s no sign that she’s incompetent.  Liberal though makes space for possibly foolish decisions.


That being the case, then the availability of care might mean that some people choose not to seek death – but it won’t establish that noone ought to, and it won’t establish that we oughtn’t to make the option available.  Sometimes, it may be true that a person would rather survive given a full range of palliative care and end-of-life treatment.  But not all the time, and not as a matter of necessity.


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