Frailty, older people and care homes.

Joint report by the Royal College of General Practitioners and the BGS
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Advanced Care Planning

The BGS has been part of a multi-agency group producing guidance on Advanced Care Planning - details. A supplement relating to the different legal position in Scotland has been prepared - details.

Dying with dignity

Consultation Document by Jeremy Purvis MSP

Response from British Geriatrics Society (Scotland), April 2005

The British Geriatrics Society (Scotland) is a professional association of physicians, general practitioners, clinicians and scientists with an interest in geriatric medicine. It is the only society in Scotland offering specialist medical expertise on the whole range of health care needs of older people, from acute hospital care to high quality long-term care in the community. It is also the largest hospital specialty in Scotland.

Geriatric medicine is that branch of general medicine concerned with the clinical, preventive, remedial and social aspects of illness affecting older people. The purpose is to restore an ill and disabled older person to a level of maximum ability and, wherever possible, return the person to an independent life at home.

BGS (Scotland) is pleased to have the opportunity to respond to this draft Bill and makes the following points.

• BGS (Scotland) contends that only very rarely in terminal illness are symptoms difficult to control, and that even if they are, some people may still find their life unbearable. Yet a policy that allows patients, in certain circumstances, to choose death, and to be helped to die by their physicians, is not the correct answer.
• BGS (Scotland) believes the duty of the physician to care for his/her patients is incompatible with a duty to bring about death even at the request of the patient. BGS ( Scotland) further believes that crossing the boundary between acknowledging that death is inevitable and taking active steps to bring about death fundamentally changes the role of the physician, the doctor-patient relationship and the role of medicine in society. The focus would shift from providing the best palliative care i.e. easing symptoms, to providing death on demand. Once quality of life becomes the yardstick by which the value of human life is judged, the protection offered to the most vulnerable members of society is weakened.
• In the experience of many geriatricians, the feeling of the small minority of older people who feel that life is unbearable in its later stages is a direct result of the reaction of others to their frailty and the care and treatment they are afforded. Our concern then is that many older people, because of the care given to them by society in general and the NHS and Social Care system in particular, will perceive themselves as a burden and feel under pressure to end their lives. BGS (Scotland) considers the best way of helping these vulnerable people is to maximise their independence and health, rather than acceding to their expressed wish to die.
• The right of any individual, whether terminally ill or not, to have their symptoms controlled is undisputed. In our opinion there is no overlap in clinical practice between symptom control and the willful termination of life (or assisted dying). To muddle the two is to cause considerable confusion . Effective symptom control may at times, as a secondary effect, shorten life, but the primary intent ion is the comfort of the patient rather than the ending of life, and this should continue to reflect good practice.
• Finally BGS (Scotland) is concerned that the while the draft Bill does not apply directly or exclusively to older people, it will lead to a change in attitude to death in society and also within the medical profession. The prohibition on intentional killing is the cornerstone of society and it is worth preserving the notion that all lives are precious. BGS (Scotland) accepts that this denies a very, very small number of persons the right to have their life ended by their physician if it is their autonomous wish. However it must be noted that every society puts some limits on respect for autonomy, which must be balanced against the greater good of society. BGS (Scotland) urges the Scottish Parliament to strive to improve the medical and social care of older people, placing them back in the centre of a society that respects their wisdom and experience. Rather than defining the conditions under which physicians may become killers, our efforts should focus on improving all aspects of palliative care, such that the debate on assisted death becomes irrelevant.
• In summary therefore, BGS (Scotland) is totally opposed to the introduction of the Death With Dignity Bill.