Nearly Beloved No 92 Death and the Best Interests of the Patient.  

In an earlier Dearly Beloved letter (No 60) I told of arguments put forward by Jonathan Sumption, the ex member of the Supreme Court, when he gave a talk nearby here in France. One argument of his I did not deal with was that, in our society, there is little thought about or expectation of death, yet when death and serious illness seem more probable during an epidemic, then people are afraid and some politicians may exploit that feeling in a way which gives them greater control. Surely it is true that modern medicine has been a victim of its own success. People expect medicine to heal them and they do not expect to die, even of serious illness. 

That is a relatively new development, my father always said that before the formation of he NHS, (ie pre July 1948) country people only called in the doctor when someone was actually on their deathbed -- that was partly because they could not afford to call him earlier, but it was also a matter of form rather than an expectation of consequent healing and perhaps a way of avoiding an inquest. 

Nowadays things are more complicated. Relatives (and sometimes even hospital administrations) often look for someone to blame when someone dies unexpectedly. (See the case of Surgeon David Sellu in DB letter No. 93 has made things even more difficult and hospital doctors have to quickly make very difficult decisions such as “would this Covid-19 patient benefit from artificial ventilation?” Artificial ventilation is quite invasive and unpleasant for the patient and if it is thought that the patient will not benefit from it and that it may speed their death the answer may be “no”. Yet, to say “no” may seem callous and in some cases the result will be to make a decision which, it could be argued, will lead to the patient dying sooner than might otherwise have been the case. This is not to write the patient off. It can be seen as a most respectful decision that a life has reached its natural end and that that end should be peaceful. 

Doctors have to act in “the best interest of the patient” – that is the Gold Standard. Treatment resulting in a lack of significant harm is not good enough.* Such very difficult decisions may fall to a junior doctor on night duty when he or she is presented with someone who has significant health problems, sometimes referred to as “co-morbidities”, often the diseases common to those who, paradoxically, live a life of poverty but also those who live of excess, frequently morbid obesity and diabetes. Such decisions are doubly difficult if the relatives, or even the patient themselves, demand interventionist treatment which doctors do not think they would benefit from or, indeed, would even survive. If treatment was refused, someone acting on behalf of the patient or the relatives themselves might then claim that the patient died of neglect. Hospitals are having to plan for such problems, ensuring, for example, that life and death decisions are made by a specific team of the most highly qualified medical personnel available and, if required, at the most unsocial of hours. Christians may not fear death. My (agnostic) wife remarked, of our elderly friend who lives next to the Church up the hill, here in France, who told us that his Catholic faith had been an integral part of his life since childhood, that he was like one of those mediaeval drawings of a soul in the lap of Abraham. Such people will expect death but not fear death. How can we be an example to others too?

Last Judgement: Angels bring souls to Abraham's Bosom. 

Reims Cathedral. Wikimedia Commons Mattana Own work.

 

A summary of an important Supreme Court judgement outlining some legal obligations of medical doctors can be found @ https://www.supremecourt.uk/news/permission-to-appeal-determination-in-the-matter-of-alfie-evans.html

Written:27 August 2021. *Not published by St Clement's Church.