Volume 1

Assisted Dying for the Terminally Ill Bill (HL) / Select Committee on the Assisted Dying for the Terminally Ill Bill.

  • Great Britain. Parliament. House of Lords. Select Committee on the Assisted Dying for the Terminally Ill Bill.
Date:
2005
Catalogue details

Licence: Open Government Licence

Credit: Assisted Dying for the Terminally Ill Bill (HL) / Select Committee on the Assisted Dying for the Terminally Ill Bill. Source: Wellcome Collection.

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    e Relief of pain and symptoms e Management of the physical effects of the disease, e.g. paralysis e Psychological and emotional support of patients and families There are a few drugs under trial to slow progression of the disease, but so far these have not been remarkable and their effects have not been evident to either the patient or his/her family as the disease progresses. Food and fluids In the late stages of the disease, swallowing may become difficult to some extent, although this is not invariable. Expert speech and language therapists can successfully teach patients new techniques to deal with this. Because these therapists are not commonly involved, more patients than necessary have a feeding tube inserted through the stomach wall—a painless and effective procedure. Most of the symptoms can be helped or relieved but there are no randomised controlled trials to measure this. Nevertheless considerable interest and progress has been made in the general management of MND over the past ten years. Because general practitioners see patients with this condition only rarely, MND should be managed in a centre with a specialist MND team consisting of a physician, nurses, occupational therapist, physiotherapist, social worker, speech and language therapist and counsellors, who can work with the primary health care team in offering patient and family care and support. Palliative care teams are increasingly involved and combined clinics with neurologists and palliative care specialists are becoming more available. Involvement with the MND Association, which can provide invaluable advice and respite, is essential. When the above exists and is coordinated well, the care and support for patients and families can be superb. Unfortunately such centres are rare (though increasing) and patients who are not involved can suffer considerably. Some questions concerning MND How effective is palliative care? In a properly constituted team, it can be good. Anecdotal evidence suggests that many symptoms can be relieved, fear of dependency and choking can be diminished, and pro-active management can prevent the occurrence of many problems. Obviously, not all suffering can be relieved. Can palliative care relieve depression? Yes, provided it is diagnosed and that treatment (drug and non-drug) is given. Can palliative care relieve “loss of self-worth”? Of 56 patients, 84% of those who did not want PAS, and 52% of those who would, looked forward to the future with “hope and enthusiasm” [6]. Does morphine in these patients shorten life? In cancer patients, the starting dose of morphine for pain control is 30-60 mg per day and may rise up to, and even beyond, 1000 mg per day with the patient remaining conscious, alert and active. In one study of patients with MND,