Social care and social work are important in end-of-life care.
Malcolm Payne's blog focuses on developments in social care and social work that affect palliative and end-of-life care. It is part of the information work of St Christopher's Hospice, London.
Perhaps stimulated by al-Megrahi, the Lockerbie bomber who was returned home on compassionate grounds because he was suffering from a terminal illness with less than three months to live, Lord Hylton in the Lords on 14th October asked how many others there were , but he was not obliged, because NOMS, the National Offender Management Service, does not keep the figures.
And in the same session another ‘what are the rules about consent to doing things that might look like assisted dying’ Lord Patten asks another:
Health: Sedation Question Asked by Lord Patten
Baroness Thornton: Yes. A person aged 18 or over who has the capacity to make such a decision may make an advance decision to refuse any treatment and, unless it relates to life-sustaining treatment, may do so verbally or in writing. An advance decision to refuse life-sustaining treatment has to be in writing, be signed and witnessed, and contain clear statements that it applies even if life is at risk. Where a person has made no advance decision and lacks the capacity to consent to a particular form of treatment, healthcare professionals should make decisions based upon the patient’s best interests, where practical taking account of the views of those close to them.
See it on the web: http://www.publications.parliament.uk/pa/ld200809/ldhansrd/text/91020w0001.htm#column_WA60
A House of Lords question yesterday on hydration, which shows the continuing drip, drip of Parliamentarians keeping on about rights to be kept alive – many people, particularly Catholics and Muslims, feel quite strongly that keeping on giving liquids is an important signal that a healthcare provider is committed to maintaining life rather than prepared to assist with death. As the answer makes clear, the medical view is that this is not the issue; that hydration is a ‘treatment’ that doctors cannot ethically give if it is medically inappropriate. This is something that needs a lot of careful explanation, and social workers need to be able to answer people’s questions about it, as well as other people who are helping people in healthcare.
Health: Hydration Question
Asked by Lord Patten
To ask Her Majesty’s Government whether patients entering NHS hospitals can request that their hydration is not stopped by doctors, nurses or other healthcare professions; and, if so, how. [HL5496]
Baroness Thornton: Yes. They may make their request in any manner they wish. However, clinicians cannot be compelled to provide the particular treatment requested. In deciding upon such a request from a patient, healthcare professionals may need to make a distinction between requests for fluids to keep the patient comfortable and hydration for a purpose that they consider to be “clinically unnecessary, futile, or inappropriate”.1
Note:
1 Paragraph 9.5 of the Mental Capacity Act 2005: Code of Practice
See it on the internet: http://www.publications.parliament.uk/pa/ld200809/ldhansrd/text/91020w0001.htm#column_WA60
A nice voluntary sector website with a series of comments what I call voluntary sector mustspeak, jargon borrowed from business, which the cool volly must be able to parrot so that people know that you only think in slogans.
http://www.bmelinks.org/the-cafe/the-cafe/511823392
While I’ve been migrating, the Director of Public Prosecutions has published his guidelines on how he is going to decide whether to prosecute people if they assist suicides. He was forced to do this by the Debbie Purdy case earlier in the year. You can find the consultation at his website:
CPS Consultation : Assisted Suicide.
It sets out a number of factors in favour of prosecution for assisting a suicide and then against a prosecution. These are not totted up: there are major and minor ones and also the CPS should look at the whole situation. It is important to know what the factors are, because people will increasingly ask about it, and practitioners should not rely on press reports.
To avoid prosecution basically someone over 18 has to make a spontaneous and consistently maintained decision that they want to commit suicide, and the assister has to be clearly motivated by compassion, have a close relationship with them and not have an interest. It is better if assisters tried to dissaude them and clearly did it unwillingly in the face of a determined person. This helps, because I have come across people who have been determined to commit suicide, and have pushed their relatives into helping even though they have been against it. Assisters can’t do it for them: that would be murder.
They have to have a terminal condition, a severe disability or a severe degenerative condition from wehich they have no possibility of recovery. They have to do the act in private (no committing suicide for a public cause – you may remember demonstrators setting fire to themselves in a political cause).
The palliative care lobby will note that assisters are less likely to be prosecuted if the victim has investigated and rejected suitable care options.
One of the interesting things for social workers or palliative care professionals is that the definition of assisting is ‘aids, abets, cousels or procures’, so giving advice is relevant as well as practical assistance. A specific factor is that if assisters are paid to care for the victim in a care setting, they’re more likely to be prosecuted. Also, the CPS is likely to be less sympathetic if they are not a close relative or friend or if they gave advice not really knowing them (eg through a website). This makes it very clear that assisting suicide is only to be done in close relationships. therefore, in giving advice, social workers should probably take the line that anyone who inherits obviously should not be an assister, but in reality the requirement that assisters should be close is likely to be in tension. What do you say to assisters whose ‘victim’ (the preferred CPS term) is likely to have to pay carehome costs? They certainly have a financial interest, because they will inherit more if the victim goes ahead with the suicide. As time goes on because this is likely to be a big issue for families of frail older people, and the CPS view is not clear to me.
The DPP is Keir Starmer; one of our nurses saw a photo and said: ‘he’s a bit of a hunk isn’t he?’ This is for me a new view of a Director of Public Prosecutions. See the pic on the Guardian website and tell me if you agree.
Keir Starmer: ‘I wouldn’t characterise myself as a bleeding heart liberal . . .’ | The Guardian
A rather nice booklet for carers about how to get involved in discharging an older person from hospital. It’s American, and social work led, but some of the tips are practically useful anywhere. For example, keep a notebook of all the people involved. I think all professionals should have a business card to give to patients in hospital, so that visiting relatives can know who’s seeing the patient. Soon we’ll be giving out mobile and website links, and we need an electronic business card.
This is the website:
http://www.scribd.com/doc/20627766/Family-Discharge-Planning
One of the little jobs I do for St C’s is organising for people to get access to records, and one of the common requests is for information about past patients, usually to sort out some family issue. A common one is for a death certificate years after the event, and many people do not know that you can order these online. this is the relevant website:
Order a birth, marriage or death certificate : Directgov – Government, citizens and rights.
Regular visitors will have noticed a gap; this is because we are migrating the blog to a new style that makes it easier to blog (they tell me) and has new St C’s colours etc. It will also provide for a new blog coming along soon. Sorry about the gap.