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Ending life and end-of-life care

Eve Richardson, chief executive of the National Council for Palliative Care and the Dying Matters coalition, argues that the government needs radically to improve end-of-life care in the UK, and makes several excellent suggestions about how that might be done.

I agree wholeheartedly, and would like to add a suggestion of my own: that end-of-life or terminal care should be a medical specialization not restricted to hospice care. Hospice care involves merely the palliation of patients’ symptoms (where such palliation is possible – sometimes, as in cases of advanced cancer, for example, pain cannot be controlled, and patients are left to die in agony). Such care should include voluntary euthanasia as a possible intervention. What might we call such a specialization? I suggest telostrics (telos being the ancient Greek word for end).

Of course, I am assuming that such euthanasia would be legal. But as it certainly should be, and quite probably soon will be, my suggestion here is not out of place.

It might be thought preferable that a loved one – a friend or relative – administer the fatal dose. That might indeed be best, but there may well be cases in which there is no suitable person available, or in which the patient would be concerned about the potentially traumatic effect it might have on that loved one.

What about an ‘ordinary’ medical practitioner? Why do we need a specialism that includes euthanasia? Again, this may work in some cases. But there is still a danger of trauma, and choosing what’s best for any particular patient may itself be difficult. Further, the issues surrounding end-of-life decisions, both for patients and their relatives, are complicated, and experience in them will often be beneficial for all concerned.

But aren’t doctors trained to sustain life? And won’t they be naturally traumatized by their killing others, just as most of us would be? Not all doctors think this way. Some of them see their role as making the lives of their patients as good as possible, and this may involve bringing that life to a less agonizing conclusion. Such doctors might, if my proposal were adopted, choose to become telostricians.

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4 Comment on this post

  1. I think it is a good idea, that should be seriously considered and worked out in detail. It seems humane and logical that people,who are terminally ill and want to die, should be able to rely on specialized practitioners for this very important period in their lives. This should not be left to doctors or even palliative care specialists to have to be involved in if they don't want to.
    I wonder if Roger is aware of the developments in the Netherlands, where NVVE has proposed the setting up of clinics attended by specialists? This for those that cannot find a doctor willing to help them end their life. I am not sure this is a good idea – people should be able to die at home with family and friends.
    I hope someone can make it work – the sooner the better!

  2. Hello, Roger, and thank you for your post. You will forgive me if I find it over-simple to reduce the end of life to the question of who administers the fatal dose. 
    First, it is not the final moment that counts , but the quality of the last days, months (or even, in some cases) years. What seems to me important is to form a collegial view of the quality of life and not to over-rely on specialists who will be more interested in the disease than the person. 
    Secondly, it is rare that the final moment consists of an euthanistic injection, but more often of increasing pain-killers and/or ceasing to give life-supporting treatment.
    Thirdly, as I indicate above, it is not specialists in the end of life that we need, but inter-disciplinary support for the person and their families.
    Finally, as it is not the end that counts, but the quality of life towards the end, you will understand that I do not support the coining of the specialism of telostrics
    Sorry, but I haven't yet come up with an alternative…

  3. Thanks, both. I didn't know about that proposal in the Netherlands, Tina, and quite agree with you that it shouldn't be the only option available. Anthony: I quite agree with that the 'end of the end' isn't the only thing that matters. My telostricians would be responsible for end-of–life care more generally. If euthanasia were available, it might become more common. But it should be an option even if it's unusual.

    1. Thanks for replying, Roger, but I would prefer "hedonotrician" or "charatrician" as a title.
      I still think for many reasons that it is not so much a question of specialism that we need, but a question of philosophy for all medical practitioners, which in many countries already exists, at least in embryo, and not just in hospices.
      Among the reasons :
      How many of these specialists would we have, and how would everyone have access to them?
      How would they relate to other specialists treating the primary cause of death (where there is one)?
      How could they find the time and opportunity to get to know the patient and their close ones to be able to properly advise them?

      (I agree completely that it would be a pity if it were only in an institution that people could find a way of dying in dignity, grace and peace.)

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