Readers' Letters: Sometimes people just need to die

As a retired GP I found the leader in yesterday’s Scotsman on assisted dying interesting. Perhaps the public are not aware that assisted dying happens every day in our NHS.

If a person has only a few days to live, medics can withdraw treatment at the patient's request, says reader (Picture: Robert Kneschke/Adobe)

In intensive care units across the country life support will be ended for those who are brain dead or have no prospect of recovery. It is routine for those admitted to hospital with very serious or end of life illnesses to sign a "do not attempt resuscitation” order. This means those in which resuscitation is very unlikely to succeed, or if successful would leave the person in a significantly disabled condition, can opt out of this procedure. In general practice doctors may, after open discussion with the patient and family, decide not to treat that final chest infection, or to slightly increase the morphine prescription. These actions in themselves will not end the person’s life but will hasten the natural process of dying.

Most experienced healthcare professionals will recognise when a person has only a few days or weeks to live. The patient may be bedbound, semi-conscious, confused, incontinent, in pain or suffering from the many other unpleasant end of life symptoms. At this time, after talking openly with the individual and their family or taking into account the person’s declared wishes, it does not seem unreasonable to help them to die. Doctors need to be better at talking about end of life. We should consider living wills which state in advance what we want to happen to us.

After a life as a GP I often found it distressing watching people die. I can only imagine what this must feel like for families. I believe that as doctors and individuals we need to get away from the idea of preserving life at all costs. Sometimes people just need to die. Although I support helping patients to die within a few days or weeks of end of life I would have reservations about extending this to months or years when outcomes are much less predictable.

Doctors, patients and their families need to be better about open, frank and honest discussions about dying. Only in this way can we take forward assisted dying and be reassured that the concerns about scrutiny can be addressed.

(Dr) Gordon Scott, Edinburgh

Burden fears

I thank The Scotsman for its wise and balanced leader urging MSPs to show extreme caution when they consider the Assisted Dying for Terminally Ill Adults Bill (28 March). They should not be overly influenced by the enthusiastic campaigning of Dignity in Dying and various celebrities but look at a wide range of evidence from the many who oppose such legislation. These include palliative care physicians, disabled people, religious groups, pro-life groups and many others.

As well as the principal arguments against the Bill highlighted in the article, there is the compelling evidence from countries and states with similar legislation that the conditions qualifying for assisted dying are inevitably extended. There are pressures, both internal and external, usually of a financial nature, on sick and disabled people to go down this route.

It should also be remembered that palliative care is the priority at the end of life. Although unbearable pain, or fear of it, is often cited as the main reason for asking for assistance to die, figures show that it is more often loss of dignity, loss of independence or a feeling of being a burden.

We all hate to see a loved one suffering pain, but let’s kill the pain, not the patient.

(Rev Dr) Donald M MacDonald, Edinburgh

I very much agree with The Scotsman leader that the “Unintended consequences of the proposed law [on Assisted Suicide] may be profound”. This is particularly the case since MSP Liam McArthur explained that his proposed law is modelled on the legislation in the US state of Oregon. In this regard, the 2023 Annual Report for the Oregon Death with Dignity Act (which was enacted in 1997) has just been published and makes for disturbing reading.

It indicates that the number of persons accessing assisted suicide has reached record levels with at least 367 deaths – an average of one a day.

Interestingly, as in previous years, the three most frequently reported end-of-life concerns of Oregonians contemplating assisted suicide did not include suffering but loss of autonomy (92 per cent), decreasing ability to participate in activities that made life enjoyable (88 per cent), and loss of dignity (64 per cent). In 159 cases, death was also motivated by a fear of being a burden on family, friends or care givers.

Other results from the 2023 report are far more alarming. Not all the deaths were quick or easy. Complications, such as seizures or regurgitating, occurred in around ten per cent of the reported cases. In the 265 unreported cases, we do not even know how many further complications may have occurred. As Oregon continues to experiment with different cocktails of lethal drugs, median times to death have increased (from 22 minutes in 1998 to 52 minutes in 2023). One individual in 2023 took more than five days to die! If this had been an execution, it would have been deemed cruel and inhumane.

Therefore, if Scottish persons want the assurance of dying in peace without suffering, then palliative care should be developed, and the dangerous procedures of assisted suicide rejected once and for all.

(Dr) Calum MacKellar, Director of Research, Scottish Council on Human Bioethics, Edinburgh

Grousing

I don’t know what Richard Dixon is a doctor of, but given the content of his article (Sustainable Scotland, 27 March) it apparently wasn’t in anything related to conservation.

He makes the point that the previous code of practice governing Muirburn failed to prevent burning “where birds were nesting and the destruction of young trees”. Red grouse are ground nesting birds and there may be some estate owners who burn their grouse, but I think they may be in the minority. It might be worth him having a quick word with the Scottish Fire and Rescue service, who support properly controlled Muirburn by experienced operators to provide firebreaks and reduce the incidence of wildfires, such as the one in the Flow Country a couple of years ago. If Muirburn had been carried out there, this ecological disaster might have been averted.

Dr Dixon also gives the impression that Muirburn is only practiced by grouse moor owners. I am not sure this is quite true but we must never let facts get in the way of a good argument.

Finally, he says that “most people don’t agree with rearing grouse so they can be driven in front of the guns of rich people”. Interesting idea! I was brought up to believe that grouse were wild birds which couldn’t be reared in captivity. But you learn something new every day!

My thanks go to the gallant doctor for presenting the “facts” in such an engaging way.

Mark Tennant, Elgin, Moray

Bright future

I read Douglas Cowe's letter with increasing despair (28 March). To imply that Scotland, unlike Ireland, Norway and Sweden, isn't a “proud nation” with an “enviable culture, self reliance and patriotism” is just bullheaded. I have just returned from Austria, a landlocked country of 8 million people which is thriving. It doesn't have Scotland's natural resources, or indeed, its whisky, salmon and other exports (which make it the only country of the component countries of faux UK to have a trade surplus) but like Scotland it has a healthy tourism industry. Oh, and it's in the EU. I'd be interested to know how many of the raging Cassandras who contribute to The Scotsman letters pages supported Brexit and if they will ever face the reality that Ireland, too, was once suppressed by “Britain” – ie England – and is now prospering. Plus, within our lifetimes it will no doubt be united!

The future looks bright.

Marjorie Ellis Thompson, Edinburgh

Back bus firm

Peter Butler seems to express scepticism at the report of a new Scottish company, Ember, securing £11 million private investment (Letters, 28 March). This is a success story so far: there is every likelihood this business will continue on its growth path. Their operation links five of Scotland's seven major cities with a regular, reliable and modern bus service. Passenger numbers are increasing and customer feedback is very good.

We should support young entrepreneurs in their attempts to improve choice in our public transport, rather than dismiss them out of hand. Transport Scotland could learn a thing or two from their example.

Jeff Rogers, Banchory, Aberdeenshire

Trough times

I can’t pretend to be anything other than disgusted that Michael Matheson stays on as an MSP, despite being found guilty of breaking the MSPs’ code of conduct. Snout in trough, Mr Matheson continued to take a cabinet secretary’s salary rather than standing down while the investigation into iPadgate took place, during which time he accrued nearly enough extra salary for being a minister to get back the £11,000 he finally reimbursed Parliament for.Can you imagine the furore from the SNP if someone at Westminster had done the same?

Brian Barbour, Berwick-upon-Tweed, Northumberland

Oh deer

I am intrigued by the article headline “Deer plans human rights warning” in yesterday’s Scotsman. They’ll be organising stag dos next!

Andrew Kemp, Rosyth, Fife

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