DAILY MAIL Earlier this month, Dr William Lloyd Bassett, a Shropshire GP, was hauled in front of a disciplinary panel at the General Medical Council. It was alleged that he’d deliberately hastened the death of a terminally-ill man by giving him a huge dose of morphine. The case made headlines across the country, and prompted debate about the fine and treacherous line between aiding a patient in distress and hastening death.DAILY MAIL But for me, this case was especially shocking. For I had witnessed Dr Bassett in action: he gave my mother morphine as she was about to die.
The recent General Medical Council hearing centred on an incident in May 2009 when Dr Bassett went to the home of a man dying from lung cancer and treated him with a high dose of diamorphine. This led to him being questioned over his fitness to practise; a serious charge that could have ended his career. Crucially, though, the family of the man who died would have nothing to do with the charges against him, and supported Dr Bassett 100 per cent in his actions. The patient had become deeply distressed in his final hours. Although Dr Bassett accepted that the 100mg dose of morphine was too high and a mistake, it led, in all likelihood, to a more peaceful death.
Last week, the hearing decided that Dr Bassett should continue to practise, but issued a warning of serious misconduct against his name. Such cases mean many GPs are now nervous about administering pain relief to people in the final hours of life, in case they find themselves in a situation similar to Dr Bassett’s. Dr Clare Gerada, chair of the Royal College of GPs, agrees that doctors are frightened to administer powerful opiate drugs.
‘It’s very difficult for doctors to offer palliative care because of the threat of manslaughter charges should the patient die soon afterwards. When one hears of a patient dying after a dose of morphine, there’s a sense of relief that you’re not the one who has administered it.’
But after witnessing Dr Bassett at work in a similar situation as he attended my dying mother three years ago, I can only thank him for his caring, professional intervention. At 83, my mother Wil — the name she was known by to all her family and friends — had been living with a diagnosis of dementia for three years. Yet she managed to remain at home because of the stalwart support of her family, and carers who came in a couple of times each day. Mum was determined to stay put. That was her resilient, forthright character — some would call it bloody mindedness, but it made her who she was. When a social worker pushed for her to enter a home, the idea was swiftly rejected — by Mum and by us as a family. She’d cling to her staunch independence, a trait compounded by losing her husband Arthur nearly 40 years earlier.
But Wil’s general health was suddenly complicated as her vital organs began to fail: heart failure, water retention, high blood pressure and immobility intensified the problems. Our family GP had no sure way of telling how long she might live, although it was suggested she might survive for another two weeks. Mum’s condition rapidly deteriorated. Within 24 hours, she looked intensely frail and was hallucinating.
But that evening she seemed to rally. She sat up in bed and enjoyed an impromptu party, drinking brandy, laughing and chatting with all those closest to her. Mum loved a good party and I think secretly enjoyed being the centre of this particular one. Our spirits were raised, even though we sensed, deep down, this would be the final stage of her illness.
At midnight, as my three sisters and I prepared Mum for bed, she had a seizure. Her eyes rolled into the back of her head, her body became a dead-weight and any colour that might have been there drained from her complexion. It was as if she’d imploded. We eased Mum back into bed, tacitly understanding the end was close. Yet none of us really quite knew what to do. We’re not a foolish or mawkish family by nature, yet confronted by our mother’s inexorable slide towards death we found ourselves helpless.
It was eventually decided to call Shropdoc, the local out-of-hours doctor’s service. Dr Bassett isn’t our family doctor; it was sheer luck that he happened to be on call that night. His response was quick, and after examining Mum he suggested sending for an ambulance. We didn’t want Wil to go to hospital; there was no logical reason to send her. Dr Bassett respected our wishes and left, urging us to call again if there were any change.
We took it in turns to sit with Mum. But as the night drew on, Wil became restless, pointing into space, trying to shift her tiny frame off the bed. Mum’s agitation and distress became more marked and then she was sick.
At 4am we called Shropdoc again and Dr Bassett returned. It was obvious that neither I nor my sisters knew what we were doing. Dr Bassett’s presence was a huge reassurance to us, and more importantly to Mum, towards whom he was compassionate. He was with us for an hour all told and his manner was exemplary. He spoke with Mum as she drifted in and out of semi-consciousness, asking her how he could help. Eventually he suggested that she might like morphine as a drip and as an oral dosage to ease her pain and relax her. (Wil hadn’t had any other medication until that point.)
Mum was unequivocal and nodded agreement. Wil was a woman who’d always said she wasn’t afraid of death, and now her old resilience flashed back. I felt an innate sense of relief, as did my sisters, that a decision had been made and a course of action taken.
Dr Bassett didn’t shy away from explaining what would happen, not to Mum nor to us, her children. The morphine would calm her and relax her; as the drug worked she’d probably slip away with less fight, drifting inescapably into a deep sleep. He attached a line to Wil’s leg and placed the morphine drip-feed device on the dressing table — an incongruous addition to the knick-knackery of mirrors, perfume and jewellery usually found there. Ensuring Mum was comfortable, Dr Bassett slipped quietly out of the house, leaving us to sit and gently talk with her.
The morphine quickly took effect, and she drifted off into a calm and deep sleep. We sat around her bed, holding her hands, stroking her hair, reminiscing about the marvellous times we’d had together and telling her how much we loved her.
Just after 9am the next day — a little over five hours later — Mum stopped breathing; she’d died with dignity and in peace. The nature of her death was due to Dr Bassett’s seemly and humane intervention. Her suffering had been minimal and she’d had the great good fortune to die in her own bed surrounded by all of her children.
Because of this experience, I’m under no illusion that assistance for those in the final stages of dying should, if requested, be given by doctors without fear of reprisal. I’m not advocating wholesale euthanasia, or ending life along the lines practised at centres such as Dignitas in Switzerland. But when life is undeniably ebbing away, it is surely our responsibility, as a kind and caring society, to alleviate unnecessary suffering.
Doctors are rightly governed by a strict code of conduct. Key to the principles of medical ethics is that the doctor acts in the best interest of the patient. This would include giving pain relief to ease the suffering of the dying patient. But this action can conflict with another key principle: do no harm. Even small doses of morphine suppress breathing, and there is a point where adequate doses may, inevitably, stop the breathing. Dr Clare Gerada explains: ‘There’s no guidance regarding the amounts of diamorphine to be used on patients. This is because some cancers require hundreds of milligrams and others maybe just 10 or 20. It makes it very difficult for doctors because it’s difficult to predict.
‘Morphine is a very good drug, not because it kills people, but because it calms people down; and in the case of lung cancer makes it easier to breathe.’ Yet I would argue that if someone was on the verge of death, then what difference would alleviating the pain and hastening the inevitable make? It’s a pragmatic approach, due in no small way to the practical influence of my mother.
‘We all have to go at some time,’ my mother would say. ‘No exceptions. There’s nothing to be scared of.’ Of course, the real fear is of dying in anguish. But the use of morphine to ease this fear still conjures up — almost unavoidably — awful memories of Dr Harold Shipman. However, we shouldn’t make these nervous connections and demonise the drug. It’s vital that we have open and honest dialogues with GPs, patients and families in order to make informed decisions.
Until recently, it was common knowledge that the family GP, when tending the dying at home, might help shorten the suffering with morphine. Maybe this was more an implicit arrangement — an unofficial, yet profoundly caring intervention that was acknowledged but not openly talked about. Perhaps in previous generations there was a greater level of interaction between doctor and patient than we have today.
Each year, approximately half a million people die in Britain. A recent report from the think-tank Demos shows two-thirds of us would like to die in the peaceful and familiar surroundings of our own homes. This is an infinitely preferable option to the noisy and frightening environments found in over-stretched and busy hospitals. Yet, in reality, barely 18 per cent actually manage to achieve this last wish — which equates to more than 190,000 dying in hospital each year when they would rather die at home.
The Dying for Change report suggests that by 2030, just one in ten will have the opportunity to die at home. Charles Leadbeater, the report’s co-author, said: ‘It’s not just that we’re living longer; part of this means that people are dying over a longer period, losing first their memory and then their physical capacities in stages. If we put in the right kind of supports for people to cope at home, many tens of thousands of people could have a chance of achieving what they want at the end of life; to be close to their family and friends, to find a sense of meaning in death.’
From sitting in those final moments with my mother, I know nothing is as intimate or as personal as being with someone as they die. It is a great and intensely private honour. And when my time comes, I can only fervently hope that someone as caring and as compassionate as Dr Bassett will be at my bedside.