That would be me as it happens.
What are the House of Lords doing?
Well, according to my old friends on the Today Programme this morning, they are trying to make it legal for me to help some patients to die. Not just me you understand. Doctors in the UK in general. But since most palliative and terminal care in this country is quite properly the role of GPs, I feel I might be included. And I'm not sure I want to be.
Over the past couple of years, and a number of iterations, we have been in receipt of reports from the Shipman Enquiry. These have made sweeping changes to the way we are supposed to prescribe and handle controlled drugs, and even to the way we complete the paperwork needed to permit cremations. These changes are intended to make it much harder for any doctor to bump off patients and arrange disposal of the evidence, and rightly so.
Unfortunately they have also made some GPs anxious about their role in palliative care. And some patients in need of palliation more nervous about medication. This is a wholly bad thing, and makes the debate in the Lords even more relevant. If we are prevented or inhibited from providing truly effective palliation, either for fear of investigation after the fact, of through reluctance of patients to accept the very treatment most likely to work for them, they are more likely to end their lives in pain and fear and looking for a quicker end.
To an extent I suspect we as GPs need to be more confident in our ability in this area and less fearful. But with PCTs threatening to batter down the doors and investigate "overprescribers" of opiates -- as is the case in Borsetshire-- this is a trifle difficult. We cannot deny the evil that Shipman did. We cannot deny that he practised as a GP. It is right that we accept scrutiny of this area of our practice. But the tone of PCT missives, and of the media in subsequent cases where GPs prescribing has been called into question, leads us to fear we will be held "guilty till proved innocent" rather than the other way about.
Granted there is more to palliation than the provision of opiates. Terminal care, once inevitable decline has been accepted, should be all about allowing a patient to achieve the best possible end of life. I question a doctors role in actively seeking to accelerate that end. Experience has shown me that the vast majority of patients nearing the end of life are quite capable of charting their own course, with the right help. In sixteen years I have yet to have a patient ask me to accelerate their demise. I do not feel I would be able to if one did.
The day I feel I am ready to do so is the day I swap sides of the desk and seek professional help.