Monday, November 18, 2019
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Peter Saunders: Doctors who kill in the name of pain relief are incompetent not merciful

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In a dramatic interjection ahead of Friday’s debate in the House of Lords over assisted suicide, Chris Woodhead, the highly regarded former Chief Inspector of Schools, declared that he may have to starve himself to death as his health deteriorates due to his motor neurone disease and cancer.

“I think it would be far better if I could have my death assisted in a peaceful and dignified way so that my suffering wasn’t prolonged, and the suffering of those nearest and dearest to me wasn’t prolonged,” he said.

Predictably, this very public appeal has elicited much sympathy. But it also points to the muddled thinking and misinformation that bedevils the debate about palliative care and which equates it with killing.

For Mr Woodhead’s anxiety is also about the ‘efficiency’ of pain relief. He is reported as saying that doctors in the past had been “more prepared to ease pain” for the terminally ill, but were now more cautious following the conviction of Dr Harold Shipman for the murders of more than 200 patients.

His concerns needs addressing.

Not least because the case for the legalisation of assisted suicide has, somewhat ironically, been strengthened by the false belief that doctors all over Britain are killing people with analgesic drugs like morphine anyway, because they need to administer these drugs in lethal doses in order to kill pain effectively. They do not.

One example of this kind of misinformation appeared in the Daily Mail a few years ago: ‘I’ll always be grateful to the GP who eased Mum’s pain – even if it hastened her death’, the headline read.

This newspaper report concerned a certain Dr William Lloyd Bassett, a Shropshire GP, who had been censured by the General Medical Council for giving an overdose of morphine to a man dying with lung cancer. In the event, a GMC hearing decided that Dr Bassett should continue to practise, but issued a warning of serious misconduct against his name.

The fact is, however, that in good hands there is no such confusion: morphine kills the pain and not the patient.

Yet there is still a need for better education of doctors in good palliative care – so that they know how to administer the drug effectively and safely.

There is an urgent need too, as Chris Woodhead’s anxiety reveals, for far better education of the public in these matters, so that the pro-euthanasia lobby (now self styled as the ‘assisted dying’ campaign) cannot continue to advance their agenda through their pernicious misinformation and scaremongering – that has left even the highly educated confused.

I would highly recommend ‘Morphine kills the pain, not the patient’ (a short article first published in 2007 in Medical News Today and as relevant today as then to anyone who shares Chris Woodhead’s concerns. As the article states in reference to a Comment in The Lancet:

‘Professional and public anxieties about the effects of morphine continue to hinder adequate prescribing of this vital painkiller for genuine pain relief……

‘Nigel Sykes, of St Christopher’s Hospice, London, UK, says that the notorious Dr Harold Shipman’s use of morphine as a murder weapon has further increased disquiet among UK medical professionals.

Dr Sykes claims that the best known fact about morphine among the public and physicians is that it can be addictive, when in fact less than one in 10,000 patients prescribed the drug as part of treatment becomes addicted.

He adds: “For physicians, the second best-known fact is that morphine can precipitate respiratory depression. As a consequence, if offered enough confidentiality, clinicians can be readily found who will confess to having shortened the life of their patients to achieve pain control.”

The Comment goes on to say that it is hardly surprising in light of these points that the media view everyday medical practice for severe pain control as increasing the dosage of morphine until the patient dies.

Dr Sykes welcomes the recent study from the US National Hospice Outcomes Project, which studies morphine/opioid use and survival at the end of life – as it provides facts with which to explode the myths about morphine.

The study assessed 725 patients with end-stage cancer, lung disease or heart disease, and found that length of survival was not linked to either absolute or percentage change in dose of morphine or other opioids.

No combination of factors was capable of explaining a variation of more than 8 per cent in survival time, which points to an overwhelming influence of the individual’s disease severity.

Only patients who have no experience of opioid treatment are at significant risk of respiratory depression.

Dr Sykes says: “A patient with moderate-to-severe chronic pain, malignant in origin or not, who is given the incremental dose-titration practised in pain and palliative care centers is not at such risk. A physician who truly is killing his or her patient in the name of pain relief is not merciful, just incompetent.”

He adds: “This problem matters because under-prescribing of opioids remains a major barrier to effective pain control.”

Properly prescribed morphine kills pain without killing the patient. It is the campaign for better  palliative care, not assisted suicide,  that Chris Woodhead should consider putting his name to.

 

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Peter Saunders
Peter Saunders
Peter is Campaign Director at Care Not Killing and CEO of Christian Medical Fellowship

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