Associate Professor A D (Sandy) Macleod is a psychiatrist and palliative medicine physician. Jane Vella-Brincat is a clinical pharmacist. They have been working in the palliative care services in Christchurch, New Zealand, for many years. Here, they explain the background to their longer article published in the November/December edition of the European Journal of Palliative Care.
There are many intriguing and as yet unanswered issues surrounding physician-assisted euthanasia. One of our lasting impressions of several decades of attending to the dying is that for most nature is kind. Occasionally, uncontrollable neuropathic pain, nasty delirium or desperate dyspnoea complicate this final passage and challenge our caring. But equally disturbing is the occasional anxious determination of the patient, the relatives or the attending doctor to pre-empt nature. This may be understandable in terms of the medical plight of the patient, and in these cases expert palliative care is indicated and necessary. However, sometimes this appears driven by timing – it may be convenient for those watching and waiting to hasten the patient’s dying.
Quite by chance we came across reports of the death of King George V of Great Britain and Ireland, Emperor of India, whose dying was hastened by the then Royal Physician, Lord Dawson, in 1936.
The king was profoundly ill, manifestly delirious and imminently dying. There were several conveniences that influenced the administration of a fatal cocktail of medicines. There were constitutional aspects (for a king surely needs to be competent to rule). For example, his doctor had pressing professional commitments to attend to the following day, the reporting of his death was preferred in the morning rather than the less prestigious evening papers, and the king’s health struggles had been long and distressing. The details of the king’s final hours were not publicised at the time. Indeed, it was 50 years before the truth emerged.
As unique as this case history undoubtedly is, it illustrates what is possibly an increasing desire in the modern world to artificially intervene and orchestrate the timing of, and perhaps sanitise, the dying process. Yet palliative care has the knowledge, the skill and, in many locations, the resources to comfortably support nature. Dying is manageable, though death is inevitable.
Read the full article in the European Journal of Palliative Care
This post relates to a longer article, The Convenient Death of King George V, by A D (Sandy) Macleod and Jane Vella-Brincat, published in the November/December 2016 edition of the European Journal of Palliative Care (vol. 23.6). If you have a web-based subscription to the journal you’ll be able to download this issue, plus all articles in the journal archive.
You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journal – click here to subscribe online.
EJPC Palliative Care Development Award 2017 – nominations form now online.
Do you know someone who has made a major contribution to palliative care policy development? Why not nominate them for the EJPC Palliative Care Policy Development Award? Click here to nominate. Launched by the European Journal of Palliative Care in collaboration with the European Association for Palliative Care, the award is aimed at professionals working in palliative care worldwide who have made a substantial contribution to policy development through research, clinical practice or as policy activists.
The 2017 Award will be presented at the 15th World Congress of the EAPC in Madrid, Spain (18–20 May 2017). Deadline for applications: 31 March 2017.