Doctors’ Dilemmas

Doctors’ Dilemmas


Recently my wife was waiting for a breast screening at a mobile clinic when she overheard another woman in an adjacent booth giving the year of her birth as 1932. At 85 the woman had already had a good helping of life.At what point, my wife asked herself, should we say of the ceaseless quest for treatment,‘enough’s enough’.

There area lot of reasons for not trying to extend the life of every citizen as far as possible at whatever cost. The prevailing practice of relentlessly deferring deathhas created two looming cataclysms. The more obvious of these is the overpopulation of the globe and its resultant warming. The other imminent crisis in the Western world is the vigorously expanding costof caring for people who are old, non-functioning but still breathing as they become part of an ever-expanding, non-contributing section of society. Closer to home, the increasing average age of the British population has been responsible for triggeringwhat might well be one of the greatest economic and sociological disasters in this nation’s recent history by the overwhelming ‘leave’ vote of old, uninformed and fearful voters in the 2016 referendum, when 64% of people over 65 voted for Brexit.

Ironically, this is the same section of the population most likely still to follow traditional Christian thinking. Have they thought how Jesus might have voted?

It was a significant aspect of Jesus’s teaching that we should aspire to non-tribal relationships with neighbouring races; that we should look beyond local groupings and embrace all races as siblings in a world family. The story of the Magi, even if apocryphal, in itself indicates the desirability of a world which transcends national sovereignties. In his story of the man who stopped and helped the victim of a wayside robbery, Jesus identifies and praises the foreign Samaritan as not just equal to but better than the indigenous Judeans who had ignored theman they had found by the wayside, robbed and beaten. Traditionally the Jews and Samaritans loathed each other, but Jesus never utters a word of disparagement against the Samaritan. He is making the point to his listeners that they must look beyond loyalty to their immediate tribe, engage with and interact with those outside it. This seems like a clear indictment of the kind of tribalism that must have influenced the decision of many of the ‘Leave’ voters. The evidence ofthe New Testament, for those to whom this is relevant, is that Jesus would have been a Remainer.

To return to the case of the 85 year old woman who had come to the breast screening clinic….   She had probably, like my wife, been invited to do so by the local health authority. The benefits of their doing this are not obvious. The NHS must be aware by now that they should address the question of how much longevity an individual might reasonably want, expect or demand as of right. And, it seems, so shouldsociety as whole. The broad assumption that everyone wants orhas the right to live as long as possible (irrespective of the cost) is one that needs to be challenged. We must learn to accept that we are all going to die, and there is no point being frightened of this.Of course, no one wants to leave their children or surviving spouses, or for that matter their old friends but we must as a species acknowledge in a dignified way the inevitability of death. In contrast to the 85 year old, the Radio 5 Live newsreader, Rachel Bland, who died recently, was 40 and mother of a two year old. She had not been offered automatic scanning, so her breast cancer was too widely spread before it was discovered. She died, though, with her dignity admirably intact.

For those, like me, whose bodily parts are becoming liable to wear and tear, there is an increasingly unlimited amount of treatment available for most ailments that will affect us. Sometimes, as I have described in a previous piece [see KCWT Feb 2018], treatments are being pressed on patients when they are statistically not necessary, simply to avoid anegligence claim against the NHS should a patient peg out without having been strongly advised to submit to sometimes very costly treatment. I turned down the chance of having the rest of my bowel removed and wearing a colotomy bag for the rest of my life. I thought I would rather go sooner with dignity than subject myself to that. As it happened, it turned out not to have been necessary, and I had saved the NHS several thousand pounds. It occurred to me that a way of the NHS saving its scarce resources would be to tell patients that if they opted not to have an expensive operation, theywould be awarded half the cost of the treatment. Obviously, I haven’t done the complete maths, but it could probably save the NHS a very significant amount of money, often on treatments that were needless anyway, and if a patient did die as a result of not having it, they would have saved the NHS a great deal of money in ongoing care, and their family all the frustration of dealing with a chronically ill, old relation hanging on in miserable, often deeply undignified conditions


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