Saturday, 24 May 2014

A Dreamless Sleep?

                                    Would you like some hemlock with that, sir? Well, same to you, snub                                                                                                  nosed bastard!

Modern medicine is a wonderful thing, although derided by some. We sometimes forget that it has not always been so. Modern, Western empirical medicine has not come easy or cheaply. Great strides have been made over the last 100 hundred and 50 years in medicine and medical care. Modern surgical techniques, antibiotics, effective cancer drugs and innovative, and expensive treatments mean that we are living longer, well at least in the civilised world. At the turn of the last century, life expectancy, for a man, in England was 47. Today, life expectancy is 77. This continues to increase. Pundits predict, that for the coming generation living to a hundred will be common place.

With great age comes great social, medical and economic dilemmas. We are truly living beyond our design tolerances. Diseases, such as cancer, were relatively rare 150 years ago. Today, 1 in 3 will be stricken by malignancy. Even with the great advances in medical oncology, especially over the last four decades, 1 in 4 alive today will succumb to malignant disease. As we live older other diseases, characteristic of old age, become more prevalent. Heart disease and dementia stalk many a quarry.

As our population demographic curve shifts to the right we are faced with ever increasing economic challenges. Public pensions are funded by the tax base. At the beginning of twentieth century England, 4% of the population were over 65. In 2050, 25% will be over 65. This raises the alarming question: where will the money come to provide these people with a livable pension? Either taxes for the working will rise to exorbitant levels or many, in their dotage, will have to adjust to a life of not so genteel poverty. Reciprocal resentment will undoubtedly set in between those who work and those who have worked.   

And the cost of modern medicine does not come cheap. The development of new effective drugs is not an inexpensive exercise. Drug development and trials come at a cost. For every effective drug there will be numerous nostrums which fail. Drug companies expect a profit and have hungry shareholders to feed. Again, this is ultimately funded by the tax base.

When we do eventually start to die, medicine is there with palliation. Palliation is designed to give us a pain free and hopefully a dignified death. From personal experience this is not always the case. After watching my father die of cancer over a period of six months, often in degrading agony, I vowed that I would not die this way. Watching someone you love turn into a nappy wearing, bed sore ridden wreck, is heart churning. If my father had asked for assistance to ease his passage I would have willing fulfilled his last request. But he never did, and I was too much of a coward to suggest his way out.

There are some realistic and practical governments who have embraced ‘Death with Dignity.’ The usual suspects are on the list. Unfettered by religious interference and uncaring dogma, these most secular of states are providing a solution to a most vexing problem.

Will euthanasia be abused? I suspect so. But this will be very much in the minority. Where there is society there will be those who test and flout. Safeguards and checks need to be there to protect those whose time is not now. But ultimately, any civilised society should acknowledge that medicine has reached the end and has one final job to do: when your time comes, exit stage left and reach for whatever version of Valhalla gives you salve.      

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