Waking up dead

A few years ago my Aunt went into hospital with an infection. She came out dead.

The day before she died she was apparently quite well. She was sitting up in bed doing the crossword. Everyone expected her to be out in a few days. My guess is if we had got her out when she was doing the crossword she might well have survived.

The next day we were told that the infection had got worse. The doctors had debated whether to put my aunt into intensive care, but had decided that it was in her best interests to be put on something called the Liverpool Care Pathway. This is a treatment used for terminally ill patients. Once you are on it, there is no getting off. It was already too late to change the decision when we were told about it.

My initial reaction was to call the Police and say that my Aunt had been murdered in the hospital, but I was persuaded that this would be pointless. The doctors would back each other up. The police would believe what the doctors told them. There would be a fuss, but nothing would change.

We buried her. She was one of the first women to be awarded a degree from Oxford. She was much loved and might have lived for another twenty years.

I’m therefore not surprised to find that in Gosport recently there has been a scandal about unnecessary deaths in a hospital. I suspect strongly such scandals are waiting to be discovered up and down the country. But most will stay hidden.

It is very difficult to know the truth. There will be conflicting testimony. Grieving relatives may well be wrong about their assessment. I may be wrong in thinking they should have done all they could to keep my aunt alive rather than in effect putting her down. Perhaps her infection really had become hopeless. No doubt if there had ever been a court case medical experts using long words none of the rest of us could understand would have shown that this was so.

But still I think there is a deep rooted problem. Our whole attitude to life and death has become distorted.

If a child is born with a major disability, huge efforts are made to keep it alive even when medical knowledge tells us that the situation is hopeless. These cases frequently make the news. Desperate parents try to raise money for revolutionary treatments. There are plans to take the child to the United States or elsewhere. There is enormous sympathy from the public.

There is intensive care for the almost hopeless case of the disabled infant, but older people are routinely put out of their misery when if only they could be made well they might live for years.  Why do we not value the lives of everyone equally? But then older people are frequently neglected and considered to be an inconvenience. Some of us treat our own relations in this way. It becomes less of a surprise then that a doctor might view an older stranger as something in the way when he might well view his own elderly mother as little more than an inheritance waiting to happen.

If a terminally ill person is in great pain, there is no problem morally in using sufficient medicine to dull this pain even if it has a side effect of killing the patient. If the intention is merely to ease the pain and this is the only way to do so, then it matters little if the person dies today or next week. Indeed it would be morally grotesque if a person was left in agony because a doctor refused to prescribe sufficient medicine to ease that pain.

The danger of high profile scandals like the one in Gosport is that doctors will end up being reluctant to prescribe pain killers in sufficient strength out of fear that they will be accused of killing patients.

But people like my aunt were not in great pain. No-one had told them that they were terminally ill. They just wanted routine treatment and came out of hospital dead.

I think this happens for a number of reasons. We have lost the sense that life is something of ultimate value. Everything else is valuable only because I have life. All the gold in the world is no use to me at all without a life to enjoy it.

But we treat life both at the beginning and at the end as something disposable. Babies in the womb are either the most valuable thing in the world, or else if they are unwanted the least valuable. More care is given to laboratory rats than is given to some 24 week old babies who might well be able to live independently outside the womb and certainly have more brain capacity than a rat. Yet there are rules about how to treat laboratory rats, while unwanted babies can be discarded with the rest of the medical waste.

We have lost the traditional sense that suicide is morally wrong. No-one anymore condemns the person who kills himself. It is simply a choice and everyone is free to make it. It is this above all that has made going to a Swiss clinic to kill yourself something that is considered to be morally neutral or even praiseworthy.

People with various medical conditions have gone to court to gain the right to die. They are scared that at some point they won’t physically be able to kill themselves and so want a doctor to be able to do it for them. These people are usually viewed with sympathy.

It’s a very short step from this to a doctor deciding independently of the patient that this person’s case is really hopeless. A great deal of time and effort will be saved and a great deal of suffering avoided if they could only die today. It is obviously in the patient’s interest to die peacefully and without pain. Why shouldn’t I just give them a large injection of morphine or put them on the pathway that inevitably leads to death?

This is what happens when you cease to think that life is the most precious of gifts and that it must be protected at all costs. A baby can be dumped because it is inconvenient and unwanted. When life becomes tiresome or unpleasant you can just check out. No-one will say you are wrong. Well this all just makes euthanasia whether voluntary or involuntary so much easier.

We have a strange delusion about healthcare in Britain. Every European I have ever met including those from Eastern Europe is absolutely horrified by the standard of care in the NHS. Many fly home for treatment, refusing to risk it here. We all accept that nationalised industries like British Leyland were more or less a disaster, but perversely think that nationalised healthcare will be a success. It won’t be. It is a bottomless, inefficient pit, which grotesquely overpays doctors and disgracefully underpays nurses. The NHS desperately needs reform so as to resemble the sort of healthcare routinely found in countries like France, Germany or Switzerland, but there won’t be any reform so long as voters continue with their delusion. Happy Birthday NHS.

To become a doctor you don’t need a first class mind. You just need to be good at learning huge numbers of facts. It’s like doing 100 “O” levels rather than one Ph.D. No original thought is required to become a wonderful G.P. In fact original thought would be a disaster. Let’s try this treatment I just made up. Lots of school children of moderate academic ability could be excellent doctors. What matters is a caring manner and common sense rather than the ability to think creatively and for yourself. It would be better if we expanded training of doctors so that there were enough and more. But instead the BMA prefers to run a sort of closed shop that keeps wages high.

Doctors are used to being treated like little gods. They can keep us waiting, but the patient dare not be late. They dispense wisdom from on high. The British public tugs the forelock to the most wonderful health service in the world and the little gods decide who is to live and who is to die.

Listen to the doctor. Do what he tells you your whole life and if you’re very, very good you might live to be a hundred. But don’t go near the hospital after seventy or you may just wake up dead.

The SNP would destroy what the NHS stands for

There’s something perverse about the SNP claiming to be the defenders of the NHS. The reason for this can be found in the letter N in NHS. When the NHS was set up in the forties it stood for something that would be available to everyone across the nation. But the nation that was being talked about was, of course, the UK. The people who created the NHS didn’t want a service that would only be available in England or Scotland. They wanted a service that would be available to everyone, no matter where they were from. It was for this reason that they called it the National Health Service.

Over time the NHS has evolved. Health is one of those areas that has long been devolved. We have a Scottish NHS, a Welsh NHS, a London NHS. These are devolved further into various trusts. But none of this really matters for the NHS is still national in the sense that it is something available to every citizen of the UK. It is available to me just the same if I’m on holiday in England or in Wales or in Northern Ireland. It still remains national in the same way in which it was created. It remains something British, something for all of us who live in Britain.

What the SNP are proposing to do is the very opposite of what the founders of the NHS wanted. They want to make the National in NHS apply only to Scotland in the same way that the National in SNP only applies to Scotland. Whereas the founders of the NHS had a vision of something that was available to every Briton, the SNP would like to break up the NHS, in the sense in which it was founded, and make it something that is no longer British but only Scottish. They want to create an NHS for the Scots, while the founders of the NHS didn’t think in those terms at all. After all, one of the reasons for setting up the NHS was that the British people had just suffered together through years of war and privation and no one cared much if you were Scottish or English, such distinctions mattered little when you had been fighting and dying together.

Had they been given the chance, would the SNP have set up a National Health Service in the forties? No, of course not, they would only have been bothered about healthcare in Scotland. But imagine if Nye Bevan had been a Welsh Nationalist and had only been bothered about healthcare in Wales. We would never have had an NHS at all. It was because he had a national vision, which extended beyond Wales that he was able to see that Britain needed a health service that would be free to everyone, no matter which part of the UK the person was from. It was because he was not a nationalist that Bevan was able to create the NHS.

It should be clear then that the SNP are not in the business of defending the ideals of the NHS, they are in the business of wrecking them. The NHS is a British institution and like every other British institution it would be destroyed by the SNP vision of independence. The Scottish NHS would of course continue, but it would no longer be part of the same whole, just as Scotland would no longer be part of the same whole. There would also be an NHS in the rest of the UK. But these organizations would share no more than the same initials. They would be separate organizations, with no more in common than the French NHS or the Australian NHS. That’s what it means when you change the meaning of the word “National” from British to Scottish.

I’ve no doubt that in an independent Scotland the Scottish NHS would provide us with excellent health care. But we would lose something and something quite special, which can be illustrated in the following way.  I heard a rather tragic story the other day about someone from Aberdeen who is really struggling with her health. She needs a transplant. Recently an ambulance took her all the way from Aberdeen to Newcastle, because there is a centre of excellence there in the type of care she needs. When a transplant organ becomes available anywhere in the UK, she will be flown to Newcastle by helicopter as will the organ. Our NHS is interconnected in ways that most of are hardly aware of until that time when we depend on an expert or a hospital somewhere quite far away in another part of the UK. What nationalists fail to realise is that it is because Newcastle and Aberdeen are part of the same country that we can expect cooperation like this to happen automatically. The SNP may try to promise that everything would stay the same if we voted to put Newcastle in a foreign land, but independence would change all our lives in ways that are hard to predict.

At present I can expect to obtain good and largely free healthcare throughout Europe if I fall ill on holiday. Moreover there is healthcare cooperation between separate countries like Britain and France. We can hope that these sorts of arrangement would continue in the event of Scottish independence and that we would get the same sort of treatment as a Frenchman gets currently in England. But the interconnectedness of healthcare which at present obtains across the UK does not obtain between Britain and France and over time is liable to be disrupted by Scottish independence. The reason for this is that such interconnectedness depends on our being part of one country, the UK. In all sorts of ways that we barely notice, our everyday lives are influenced by the interconnectedness that exists because we live in a single nation state, Britain. Whatever the SNP promises, they cannot promise that this degree of interconnectedness would continue for independence essentially is about creating a separate nation state. No two independent nation states are as closely interconnected as the parts of one nation state. Once this is understood, it becomes clear that Scottish independence involves the loss of something fundamental and something that we all take for granted. We might not even notice its loss until such time as we need it.