The decision to die

This blog is going to be a combination of two topics that I feel link which are Ageism and the new proposed bill linked to assisted dying.

I went on a session recently about ageism and it got me thinking even more about we way we think about people in our society. As I have explained previously I work in an Older People's team so it is something that I am mindful of on a regular basis but there are a lot of comments that get made in day to day life to people of all ages.

I am sure we have all heard comments like “act your age, not your shoe size” or “should you be doing that at your age”. I think if someone was making similar comments about any of the other protected characteristics under the Equality Act then it would not be acceptable but people seem to think that saying it about age is okay because it is so engrained into society that people see it as banter instead. That is where thinking about it in relation to other characteristics such as sexuality makes people feel uncomfortable and hopefully would get them thinking about why they are so much more comfortable when it is in relation to age as well.

I feel like some of this ingrained ageism could potentially cause difficulties when it comes to the assisted dying bill that has been suggested because are people going to think that someone cannot make this type of decision due to age or shouldn't be able to because they are younger. The proposed bill explains that this would be for people who have been given a terminal diagnosis of 6 months or less and must have the capacity to make the decision.

I think there would end up being situations where someone of a younger age wanted to make this decision and people would question why because they haven't lived a full life or make suggestions of what they could do with the time they have left. When listening to the Lets Talk Social Work podcast about this topic they mentioned a family member who was given 6 months and ended up living 14 months and questioning what would have happened if they have utilised this proposed bill. Sometimes having longer with someone is all good and well but actually is it the best thing for that person or is it a selfish decision relating to the people who are left behind wanting longer with that person. Also it is about quality of life, if that person is in a lot of pain due to cancer or other similar illnesses would it be better for them to make that choice and go sooner but suffer less than they would if they didn't make that choice at all.

They also mentioned in that podcast about how there are not really any safeguards included because not only does it not mention Social Workers who are much more comfortable completing capacity assessments than a lot of their medical counterparts it also does not in its current form think about the potential for coercive control or someone being pressured to make a decision to end their life.

This is where the wider conversations are so important to be able to understand a person's reasons for choosing to make a decision like this, is it what they want or are there other factors at play such as family perspective or societal. Societal pressures relating to strain on the NHS for example are something that someone may not consciously realise are influencing their decision, especially if they are someone who requires this type of support regularly. Also what happens if someone has started the process in terms of the assessments that are required to make this decision and then for whatever reason are no longer able to engage and lose the capacity would their wishes and feelings on the topic be taken into consideration or would the loss of capacity also take away the choice.

Although I understand there has to be guidelines for something such as this I personally feel this is something that people should be able to make an advanced directive about. If someone has to have capacity to make this type of decision but then receives a diagnosis of Dementia or another similar diagnosis where their abilities are going to reduce to a level where they cannot care for themselves any more or may not be able to remember friends or family they would not be able to make this decision themselves. When receiving this diagnosis you are not given a time frame so it would not factor into the current bill as it is suggested. The bill does not allow for someone else such as a Power of Attorney to make this decision on someone's behalf. When creating a Power of Attorney you can say whether the attorney can make decisions relating to life sustaining treatment and put in writing decisions you would want to be made on your behalf and I feel that people should be able to specify once I reach a particular stage of dementia for example I want my life to be ended. This would allow people to have some control over how their life ends and what level they deteriorate to instead of being made to live until the diagnosis or other co-morbidities takes their lives.

I feel that by allowing someone to decide how far they were willing to go within a diagnosis of dementia it would support their human rights and ability to make their own choices. Currently putting some information in a Power of Attorney or an advanced directive relating to treatment or the right to refuse it is the only decision that can be made but I do not feel that is enough. I know if I received a dementia diagnosis I wouldn't want to get to a stage where I couldn't remember who my family were, was getting frustrated because I didn't realise how much support I needed or lashing out at people around me I would have wanted to be able to decide before I got to that stage how much I was comfortable with and that is not something I would be able to do.