Assisted dying invoice: ‘I’m a physician – we have to cease horrific, horrifying deaths’
Dr Liam Hughes says he gave a ‘very large dose’ of painkillers to stop a patient’s suffering despite being aware that it could hasten his death. The patient died five hours later.
A cardiologist says he is supporting the assisted dying bill after seeing “frightening, horrific” and “grotesque” deaths.
Recently retired, Dr Liam Hughes, says while most people experience a peaceful death, some can be horrifying. “I’ve had a lifelong involvement with end-of-life care of people in hospital,” he told The Mirror. “I’ve seen how I think to best allow people to have a peaceful death. I just want people to die surrounded by love, not fear.”
The recently retired medic explained how he administered “a very large dose” of painkillers to a patient despite being aware it might hasten his death. The sick dad “had a profound effect’ on Dr Hughes after going through “horrible” suffering. The patient died five hours after his painkillers were increased.
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“I gave him an increase in his syringe driver, my intention was to alleviate his suffering by exceeding his risk,” he told The Mirror. “I’d hoped that he would have some peace and five hours later I was relieved for him when he didn’t wake up.”
The retired doctor explained his treatment of his patient came under the so-called ‘doctrine of double effect’. This is an accepted principle used to justify when a doctor gives drugs such as morphine and opiates, to a patient to relieve distressing symptoms – even though they know this could shorten the patient’s life.
This is because the doctor is not aiming directly at killing the patient but to reduce their pain. Peter Prinsley, a Labour MP for Bury St Edmunds and Stowmarket, who is a retired NHS ear, nose and throat (ENT) surgeon, said this medical decision is not “unusual”.
He said: “Every doctor who’s looked after terminally ill patients, certainly of my generation, will have been involved in exactly the process that Liam Hughes so graphically describes. We’re not talking about something which is unusual.”
Dr Hughes, 72, spent more than 40 years in the NHS, experiencing the frontline of death. He retired from his role as consultant senior cardiologist around 18 months ago.
But he fears now, the newest generation of doctors, might be too scared to treat terminally ill patients with “horrible symptoms” in the same way as he did.
He believes they worry about being accused of being “too aggressive with these medications” as they do not have the time to get to know their patients’ wishes.
“This is both unfair on them and the patients under their care,” he said. “To make these life-reducing decisions you have to spend time with the patient but few patients these days who are dying in hospital get to see the same junior doctor on a daily basis”.
Dr Hughes explained he’d used the ‘double effect’ principle – often used in hospices across the country – 45 years ago after he’d recently left medical school. One of his patients, a dad of two in his 40s, had cancer in his liver, his bowel was obstructed and he’d developed gangrene of his legs.
“I have no idea how he survived as long as he did. He was tough,” Dr Hughes said. “I felt I was doing the right thing by him and this is where continuity really matters in these decisions because you need to have had a conversation about this when the patient isn’t in huge distress or already on large doses of stuff which might alter their cognitive ability and ability to concentrate and make decisions.
“I gave him a very large dose after I’d discussed it with the senior nurse who had been caring for him throughout his long admission. He was already on a drip, a syringe drive, which delivers pain meds continuously. I used to see them twice a day at least. He was in hospital for two months.
“Six weeks earlier he’d told me when he’d had enough he’d let me know. And I just went to see him and said; ‘How are you?’ He just looked me in the eye and I said: ‘I’ve had enough.”
“I gave him an increase in his syringe driver, my intention was to alleviate his suffering by exceeding his risk. I’d hoped that he would have some peace and five hours later I was relieved for him that he didn’t wake up.”
Decades later the doctor was helping a lecturer in ethics at a university hospital and gave this case as an example to medical students.
“I used this case as an illustration, to describe that the law is very very black and white but actually clinical medicine isn’t.”
But the next day he was told that the police were going to phone me up.
“They never did phone me but two of the medical students had complained to the police that I’d killed somebody,” he recalled.
Dr Hughes explained: “I know from my own observation and talking to many hospital doctors of my generation, that there is a growing reluctance for junior staff particularly, to use traditional medication for palliating.”
During his career Dr Hughes helped raise more than £2 million to develop cardiac services, including by rowing the Atlantic in a world-record time.
Speaking from his home in France, he says of patients who reach the end: “When they look you in the eye and you can’t believe they’re still going, but they are, and say, ‘I’ve had enough’, and you can help, we must be able to continue to care with the patient’s wishes in mind.
“I mean, it’s not good medicine if we say, ‘no, I don’t believe you, I don’t accept what you’re saying’. But I must point out that most people die peacefully. People with head neck tumours for instance often die because a major blood vessel gives away and that is frightening, horrific, grotesque death.
“Some cancers in the lungs actually erode into a blood vessel and you die very dramatically, coughing up blood. It’s extremely painful, extremely distressing for the sufferer and of course equally distressing for the relatives.”
The doctor, who has a book called ‘Bodily Fluids’ out in February, fears the House of Lords are “filibustering” as they suggest that ‘choosing to end your life is irrational’.
“It is incredibly rational though if you know you’re dying and your body is failing you and you are existing, not living. I would probably find a way myself to get enough medication.
Of the House of Lords ‘delay tactics’, he said: “I would question their humanity. And I would say to them if a patient who you knew well and had days to live and enduring horrible symptoms and they ask [please please I don’t want to wake up tomorrow. How would they answer that patient? What would they say to them?”
Those who oppose the bill claim it would alter society’s attitude towards the elderly, seriously ill and disabled, signalling that assisted dying is an option they ‘ought’ to consider. And they say high quality palliative care can effectively alleviate distressing symptoms.
