A sculptured bust of Hippocrates and a reproduction of the original Hippocratic oath ‘manuscript’. Accessed at https://en.wikipedia.org/wiki/Hippocratic_Oath on 30 January 2016.
I formulated this title for the current blog entry prior to discovering the following after researching several of my Google hits. “Hippocratic and Hippocritic Oaths” – not quite identical, I appreciate, but sufficiently close thematically to cast doubt on my independent originality. But clearly, I have like-minded empathetic ‘friends’ out there: I did think of the title a couple of days ago – during a dinner conversation (see later interlude of the euthanasia debate involving Elaine, Jacqueline and Linda as well as my good self), so I do have witnesses. But still, I wasn’t first, damn it!
[The Hippocratic Oath goes back a long way. One version I have seen in the past contains the line, “First, do no harm”. Sadly in recent years, accelerating with the formation of NICE and the PCTs, the oath really needs to be reworded, “First, spend no money”. The current “version” of the Hippocratic Oath used in the UK is the GMC Guidance On Good Practice. However, if you actually read what doctors are supposed to do and compare with what they actually do, you may find just a few discrepancies. There’s an old saying, “What do you call the doctor who graduated bottom of the class?” “Doctor”]
I love it!
I’ll return later to the main substance (hypocritical views) of the debate around euthanasia and assisted death, especially when it is declared ‘illegal’ in your own country (most of the world, including the UK, by the way! ). Meantime, I’ll follow up on a question I asked you all in my previous blog, “…do you want me to blog in much shorter chunks, but more frequently; or …should I carry on as I have been doing? ”, ie suiting myself how frequently and how much I write?
Well, the result is in of my informal, non-randomised, and unrepresentative sample of blog-readers and more importantly, blog responders, – a grand total of 3 ‘visitors’. This comprised 2 females and 1 male (Variable: Sex – I refuse to use the more PC term Gender); 2 Australians and 1 UK citizen (Variable: Nationality). Just to confuse you, here Sex and Nationality were associated variables. So no, there weren’t 5 responses (perhaps an inference to draw from the picture below!?) in total – just three as previously stated!
Don’t you just wish?
This represents 11.6% of the number of you (35) that have read the blog entry. So, draw your own inferences. Anyway, there was a unanimous vote (3; 100%) in favour of letting me carry on as I am currently doing – hence the three-day gap for publishing this blog entry!
What has happened since my last blog, and what on earth is that title supposed to mean, do I hear you ask? Ok then- here goes…
On Wednesday I resumed my in-door cycling routine to try to stay fit-ish! I can manage about 20 mins in ‘top gear’. My target by the end of this cycle of Chemo is 30 minutes, and that should equate to about 7 miles when I eventually get back out on the road, and I will, I promise! In the afternoon I felt nauseous (though not actually sick) for the second day running, further proof, if proof were needed, that the 2-day treatment with dexamethasone on day 1 and 2 after the Chemo cycle really are required.
Anyway, by the evening I get over it and can resume consumption of my Cadbury’s crème eggs and whole nut milk chocolate as well as Terry’s Chocolate Orange-segments, “Segsations” (courtesy of Ellen’s boyfriend, Craig), liberally interspersed between handfuls of wine gums or midget gems. It’s marvellous what prescriptions the NHS can come up with! Unfortunately, such items are not free like the rest of my chemo or other 9 medications, but they do taste infinitely better!
Accessed at https://www.google.co.uk/search?q=cadbury+creme+egg 30 January 2016.
Thursday was a largely uneventful day for the most part for me, though we did have a visit from the company who installed our multi-fuel wood-burner (if that isn’t tautology?), ostensibly to clean its flew, 2 years now after purchase. I’m pretty certain we were his “first or guinea-pig customer” for the guy who turned up. He knew absolutely nothing (zilch, zero, nada) about how to dismantle our Jotul F100, though we bought it from the shop where he works; and, he had to borrow our own ash-vacuum cleaning device to remove the overnight remnants of our fire so that he could commence the work. Not a good start, or even a good look!
Our lounge – just after the Jotul F100 had been fitted (December 2013)
However, he did have some clever-fitting sweeping rods with a rotating ‘thing’ on the end that could be driven by a portable drill to ‘sweep’ the inside of the flew liner, hopefully properly, since you never get to see how good the fit is between whirly ‘thing’ and inner surface of the flew at the top of the stove. After about 20 minutes of application of the whirling device he retrieved his rods to reveal a pretty small ‘fall’ of soot and minor debris – and voila! -we are done– £30 quid, just like that!
Elaine and Jacqueline went shopping in Cupar, mostly LiDL and Aldi, as we are, or at least have become, pretty-much cheapskate penny pinchers, though we like to think we are simply great bargain hunters! This particular shopping spree was timed to coincide with the arrival at Cupar Railway station of our friend, Linda, from Bristol, who was also visiting and staying with us for a long weekend (she returns to Bristol on Monday). It’s all go at chez nous all of a sudden!
Elaine cooked a fabulous meal for 4, including Chicken in tomato sauce (hand-crafted from a kilo of roasted vine tomatoes, garlic and our own fresh garden herbs). Yes, our ‘backdoor’ herb garden is thriving even in a Scottish winter in Ceres! This was followed by Brownie, as prepared by Elaine’s own fair hand again using almonds, sugar, coffee and syrup, topped with both cream and ice-cream. And ‘cos we were still starving (obviously!) we finished off with a selection of cheeses and wholemeal rye and wheat-grained-studded cracker biscuits. Oh, and there was starter Gin and tonics as well as wine for “swilling-down” purposes. And that was just Elaine’s portion! We all declared we’d… “…have the same as she was having” (allusion to Meg Ryan’s orgasmic performance in, “When Harry Met Sally”).
“The scene” from Katz’s Delicatessen – in “When Harry Met Sally”.
Accessed at https://www.youtube.com/watch?v=F-bsf2x-aeE on 30 January 2016
On Friday evening/Saturday there was an overnight blizzard here in Fife, as in much of Scotland, and so travel arrangements were affected. Jacqueline left us on Saturday morning. Elaine drove her to Leuchars railway station. The Forth Road bridge was closed to all vehicles because of the snow and 60 mph gale-force winds, so car or coach travel weren’t options. We learned later that Jacqueline’s flight from Edinburgh to London Heathrow had been cancelled, and she had a long wait for a substitute. She duly arrived in her daughter’s flat at 7:30pm, having left our abode at 8:30am – some journey, eh?
So what about this Hippocratic stuff? Well, in the course of our post-prandial discursions (new word to indicate wide-ranging discussions? ) that took us to bedtime, we waxed (at some length!) upon government policy on euthanasia and comparison of attitudes to it (See Appendix I) between the UK (and most other countries) and those like Holland, Belgium and Luxemburg where it is legal, and others such as Switzerland, Germany, Mexico and five American states where only some types of assisted suicide and passive euthanasia are legal). Not that I was fearing (just yet) the pre-arranged ‘pillow’ that Elaine and I have agreed upon when the quality of my own life fails to meet certain thresholds – like, not purchasing second-hand books, CDs and LPs or more apposite, wiping my own bum for instance!
My point in this discussion can be put simply. The UK, and by extrapolation most of the rest of the world, do not have a voluntary euthanasia policy because some but influential people or bodies (including majorities in the House of Lords, particularly) think they know better than others what is good for us UK citizens despite successive consultations that show otherwise.
Yet an even older version of the Hippocratic Oath: A fragment of the Oath on the 3rd-century Papyrus Oxyrhynchus 2547.
Accessed at https://en.wikipedia.org/wiki/Hippocratic_Oath on 30 January 2016.
We are a nation of unbelievably adamant dog or pet owners and lovers. Some of the lengths that the latter go to are inexplicable (to me anyway). These include dressing their pet in human-type clothes; ordering ‘take-away’ for them as a special treat on their birthdays; and leaving their entire inheritance or fortune to their pet rather than to any of the rest of their family, extended to however many generations to include, “absolutely all of them, deliberately!”.
Nevertheless, we are also a nation of fervent supporters of “putting down” these same pets when they are clearly suffering physically or ‘mentally/emotionally’. “I would always know that Rex, Duke, or Megan, Lady was having a bad time – you can just tell by looking at him/her. It’s the eyes mostly that give it away, you know!” A fair proportion of the rest of the nation might say these things or many others of similar ilk. Now I would totally agree with these observations. We certainly have government-approved euthanasia carried out by veterinarian surgeons (Vets). Most people, reluctantly albeit, have their suffering pet put down. We had Holly, our pet dog, Part-Retriever (87.5%) and Part-Collie (12.5%), put down when things got too bad, though even then we waited until the end of semester for both Ellen and Richard to return from university so that they could say their goodbyes. This was a much longer wait for Holly than she deserved, but we did it relutantly for our children’s sakes.
If this is good for animals why isn’t it good for humans, after all we are animals, aren’t we? Maybe (we argue) it is because we are ‘special animals, sentient beings etc’ that the same rules shouldn’t apply automatically to us? Well, I know many pet owners, though I am not one of them, that sees ‘many-a-human trait’ in their Fido or Beauty. “Of course she has a personality”, they say. Now me, I don’t need this level of speculation. I am happy that Holly had a (nevertheless very strong and ‘nice’) ‘animality’, as I would call it, the equivalent trait in humans. All the same, I do know and understand the direction towards which “these people” are leaning! Accordingly, to me, regardless of whether humans are tending towards animals or animals are tending more towards humans, it is clear that successive UK governments, on either free or party-whipped votes, are and have denied we humans our (animal and human) rights! Why do we let them get away with it?
Naturally, governments will argue that it is not that simple. Actually it is, of course, but let’s give them some further “wiggle room”. They (Government) point immediately to the medical (rather than Veterinary) profession and say, “Ah, but doctors themselves are not in favour of euthanasia; they consistently vote to reject legislation to permit euthanasia, which they would be responsible for administering”. As an aside, I’m sure they are whispering between closed lips, “and we fully agree!”.
And one of the reasons they purport or argue is that euthanasia (suicide or assisted suicide) is contrary to their sworn “Hippocratic Oath”. Interestingly, I have recently learnt that the Oath does not now have to be sworn. It is worth looking at the exact wording of sections of the Hippocratic Oath and its interpreted version of guidance given to doctors, the “Good Medical Practice (GMP)”, published by the General Medical Council (GMC), and which embodies many of the underlying principles of the original Hippocratic Oath. See Appendix II for a reproduced version of these documents where I have highlighted (lime green! ) the appropriate wording relevant to our current discussion.
In the original Hippocratic Oath statement bullet point 2 is of primary relevance, comprising the key phrase is, “a promise of beneficence” or, translated from Latin version as, “do good or avoid evil”, as well as a promise of “non-maleficence“, towards patients. However, the second phrase, “primum non nocere – non-maleficence”, or “do no harm” that is often associated with this bullet point is not actually part of the original Oath, apparently! The third bullet point is a promise, “Not to assist suicide or abortion”. This intrigues me because many, though clearly not all, doctors (and nurses and mid-wives) routinely carry out or assist in providing abortion on demand, and without coercion.
Furthermore, for any of you who, as I have, experienced a loved-one nearing the end of their life and who has been dependent upon ever-increasing doses of morphine to alleviate pain, will know that the medical care team will approve and administer an amount of morphine that will undoubtedly hasten death. I am not complaining, indeed I approve! But surely, any first year student (fresher, UK or freshman, USA, Canada ) of Logic (Logic and Metaphysics 101? ) can see as transparently as, “le nez sur la visage”, that this is assisted suicide (though highly justified, I might add) rather than what it may be referred to by some? It is interesting that Domain 3, bullet point 6: “Listen to and respond to their concerns and preferences.”, and bullet point 8: “Respect patients’ right to reach decisions with you about their treatment and care.”, seem at least a little at variance with the notion that only medical professionals should control a patient’s treatment and fate. In summary then, is this not a case of Hippocritic Oafs practising or hiding behind Hippocratic Oafs?
Why can’t more of the UK (and global) medical profession be as honest as the Dutch, Belgians or Luxenburgians (?) clearly are, and call a spade exactly what it is, a spade or even a shovel! Now ignoring the fact that though the medical profession and governments will argue, often pedantically or semantically, about this latter point, aren’t they dodging the bigger issue? In the most recent parliamentary debate (House of Lords again) there was a strong lobby against legislating in favour of assisted suicide, presumably, not because they didn’t agree with it at least in some cases, but because it would signal the beginning of a slide down a very slippery slope!
This slope would include conflicts of interest between relatives and friends who could not (necessarily) be trusted not to coerce their loved ones into wanting to hasten their own deaths. Reasons for coercion might include: getting out of providing further continuous health care to their loved one; being motivated by being the recipient of an actually-agreed Last Will and Testament or promised inheritance upon death of the loved one; and so on… Now leaving aside that these would be criminal offences (or should be, see Appendix I again), should we not resist any situation where a small or minority problem, (though it might be serious) should dictate practice, policy or indeed, the law? I think so. What about you? Answers please, in the usual place at the end of this blog?
That’s all folks! Appendices follow after this endearing picture of Buggsy:
Accessed at http://www.nhs.uk/conditions/euthanasiaandassistedsuicide/pages/introduction.aspx on 1 February 2016
Euthanasia and assisted suicide
Euthanasia is the act of deliberately ending a person’s life to relieve suffering. For example, a doctor who gives a patient with terminal cancer an overdose of muscle relaxants to end their life would be considered to have carried out euthanasia.
Assisted suicide is the act of deliberately assisting or encouraging another person to kill themselves. If a relative of a person with a terminal illness were to obtain powerful sedatives, knowing that the person intended to take an overdose of sedatives to kill themselves, they may be considered to be assisting suicide.
Both active euthanasia and assisted suicide are illegal under English law. Depending on the circumstances, euthanasia is regarded as either manslaughter or murder and is punishable by law, with a maximum penalty of up to life imprisonment. Assisted suicide is illegal under the terms of the Suicide Act (1961) and is punishable by up to 14 years’ imprisonment. Attempting to kill yourself is not a criminal act in itself.
Types of euthanasia
Euthanasia can be classified in different ways, including:
- active euthanasia – where a person deliberately intervenes to end someone’s life – for example, by injecting them with a large dose of sedatives
- passive euthanasia – where a person causes death by withholding or withdrawing treatment that is necessary to maintain life, such as withholding antibiotics from someone with pneumonia
Euthanasia can also be classified as:
- voluntary euthanasia – where a person makes a conscious decision to die and asks for help to do this
- non-voluntary euthanasia – where a person is unable to give their consent (for example, because they are in a coma or are severely brain damaged) and another person takes the decision on their behalf, often because the ill person previously expressed a wish for their life to be ended in such circumstances
- involuntary euthanasia – where a person is killed against their expressed wishes
Depending on the circumstances, voluntary and non-voluntary euthanasia could be regarded as either voluntary manslaughter (where someone kills another person, but circumstances can partly justify their actions) or murder. Involuntary euthanasia is almost always regarded as murder.
There are arguments used by both supporters and opponents of euthanasia and assisted suicide. Read more about the arguments for and against euthanasia and assisted suicide.
End of life care
If you are approaching the end of life, you have a right to good palliative care – to control pain and other symptoms – as well as psychological, social and spiritual support. You’re also entitled to have a say in the treatments you receive at this stage. For example, under English law, all adults have the right to refuse medical treatment, as long as they have sufficient capacity (the ability to use and understand information to make a decision).
If you know that your capacity to consent may be affected in the future, you can arrange a legally binding advance decision (previously known as an advance directive). An advance decision sets out the procedures and treatments that you consent to and those that you do not consent to. This means that the healthcare professionals treating you cannot perform certain procedures or treatments against your wishes.
Active euthanasia is currently only legal in Belgium, Holland and Luxembourg. Under the laws in these countries, a person’s life can be deliberately ended by their doctor or other healthcare professional.
The person is usually given an overdose of muscle relaxants or sedatives. This causes a coma and then death. However, euthanasia is only legal if the following three criteria are met:
- The person has made an active and voluntary request to end their life.
- It is thought that they have sufficient mental capacity to make an informed decision regarding their care.
- It is agreed that the person is suffering unbearably and there is no prospect for an improvement in their condition.
Capacity is the ability to use and understand information to make a decision. Read more about the capacity to consent to treatment. In some countries the law is less clear, with some forms of assisted suicide and passive euthanasia legal, but active euthanasia illegal. For example, some types of assisted suicide and passive euthanasia are legal in Switzerland, Germany, Mexico and five American states.
Page last reviewed: 11/08/2014 (Next review due: 11/08/2016).
Hippocrates was a Greek philosopher and physician who lived from 460 to 377 BC. He is known as the “father of modern medicine”.  His work included the Hippocratic Oath which described the basic ethics of medical practice and laid down a moral code of conduct for doctors. The classical Hippocratic Oath has been translated and interpreted.  However, modern versions have also been proposed, using many of the basic principles of the original. Many people think that doctors still swear the Hippocratic Oath. It is not compulsory but in fact many medical schools now hold a ceremony where graduating doctors do swear an updated version. The British Medical Association (BMA) drafted a new Hippocratic Oath for consideration by the World Medical Association in 1997 but it was not accepted and there is still no one single modern accepted version.  In some medical schools the Declaration of Geneva physician’s oath is used.  In others an oath individualised by the institution is used. In the UK, the closest to a modern Hippocratic Oath are the core values and principles set by the General Medical Council (GMC), laid out as the duties of a doctor under the title “Good Medical Practice”. 
The classical Hippocratic Oath has been summarised as:
“A solemn promise:
- Of solidarity with teachers and other physicians.
- Of beneficence (to do good or avoid evil) and non-maleficence (from the Latin ‘primum non nocere’, or ‘do no harm’) towards patients. (In fact the well-known “first do no harm” phrase does not feature in the classical Hippocratic Oath.)
- Not to assist suicide or abortion.
- To leave surgery to surgeons.
- Not to harm, especially not to seduce patients.
- To maintain confidentiality and never to gossip.”
General Medical Council: Good Medical Practice 
The GMC is charged with the supervision of the conduct of the medical profession. This includes educational standards, ethics and behaviour. The extent to which the GMC should question personal ethics and behaviour if they do not impinge on medical practice may be debated.
The GMC publishes advice to doctors on the standards expected of them in the form of the document “Good Medical Practice”. It discusses the duties of a doctor registered with the GMC. This covers many of the principles of the original Hippocratic Oath.
Patients must be able to trust doctors with their lives and health. To justify that trust you must show respect for human life and you must fulfil certain duties which the GMC categorises into four domains:
Domain 1. Knowledge, skills and performance
- Make the care of your patients your first concern.
- Provide a good standard of practice and care:
- Develop and maintain your professional performance.
- Apply knowledge and experience to practice.
- Recognise and work within the limits of your competence.
- Record your work clearly, accurately and legibly.
Domain 2. Safety and quality
- Contribute to and comply with systems to protect patients.
- Respond to risks to safety.
- Protect patients and colleagues from any risk posed by your health.
Domain 3. Communication, partnership and teamwork
- Communicate effectively.
- Work collaboratively with colleagues to maintain or improve patient care.
- Teaching, training, supporting and assessing.
- Continuity and co-ordination of care.
- Establish and maintain partnerships with patients:
- Listen to and respond to their concerns and preferences.
- Give patients the information they want or need in a way they can understand.
- Respect patients’ right to reach decisions with you about their treatment and care.
- Support patients in caring for themselves to improve and maintain their health.
Domain 4. Maintaining trust
- Show respect for patients.
- Treat patients as individuals and respect their dignity.
- Treat patients politely and considerately.
- Respect patients’ right to confidentiality.
- Treat patients and colleagues fairly and without discrimination.
- Act with honesty and integrity.
- Never abuse your patients’ trust in you or the public’s trust in the profession.
- You are personally accountable for your professional practice and must always be prepared to justify your decisions and actions
For full details and elaboration, refer to the GMC’s Good Medical Practice advice. . The GMC also has further guidance on the duty of confidentiality, and on acting on concerns about patient safety (for example due to a colleague’s ill health or performance or due to inadequate premises, equipment, systems or policies).