Tony Nicklinson and ethics

Tony Nicklinson is a 58 year old man. In 2005 he suffered a stroke which left him paralysed and unable to do anything except blink and move his head. He has “locked in” syndrome – where physically he is almost completely paralysed but he has unimpaired mental abilities. He wants to end his life but due to his complete physical disabilities, he cannot do it himself. This means that any end to his life would not be euthanasia (assisted suicide), but actually classed as murder.  He was in the news a while back, but today I was listening to a podcast called “Inside the Ethics Committee” (http://www.bbc.co.uk/iplayer/episode/b01ksc3b/Inside_the_Ethics_Committee_Series_8_Restraining_Patients_in_Intensive_Care/) which reminded me of him, and some of the other ethical decisions which can face the doctors of today. 

The IEC episode I was listening to was about Monty, a severely autistic adult with acute pneumonia. Pneumonia is an infection in the lungs and can be life threatening. The problem with this situation was that he was sedated, and to allow him to get sufficient oxygen into his body, he had a tube down his neck. When the doctors feel that he is well enough, they can wake him up, and give him a mask instead. However, being autistic he doesn’t like change so when he gets woken up he refused the drips and the mask and begins to flail around. When he does this, the exertion uses up what little oxygen there is in his body, and as he cannot breathe sufficiently without the mask, he turns blue. This means that the doctors have to sedate him again and give him the tube back, but there are complications with someone being on the ventilator for longer than normal. I won’t give you a blow by blow account of what happens (you’ll just have to listen to it yourself!) but it is an extremely complex situation which brings about questions like how do you determine when someone has capacity (ability to make informed decisions about their own care) as well as others. 

One thing in particular which I found interesting was the fact that there are cultural differences in practicing medicine. In Monty’s situation, the doctors and nurses found themselves considering physical restraints as opposed to chemical restraints (sedatives to keep him unconscious). This is very uncommon in Great Britain, so much so that the nurse who wrote the guidelines actually didn’t know much about the mechanics of the situation – that is, how to actually restrain someone. The programme did say, however, that it is far more common in other countries. I assumed at first that they meant poorer countries where the drugs and methods of administering them were too expensive but Australia and other developed countries were on the list as frequent users. 

The cultural differences on that one topic I think go to show haw varied opinions are on all sorts of ethical debates within medicine, and the kind of problems that doctors can face. One reason that they have to be so careful with these issues is not only the fact that they obviously want the best for their patients (another question was who gets to decide what the best course of action is for a patient?) but also that in today’s society it is normal for doctors to be sued. This can make them very cautious and I think that this is fair. For example, when doctors prescribed Thalidomide, a whole generation of people were affected, and the doctors and pharmaceutical companies were rightly held responsible. In the past few years, I have heard of a couple of cases where doctors have been criticised for not prescribing drugs to patients which have seemingly beneficial effects, because they were waiting for the full courses of long term tests to run. It seems that they are between a rock and a hard place, and the fact which exacerbated the public reaction was that some doctors were prescribing them, while others refused to.

All in all, doctors’ lives are very complicated, and I think that as a result to be a doctor you need to be able to think analytically about the circumstances of any situation and come up with your own opinion and reasons for it. 

Edit: On Thursday 16th of August, judges ruled that they did not have to power to decide whether a doctor should be allowed to kill Tony Nicklinson. Subsequently, he stopped eating, and died on Wednesday the 22nd of August, from pneumonia. His last tweet was "Good bye world the time has come, I had some fun".

http://www.guardian.co.uk/uk/2012/jun/23/tony-nicklinson-assisted-suicide-twitter-interview
http://www.telegraph.co.uk/health/healthnews/9492021/Tony-Nicklinson-right-to-die-campaigner-with-locked-in-syndrome-dies.html#