Human Rights, Morality, Dignity and Public Image……

20 Apr

‘I an returning to a subject which I have covered before and the original articles can be found at the 18 July 2012 entry “Tony Nicklison’s Right to Die” and, 27 August 2012 “Tony Nicklinson – A Fight for Dignity” – Enter “Tony Nicklinson” into the site’s search box to find the articles……’

‘The case of a paralysed man who wants the right to end his own life will be heard in the Court of Appeal next month and public health leaders in Brighton will consider recommendations regarding the treatment of drug addicts within the city.  Although apparently unrelated both of these issues remain unresolved, despite having clear solutions and are being held up by bureaucratic stupidity rather than any real concerns for the people affected……’

What do they have in Common…..?

Real people’s lives; real people, in real situations, that affect real quality of life to them and that of those who care for them.  Not the philosophical or ideological arguments about the morality and rights and wrongs of certain courses of action which bear no relevance to the issues of the individuals bringing the cases.  Whilst considerations have to be given to potential abuses of any changes made to laws there are quite clearly situations that arise and transcend legal, moral and political arguments.  Euthanasia and the treatment of addiction are two instances that have large amounts of scientific, peer reviewed evidence in support of the proposals.  However, instead of consideration of the individuals affected by these cases they are soon overshadowed by the wider arguments which claim the vulnerabilities of some groups in society and the potential for abuse are placed at the forefront of the debates, making the individual’s logical and well demonstrated cases being over ruled by what could be described as the legal professions equivalent of NIMBYism……

 

The Case of Paul Lamb’s Continuation of Tony Nicklinson’s Fight……

Paul Lamb

Paul Lamb

Paul bravely picked up the torch from Tony Nicklinson who died last year from complications related to his illness shortly after loosing the legal bid to allow a doctor to assist in his suicide, with protection from prosecution.  Tony, like Paul, felt that their quality of life was so profoundly affected by their medical conditions they simply wanted the choice to end their lives with dignity at some point in the future when they deemed it appropriate, with the support of their families.  Both incredibly articulate and intelligent men there was no questions that arose surrounding the possibility of outside pressure leading them to make such a brave and considered request.  Suicide is not illegal and those who are able bodied can take steps to bring about the end of their lives should they wish to do so, but due to Paul and Tony’s practical physical restrictions it would almost certainly require a degree of help from another person, whether a family member or doctor leaving them with the possibility of facing charges, including murder.  This is not a situation which Paul and Tony found acceptable, that someone close to them who had may have had to endure the pain of watching their loved ones suffering, may be put through the trauma of facing a public trial.

It is here that the politically correct version of NIMBYism enters the equation.  I completely accept that safeguards would have to considered when granting the sort of requests that Paul and Tony were asking for but, in both cases, even a layman can clearly see that their cases were in no way influenced by external pressures from the families in fact nothing could be further from the reality.  These articulate men were presenting an indisputable case for a member of the medical establishment to assist in what would be a painless act of mercy to end their suffering.  There are no grey areas in the hypothesis and I strongly feel that under such clear and indisputable circumstances a change to the regulations is workable.

I wish Paul every success in his challenge to the current status quo……

The Treatment of Addiction……

Although, these cases appear to unrelated they do share a number of similar institutionalised orthodoxies, which despite years of scientific peer reviewed studies, all of which draw very similar conclusions, they continue to be ignored by the medical services charged with delivering results; again displaying the politically correct NUMBYism that does not affect the people who are either, going through, effected by someone who is going through or as a part of the structure of institutions charged with producing results using a methodology which has been proven to be largely ineffective and they are unwilling to change.  All of this despite the fact that what is considered by science and medicine as the best practice, demonstrated by favourable results within the small scale trials which sometimes take place……

The National Approach to Dealing with Opiate Addiction……

A patient presents with an addiction to Heroin which is the ‘street’ name for Diamorphine Hydrochloride, commonly used in medicine for the management of post operative and severe pain.  The treatment given to all patients is a replacement therapy with either Methadone Hydrochloride or Bupronophine; both are Diamorphine substitutes but lacking in some of the characteristics of Diamorphine and, it is due to this subtle difference that the substitute medication regime fails in the majority of cases to prove effective.

The second contributory factor to the failure of substitute medication’s failure to prove effective is the delivery by whichever agency is charged with its prescribing.  The National Institute for Clinical Excellence list 8 key principals for dealing with Opiate addiction.  One of the first states that ‘the prescription of substitute medication alone does not constitute treatment and should be used with a psycho-social intervention’, or dealing with the psychological reasons for addictive behaviour.  This is simply not done.  The key workers a patient sees have little if any specialist training in dealing with patients physiological needs.

This approach has changed little in since the 1960s, which is when the prescription of Diamorphine was replaced by that of Methadone.  This was not done for the benefit of patients, rather as a result of one rogue doctor who was abusing his position and supplying drugs…….

What Does the Scientific Community Recommend……

 Over the past 30 years the UK Government have commissioned hundreds of studies into the most effective way of delivering the safest, most compliant method for patients and with the maximum harm reduction and every one has recommended the reintroduction of the prescribing of Diamorphine Hydrochloride; the drug to which Heroin addicts are addicted.  These studies show a compliancy of between 92 and 98% whereas with Methadone it is closer to 12%.  The tendency of users to carry on using Heroin on top of their Methadone prescriptions fuels crime, from local level to high end organised crime.  The need to make money to fund the patient’s habit again equates to crime.  The costs to the retail industry, criminal justice system and the cost of locking up offenders at a cost of £30,000 per year is completely false economics, especially as the solution to the problem is simple, advised in the NICE recommendations and falls within the legal framework already in place, it seems crazy to dismiss these scientifically quantified recommendations……

The Effect on the Individual Patient……

The patient is unable to control their drug usage (unless they were prescribed the appropriate substitute) and this leads to the crime, isolation from ‘normal’ life, depression and anxiety and the dangers of exposure to life threatening illnesses such as Hepatitis C and HIV.  There are also many inherent dangers with the 95% of the unknown substances with which the Diamorphine is ‘cut’ by unscrupulous dealers wishing to expand profits.  The damage caused by addiction to Opiates is not the Opiate itself, it is the behaviour associated with continued illicit drug use……

The Solution……

As has been proven by every scientific study into the best way to treat these people is to prescribe the drug to which they are addicted.  This has the effect of ending the destructive behaviour which causes the harm, giving the patient the opportunity to rebuild their lives after which they can be successfully detoxified and continue being a productive member of society.

Why is this not done despite recommendations to our Government that this is the best course of action?  Because of political motives.  Any government taking this approach would face accusations that they are supplying ‘illegal’ drugs to addicts when the truth of the matter is that they are supplying them anyway, albeit under a different name.  The initial cost may increase but the eventual outcomes would be more effective in reducing crime and relapse and, in reintegrating addicts into society.  It is not done for the same reason that people like Paul Lamb and Tony Nicklinson were not given the dignified options they needed; ineffective politicians, ineffective courts and the worry of the damage it might do to their public image and to hell with ‘real’ peoples lives.

There are several countries which have taken this approach including Switzerland, Canada, The Netherlands and Portugal.  All report positive results in both reducing harm to individuals and achieving abstinence……

‘Our political classes, many of whom have never worked or experienced the real world, should be ashamed of themselves for they do not care about individuals, they only care about themselves……

Tony Nicklinson

Tony Nicklinson

 

In memory of  Tony Nicklinson, 4 February 1954 – 22 August 2012……


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