British medical bulletin
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Most deaths in Britain occur in old age, and old people dying have as many symptoms as do the young. Management is complicated by diagnostic difficulty, by the frequency of mental disorder (sometimes treatable) and of severe disability, and by the difficulty in ascertaining patients' feelings. Decisions about the management of dying are inevitable, and multifactorial, and views of others may be helpful. ⋯ Palliative care is important, not only in cancer. Euthanasia is seldom requested at present, and in The Netherlands is carried out less in old people than young. It would do little for the most serious problems of old age.
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One of the major dilemmas for the clinician caring for people with chronic disabling conditions is how to provide not only a good quality of life but also the best quality of dying. It is my view that the clinician should provide the opportunity for living before giving the opportunity to die. By this I mean that the clinician has the responsibility to ensure that efforts have been made to improve the quality of life by controlling clinical situations and providing psychological and emotional support. ⋯ In addition, a more satisfactory procedure than application to the High Court for a directive on withdrawal of tube feeding needs to be found. This method is very stressful for family and staff already in distress and is an extremely expensive approach. An independent ethical panel to ensure that the decision to end the patient's life is clinically appropriate, is being carried out purely for the best interests of the patient and is not influenced by the other considerations.