93.Memorandum from Marie Columb (MIB 198)
1. As a registered nurse in a stroke unit
I am involved with decisions to treat or whether prolonging life
is too burdensome, regularly. It is very obvious that as a patient
becomes more dependent their personal wishes become more intense
and then blurred as they see themselves as being a burden on their
loved ones. I have seen relatives swayed by the patient themselves
or by other relatives into believing they want to be left to die
and putting great pressure on doctors who believe there is a very
sustainable life to be treated here. Quite apart from the fact
that these relatives usually have no idea what is involved when
you allow a patient to die from neglect when they are not dying
I feel as a nurse I am morally bound to protect and sustain life.
We live in a society prepared to do anything to get what they
want, a society who is used to thinking of disabled people as
being less than human or as second class citizens. I have seen
patients in my care refusing all treatment, unable to face life
disabled and going through an agonising death despite all our
efforts. A death from starvation and following a "not too
serious" stroke but their choice has been respected and their
wishes upheld. There was no need for an advanced directive.
2. ln our hospital the view is that diet
and fluids are a basic human right and are not treatment be it
by ANH (Artificial nutrition and hydration) or ordinary nutrition
I feel that Florence Nightingale was correct.
Her motto was simply "Do no harm".
3. Often a decision to treat can be complex
and one informed conscience can differ from another as we have
seen on the news as pathologist experts have come to such differing
conclusions even under oath in court on many occasions. It is
now generally agreed that the decisions made from the collective
conscience of "the team" (of doctors, nurses, physiotherapists,
occupational therapists and social workers) is medically and ethically
correct and bound to be less subject to the unreasonable pressure
a relative or indeed the patient themselves may feel.
4. Consultants are always looking for simple
ways to be able to come to the right decision in all cases (without
damaging the traditional paternal role they have held in the past.
Unfortunately many patients or their relatives have lost the trust
they used to have in doctors. This bill would further damage that
5. The public seem to feel they must make
their Advance Directive now while they are healthy because it
will be expected of them to make these huge decisions about their
treatment when they are at their most vulnerable. When they are
probably still feeling very traumatised and are certain to be
the least informed about what is ahead of them or will be available
and the type of life they will need to adapt to. When in fact
this is not true and the treatment of these people would be severely
hampered if the doctors were prevented from treating them because
of a legally binding Advanced Directive that was written many
6. It is common knowledge that your views
change from day to day and when you are actually in a life and
death situation your views change dramatically from what they
may have been when you first wrote the directive. Our aim is to
always inform our patients as much as possible about their stroke
with videos, tapes and leaflets when they come in first. Having
seen the information you can see the change in their attitude
and the realisation that there is so much more they don't know.
They realise they need to rely on the professionals and they relax
and are prepared to wait and see what real damage is left after
6-8 weeks. Each stroke is different. Legally binding advanced
directives would only inhibit their care.