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In the last programme of the summer 2009 series of Inside The Ethics Committee Joan Bakewell and guests discuss the real-life case of Mary, a terminally ill woman with end stage heart failure who has weeks, or possibly months, to live. Mary is initially diagnosed by her GP who is surprised she hasn’t seen her earlier, given the advanced stage of her illness. Mary is very weak and tired but doesn’t want any treatment or palliative care. She talks quite openly with those around her from her close relative to her GP that she wants to die and asks for help to do so.
Reluctantly she goes to a hospice for respite care. There she requests euthanasia a number of times and on the first day she takes an overdose of paracetamol. The dose isn’t enough to kill her. The medical staff bring in the mental health team to asses whether she has any underlying psychiatric or mental health condition contributing to her continual suicidal thoughts. But a psychiatric assessment concludes she isn't depressed and has had no history of psychiatric illness.
Mary explains her suicide attempt as an attempt at euthanasia.
Mary refuses offers of palliative care and medical or psychological therapies and is ultimately discharged home from the hospice.
The staff looking after her are very worried about what will happen when she goes home. She wants no more visits from any of the palliative care team though will take phone calls. But given her suicidal behaviour should she by allowed to refuse monitoring from the mental health team?
At home she is looked after by a carer who is now in the position of looking after and possibly trying to prevent the suicide of the woman she is supposed to be looking after. Is this a fair position for her to be in and what about if the carer tells the medical team that Mary is suicidal or about to act on her thoughts again? What should the team do? Is not doing anything the equivalent of a policeman walking past a man about to jump off a building and doing nothing? Is it ethical to use the mental health act to bring Mary into hospital for assessment against her will ? Or should her autonomy be respected given the team know very clearly what her wishes are?
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