Friday 15 December 2017

Rude health: No sniffing matter

With France opting for Deep Sleep rather than a Quick Exit, writes Maurice Gueret, we need to wake up to cost of suing

Sir Terry Pratchett died last month aged 66
Sir Terry Pratchett died last month aged 66
Dr Maurice Gueret

The death of Terry Pratchett from a 'rare' form of Alzheimer's disease was particularly sad. All forms of this disease are cruel friends, but unusual variants that strike in early age are particularly pitiless. I never did finish any of his books - my fault and not his, I'm sure. I knew him better in latter years when he had a keen interest in that oft-neglected human right, autonomy about one's own death.

Pratchett was a humanitarian, and I do hope the BBC re-shows his award-winning documentary Choosing to Die, which focused on the experience of British families at the Dignitas assisted-death clinic in Switzerland. I wasn't surprised that Pratchett died at home rather than abroad. I got the impression from his programme that while he supported the right of others to assisted death, it was not a right he would exercise himself. His family and carers announced his death by saying that "Terry took Death's arm and followed him through the doors and on to the black desert under the endless night". We'll all follow in his wake someday.


France are world beaters at avoiding difficult decisions. As his unpopular government nears its end, President Francois Hollande is under pressure to fulfil promises he made about voluntary euthanasia. But French syringes have been watered down. Parliament is passing a law that will allow terminally ill patients to choose deep sleep rather than a quick exit. It's a rung on the ladder well before euthanasia, and would allow patients to choose continuous sedation until they happen to die, rather than the quicker, more concentrated form of respiratory depressant that a vet might give to a sick animal. The new law, which still has to be approved by the French senate, also gives legal effect to the living wills of patients, meaning that doctors won't find it easy to ignore them any more. Polls show that 96pc of French people are keen on patients having the right to a deep sleep, and politicians do like polls.

Liability insurance

No matter what business you are in, it's essential to take out some form of liability insurance. Ireland has a top table place among the great claiming nations on Earth. If you work in the IT sector, annual premiums start at about €200 a year. This quadruples to €800 a year for engineers, architects and barristers. Doctors used to pay these sort of rates too. Not any more. The annual premium for an orthopaedic surgeon in Ireland has recently risen to €98,000 per annum. They stump this up in January of each year for the privilege of mending broking limbs, replacing joints and assessing bone tumours. It doesn't allow meddling with spines. Should an orthopaedic surgeon wish to operate on your back, then the annual premium is now €200,000 per annum. Assuming that the spinal surgeon sees ten new patients every week on top of an existing crop of patients, this means he has to pay a €400 premium to his insurance company per patient. Worth bearing in mind when we might complain about fees. It mightn't be long before spinal surgery in Ireland is abandoned. Patients will be advised to go to the UK, where injury payments are about one quarter of those that are paid here. Of course there is always the public service. But your problem here is that your taxes are already paying these same insurance premiums for public service surgeons. If private practice ends, queues will stretch from one hospital to another. There may soon come a day when nobody will deliver your baby or operate on your back. And then we might wake up to the true cost of the suing industry.

Long Term Illness Scheme

The Long Term Illness Scheme is a wonderful facility. If you can make head or tail of some of its provisions. Basically, if you have a specified long-term illness or disability, you can apply for a little book that allows you get medicines and appliances directly related to your illness free of charge. One of the long-term conditions is mental illness. To qualify, patients have to be under the age of sixteen. The implication is that mental illness in a child is a long-term thing, but in an adult it is nothing but a temporary inconvenience. Adults with long-term psychotic illnesses are very deliberately excluded by the State from this scheme. Patients on disability allowance who have lost their medical cards now have to fork out up to €140 each month to pay for their anti-psychotic medication. All because the State says that no mental illnesses in adults are long-term. A crazy situation, made worse by the fact that some of these patients can have medication compliance issues. I am surprised that mental health organisations aren't banging on Dr Varadkar's door about this blatant discrimination against vulnerable adults.

Hand shaking practice

Next time your doctor shakes hands with you, check to see what he does next. The hygiene industry may argue that he should immediately wash his maulers, but scientists at Israel's Weizman Institute of Science have been observing rather different behaviour. Many humans are actually conditioned to smell their own hand very soon after making contact with others. It's an inquisitive, information-gathering thing. A human variant of the less socially acceptable canine behaviour of taking a whiff of each other's rear ends. The suspicion is that the information garnered from such behaviour may be helping in a subliminal way to assess odours, chemical cues, social status and perhaps even the health of the person who's hand has been shaken. So it could even be a sign of a particularly astute doctor.

Dr Maurice Gueret is author of 'The Doctor's Case'

Sunday Independent

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