Living for the dying

Ilora Finlay is a consultant and professor of palliative medicine. She is also Baroness Finlay of Llandaff, a member of the UK House of Lords and president of the Royal Society of Medicine. She shares some thoughts with David Metcalfe

I was aware of the life threatening nature of disease from a young age. My brother and my father nearly died, and in my early teens my friend's brother died of meningitis. I always have hated seeing people suffer. But as a junior doctor we had received no training in how to care for dying patients, and I still feel ashamed that we did not even know how to relieve pain adequately—many patients were simply left isolated in a hospital room to die. While working as a general practitioner I began volunteering in my spare time at a local hospice, and when an opportunity arose to set up a hospice for Marie Curie it made sense to follow what I cared passionately about. I took a leap in the dark and applied for the job.

The buzz I get from palliative care is being able to take someone from the depths of despair and being able to make them feel that their life is still worth living. Often it is something seemingly trivial that can make the largest difference to quality of life. An example is one of my female patients from a few years ago with motor neurone disease who was dependent on a ventilator and wanted euthanasia. When I asked her what we could do, however trivial, to make her feel more comfortable she indicated that she was distressed by some facial hair. The nurse and I gave her a "facial" and then she wanted to be made up. It made a huge difference, and she never asked for euthanasia again. The low is probably dealing with competition between different charities for status and funds. But patients need good care irrespective of where it comes from.

Women's careers are often different to men's, in part because of our reproductive biology, but I have never felt that being female was a disadvantage. I have had some fantastic male mentors over the years, and the Medical Women's Federation has been incredibly supportive throughout my career and helped tide me over rough patches. The only time that I can recall there being a problem was one day when I was studying for the membership exam of the Royal College of General Practitioners. I had balanced the BMJ on the cooker and was trying to feed my daughter, when I noticed that the BMJ was on fire. Thankfully disaster was averted, but it is sometimes difficult to juggle professional and family commitments.

I have never had work-life balance. I love what I do, and like always to feel productive. My family is important to me; they are my priority, and I'll drop everything if they need me. One of my fun moments is cycling with my husband on our tandem bicycle—we spend time together, stay healthy, and buy organic vegetables from the local farmers' market, all at the same time.

With great difficulty. I can only really manage these three responsibilities because I am lucky enough to work with a fantastic set of colleagues and for an outstanding National Health Service trust that works hard to support its staff.

I have been appalled at the distress that the UK medical training application service (MTAS) has caused to our junior doctors. Two of my very best students at Cardiff have found themselves without jobs. These two doctors have already given so much to the world, are conscientious, and are great doctors. It cannot be an effective system that has left them out in this way. And there are many more like them.

Of course my professional experience has informed my involvement in legislation and the questions I ask. A few years ago I proposed a bill to ban smoking in public places in Wales, largely because I have seen the awful consequences of diseases related to smoking. Although my bill was not enacted, smoking in public places has been prohibited throughout the United Kingdom—so we got there in the end.

I also introduced another piece of legislation, the Palliative Care Bill, because I am painfully aware that not everyone with a terminal illness gets the treatment that they need. We know what to do but are just not doing it. At the moment I am also chairing a select committee inquiry on allergy, which is a little different.

I approach this debate from the perspective of a practical clinician. The truth is that for all the talk of safeguards, these can never be adequately regulated. People around a dying person—whether family or professionals—send subliminal messages, positive or negative, about the patient's worth. And this can easily reinforce a person's fear that they are a burden on people and resources. Also, looking at places where physician assisted suicide or euthanasia is legal, such as Holland and Oregon in the United States, that specialist palliative care just does not exist.

It is far too easy to give up on terminally ill patients. I have seen too many patients over the years suddenly improve with good care—improvements far beyond anyone's expectations. And I have seen how easy it is to give up on someone. I have seen first hand how things change when doctors are permitted in law to kill their patients. It seems to stifle creative thinking and it becomes too easy to throw in the towel, rather than work to actually make a person's life worth living—no matter how long or short that life is.

Competing interests: None declared.

   

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