I’ll always be grateful to the GP who eased Mum’s pain – even if it hastened her death

By Nick Maes

Nick Maes's mum Wil lived with a diagnosis of dementia for three yearsNick Maes’s mum Wil lived with a diagnosis of dementia for three years

Earlier this month, Dr William Lloyd Bassett, a Shropshire GP, was hauled in front of a disciplinary panel at the General Medical Council.

It was alleged that he’d deliberately hastened the death of a terminally-ill man by giving him a huge dose of morphine.

The case made headlines across the country, and prompted debate about the fine and treacherous line between aiding a patient in distress and hastening death.

But for me, this case was especially shocking. For I had witnessed Dr Bassett in action: he gave my mother morphine as she was about to die.

The recent General Medical Council hearing centred on an incident in May 2009 when Dr Bassett went to the home of a man dying from lung cancer and treated him with a high dose of diamorphine.

This led to him being questioned over his fitness to practise; a serious charge that could have ended his career.

Crucially, though, the family of the man who died would have nothing to do with the charges against him, and supported Dr Bassett 100 per cent in his actions.

The patient had become deeply distressed in his final hours. Although Dr Bassett accepted that the 100mg dose of morphine was too high and a mistake, it led, in all likelihood, to a more peaceful death

Last week, the hearing decided that Dr Bassett should continue to practise, but issued a warning of serious misconduct against his name.

Such cases mean many GPs are now nervous about administering pain relief to people in the final hours of life, in case they find themselves in a situation similar to Dr Bassett’s.

Dr Clare Gerada, chair of the Royal College of GPs, agrees that doctors are frightened to administer powerful opiate drugs.

‘It’s very difficult for doctors to offer palliative care because of the threat of manslaughter charges should the patient die soon afterwards. When one hears of a patient dying after a dose of morphine, there’s a sense of relief that you’re not the one who has administered it.’

Dr William Bassett gave Wil morphine as she was about to dieDr William Bassett gave Wil morphine as she was about to die

But after witnessing Dr Bassett at work in a similar situation as he attended my dying mother three years ago, I can only thank him for his caring, professional intervention.

At 83, my mother Wil — the name she was known by to all her family and friends — had been living with a diagnosis of dementia for three years.

Yet she managed to remain at home because of the stalwart support of her family, and carers who came in a couple of times each day.

Mum was determined to stay put. That was her resilient, forthright character — some would call it bloody mindedness, but it made her who she was.

When a social worker pushed for her to enter a home, the idea was swiftly rejected — by Mum and by us as a family. She’d cling to her staunch independence, a trait compounded by losing her husband Arthur nearly 40 years earlier.

But Wil’s general health was suddenly complicated as her vital organs began to fail: heart failure, water retention, high blood pressure and immobility intensified the problems.

Our family GP had no sure way of telling how long she might live, although it was suggested she might survive for another two weeks.

Mum’s condition rapidly deteriorated. Within 24 hours, she looked intensely frail and was hallucinating.

But that evening she seemed to rally. She sat up in bed and enjoyed an impromptu party, drinking brandy, laughing and chatting with all those closest to her.

Mum loved a good party and I think secretly enjoyed being the centre of this particular one. Our spirits were raised, even though we sensed, deep down, this would be the final stage of her illness.

At midnight, as my three sisters and I prepared Mum for bed, she had a seizure. Her eyes rolled into the back of her head, her body became a dead-weight and any colour that might have been there drained from her complexion. It was as if she’d imploded.

We eased Mum back into bed, tacitly understanding the end was close. Yet none of us really quite knew what to do. We’re not a foolish or mawkish family by nature, yet confronted by our mother’s inexorable slide towards death we found ourselves helpless.

It was eventually decided to call Shropdoc, the local out-of-hours doctor’s service. Dr Bassett isn’t our family doctor; it was sheer luck that he happened to be on call that night. His response was quick, and after examining Mum he suggested sending for an ambulance.

Nick Maes, aged four, with his mum WilNick Maes, aged four, with his mum Wil

We didn’t want Wil to go to hospital; there was no logical reason to send her. Dr Bassett respected our wishes and left, urging us to call again if there were any change.

We took it in turns to sit with Mum. But as the night drew on, Wil became restless, pointing into space, trying to shift her tiny frame off the bed. Mum’s agitation and distress became more marked and then she was sick.

At 4am we called Shropdoc again and Dr Bassett returned. It was obvious that neither I nor my sisters knew what we were doing. Dr Bassett’s presence was a huge reassurance to us, and more importantly to Mum, towards whom he was compassionate. He was with us for an hour all told and his manner was exemplary.

He spoke with Mum as she drifted in and out of semi-consciousness, asking her how he could help. Eventually he suggested that she might like morphine as a drip and as an oral dosage to ease her pain and relax her. (Wil hadn’t had any other medication until that point.)

Mum was unequivocal and nodded agreement. Wil was a woman who’d always said she wasn’t afraid of death, and now her old resilience flashed back. I felt an innate sense of relief, as did my sisters, that a decision had been made and a course of action taken.

Dr Bassett didn’t shy away from explaining what would happen, not to Mum nor to us, her children. The morphine would calm her and relax her; as the drug worked she’d probably slip away with less fight, drifting inescapably into a deep sleep.

He attached a line to Wil’s leg and placed the morphine drip-feed device on the dressing table — an incongruous addition to the knick-knackery of mirrors, perfume and jewellery usually found there.

Ensuring Mum was comfortable, Dr Bassett slipped quietly out of the house, leaving us to sit and gently talk with her.

The morphine quickly took effect, and she drifted off into a calm and deep sleep. We sat around her bed, holding her hands, stroking her hair, reminiscing about the marvellous times we’d had together and telling her how much we loved her.

Just after 9am the next day — a little over five hours later — Mum stopped breathing; she’d died with dignity and in peace.

The nature of her death was due to Dr Bassett’s seemly and humane intervention.

Her suffering had been minimal and she’d had the great good fortune to die in her own bed surrounded by all of her children.

Because of this experience, I’m under no illusion that assistance for those in the final stages of dying should, if requested, be given by doctors without fear of reprisal.

I’m not advocating wholesale euthanasia, or ending life along the lines practised at centres such as Dignitas in Switzerland. But when life is undeniably ebbing away, it is surely our responsibility, as a kind and caring society, to alleviate unnecessary suffering.

Doctors are rightly governed by a strict code of conduct. Key to the principles of medical ethics is that the doctor acts in the best interest of the patient. This would include giving pain relief to ease the suffering of the dying patient.

But this action can conflict with another key principle: do no harm. Even small doses of morphine suppress breathing, and there is a point where adequate doses may, inevitably, stop the breathing.

Dr Clare Gerada explains: ‘There’s no guidance regarding the amounts of diamorphine to be used on patients. This is because some cancers require hundreds of milligrams and others maybe just 10 or 20. It makes it very difficult for doctors because it’s difficult to predict.

‘Morphine is a very good drug, not because it kills people, but because it calms people down; and in the case of lung cancer makes it easier to breathe.’

Yet I would argue that if someone was on the verge of death, then what difference would alleviating the pain and hastening the inevitable make?

It’s a pragmatic approach, due in no small way to the practical influence of my mother.

‘We all have to go at some time,’ my mother would say. ‘No exceptions. There’s nothing to be scared of.’

Of course, the real fear is of dying in anguish. But the use of morphine to ease this fear still conjures up — almost unavoidably — awful memories of Dr Harold Shipman.

However, we shouldn’t make these nervous connections and demonise the drug. It’s vital that we have open and honest dialogues with GPs, patients and families in order to make informed decisions.

Until recently, it was common knowledge that the family GP, when tending the dying at home, might help shorten the suffering with morphine.

Maybe this was more an implicit arrangement — an unofficial, yet profoundly caring intervention that was acknowledged but not openly talked about.

Perhaps in previous generations there was a greater level of interaction between doctor and patient than we have today.

Each year, approximately half a million people die in Britain. A recent report from the think-tank Demos shows two-thirds of us would like to die in the peaceful and familiar surroundings of our own homes.

This is an infinitely preferable option to the noisy and frightening environments found in over-stretched and busy hospitals.

Yet, in reality, barely 18 per cent actually manage to achieve this last wish — which equates to more than 190,000 dying in hospital each year when they would rather die at home.

The Dying for Change report suggests that by 2030, just one in ten will have the opportunity to die at home.

Charles Leadbeater, the report’s co-author, said: ‘It’s not just that we’re living longer; part of this means that people are dying over a longer period, losing first their memory and then their physical capacities in stages.

‘If we put in the right kind of supports for people to cope at home, many tens of thousands of people could have a chance of achieving what they want at the end of life; to be close to their family and friends, to find a sense of meaning in death.’

From sitting in those final moments with my mother, I know nothing is as intimate or as personal as being with someone as they die. It is a great and intensely private honour.

And when my time comes, I can only fervently hope that someone as caring and as compassionate as Dr Bassett will be at my bedside.

FactCheck: Is Lansley misleading us over the NHS?

The claim

“This meeting deplores the government’s misleading and inaccurate talking down of health outcomes in the UK in order to justify its White Paper reforms and Health Bill in England.”

British Medical Association (BMA) Special Representative Meeting to debate NHS reforms in England, Motion 10, March 15, 2011

By Emma Thelwell

The background

Doctors charged the Government today with feeding the public “deliberate unashamed misinformation” in its bid to push through radical NHS reforms.

Almost 400 doctors gathered at the BMA’s first emergency meeting in almost 20 years to vote against the Health and Social Care Bill – and to vote on three separate motions of no confidence in Health Secretary Andrew Lansley.

Mr Lansley, who lost the support of his Coalition partners over the weekend at the Lib Dem conference, has insisted that patients are at the heart of the reforms.  He argues that the NHS needs reform on the basis that it lags behind Europe, specifically with poor death rates in cancer and heart disease.

But is the NHS really the sick man of Europe? FactCheck investigates.

The analysis

The whole of Europe “could do better” in the health care stakes, according to latest analysis from the Organisation for Economic Co-operation and Development (OECD).

While no one’s been issued a clean bill of health, the OECD’s summary of the UK’s battle against cancer and heart disease isn’t all bad.

Take breast cancer. It’s the most common form of cancer among all women in all EU countries – accounting for 31 per cent of cancer incidence and 17 per cent of cancer deaths among women in 2008.

The UK screens more women for breast and cervical cancer than most other developed countries and in the OECD’s 2010 Health at a Glance, we ranked third for cervical cancer screening and fifth for mammography screening over the period 2000 to 2008.

Survival rates, however, are less healthy. For both cancers, the UK dips below the European average – the 5-year survival rate for cervical cancer during 2002-2007 was 59.4 per cent – versus an OECD average of 65.7 per cent; and for breast cancer the rate was 78.5 per cent, slightly lower than the OECD average of 81.2 per cent.

But, the OECD points out that survival rates for different types of cancer is improving in the UK.

And data from the Office for National Statistics (ONS) rubber-stamps this; with latest figures showing that the UK survival rate for most of the 21 common cancers improved – for both men and women – over the period 2003-2007 compared with the period 2001-2006.

Furthermore, ONS stats show that the five-year survival rate for women diagnosed with breast cancer during 2003-2007 was 83.3 per cent. This was 1.3 per cent higher than for women diagnosed in 2001-2006

As for heart disease, the official Ministerial briefing for the Bill claimed that, despite matching the French for healthcare spending, our rate of death from heart disease is double theirs.

This claim was repudiated a few months ago by the Kings Fund’s chief economist John Appleby. He said the comparison was made over just one year of OECD figures, and with France – a country with the lowest death rate for “myocardial infarction” – or heart attacks – in Europe.

Mr Appleby pointed out: “Not only has the UK the largest fall in death rates from myocardial infarction between 1980 and 2006 of any European country, if trends over the past 30 years continue, it will have a lower death rate than France as soon as 2012.”


Dr Chaand Nagpaul, the GP representing Edgware and Hendon at today’s BMA meeting, tabled the first motion against Mr Lansley. Dr Nagpaul could not accept  what he called the Government’s “plain ignorance” on the NHS’s record.

“Did they really not know that heart disease mortality has fallen more sharply in the UK than any other European nation…Did they really not know that the UK leads Europe in the reduction of breast cancer mortality rates, and that lung cancer death rates in men is actually lower than those in France?,” he said.

The verdict

Since kicking off his case for the “liberation” of the NHS in July, Mr Lansley has repeatedly claimed that “compared to other countries” the NHS has achieved poor outcomes in some areas.

But as he stated himself, the notably poor performances are in areas such as diabetes and asthma – confirmed to FactCheck by the OECD.

The OECD does say that most other European countries achieve higher survival rates for different types of cancer.

Yet, it also acknowledges that our cancer survival rates have improved. Plus, the organisation also tipped its hat to the UK for having a lower number of hospital admissions for congestive heart failure and hypertension than the rest of Europe.

Dr Nagpaul accused the Government of being “so bereft of national pride” that it totally ignores such facts, as well as the findings of the Commonwealth Fund.

FactCheck however, won’t be falling foul to that charge – we’ve read the 2010 Health Policy survey by the US health think tank, which pits the UK against Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the US.

The UK scored highest on confidence in NHS treatment and second only to New Zealand on the quality of care from doctors – with 79 per cent of those questioned rating the care they’d received in the past 12 months from their doctor as very good or excellent.

The NHS isn’t a picture of health, but we’re hardly the worst in Europe. So why is Mr Lansley being such a hypochondriac?

Andrew Lansley bankrolled by private healthcare provider

Andrew Lansley, the shadow health secretary, is being bankrolled by the head of one of the biggest private health providers to the NHS, The Daily Telegraph can disclose . http://www.telegraph.co.uk/news/newstopics/mps-expenses/6989408/Andrew-Lansley-bankrolled-by-private-healthcare-provider.html

John Nash, the chairman of Care UK, gave £21,000 to fund Andrew Lansley’s personal office in November.

Mr Nash, a private equity tycoon, also manages several other businesses providing services to the NHS and stands to be one of the biggest beneficiaries of Conservative policies to increase the use of private health providers.

Andy Burnham, the Heath Secretary, is planning to write to David Cameron, the party leader, asking for him to guarantee that Conservative health policy is not dictated by private health care companies.

A senior Labour source said: “This raises serious questions about Andrew Lansley’s judgement and it is difficult to see how he can continue on in his role as shadow health secretary when it would appear that a private health care company is helping to fund the development of Tory healthy policy.

“David Cameron claims that the Tories are now the party of the NHS – it makes his claim look more absurd than ever.

“How can the public trust Cameron on the NHS when his health secretary is hand in glove with a big beneficiary of Tory health policy?

“There is an apparent contradiction at the heart of Tory health policy and we urgently need to hear a detailed read out of what this money was donated in exchange for or the money should be refunded.”

It is the first private donation registered with the Electoral Commission by Mr Lansley since 2001 and it is not clear why he accepted the money just months before a general election. Although he will not profit from the donation, it will help bolster his political profile.

Care UK provided services for 500,000 people last year, working with all ten Strategic Health Authorities and one in three Primary Care Trusts. It runs hospitals, NHS Walk-in Centres, GPs’ practices and care homes. It currently runs 59 residential care facilities with 3,400 beds.

In a recent interview, a senior director of the firm said that 96 per cent of Care UK’s business, which amounted to more than £400 million last year, came from the NHS.

Earlier this month, the Conservatives pledged to increase the use of private providers if elected.

In the draft manifesto published by the Conservatives, the party promised to “open up the NHS to include new independent and voluntary sector providers.”

In official company documents, Mr Nash, who is also a major shareholder in Care UK, praised reforms proposed by the Conservative party.

“We welcome recent policy statements by the opposition Conservative Party in the UK which have substantially strengthened their commitment to more open market reform to allow new providers of NHS services and for greater freedom for patients to choose their GP and hospital provider,” he said.

Mr Nash, 60, also founded the private equity fund Sovereign Capital in 1988, which owns several healthcare companies, as well as the independent schools group Alpha Plus.

Along with his wife, Caroline, Mr Nash sponsors a city academy in Pimlico, London through their charity Future.

Mr Nash previously worked at Advent, the private equity firm, and Lazard, the investment bank. He has been the chairman of the British Venture Capital Association.

Mrs Nash gave the Conservative party £60,000 last September and Mr Nash gave £6,000 to held fund David Davis’ unsuccessful leadership campaign against David Cameron in 2006.

The donation comes amid growing scrutiny of Conservative backers in the run-up to the election. Unlike most Labour ministers, senior Conservatives routinely accept money to help run their private offices from wealthy individuals or companies. Some Labour MPs receive such assistance from trade unions.

However, there have previously been concerns over potential conflicts of interest from the Conservatives’ funding arrangements.

Alan Duncan, the then Energy spokesman, was heavily criticised after it emerged that his private office was being funded by Ian Taylor, the chairman of Vitol, a firm of oil traders.

The private office of George Osborne, the shadow chancellor, is funded by the hedge-fund bosses Michael Hintze of CQS and Hugh Sloane of Sloane Robinson.

A spokesman for the Conservative party said: “We have been completely transparent about this donation. It has been properly registered with the parliamentary register as well as with the Electoral Commission and is therefore fully within the rules.

“John Nash and his wife have a wide range of interests, of which CARE UK is just one. This donation to support Mr Lansley’s office was made through CCHQ. Mr Lansley did not solicit this donation. Donations from private individuals in no way influence policy making decisions.”