Dani Garavelli: A matter of life or death

Published on Saturday 3 October 2009 19:43

PITY the poor doctors on duty the night Kerrie Wooltorton was wheeled into Norfolk and Norwich Hospital having swallowed a lethal dose of anti-freeze for the ninth time in 12 months. Just as they were gearing up to flush out her kidneys again, she presented them with a letter insisting that, though she called an ambulance, she didn't want to be treated, and an ethical dilemma no amount of training could have prepared them for.

How, in the heightened atmosphere of a busy hospital and with the clock ticking on their patient's life, could they weigh her clear and vociferous rejection of treatment against her questionable mental health and decide, with any degree of confidence, the right course of action?

In the end, they let the 26-year-old die, driven, renal consultant Andrew Heaton told last week's inquest, not by the fear she would sue if she survived, but by the thought that she could legitimately say: "What else do I have to do to make my wishes known."

You can see his point. And I've no doubt he made a difficult call in good faith, which is why I am glad he was not castigated. But the coroner's ruling – that for doctors to have acted against their patient's wishes in this case would have been unlawful under the Mental Capacity Act 2005 – demonstrates how a law drawn up to allow the terminally ill to die with dignity is being abused to aid the self-destruction of those who are going through a period of deep, but for the most part, reversible mental turmoil.

Certainly, it does nothing to address the central question the Wooltorton case throws up – how it is possible to establish beyond reasonable doubt if someone in the midst of a depression or and with a history of psychiatric illness is capable of making a rational decision to end their own life?

Up until now, society seems to have accepted it was right to try to save the lives of those who attempt suicide, even if they actively resisted. If a man was drowning in a river, he would be hauled to the safety of the bank, even if he was struggling against his rescuers. And we wouldn't stand by impassively as someone threw themselves off Beachy Head just because they'd blogged about how much they wanted to kill themselves on the internet.

Taking the phrase "suicide is a permanent solution to a temporary problem" as a guide, the assumption has been that those at the end of their emotional tether are not best placed to make decisions about their future and that there might be more constructive ways to end their pain than by cutting off their lives so prematurely.

But the more concessions the pro-euthanasia lobby wins on "the right to die", the more accepting society seems to be that any individual – no matter how mentally unstable – should be allowed complete autonomy over their destiny. Combine this with a lack of resources for the treatment of depression and other psychiatric disorders and you find you are sliding into a "suicide culture".

If this is not true then why was this "living will" given any more legitimacy than the notes left by countless suicide victims across the generations? And why were those involved in her care so blas about the poor mental state of the woman who penned it.

At the inquest, it emerged a psychiatrist who had seen Kerrie in the "months" before her death had judged her mentally competent to refuse treatment (although she had been sectioned on several occasions). It was also suggested that her previous suicide attempts were evidence of her determination to end her life. And yet, everything about the way in which she approached them seemed to scream ambivalence.

On several occasions, she texted her best friend to tell her she had swallowed the anti-freeze, knowing, surely, that she would intervene. The last time she called an ambulance herself, and yes, it's possible her only motive was to guarantee she didn't die in agony alone, but in doing so she took a risk that the doctors would not comply with her stated wishes and that she would still be alive in the morning. In Kerrie's personal game of Russian roulette, she continued to leave one of the chambers empty.

Such behaviour may sound perverse and attention-seeking, but then Kerrie was a deeply disturbed young woman. Born with a distressing medical condition which made sex and conception difficult, she had also been diagnosed as suffering from borderline personality disorder. In and out of care homes for most of her life, she was, at the time of her death, living in a housing complex for people with enduring mental problems. More recently, she had become depressed by the thought that she would never conceive.

According to doctors, the symptoms of BPD include impulsivity, dramatic mood swings and repeated suicide attempts – exactly the pattern of behaviour Kerrie was locked in. But it is worth noting that though 8-10 per cent of BPD patients do go on to kill themselves, the condition is at its most acute in late teens and early 20s with most people attaining more stability in their 30s and 40s.

Such a drain do patients with BPD place on the therapists who care for them they are often – like Kerrie – branded "untreatable". Yet there is increasing evidence that some intensive forms of psycho-therapy can result in a marked improvement in their condition.

Given that we don't have access Kerrie's full medical history, it may be too speculative to ask whether, if psychologists had tried harder to improve her mental health, the doctors might not have been forced to take such a drastic decision about her physical health. But, as the debate over living wills and assisted suicide rages on, it is entirely reasonable to suggest we should spend less time arguing about people's "right to die" and more on trying to make their lives worth living.