Rebecca Coulson is a freelance classical musician and writer, and the Conservative Prospective Parliamentary Candidate for the City of Durham.
…and this is why I’m not going to use my first fortnightly ConservativeHome column to tell Scotland to say no to independence. My political convictions derive from my hatred of being told what to do, and increasingly, most Scots seem similarly motivated. Alex Salmond – who is never bossy, himself – sinks further on to his anti-establishment throne every time another Englisher crosses the #indyref border.
For me, it usually comes back to freedom of choice. I like that we Conservatives have faith in the individual – faith that we don’t need the state to make all of our decisions for us. But this is why access to education remains essential; autonomy is a gift best exploited from an informed standpoint.
Arriving at A&E in the ambulance with my grandmother one Monday evening last October was the start of a tough week – not least because my parents were also in, or just out of, different hospitals. But it’s the accusation of immorality which remains with me. It was very early the next morning, and he was wearing an excellent suit. He took me into a small room, and told me that I needed to agree to a Do Not Resuscitate (DNR) notice. When I refused to do so – having explained her situation, her views, and my reasoning – he called me immoral.
Kate Granger, a thirty-two-year-old doctor dying of a rare cancer, is a social media phenomenon. Her campaign to make healthcare professionals introduce themselves to their patients, and wear a #hellomynameis badge has racked up over 56 million Twitter impressions in the last year, and is adopted by several hospitals a week. This is admirable, but the need for this level of infantilisation exemplifies NHS failure. Granger’s revolution signals something much greater than poor communication.
We finally have autonomy over our healthcare, but subservience is simply the crest of the struggle we face in its realisation. How can you make the right life-or-death decision if you don’t fully understand your options? When staffing is apportioned so poorly that hospitals work five-day weeks, is there enough time for someone to explain those options to you? And if there were, would they be able to?
Fumbling patients and relatives are, all too often, given weighted choices about complex issues, which are presented as clear cut. This won’t make me popular – but organ donation is a significant example. The demand for organs is in no way underestimated, nor are the incomparable results their transplantation allows, but the ethics involved in their harvesting (an admittedly emotive word, unsurprisingly often avoided) are rarely discussed properly in the public arena, let alone on the hospital ward. The first night I spent in an ITU waiting room in the summer of 2013, the only reading material of any kind on offer was a terrifying brightly-coloured leaflet called, Organ Donation: The Gift of a Life, in which everyone was smiling.
In Applied Ethics, British philosopher David Oderberg deliberates the harvesting of organs in eye-watering detail. Regardless of the deeper – most important – discussion of personhood and consciousness, the easy convention of donation might, for many, be clouded by reading that, ‘brain dead patients who are cut open for their organs sometimes show an immediate rise in blood pressure and the quickening of their heartbeat, both of which are brain-regulated … consistent with the fact that the person having their organs taken out is feeling pain.’ The words Oderberg italicises are obviously contentious, but knowledge about the difficulty of ascertaining when death occurs, and the benefits of a continuing heartbeat during effective organ removal, should be made accessible to all. If it were, the popular cry for opt-out donation might become less of a cuddly given.
Doctors are not obliged to continue the cursory study of medical ethics they may have undertaken during their pre-qualification training. This should change, and, like in much of Europe and North America, the UK should consider introducing clinical ethicists to the hospital scene – a solution proposed in last week’s BMJ.
‘She’s clearly old and frail, and has Alzheimer’s. It wouldn’t be right.’ No. Whilst her short-term memory had ebbed, she was as stubborn and sharp as ever, and physically fitter than me. But it wasn’t just because I knew her so well that I didn’t agree to my grandmother’s DNR. It was because I had the luxury of having previously considered the issues involved, in abstraction.
And this takes us back on the high road to Scotland. Not only by reminding us that deception about the NHS has played a key role in the Salmond campaign, but also because a representative referendum relies upon informed choice. We’re immensely fortunate to have the right to influence, and hold to account, our kingdom’s governance. But there’s a big difference between offering someone the knowledge needed to help them exercise their autonomy, and telling them what to do.
If Scotland votes recklessly, it may well be because this dividing line has been trampled too many times.