Saturday, 19 June 2010

Foolish or Brave?



I know this man. He is Dr Howard Martin who today spoke out about the number of people he has helped 'die with dignity' - his words.

It wasn't until a couple of years ago I discovered that some people were referring to him as 'another Shipman'.

Today, a day after he has been struck off the medical register, he has decided to speak out as, on legal advice, he did not talk about what he had done during his triple murder trial, subsequent inquests or the GMC hearing. He decided to speak out to call for reform of a system of care which - he claims - takes the 'soft' option of confining the terminally ill to hospitals and hospices rather than allowing them the dignity of dying at home with their loved ones.

“A vet would put a dog down, but under the current system a doctor is not allowed to take positive action to help a patient in a humane way,” he said.

“I don’t believe I’ve killed any patients. I believe I’ve made them comfortable in their hour of need. But I am deemed to be arrogant because I used my discretion.

“They want to extrapolate that to say I’m choosing to kill people. It’s not like that. The patients are about to die and I want to make sure they are comfortable. How can a so-called caring society not understand that? How can I be reckless with someone who is about to die?”

Matt Wardman accuses him of being a murderer.

It's about 32 years since I last saw Dr Martin. He had not long left the army, where he was a medical consultant specialising in gynecology, and had set up as a GP. In his position as a senior medic he was the gynecologist who saw me through a very complicated first pregnancy. He's not a charismatic man, rather brusque perhaps, but certainly one whose first priority was the well-being of his patients. What impressed me most about him was his openness and determination to discuss any treatments in detail. Never did he undertake any procedure without explaining why it was needed and how it was performed.

My child arrived during the day and I had no cause to think anything was untoward. However, because I never sleep well in hospitals, I was awake when a dinner-jacketed man appeared at my bedside around 2am. I distinctly remember joking about the hospital coffee and saying he obvious was addicted, only for him to explain that the baby had turned rather blue early in the evening and he'd called in to see him prior to his evening out. He explained he was sure nothing was wrong and had arranged for constant supervision. His reason for returning at that time of night was 'I was passing by and thought I'd just have a look at the records and check all was well.' It was.

He is a religious man who didn't attend church because of obligation but because of his commitment to his faith. I've read nothing about his overseas work. He spent a considerable part of his holidays in Africa training women to be midwives and setting up women's clinics. It wasn't often he spoke about this work but once I asked him why he undertook it especially since he had a young family of his own. I'm paraphrasing here but the answer was, "Women there go into the countryside alone and give birth. If complications arise there's nobody to assist them. I want to help change that." He did the work because he believed he should offer his skills to those less fortunate than himself.

Although I knew him quite well in a professional capacity, because I needed to see him often, we never mixed socially. He was not a friend but a capable medic and then GP.

I understand at his trial there were hundreds of ex-patients and many ex-colleagues who offered character references to the court. That doesn't surprise me in the least.

Dr Martin wants a discussion about dying free from pain and dignity. There will be some of you reading this who think he did overstep the mark. Some of you will believe that the palliative care offered to the terminally ill who are in great pain is excellent. It may be in many cases but not all.

He believes that about half of all doctors give injections to those who are about to die. I don't know about that but I do know one who did. The one who 'helped' my father's last couple of days because my father had said he's had enough. That doctor died of cancer himself a few years later. During the last conversation I had with my Dad in the hospice, he said he wondered why he was being left there to rot in a bed and do nothing other than harass the nurses for more and more pain-killing medication. He had prostate cancer which had spread to his bones and even moving his arms slightly was dreadfully painful.

The GMC call Dr Martin arrogant. Indeed, his brusqueness could be interpreted in that way. Many of his peers may not agree that a dignified death in the comfort of your own home is the most humane way to leave this world. I do and I have a gut feeling there are doctors all over the country who, having watched the determination with which the law has investigated each and every case, will be thinking 'There but for the grace of God go I".

The CPS will make their decision about today's 'confession'. Whatever it is it's my belief that Howard Martin will accept the verdict. He's no Shipman. He's an honest man. Honest enough to speak out. Whether you think that brave or foolish is your decision. He could well have stayed silent and spent his own twilight years in relative obscurity.

Update: The Telegraph has a video interview with Dr Martin. View it here.


18 comments:

Witterings From Witney said...

SR, may I say that was one hell of a post, obviously written from the heart due your personal contact with this man.

'Speak as you find' is the only way in which to judge people and one wonders about the skewed opinions of the GMC and possible 'box-ticking' mentality, coupled with a great deal of 'self-rightiousness' mentality.

I know for a fact my brother was 'helped' and that was in a private hospital, when he was 37. Like many relatives in the position of watching a family member die, I was more than grateful that my brother suffered little pain with his terminal cancer due his being so 'high' on morphine he probably 'floated off'.

People who vilify doctors such as this man might remember that, later, they pray they have one in their hour of need!

wisnaeme said...

Eight years ago yesterday, I buried my soulmate. nearly four years she suffered from a brain tumour and for months before she died it could not be described as "quality time".
If by chance I met this caring human being who has been witch hunted by the status quo for his kindness and his duty of care and compassion to others
... I would shake his hand in thankfulness that there are such people that folk in their last misery can turn to in their last hours of desperate need to be away from it all.

tris said...

A touching and moving post SR.

I hope a man of his calibre is around when my turn comes.

subrosa said...

Many thanks WFW. It always amazes me how, at times, family members know more about their terminally ill relative than the relative and their doctor.

This man has been chased now for 10 years. He could well have stayed quiet, but being the type of person he is, he's decided to speak out and be honest. Of course he's nothing to lose now he's been struck off but he's still firm in his beliefs. I commend that, regardless of whether I agree or not.

WFW, I wonder just how many terminally ill people have excess doses of morphine in their blood. Far more than we'll ever know possibly.

So sorry you lost your brother so young. Cancer is a hellish disease.

wisnaeme said...

.

... and may I draw your attention to an article in today's Sunday post. Entitled, "Means tests for dying cancer patients."

subrosa said...

Is it that long ago wisnaeme? I bet at times you still remember her suffering. It's something we never forget.

Howard Martin was a compassionate man. I'm sure he still is. I will always be grateful for what he did for me. He went way beyond his call of duty to ensure I received the best testing available in the land and even convinced the 'inventor' of the amniocentesis test (before it was publicly available) that I needed it. I got it.

subrosa said...

Thank you Tris. Me too but sadly, after this case, I doubt if many GPs will give any assistance and we'll be passed over to the palliative care teams. You know the ones - "You can't have more medication for your agony at the moment. You'll have to wait another 1,2,3 hours".

Dark Lochnagar said...

Rosie, that was a very moving post. My only concern with him speaking out is that it discourages other doctors from 'helping' patients to end their time in comfort rather than pain.

subrosa said...

I does DL, but on the plus side, he's pushing his accusers into proving that all terminally ill people die without pain and with dignity.

Gedguy said...

The only difference between this doctor and thousands of others is that this doctor has spoken out about it. That was his only crime. Those of us who have had some connection with the medical profession will know that this 'treatment' has been going on for decades. If someone is dying in a painful way then the doctors will ease that pain by injecting this drug which the doctors know is a respiratory suppressant and will kill the patient if the patient's dose is high enough. If the doctor doesn't do this then their patient will still die, but in terrible pain and/or discomfort.
There are times in our lives when we have to let people go. I remember having to go to hospital to see my aunt when she had a massive brain haemorrhage. She was lying in the hospital bed looking like a living corpse. I met a young doctor as I came out of the room and felt sorry for the doctor as he struggled to ask me something. I told him that I did not want my aunt to be resuscitated if she slipped away. I could see on the young doctor's face that this is what he was struggling to ask me. I did what I thought was the best course of action for my aunt and the rest of the family whom I was there to represent. I am confident that Dr. Howard Martin was just doing the same thing with his patients; he was making a decision on their medical needs. We should be praising this man, not trying to hound him.

gildas said...

Subrosa
Very moving and compelling. Heaven knows what the future holds, but I wouldn't want to hang around in agony.
The GMC is a body i wouldn't trust with a burned out match, by the way.

subrosa said...

Thanks for your comment Gedguy. I'm still trying to decide if Dr Martin (I knew him as Colonel Martin) is brave or foolish but I think his religious beliefs may have something to do with him speaking out.

JRB said...

It has been with some emotion that I have read your post. Obviously straight from your heart, it as reached out and touched mine.

I thank you and your contributors and of course Dr Martin, for bringing this often vexed topic to general discussion.

Being in the position where one now has had to give serious consideration and discussion to what is euphemistically called my ‘Anticipatory Care’, indeed, as WFW commented - “they pray they have one in their hour of need”

Many thanks for this most excellent post and the thoughtful replies.

JRB

subrosa said...

The least said about the GMC the better gildas.

Mind you they're a smart bunch. They're the ones who carved out their luxury contract on the back of a fag packet and told Labour that was the minimum they would tolerate. Labour fell for it. Now we're all paying for a part-time service.

subrosa said...

Good morning John. I thank you for your kind words. You, of all people, will understand there are times when we have health problems and we rely upon the medical profession to look after us.

This man did look after me. Not with platitudes or unnecessary chat but with facts which he took time to ensure I understood.

He was much in demand throughout the area for his skills and I think that may have been one reason why he resigned from the military and became a GP. His first practice was in Catterick and I've no idea when he moved from there as I too moved not long after he became senior partner in the local surgery.

It is of little surprise to me that so many support him. Even in the Telegraph video you can see the man he was 30+ years ago. Principled, honest in his beliefs and prepared to stand by them.

John said...

There is a recent GMC Directive regarding a doctor's duty to discuss things with patients in an end of life situation(http://www.gmc-uk.org/guidance/ethical_guidance/witholding_lifeprolonging_guidance.asp) that should reassure GP and others faced with these situations. There should be greater publicity to Advanced Directives - the GMC paper links to such Living Wills. My daughter died from a malignant brain tumour after being - basically - sent home to die in peace. She was tended by a marvellous nursing organisation that deal with such end stage patients. I am convinced that they gave the final dose of pain killing medicine knowing it was of such strength as to cause her death. I later spoke with one of her team and thanked them for this. The analogy to a dog is very apt - I have always reconciled myself to the horror of having a dog put down by acknowledging that it was the last service I could do for them.

gildas said...

My condolences John. That is a very moving post, but an important contribution.
Regards
Gildas

subrosa said...

Hello John. Another GMC guidance note which I'm sure provides them with information. But as Howard Martin said there are special circumstances, such as being a locum etc, where it would be difficult to create a 'chat' in the last days of life.

John, what can I say? I didn't realise you had lost your daughter. Reading your comment I realise she had the best of care. That can be of some comfort to those left behind.

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