Pain management is always fraught. Photo: Getty
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Jill thought she knew best for her father so she kept the morphine coming

Whatever her motivations – and whether she had even been aware of them – she had been hastening his demise.

The call came on Sunday evening, flagged as urgent on the computer. I rang the home number, which was answered by a woman.

“My father is dying of prostate cancer with bony mets,” she explained. “He’s in a lot of pain.”

The medical terminology struck me. “Are you in health care?”

“I’m a nurse. I don’t mean to tell you your job, but I think it’s time for a syringe driver.”

As death approaches, medication taken by mouth can become unreliable. In order to control symptoms, drugs are administered subcutaneously by a device known as a syringe driver. The siting of a driver often heralds the final hours of life. As well as relieving pain and mental distress, the potent drugs used can depress consciousness and respiration, which more often than not hastens the end. This is not euthanasia: it is permissible as the price of effective palliation, the “doctrine of double effect”.

When I arrived at the house, Frank was alone with his daughter, Jill, a neatly dressed woman in her forties who had travelled down from her Northumberland home to nurse him in his final illness. She described how, no matter how much morphine she gave, she didn’t seem able to control his pain. Frank was indeed in a bad way – semi-conscious, markedly confused and rambling – but he didn’t appear objectively to be suffering. There was one brief moment when he did wince. Jill responded instantaneously, spooning in a dose of liquid morphine as a parent might feed a baby.

“How much has he been having?” I asked.

Jill shrugged. “I give him some every time he’s in pain.”

When working out of hours, one has no access to patients’ records – all information has to be gained first-hand. I asked to see the rest of Frank’s medication. In the depths of a laden carrier bag I found plenty of paracetamol and diclofenac, an anti-inflammatory.

“Is he having these?” I asked.

“Oh, no, he’s just on morphine now,” she replied.

Bone pain doesn’t generally respond to morphine alone. One usually prescribes anti-inflammatories and paracetamol; these potentiate the effect of morphine, allowing far less opiate to be used.

I wrote out a schedule, specifying regular doses of the two abandoned drugs, and insisting that Jill note down every dose of morphine given.

It had all taken a long time. Leaving, I bumped into two other women coming in at the gate. They turned out to be Frank’s elderly wife with another daughter. I’d had no idea there was a spouse around. She seemed equally bewildered to meet me, saying that her daughter had taken her out for an evening drive. It was midwinter, and dark outside.

The overdosing on morphine was one thing; quite another was the removal of Frank’s wife before calling the doctor in. Safeguarding children is a familiar concept, but in recent years there’s been a growing realisation that adults are sometimes in need of protection, too. I contacted Frank’s GP first thing in the morning and he convened an urgent safeguarding conference. A troubling picture emerged. Frank’s four children had a lifelong history of rivalry, division and competition for paternal attention. Jill and her sister were allies against the other two, and against their mother. The wider family reported that Jill had descended on the home, taking control of Frank’s treatment and shutting the others out, pulling rank by virtue of her spell in nursing some 15 years earlier.

The conference prohibited Jill from further direct involvement in her father’s care. Treatment optimised, Frank came off virtually all morphine. His confusion resolved completely, and he had another five months of good-quality life. Whatever her motivations – and whether she had even been aware of them – Jill had been hastening his demise. How easy it would have been for an out-of-hours doctor unwittingly to have colluded, taking things at face value and acceding to Jill’s suggestion that the time for a syringe driver was nigh.

This article first appeared in the 16 July 2015 issue of the New Statesman, The Motherhood Trap

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19 things wrong with Daniel Hannan’s tweet about the women’s march

The crackpot and these women.

Since Daniel Hannan, a formerly obscure MEP, has emerged as the anointed intellectual of the Brexit elite, The Staggers is charting his ascendancy...

State of this:

I mean honestly, where do you even begin? Even by Daniel’s rarefied standards of idiocy, this is a stonker. How is it stupid? Let me count the ways.

1. “Our female head of government” implies the existence of “their female head of government”. Which is odd, because the tweet is clearly aimed at Hillary Clinton, who isn’t anybody’s head of government.

Way to kick someone when they’re down, Dan. What next? “So pleased that my daughter received a wide selection of Christmas presents, unlike those of certain families”?

2. I dunno, I’m no expert, but it’s just possible that there are reasons why so few women make it to the top of politics which don’t have anything to do with how marvellous Britain is.

3. Hillary Clinton was not “the last guy’s wife”. You can tell this, because she was not married to Barack Obama, whose wife is called Michelle. (Honestly, Daniel, I’m surprised you haven’t spotted the memes.)

4. She wasn’t married to the guy before him, come to that. Her husband stopped being president 16 years ago, since when she’s been elected to the Senate twice and served four years as Secretary of State.

5. I’m sure Hillary would love to have been able to run for president without reference to her husband – for the first few years of her marriage, indeed, she continued to call herself Hillary Rodham. But in 1980 Republican Frank White defeated Bill Clinton’s campaign to be re-elected as govenor of Arkansas, in part by mercilessly attacking the fact his wife still used her maiden name.

In the three decades since, Hillary has moved from Hillary Rodham, to Hillary Rodham Clinton, to Hillary Clinton. You can see this as a cynical response to conservative pressure, if you so wish – but let’s not pretend there was no pressure to subsume her political identity into that of her husband, eh? And let’s not forget that it came from your side of the fence, eh, Dan?

6. Also, let’s not forget that the woman you’re subtweeting is a hugely intelligent former senator and secretary of state, who Barack Obama described as the most qualified person ever to run for president. I’m sure you wouldn’t want to be so patronising as to imply that the only qualification she had was her husband, now, would you?

7. I’d love to know what qualifications Dan thinks are sufficient to become US president, and whether he believes a real estate mogul with an inherited fortune and a reality TV show has them.

8. Hillary Clinton got nearly 3m more votes than Donald Trump, by the way.

9. More votes than any white man who has ever run for president, in fact.

10. Certainly a lot more votes than Theresa May, who has never faced a general election as prime minister and became leader of the government by default after the only other candidate left in the race dropped out. Under the rules of British politics this is as legitimate a way of becoming PM as any, of course, I’m just not sure how winning a Tory leadership contest by default means she “ran in her own right” in a way that Hillary Clinton did not.

11. Incidentally, here’s a video of Daniel Hannan demanding Gordon Brown call an early election in 2009 on the grounds that “parliament has lost the moral mandate to carry on”.

So perhaps expecting him to understand how the British constitution works is expecting too much.

12. Why the hell is Hannan sniping at Hillary Clinton, who is not US president, when the man who is the new US president has, in three days, come out against press freedom, basic mathematics and objective reality? Sorry, I’m not moving past that.

13. Notice the way the tweet says that our “head of government” got there on merit. That’s because our “head of state” got the job because her great, great, great, great, great, great, great, great grandmother happened to be a protestant in 1701 and her uncle wanted to marry a divorcee – all of which makes it a bit difficult to say that our head of government “ran in her own right”.  But hey, whatever makes you happy.

14. Is Daniel calling the US a banana republic? I mean, it’s a position I have some sympathy with in this particular week, but it’s an odd fit with the way he gets all hot and bothered whenever someone starts talking about the English-speaking peoples.

15. Incidentally, he stole this tweet from his 14-year-old daughter:

16. Who talks, oddly, like a 45-year-old man.

17. And didn’t even credit her! It’s exactly this sort of thing which stops women making it to the top rank of politics, Daniel.

18. He tweeted that at 6.40am the day after the march. Like, he spent the whole of Saturday trying to come up with a zinger, and then eventually woke up early on the Sunday unable to resist stealing a line from his teenage daughter. One of the great orators of our age, ladies and gentlemen.

19. He thinks he can tweet this stuff without people pointing and laughing at him.

Jonn Elledge edits the New Statesman's sister site CityMetric, and writes for the NS about subjects including politics, history and Daniel Hannan. He is on Twitter, almost continously, as @JonnElledge.