Readers’ letters, Community Care, 3 December 2009

Loaded words in DPP’s guidance

The director of public prosecutions’ draft guidance on assisted dying is unsatisfactory and incomplete.

To begin with it uses “prosecutor speak” so S (the person wishing to end their life) is referred to as the “victim”, when S is the opposite of a victim. He/she is a person seeking to control the manner and timing of their death, and not be a victim of it. The word “victim” is understandable for considering cases of robbery, burglary and assault but is inappropriate for a case of voluntary assisted dying.

The guidance also speaks of the “suspect” (ie A) and “committing suicide”. These words are loaded and might even appear to pre-judge the decision to be made by the prosecutor.

More neutral words are called for to reassure the public that the prosecutor has a clear mind in approaching the facts. The decision to control the manner of death is a way of capturing dignity in the process of dying. Does not using such terminology tend to sully this dignity?

However, the state of the law and the guidance itself are likely to be just an interim phase. Such an important step as deciding to take one’s own life, although taken by an individual alone in the first place, should not inevitably be private. Is it satisfactory that both S’s decision and that of the prosecutor whether to prosecute must be made behind closed doors?

Safeguards such as the agreement of two doctors to an assisted suicide are still decisions made in private.

Perhaps the answer is some way of achieving advance clearness for the proposed assisted suicide, such as a speedy hearing of a tribunal composed of members with the status and experience to check by inquiry what the relevant circumstances are – social, personal and medical – and to give clearance to the proposal. But such an idea will take legislation.

Guy Otten, consultant solicitor, Hempsons, writing in a personal capacity

Treat obsessional behaviour gently

I agree with Jennifer Harvey that trying to break obsessions in people with autism will often lead to unnecessary trouble, and may well be unsuccessful .

But my experience of working with autistic people (mostly children) is that a two-dimensional approach often works best.

Many autistic people exhibit a high level of anxiety, largely due to the difficulty they have in their relationships with others and with the world in general; obsessional behaviour can help reduce the anxiety by acting as a comforter. So, it is futile and even cruel to try to reduce obsessional behaviour by itself. Equally, helping with social adaptation and understanding is not likely to be very successful when blocked by obsession.

My preferred approach has been to try to negotiate obsessional behaviour down at the same time as helping to make the child feel secure and confident in their social functioning. This approach needs to be gentle; rush things and the result will be anxiety and a retreat into even more extreme obsession.

However, with an approach that is genuinely consensual and does not try to rush matters, the outcome can be a reduction in anxiety, an increase in adaptability, easier social functioning and a generally happier person.

I agree that one should not try to break obsessions – but there is nothing wrong with trying to reduce dependence on them if this is done sensitively.

John Ramsey, Specialist fostering social worker for disabled children, Hackney

Spending review is not about cuts

London Councils, as part of an ongoing dialogue with foster care services and residential special schools, has asked that providers review spending plans for the next year.

This is not about cuts, but about encouraging providers to work with local authorities as a united service across London.

We have made it clear to providers that we are seeking agreements on costs. For example, if they explore how they can share space for events or organise training in large groups, savings can be made with no compromise on service quality.

We plan to make recommendations to boroughs in the new year and work with the providers in supporting them to deliver outstanding children’s services.

Mark Brangwyn, London Councils