My wife and son had terminal diagnoses - she chose assisted dying, he didn't

Five years after his mum’s death, Max was diagnosed with Ewing’s Sarcoma – a soft tissue and bone cancer – aged 25

The effects could vary widely from one person to the next, but she knew it could be a protracted, painful process – one she desperately wanted to avoid. ‘I can’t abide this illness’, she told me. It was then that she started seriously to discuss assisted dying, and, although it broke my heart, I told her that as long as she had the support of our son and daughter then I wouldn’t stand in her way.Because of the law surrounding assisted dying in the UK, we were forced to skulk around like a couple of criminals. She couldn’t discuss her wishes with any medical professional as they would have been under a duty to inform the police.

Before we flew to Switzerland, my son Max, 20, was a nursing student at the time and someone at his college had advised him not to push his mother’s wheelchair in the airport for fear of being seen to assist in a suicide, which is punishable by up to 14 years in prison in the UK. He ignored this and did it anyway – wanting to be there for his mum on her final journey.

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Racial and Ethnic Disparities in Opioid Access and Urine Drug Screening Among Older Patients With Poor-Prognosis Cancer Near the End of Life | Journal of Clinical OncologyPURPOSE To characterize racial and ethnic disparities and trends in opioid access and urine drug screening (UDS) among patients dying of cancer, and to explore potential mechanisms. METHODS Among 318,549 non-Hispanic White (White), Black, and Hispanic Medicare decedents older than 65 years with poor-prognosis cancers, we examined 2007-2019 trends in opioid prescription fills and potency (morphine milligram equivalents [MMEs] per day [MMEDs]) near the end of life (EOL), defined as 30 days before death or hospice enrollment. We estimated the effects of race and ethnicity on opioid access, controlling for demographic and clinical factors. Models were further adjusted for socioeconomic factors including dual-eligibility status, community-level deprivation, and rurality. We similarly explored disparities in UDS. RESULTS Between 2007 and 2019, White, Black, and Hispanic decedents experienced steady declines in EOL opioid access and rapid expansion of UDS. Compared with White patients, Black and Hispanic patients were less likely to receive any opioid (Black, –4.3 percentage points, 95% CI, –4.8 to –3.6; Hispanic, –3.6 percentage points, 95% CI, –4.4 to –2.9) and long-acting opioids (Black, –3.1 percentage points, 95% CI, –3.6 to –2.8; Hispanic, –2.2 percentage points, 95% CI, –2.7 to –1.7). They also received lower daily doses (Black, –10.5 MMED, 95% CI, –12.8 to –8.2; Hispanic, –9.1 MMED, 95% CI, –12.1 to –6.1) and lower total doses (Black, –210 MMEs, 95% CI, –293 to –207; Hispanic, –179 MMEs, 95% CI, –217 to –142); Black patients were also more likely to undergo UDS (0.5 percentage points; 95% CI, 0.3 to 0.8). Disparities in EOL opioid access and UDS disproportionately affected Black men. Adjustment for socioeconomic factors did not attenuate the EOL opioid access disparities. CONCLUSION There are substantial and persistent racial and ethnic inequities in opioid access among older patients dying of cancer, which are not mediated by socioeconomic variables.
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