News Spike: Q: Who Killed Paula Yates…? A: Charlotte Korshak, with Morphine Syringe, in the Upstairs Bedroom.

News Spike
The Blog of Internet Muck-raking Scandal Wizard Spike1138
Wednesday, 14 May 2014
Q: Who Killed Paula Yates…? A: Charlotte Korshak, with Morphine Syringe, in the Upstairs Bedroom.

The television presenter Paula Yates died of a heroin overdose in a “foolish and incautious” binge after having apparently overcome her drug problem, an inquest found yesterday.

The coroner, Paul Knapman, said the amount she snorted would not have killed an addict, but as “an unsophisticated taker of heroin” Miss Yates had no tolerance to the drug.

Recording a verdict of death by non-dependent abuse of drugs, he told the court: “The evidence does not point to this being a deliberate act of suicide. It seems most improbable that she would attempt to kill herself with her daughter in the house. Her behaviour was foolish and incautious.”

Miss Yates, 41, died at her home in Notting Hill, west London, on September 17, after moving back from a break in Hastings.

The last adult to see her was a former heroin addict she had met at the Priory clinic, but her four-year-old daughter Heavenly Hiraani Tiger Lily, whose father Michael Hutchence died three years ago, was alone with her when she died.

Pathologist Iain West told the court he had found morphine in her blood, but no trace of alcohol or other illegal drugs.

“The powerful narcotic drug depressed the cells of the brain which basically stopped her breathing,” he said.

Miss Yates’s close friend Belinda Brewin, who visited her on the evening before her death, told the court: “She was slightly staggering, her eyelids were drooping, she was slightly incoherent. I could tell that she had been taking drugs.

“I said, ‘What the hell are you doing this for after all this time?’ She hadn’t taken drugs, illegal drugs, for nearly two years. She said it was the pressure of being back in London.”

After bathing Miss Yates because she had been sick, Mrs Brewin left the star in a “quite coherent” state. Unknown to Mrs Brewin, Charlotte Korshak, a former heroin addict, was upstairs throughout the visit and was the last person to see Miss Yates.

Miss Korshak, 21, told police that Miss Yates had taken heroin, cocaine, ecstasy and acid “from time to time”.

But she said she did not see Miss Yates take any drugs on September 16 and when asked by the coroner if she had supplied Miss Yates with illegal drugs replied: “Absolutely not.” She told the court she left her friend “fine, in a really good mood, happy”.

Miss Yates’s body was found by her longstanding friend Josephine Fairley Sams, who visited the house after trying to call her repeatedly. She was let in by Tiger Lily. “I rushed upstairs to tell Paula to wake up and took one look at her and knew she was dead,” she told the court.

“She was naked, half-out of the bed. I touched her and she was very cold.”

Miss Yates found fame in the 1980s as co-presenter of Channel 4 show The Tube, and as girlfriend and later wife of Sir Bob Geldof. They had three children – Fifi Trixibelle, 17, Peaches, 11, and Pixie, 10 – but in 1995 she left him for INXS singer Michael Hutchence. An acrimonious divorce and custody battle followed.

Amid a blaze of headlines she gave birth to Hutchence’s daughter, Tiger Lily. But only 14 months later he was found hanged by a belt in his Sydney hotel room in November 1997. Miss Yates refused to accept the coroner’s verdict of suicide. Her life was rocked again when it was revealed that her father was not the late TV presenter Jess Yates, as she had believed, but another TV personality, the late Hughie Green. Following Miss Yates’s death Tiger Lily was made a ward of court and is being cared for by Sir Bob, who already had custody of his three children.

After the inquest Miss Yates’s solicitor, Anthony Burton, read a statement on behalf of her friends. “An inquest tells you how someone died, not how they lived. It gives no clue to the fullness and joy of Paula’s life. Her friends will always remember her as loving, affectionate and witty.”

Paula lived with Tiger Lily in a home in St. Luke’s Mews, in the Notting Hill section of London.

Here is their house.

On Saturday September 16th, 2000, Paula was going about her business. She had a strange habit of going to the local off license (liquor store)

in the nearby Westbourne Park Road,

and buying tiny bottles of vodka (I am not a drunk. I am not a drunk.), sometimes up to 6 times a day. This day was no different. Around 2pm and 4pm, again around 6pm, then 10pm, she wandered over (its only a 2 minute walk) barefoot (very odd) over this crosswalk,

and bought little bottles of vodka. At the 10 o’clock stop, store owner Zhahid Shafi said she was “barefoot, her hair was scruffy and thought she wasn’t very drunk, she was certainly tipsy.” “She was very, very down and speaking slowly.

I asked her, ‘Do you need help?’

She said, ‘I’ve got problems but I’ll be OK. I’ll see you tomorrow. I’m in a hurry.’

She bought kitchen cleaner and furniture polish.

They were the last legal substances she would buy. Here is a picture of the door of the shop, note the headline of the newspaper ad. This was less than 48 hours after her body was discovered.

UPDATE Monday Sept 25 – Myself and my buddy Ryan went back to Paula’s house on Saturday evening. First we stopped in a few pubs, so we were pretty juiced, then we went to the off license. I went in and asked for a “bottle of Paula Yates vodka.” I know. How ashamed am I? Okay, not much.

He sold me this bottle.

Remember, this is the evening of her funeral. God, I’m tacky. Then I asked the guy behind the counter about Paula. He said she was a very nice woman. Then he said, and I swear you cannot make this shit up, “I’m going to miss her. She was a good customer. I’m going to lose a lot of money.” We were buckled over laughing. Okay, its not that funny, but how funny!

On Sunday morning the 17th, a friend called Paula. Little Tiger Lily answered the phone. She said that she couldn’t wake her mother. Nuff said. Paula had basically been on suicide watch for a couple of years since Michael died. Once she tried to hang herself. So the friend rushes to the house to find Paula in the bedroom laying in her own vomit. She called the ambulance at 10:10am, and they arrived shortly thereafter. Paula was pronounced dead at 11:15am. They removed her body

from the house, from this front door.

She was only 41.

They found heroin, pot, and a ton of tiny vodka bottles around her.

Her body was taken away for an autopsy.

Their results are inconclusive, but we’ll know more eventually.

No funeral plans yet, but I’ll bet she’ll be cremated and somehow scattered wherever Michael Hutchence is. Some say that Paula had some of Michael’s ashes in a pillow in her house. I don’t know… It’s all too much really. When I get all the info, I’ll post it.

Most of her friends agree that Paula did not commit suicide, but that this was an accidental overdose.

Nevertheless, it was extremely irresponsible and totally fucked up, especially with a kid involved.

The media is now making this woman out to be some sort of sad case, which she was. Sadly, this is the same media that totally destroyed her. They picked at her every fault, at any given chance. This girl couldn’t sneeze without some story surfacing about her being a coke head or something. I honestly believe that they are at least partly responsible for what happened to her. And that is my soap box speech.

A lot has been made out about Paula’s last public appearance at the premiere of the Madonna film, The Next Best Thing. I sat behind her at that, and she was fine.

Not at all like people made her out to be. Drunk, out of control and asked to leave. True, she did leave, but she wasn’t at all out of hand.

On a final intrusive note, when I went to the house yesterday, I stuck my camera in her window.


Sunday 28 February, 1993

PAULA YATES took me to bed.

There were other rooms where we might have done the interview; there were even two perfectly comfortable chairs in the room she chose. But no, she skipped up on to the heart-appliqued counterpane, commandeered the pillow end, and proceeded to disport herself. Sometimes she sat with her little boots planted firmly on the bed, knees apart, her limp grungey dress falling fetchingly between her legs; sometimes she twisted round to lie down, so that I felt I was interviewing her cleavage; sometimes she clasped the pillow to herself like a lover, and gazed at me winsomely from over the top of it.

‘Paula flirts with everyone,’ explains her great friend Sue Godley, wife of the musician Kevin Godley. ‘She flirts with her children, she flirts with me, she even flirts with my cats.’

‘The only person who refused to get on this bed with me was Cecil Parkinson,’ announced Paula, wide-eyed and pouting; I quickly scrambled up. On this bed, Paula conducts daily interviews for The Big Breakfast, Channel 4’s anarchic, cultish hit. Here she has probed Diana Ross – ‘have you ever had any fat bits?’ – and pressed Claudia Schiffer about what luxury she would take to a desert island.

‘A bikini,’ Claudia decided – astonishingly stupidly, given that there would be no one there to see her; Paula rolled her eyes, then gurgled to camera: ‘This is the lesbo-action bit of the show.’

Flirty, flirty Paula. Even her job sounds a bit naughty, the way she talks: ‘I don’t think,’ she says, ‘that sleeping with one of the owners gives you the advantages people think it does.’ This is a reference to the fact that Bob Geldof, her partner of 16 years, husband of seven years, and father of her children, owns a third of the company behind The Big Breakfast and The Wednesday Weepie, an afternoon show in which couples talk about their love-affairs: Paula presents – from bed – drowning in red velvet.

Now 32, Paula Yates is most famous for once having given Bob Geldof a blow job in the back of a taxi (or so he says in his autobiography; she seemed rather startled when I mentioned it). She has since modelled, designed lingerie, marketed perfume, and compiled a book called Pop Stars In Their Underpants. She has been a television presenter – on the music show The Tube and the London arts programme 01 – and an author, most recently of two books about motherhood. Motherhood? Daffy Paula, tattooed peroxide pet, is remaking herself as a professional mother? But she’s such a girlie.

AT 23, Paula Yates produced Fifi Trixibelle, now nine, then Peaches Honeyblossom, four, and Little Pixie, two, and became something of a self-appointed expert on mothers. In The Fun Starts Here (1990), ‘a practical guide to the bliss of babies,’ she suggests that working mothers are ‘at best irresponsible and at worst selfish’ and continues: ‘It seems to me obvious that there is a clear stark choice: to have a career until such time as your desire for children overrides your desire for work . . . Or the converse: you have your children now, wait till they’ve grown, then begin your work outside the home.’

To those who cannot afford this stark choice, this seems at best irresponsible. What’s more, it comes from someone who does work – a lot – and for whom feeling fulfilled must presumably be something of a breeze.

The Fun Don’t Stop, just out in paperback, is an exhausting catalogue of activities for all those mothers who don’t have a job, but do have a large income and plenty of space. A nanny – Paula has employed the same one for nine years – would also be useful. ‘You might think about putting some heavy-duty hooks into the ceiling joists and beams so that you can have a rope ladder, or a small swing inside your house,’ Paula suggests. ‘In the kitchen, we let Peaches have one cupboard at ground level filled with empty boxes and containers to sort through and rearrange, while I cooked.’ And so on. All very well if you have a converted priory in Kent and a house in Chelsea.

The proselytising for parenthood, like the manic flirtation, is, Paula would tell you herself, a consequence of a weird and lonely childhood up a Welsh mountain. Her mother, a starlet, was never there; her father, Jess Yates, played the organ on the God-slot television programme Stars on Sunday, and later became the subject of a tabloid scandal when he ran off with a showgirl 30 years his junior.

[NB – As we have since learned, 4 years subsequent to this interview occurring – God-Botherer and dutiful Jess Yates was indeed not her father at all – her actual father, as everybody else around her except for her appeared to be fully aware, Neo-Rhodesian Canadian Vaudevillan and notorious Skirt-botherer, Hughie Green of Opporunity Knocks – turned out a better title for the Britain’s Got Talent of it’s day might have perhaps been “Opportunity Knocks Up – and for a man with the kind of egotism and arrogant, bullying public deportment that would make Simon Cowell blush with shame, that’s a fairly nauseating proposition, to begin with…]

Paula thinks it is amazing she was ever conceived. ‘I don’t remember my parents together, ever: my father was much older, and really only interested in collecting magazines and bathroom suites; we were the only family in the area to have a bathroom suite on the lawn.

[See above. Not weird at all, perfectly understandable, given the circumstances.]

My mother was always in those films where it’s the end of the world and a meteor’s about to hit London; there’s only six people left, and one of them’s in purple underwear. That was always my mother, running from this meteor in purple underwear and spraining her ankle.’

All the running away from meteors meant she was never at home.

Paula became ‘this whining, whining, clinging child; she must have been driven almost mad by it. She would come back from being off, and I would lie outside the toilet if she went to the loo.

She must have felt that she was coming back to my dad and his bidets, and me and my whining – so in the end, to avoid the confrontation, she’d leave in the night.

I used to go to bed not knowing if she’d still be there in the morning, and then whether she’d be back for six months.”

‘I spent a lot of time looking at 1955 editions of the Saturday Evening Post – my dad had this whole room devoted to magazines – and they were the formulation of all my ideas about families. Everyone had a white picket fence, a mum in a fucking apron, and a big fridge.’

[This is mirrored in exact parallel with the life of Paula’s later idol, Marilyn Munroe – Paula and Marilyn, and later even Peaches, themselves, are all the end products of a self-fashioned and conscious act of synthesis, to create themselves in their adult existence in their own, idealised archetype of what a woman/wife/mother/sex symbol/groupie/functional, normal happy family should be.]

And so she developed a powerful morality about the responsibilities involved in parenthood, and a yearning for the security of an old-fashioned family.

Nothing wrong with that. Her evangelism about it, however, is wildly out of touch with the complicated feelings many women have about managing motherhood and a life outside the home, feelings with which she, by and large, does not have to contend.

[“Attachment Parenting”]

Yates is a smart girl who has made a career out of pretending to be an airhead.

[Kissinger had his own entire networks of these, to bring him information.]

She talks a lot about hanging out in nightclubs when she was 14, less about the fact that by then she already had her O-levels. How many? ‘Oh, eight or nine,’ she says vaguely.

She implies that she abandoned school altogether in her mid-teens, when her mother (who had switched career to become a writer of bodice-rippers) carted her off to live in Spain;

[This seems like a really odd thing to do, especially in view of the fact that there’s nothing to indicate that her mother was from Spain, or had any family or roots back there; after all, you can write bodice rippers just as well, if not better, living in hermitage halfway up a Welsh mountain as you can in (presumably rural) Spain.

It very much sounds to me, when viewed objectively with the benefit of historical hindsight, as though perhaps her godly, pious and dutiful stepfather Jess Yates married her unwed and expectant mother and moved them out to the rural Welsh wilderness to keep them safe and ensure they were protected and well-provided for and well-taken care of.

Once Jess flies the coop a decade and a half later, her mother’s first instinct is to skip the country, with young Paula in tow behind her, and go into self-imposed exile.

What, or who are they all three running from..?]

but if you press her about the legalities of not attending school, she mutters: ‘Oh, I think I went occasionally. I remember it being fairly lax, y’know, for a couple of years.’

[Is she being consciously evasive or is it the case that she cannot actually remember much of this period..?

It sounds to me as though she really doesn’t know. The question of this kind of thing had just never occurred to her before.

She doesn’t seem to be very aware, at least consciously, that the biographical story of her life doesn’t seem to make a great deal of sense – like Amy Pond, growing up an only child, living alone, in a massive, six bedroom Victorian town house, without ever thinking to move in her lifelong BFF/Male nurse boyfriend/Fiancé , when the anomalies and glaring plot-holes and incongruities in her past are pointed out to her, she can’t see them – the result is cognitive dissonance.

“It’s like being punched on the nose by the a Invisible Man – you can see the effect, but not the cause.”

This sounds generally and vaguely like “missing time”, memory gaps and blackout associated with traumatic events – occasionally, and in many cases, purposely induced, as an aspect of outside programming as a control, concealing the damage of healed-over psychic scar tissue.]

She returned to England to do A-levels at an Oxford crammer; ask her which subjects and she claims at first that she can’t remember, before finally admitting to English, History, Art and History of Art. Nowadays, she claims, ‘my interest in work is fairly minimal. If I didn’t need the money all the time, I’d be quite happy staying in bed.’

This suggests that her cash flow is, and always has been, relatively liquid, bit there is clearly a distinct disconnect, here – she is conscious of the need for a reliable and steady income, and the necessity of paid work to ensure that is the case on an ongoing and long term basis, but the two things don’t appear to be completely aligned up or joined together in her head – the two concepts just don’t have any tangible connection with one another.

Also, does she need the money..? Does she need the work…?

It’s not clear that she does, at this point.

She seems to think that she does. Which is rather strange, for an ex-aspirant groupie, who bagged the whale her first time out in 1979 – by 1993, she had been in a committed, longterm relationship with Geldof, raising kids together, for nearly 15 years, and legally married (with all the contractual and legal obligations that entails) for around five years.

Sure, “I Dont’ Like Mondays” is a solid Gold meal ticket for about 6 months, appearing in The Wall will keep the wolf from the door for about a year or so , but it’s fair to say that during the 1980s, the Geldofs were NOT excessively rich, certainly not amongst the super-rich of the music and entertainment industry – but then the Big Breakfast happened in 1992, Chris Evans, TFI, and don’t forget your toothbrush rode the crest of the Loaded wave all the way to the bank and Planet 24 Productions just blew up like a money bomb.

SO HERE we have a woman who boasts of being lazy. Yet she has three children, and people who know her insist she is an extraordinarily attentive and devoted mother. She interviews someone every weekday, for which she has to do a reasonable amount of research – ‘for example, if it’s an author, I always read the books’. And she churns out books herself: her next, out this autumn, is about a year of living in the country, for which, she says in a throwaway aside, she has just ‘re-read Cobbett’. She has to get up at 4am to write. This is not merely a woman who is not lazy; this is a woman who is phenomenally energetic.

Or take the voice. In person, she speaks like she writes: punchily, with a developed, pacey sense of timing. On television, the vowels become flatter; the public school accent, which, she admits cheerfully, ‘has been beaten into submission’, is overlaid with Northern and cockney, and veers alarmingly between them. ‘Yeah, it’s bizarre, the voice: I think from living with Bob maybe, and working up North for about five years. I’ve no idea. It’s a bit weird – ‘cos I’m a real public school kid.’

She is a woman who appears to be having it all ways – bright but dumb, lazy but productive, rich by most people’s standards, but claiming she only works because she needs the money; a privileged person bringing street-cred to the small screen. She takes Pixie into work with her every day, and the others sometimes in the holidays. ‘We love her children, even when they wander into the make-up room and try out all the colours,’ The Big Breakfast’s editor Sebastian Scott says sweetly. But as Paula’s nanny once remarked to me when Paula was first taking Fifi to work at The Tube, ‘Of course, she can get away with taking her child. It might be different if the make-up girl wanted to do it.’

And yet she can inveigh, in The Fun Starts Here: ‘We have been seduced by the glossy magazine ethic of ‘having it all’. It is a great lie. It has caused women untold misery and generated a million guilt-ridden insecurities. No one can have it all; nobody ever does.’

She comes closer than anyone. ‘I suppose I do have it all, more than anyone else I know . . . But I still get irritated by all this juggling bollocks, this idea of having a job and then going home in the evening and dancing round in a pair of mink-trimmed split-crotch knickers. People point the finger and say ‘But you’re doing this, this and this, how do you reconcile it?’ I reconcile it because I’m willing if necessary to go with five hours’ sleep to live by this thing that I believe in – but it’s just something I believe in for me, for obviously personal demons, to do with when I was little. All I was really saying in the book was that everyone should be in a position where if governments were more aware and employers were more aware, everyone should have that luxury . . . To spend five years with your kids? It’s not very long.’

Ah, but here we have a very different argument. Protesting that the Government could provide more choice is very different from accusing women who work of being selfish. Unfortunately, she lacks much in the way of concrete proposals: ‘I think they could do millions of things. You’d only have to sit down for half an hour and we could come up with 20 ways they could make it easier . . .’

PAULA, all her friends testify, is generous, funny, hard-working, devoted to Bob and the kids; and these days, has hardly any social life. She is, however, a prime victim of what might be called Celebrity Fallacy: being famous, she is inclined to think that something which seems momentous to her will be similarly interesting to everyone else. Giving birth always feels extraordinary, but it is also the most mundane of events. Beforehand, it is a mystery; afterwards, one is inclined to feel in possession of secret, surprising knowledge. The famous can forget 20 million others may have it too.

And being a notorious flirt, saying ‘fuck’ a lot, and being celebrated for blow jobs doesn’t make your experience of motherhood especially interesting, still less applicable to other people. Paula is most certainly not stupid. But she abuses her intelligence by failing to take account of what the world might look like beyond her own remarkable life. Her opinions elevate gut reaction into system of thought. ‘One of the main problems in this country,’ she asserts for example, ‘is that no one breastfeeds any more, or hardly anyone does’ – a view which must have more to do with her failure to breastfeed her own first two children than with any national trend, which, as midwives will confirm, and anyone who has dined with young parents probably knows only too well, is towards the getting out of breasts at every available opportunity.

Her obsession with motherhood as opposed to fatherhood seems a similar reflection of her own experience: ‘Bob’s involved,’ she says, ‘but in quite a distanced way. I find him scuttling into the library, where he lies with the Spectator over his face. I think he rather admires Evelyn Waugh. He was reading Evelyn Waugh’s letters when I was having the last baby, and he found this one which said ‘Have you had the baby yet? And what have you called it?’ He said: ‘Look at this: this is rather excellent.’ ‘

Bob, she claims, is responsible for the names. ‘He waits until they’re born to see what they look like, then he puts on a Southern accent: ‘Hey, baby, ah’m a-comin’ rahnd, I wanna see Peaches Honeyblossom.’ Of course, we don’t know anyone who talks like that. We live in fucking Kent.’

There is nothing wrong with bottle blondes who specialise in girlish, flirty behaviour having views about the best ways to bring up children; and when Paula says, ‘I am a bit sneery about the way English people can’t reconcile being sexy and a mum, the old Madonna-whore thing,’ it is impossible not to sympathise. But what people who feel outraged by her pronouncements (which are all the more upsetting because working mothers do feel ripped apart by conflicting demands) chiefly object to is the aggrandisement of personal prejudices into a general system of morality.

‘I’m not wrong]’ Paula cries defensively, clutching her pillow: ‘I’m not wrong about anything I say] How could anyone disagree with anything I say? Who could disagree?’

Well, I suggest, people could disagree with the sense that there is a right way to do it.

‘I’m not like those experts in the 1930s,’ she responds, ‘preaching that you should do bizarre things with your children, like feeding them every four hours and leaving them out in the cold . . . but I think there probably is a correct way of doing things, just from the point of view of ignoring experts and trusting one’s own instincts. If you truly just went by your own instincts, you probably would just sleep in the bed with your baby, and breastfeed it, and keep it close to you and just be with it. If you just trusted your instincts . . . that’s just the way it should be. So in that sense, I’m not wrong.’

June 28, 1997
‘Passive Euthanasia’ in Hospitals Is the Norm, Doctors Say

When the Supreme Court ruled on Thursday that states may continue to ban doctor-assisted suicide, it addressed the kind of death in which doctors actively help patients kill themselves. What was not considered in that decision is the fact that nowadays many, if not most, Americans die because someone — doctors, family members or they themselves — has decided that it is time for them to go.

What might be called managed deaths, as distinct from suicides, are now the norm in the United States, doctors say. The American Hospital Association says that about 70 percent of the deaths in hospitals happen after a decision has been made to withhold treatment. Other patients die when the medication they are taking to ease their pain depresses, then stops, their breathing.

There is less information on the deaths that occur in nursing homes and in private homes. But doctors say they often discharge patients from a hospital with the implicit understanding that they are sending them home to die, with a morphine drip for pain or without the ministrations of what they would call overzealous doctors at a hospital who might start antibiotics to quell a fever or drugs to stabilize a fluttering heart.

”It’s called passive euthanasia,” said Dr. Norman Fost, director of the Program in Medical Ethics at the University of Wisconsin. ”You can ask who’s involved and is it really consensual, but there is no question that these are planned deaths. We know who is dying. Patients aren’t just found dead in their beds.”

Doctors, Dr. Fost said, decide not to provide antibiotics to treat an infection, or they withdraw drugs that maintain a patient’s blood pressure, or they remove a patient from a ventilator.

Dr. Maurie Markman, a gynecological cancer specialist at the Cleveland Clinic, said a typical case might involve a woman with ovarian cancer who at first responded to chemotherapy but whose cancer now seemed impervious to the powerful drugs, and had developed bowel obstructions.

He could operate to try to remove the obstructions, but the chances are that it would do no good. Or, Dr. Markman said, ”you can put a tube in to drain her stomach so she doesn’t throw up.” But then, he added, ”you have to ask the woman, ‘Is that what you really want?’ ” She would have to live with that tube for the rest of her life.

Dr. Markman, who said he sees such patients ”at least once a week,” tells the woman that he wants to focus on her symptoms rather than on her underlying disease. He sends her home with pain medications if she is in pain and anti-nausea drugs if she is nauseated, but the woman will never eat or drink again because of her obstructions. She will not return to the hospital for any sort of aggressive treatment.

Dr. Markman said he never bluntly tells the woman that there is no hope and she is going to die, but he, and probably she, know what is going to happen — and soon.

Is that assisted suicide or assisted death, or is it relief of suffering? For Dr. Markman, the answer is clear. ”My intent always is to relieve suffering. If that’s my goal, I can look myself in the eye. I can go to sleep at night.”

Dr. Joanne Lynn, director of the Center to Improve Care of the Dying at George Washington University School of Medicine, said her typical case might be an old man, fragile and with multiple medical problems. She will finally discharge him from the hospital and send him home to his family, knowing that the decision to send him home is a decision to let death come soon. If he develops a fever, there is no reason even to take his temperature, she said. ”The agreement is that he will not come back into the hospital for almost anything.”

Dr. Lynn added: ”Many of the decisions may be ambiguously articulated. They may be as much as a nod, something brought up in conversation, ‘How do you feel about staying here?’ ”

But underneath the nods and significant glances, she said, is a conclusion that it is time for the patient to die.

Yet, Dr. Margaret P. Battin, an ethicist at the University of Utah, asks, how much do the patients and family members really understand? She said patients and family members might not grasp the hidden message in their doctor’s words. ”When a patient is asked, ‘Do you want to go home and be with your family?’ it would be easy to misinterpret that,” Dr. Battin said.

Or, she said, if a doctor says, ”I can see you’re in pain, let’s start a morphine drip,’ ” a patient may not realize that the pain medication will shorten his life. ”I can imagine a great many patients who would say, ‘I don’t want this pain, but if the medication is shortening my life, I can live with the pain,’ ” she said.

”That lack of candor about how the patient’s death will occur and under what conditions is the thing that’s particularly troubling,” Dr. Battin added. ”The patient is being invited to make a choice without understanding what the stakes are.”

It is even worse, she said, when family members make these choices for patients. Dr. Battin said she spoke about the issue to an ethicist when she visited the Netherlands, where doctors who help patients kill themselves are typically not prosecuted.

”You Americans talk so much about the slippery slope,” she recalled the ethicist saying, ”But we perceive you as being much farther along the slippery slope than we are.” Dr. Battin said she agreed.

But that analysis is glib, some doctors say, and they tell heart-wrenching stories to support their view.

Dr. Beth Y. Karlin, director of the Gilda Radner Ovarian Cancer Program at Cedars Sinai Medical Center in Los Angeles, said she had a 40-year-old patient with ovarian cancer. The cancer had spread to her liver and she was jaundiced and in such agonizing pain that she could not sit up. ”She did not want to die,” Dr. Karlin said, but death was near and living as she was was agony.

Dr. Karlin sent her home with a morphine drip, which soothed her pain, sedated her — and hastened her death. The woman’s death was peaceful.

But Dr. Karlin said she had never specifically asked the woman whether she wanted to die more quickly, and tranquilly, with morphine. ”It is the ultimate caring to allow patients to have some dignity,” she said.

Dr. Karlin and other doctors recoil from the idea of bluntly telling patients they are going home to die.

”You take away hope when you say that nothing can be done,” Dr. Markman said, adding that he does not even tell a patient that he wants to relieve suffering.

”Suffering has a horrible connotation,” he said. ”I say, ‘Let’s focus on another aspect of your cancer — symptom management.’ ”

Dr. Daniel Brock, director of the Center for Bioethics at Brown University School of Medicine, said Americans debating death and dying have assumed that the decision to allow doctor-assisted suicide is ”the big leap where bad things are likely to happen.”

”That seems to me clearly wrong,” Dr. Brock said, adding that his concern is with the covert managing of death. At least with doctor-assisted suicide, he said, the patients ask to die and take the lethal medicine themselves. But many doctors oppose the notion of routinely prescribing lethal drugs for dying patients, and deny that by managing death they are breaching moral boundaries.

Dr. Fost said: ”Every civilization throughout history has had strict rules against killing, but almost none have prohibitions against letting people die. Many people feel that there is a kind of brutalization when doctors kill people, a dulling of sensibilities, a feeling of dirty hands.”

Dr. Lynn said: ”It’s one of these things where the spin is the message. If the question is, ‘Is there some decision made that affects the time and manner of dying?’ the answer is, ‘Yes, and of course there should be.’ ”

But that is not the same as actively killing, she said, adding: ”When a patient is ready to die, I can stop nutrition and hydration. I can stop insulin and ventilation. I can sedate them. I can creatively collaborate with the forces of nature. But if they really want the control of being dead tomorrow morning at 10, I cannot promise that.”

Dr. Lynn said that some people ”find it startling or worrisome or a little bit scandalous to think that maybe some exercise some discretion over how they die.” Others, she added, would say, ”But of course.”

That is not to dismiss the anguishing questions about how far doctors should go in managing death, Dr. Lynn said. ”Almost all who have multiple grounds from which they find their morals find this a terribly troubling issue,” she added. ”If you don’t find it troubling, you aren’t thinking hard enough.”

Photo: Dr. Joanne Lynn, director of the Center to Improve Care of the Dying, talked to an elderly patient at George Washington University Hospital yesterday as Dr. Geoffrey Namata, a geriatrics fellow, looked on. (Michael Geissinger for The New York Times)

Paula Yates
Paula Yates pictured in London earlier this year

Former television presenter Paula Yates has been found dead at her London home.
Scotland Yard said officers were called to an address in St Luke’s Mews, Notting Hill, west London, on Sunday by an ambulance crew.

“The body was found in a bedroom and the cause of death will not be known until the post mortem,” said a spokesman.

Miss Yates’ solicitor, Anthony Burton, has confirmed her death.

Her former husband and the father of three of her daughters, Bob Geldof, said in a statement: “We are all so sad. The loss for all the children is insupportable.”

Speaking of the family’s “pain” at Paula’s death, the statement added: “It doesn’t require much imagination to understand the pain. Please do nothing to add to that.

Bob Geldof
Bob Geldof has called for the family to be left alone in their grief
“Leave them [the children] with their loss and Paula with her dignity.

“Thanks, we appreciate it. Bob.”

Paula’s mother, Heller Thornton-Bosment, speaking from her home in southern France, said she was “devastated” after learning of her daughter’s death.

“This has come as a terrible shock to everyone,” she said. “I am waiting for calls from London to find out exactly what has happened.”

A forensic medical examiner at the scene confirmed that Miss Yates was dead at 1130BST.

Police have cordoned off the exclusive street where the body was found.

Pop personality

The 40-year-old first made her name presenting Channel 4 pop music show The Tube in 1982. More recently, she was a co-presenter on The Big Breakfast on the same channel.

After her marriage to Boomtown Rats singer-turned-businessman Bob Geldof ended, she became involved with INXS singer Michael Hutchence.

Miss Yates remained Hutchence’s partner from 1994 until he was found hanged in a hotel room in Sydney in 1997.

Paula Yates
Paula Yates with daughter Tiger Lily at Michael Hutchence’s funeral
She always contended that he did not commit suicide, but that he died by accident playing a sex game.

Last year she tried to challenge an Australian coroner’s finding that Hutchence had committed suicide.

In February this year it was announced she was signing up to be an agony aunt for Aura magazine under former Sunday Express editor Eve Pollard.

“Paula was always so full of life,” Eve Pollard told BBC News 24. “She had had a tragic time but was coming out of it. She adored her children and they will find it hardest of all to recover from this.”

In 1998, Ms Yates learned that Opportunity Knocks presenter Hughie Green was her biological father, not the broadcaster, Jess Yates, who had brought her up.

She was recently treated for depression at the Priory clinic in Roehampton, south west London.

She had three children with Bob Geldof – Fifi Trixibelle, 17, Peaches Honeyblossom, 10, and Pixie, seven.

Miss Yates also leaves a four-year-old daughter, Heavenly Hiraani Tiger Lily, by Michael Hutchence.

Her former solicitor, Mark Stephens, told BBC News 24: “Whatever the circumstances, which are still unclear, our hearts have to go out to the children.”

Paul Coker at 17:10

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