Call to let doctors help terminally ill patients die

Top doctor says people who are dying need equivalent of midwives to help ease, and possibly end suffering and pain

Doctors should be able to help terminally ill patients end their lives days or weeks before they die, one of the leaders of Britain's medical profession has urged.

Terminally ill patients should be provided with the professional equivalent of midwives to help ease the pain and suffering and if necessary shorten the end of their lives, said Prof John Ashton, president of the Faculty of Public Health.

He demanded a change in the law so that doctors caring for people who are dying can end their suffering by giving a lethal dose of drugs to those who want it without the risk of prosecution.

He is the most senior doctor yet to publicly back patients' right to die. In an interview with the Guardian he also:

• Argued for a national move to a four-day working week to combat rising levels of mental illness. He said: "When you look at the way we lead our lives, the stress that people are under, the pressure on time and sickness absence, [work-related] mental health is clearly a major issue. We should be moving towards a four-day week because the problem we have in the world of work is you've got a proportion of the population who are working too hard and a proportion that haven't got jobs."

• Raised concerns about the rising suicide rates among men over 40: "There's something in the dramatically changed position of men in society vis-a-vis women and vis-a-vis the labour market that's affecting men's self-esteem and self-confidence as a result of this dislocation, with the reduction in their traditional role as breadwinners."

• Claimed child mental health services were in crisis: "We're not preventing problems in young people and we're not responding to them when they get them. People can't get seen, even when they're really ill."

• Attacked the lack of sex education in schools: "Classroom teachers will tell you boys are looking at pornography on their iPhones at the age of 11,12 and 13. This is where they're getting their sex information from, because we're not giving them proper sex and relationships education."

On assisted dying, he said: "All over the country people are spending their last days and weeks in major discomfort because their medical carers are not willing to accept that it's the end of the line and to give them the necessary sedation to just speed things up a bit."

Just as midwives help babies come into the world, some terminally ill patients in pain may seek the help of a health professional to end their life. "We have midwives; we need an equivalent of a midwife at the end of life," he said.

He also urged the NHS to stop "keeping people going at any price" when they are near death by doing everything possible to prolong their lives, such as using drips and trying other forms of treatment, which he described as "a big problem".

His remarks ignited a new row over doctors' role in end of life care. On 18 July peers will debate a private member's bill proposed by the former Labour minister Lord Falconer which wants terminally ill adult patients who have less than six months to live and who are mentally competent to be able to choose an assisted death in which a doctor would write the prescription for the drugs but the patient would administer them.

One religious group said Ashton's views were chilling and that doctor-assisted suicide would let doctors "play God" with dying patients and would see vulnerable patients being killed.

Ashton said: "I think a significant proportion of the population would like to feel confident that if it came to the crunch they could call on their doctor to help them out … if their quality of life is so poor and that it's only a matter of days or weeks anyway, that they would like to be able to draw down that gift of a [medical] practitioner." He stressed after the interview that he was speaking in a personal capacity on that issue.

The veteran public health expert, who held a number of senior NHS posts until he retired last year, said he would be happy for doctors "to stop treatment, to be more ready to prescribe the sort of medication that doctors do prescribe in terms of sedatives, comfort drugs and medicine … that means they will be more likely to [die] sooner rather than later.

"When doctors take this strident view that doctors won't get involved in this in any way I don't think they are in tune with what the public want to be able to get from their advisers. There is a narrow line between actively taking someone's life and supporting their passing, and that's the art of medicine."

He added: "Personally, I would like that for myself if I was in this position. I would like to be able to call on a doctor to help me take this last step."

Andrea Williams, the chief executive of the Christian lobby group Christian Concern, led criticism of Ashton. "To say that it's care for a doctor to kill is … a complete denial of their Hippocratic oath," she said. "A doctor is there to care for the patient, not to kill the patient. Midwives joyfully bring life into the world. It's not a doctor's place to play God at the end of life."

The medical royal colleges representing hospital doctors and GPs, whose members would be most affected by any change in the law, both said they were opposed to assisted dying being legalised.

But Prof Raymond Tallis, the chairman of Healthcare Professionals for Assisted Dying, a 1,000-strong group of doctors and nurses, backed Ashton. "It's totally appropriate that they should have the assistance of physicians if they have intolerable symptoms. It's very much the humane response to human suffering," said Tallis, an ex-professor of geriatric medicine at Manchester University.

Ashton had previously said that he "absolutely" supported doctor-assisted suicide. "As a humanist I believe each person as a citizen has an exclusive right to the final freedom – the choice of when and how to exit life," he told the BMJ.

A Ministry of Justice spokesman said: "The government believes that any change to the law in this emotive area is an issue of individual conscience and a matter for parliament to decide, rather than government policy."

• This article was amended on 17 July 2014. The earlier version said John Ashton had raised concerns about rising suicide rates among younger men; Ashton had referred to "the under-40s" in the interview, but had meant to refer to men over 40.


Denis Campbell, health correspondent

The GuardianTramp

Related Content

Article image
Obese patients ‘being weight-shamed by doctors and nurses’
Exclusive: Research shows some people skip medical appointments because they feel humiliated by staff

Denis Campbell Health policy editor

10, Aug, 2022 @5:00 AM

Article image
At life's end: dying painlessly and peacefully is the goal of most
As the assisted dying bill goes to the Lords, doctors explain how most wish for palliative care, friendship and dignity at the end

Sarah Boseley, health editor

17, Jul, 2014 @7:02 PM

Article image
Atheist doctors 'more likely to hasten death'
Study finds medics' faith affects care of terminally ill, as hospital clinicians admit 'ethically controversial' decisions

Sarah Boseley, health editor

25, Aug, 2010 @11:05 PM

Article image
Assisted dying: leading doctors call on Lords to back legalisation

Twenty-seven leading figures write to every peer urging them to back Lord Falconer's private members bill on assisted dying

Denis Campbell and Dominic Smith

15, Jul, 2014 @4:56 PM

Article image
We need better palliative care, not assisted dying | Zara Aziz
As the assisted dying bill receives its second reading in parliament, the risk of causing harm far outweighs any potential benefits

Zara Aziz

09, Sep, 2015 @2:00 PM

Article image
Harmoni out-of-hours GP service putting patients at risk, say doctors

Private healthcare provider Harmoni rejects allegations its service has become unsafe after cost-saving measures

Felicity Lawrence

17, Dec, 2012 @8:01 PM

Article image
Assisted dying bill raises hopes and fears for end-of-life care | Letters
Letters: The debate should not be about what doctors/lawyers/baronesses ‘like’. The debate is about patients and what they think


10, Sep, 2015 @6:11 PM

Royal colleges create charter for terminally ill patients
Aim to help patients leave a clear record of how they'd like to be treated in the days before their death

Jonathan Paige

01, Jun, 2011 @12:54 AM

Article image
Electing when we die is the ultimate choice. It must be ours and ours alone | Jacky Davis
Jacky Davis: My terminally ill brother's lonely suicide has only strengthened my conviction that assisted dying must be legalised

Jacky Davis

10, Mar, 2014 @3:15 PM

Article image
Doctors, nurses and managers to face five years in jail if they neglect patients

Health secretary Jeremy Hunt to announce new offence of wilful mistreatment in wake of Mid Staffs scandal

Rowena Mason in Colombo

16, Nov, 2013 @12:01 AM