Medical profession’s views on the assisted dying bill

Letters: An assisted dying law would not radically alter medical culture; it would instead provide much-needed safeguards to a practice that is already happening, unregulated and behind closed doors

We, the undersigned, express our support for the assisted dying bill, which will be debated in the House of Commons on Friday 11 September. As healthcare professionals, we believe that the current law prohibiting assisted dying is dangerous, cruel and in direct conflict with our duty to care for our patients. Forcing people to travel abroad to die or to end their own lives in this country in distressing circumstances is not consistent with patient-centred care. We urge our patients to exercise choice throughout their lives, yet the law dictates that they are denied choice at a time when they want it most.

An assisted dying law would not radically alter medical culture; it would instead provide much-needed safeguards to a practice that is already happening, unregulated and behind closed doors. Our patients agree: 87% of people say a change in the law would increase or have no effect on their trust in doctors.

Further to this, 54% of GPs support or are neutral to a change in the law and only 49% would at present be against being involved in the process should the law change. The British Medical Association has never surveyed its membership on this issue; its opposition to assisted dying does not reflect the wide range of views held within the profession.

Following consultation with their members, both the Canadian and Californian medical associations recently changed their stance on this issue. They are now engaging with lawmakers to construct effective legislation that works for dying people and those that care for them. This is a logical step. The body of evidence from jurisdictions where assisted dying is legal shows that the fears of those who initially oppose change have not been realised.

Assisted dying has been legal in Oregon since 1997, where there have been no cases of abuse and no extension of the law. The Oregon Hospice Association was initially opposed to assisted dying, but later acknowledged “there is no evidence that assisted dying has undermined Oregon’s end of life care or harmed the interests of vulnerable people”.

We write to represent the many thousands of healthcare professionals who no longer want to be misrepresented by opponents to a change in the law. We want terminally ill people to have the choice of assisted dying should their suffering become unbearable to them during the last few days or weeks of their life. However, healthcare professionals have no right to wield undue influence in this debate. The decision to have an assisted death is one that only a dying person is qualified to make; the decision to change the law is one for society as a whole. We urge you to support this bill.

Dr Jacky Davis Chair, Healthcare Professionals for Assisted Dying; member, BMA council
Dr Sheila Adam MD FRCP FFPH FRCGP Former deputy chief medical officer of England
Dr Aileen K Adams FRCA Past president of Royal College of Anaesthetists
Prof Peter Armstrong FRCR FRCP FMedSci Past president of Royal College of Radiologists
Prof Sue Atkinson CBE FFPH Former regional director of public health for London
Prof Martin Bobrow FRCP FRCPath FMedSci FRS Founding fellow of Academy of Medical Sciences; life president of Muscular Dystrophy UK
Fiona Caldicott FRCPsych FMedSci Past president of the Royal College of Psychiatrists and British Association of Counselling and Psychotherapy
Graeme Catto FRCP FRCGP FMedSci Past president of the General Medical Council
Prof June Clark DBE FRCN Past president of the Royal College of Nursing
Prof Jill Macleod Clark PhD FRCN Former chair of the UK Council of Deans of Health
Harriet Copperman SRN
Prof Lindsey Davies FFPH FRCP Past president of the Faculty of Public Health
Terence English FRCS Past president of the Royal College of Surgeons and the British Medical Association
Prof Godfrey Fowler FRCP FRCGP Emeritus professor of general practice, University of Oxford
JA Muir Gray FRCPSGlas FCLIP Chief knowledge officer of the NHS
Prof Sian Griffiths OBE FRCP FHKAM Past president of the Faculty of Public Health
Peter Lachmann ScD FRS FRCPath FMedSci Past president of Royal College of Pathology
Prof David Mant FRCGP, FRCP, FMedSci Emeritus professor of general practice, University of Oxford
Henry Marsh MA FRCS Neurosurgeon
Dr John Mitchell FRCP
Yvonne Moores FRSH Former chief nursing officer of England
Dr Rajesh Munglani FRCA FFPMCA Editor in chief of the Journal of Observational Pain Medicine
Prof Adrian Newland CBE FRCP FRCPath Past president of Royal College of Pathology and the British Society of Haematology
Christopher Paine DM FRCP FRCR Past president of the British Medical Association
Lesley Rees FRCP Former director of education at Royal College of Physicians
Prof Glenis Scadding MD FRCP President of the UK Semiochemistry Society
Prof Raymond Tallis FRCP FMedSci Emeritus professor of Geriatric Medicine, University of Manchester
Margaret Turner-Warwick FRCP Past president of Royal College of Physicians
Dr Graham Winyard FRCP FFPH Former deputy chief medical officer of England

• Polly Toynbee says “there have been no cases of abuse” of the assisted dying law in Oregon (MPs should be brave and at last give us the right to die, 8 September). Oregon’s own official statistics show a sharp ongoing increase in assisted suicides – there was a 44% increase last year alone. Moreover, there is no official scrutiny system in Oregon. We simply do not know if the law is being abused. But independent research showed that a significant number of patients suffering from undiagnosed clinical depression were provided with lethal drugs for suicide.

Charles Falconer’s assisted dying bill was not “passed unanimously by the House of Lords” as Toynbee claims. His bill was granted committee stage to allow scrutiny line by line. Giving a bill time for proper consideration does not signal unanimous approval. The proposed amendments – under half of which were discussed – reflected the serious concerns that the proposals are unsafe.

Having been involved in the care of thousands of dying patients, I know that open conversations and good palliative care can transform life for the terminally ill. Sadly, bad deaths such as Toynbee’s own experience still occur, but it is often a case of “we know what to do but just aren’t doing it”. Legalising assisted suicide would do nothing to improve the care of the dying. It suggests hopelessness and that they should contemplate suicide. This is not a message for the medical profession to endorse.
Ilora Finlay
Co-chair, Living and Dying Well

• Polly Toynbee misunderstands why 90% of palliative care doctors are opposed to the Marris assisted dying bill. From everyday clinical experience, we know that more people will be harmed than helped by legalising assisted suicide for the terminally ill. Thus, opposition is based on “consequentialism”, not religious belief. One of the most supportive responses to the patient who asks for “an injection to finish me off” is for the doctor to reply along the lines of, “I can’t do that – for one thing, it’s against the law. But, tell me, what made you say that?” This gives the patient the opportunity to express his distress and his fears. The conversation would conclude along the lines of, “This is what I suggest we do… And we can come back to the question of an injection to finish you off in a couple of weeks.” When challenged after this time, the patient invariably says, “I don’t feel like that any more.” In the interval, I and my colleagues will have been working hard to relieve pain, ensure a reasonable night’s sleep etc. Toynbee also ignores those who refuse referral for palliative care because they are convinced that they will be “done away with” – and suffer as a result. Their number will inevitably increase if MPs are shortsighted enough to support the assisted dying bill when it is debated on Friday.
Robert Twycross
Emeritus clinical reader in palliative medicine, Oxford University

• Polly Toynbee’s opinion, based on her experience of her mother’s death (which sounds truly horrid, for which I am deeply and sincerely sad) differs from the opinion of specialists with experience of looking after tens of thousands of dying people. Her suggestion that medical objection to legalisation of “assisted dying” is motivated by personal religious belief suggests (anti-)religious fervour of her own.

My experience of in-depth discussion with around 14,000 dying people over 30 years is that most deaths are gentle (which Toynbee acknowledges); that although people ask about “help to die” early in their illness, requests for earlier death are vanishingly rare as dying approaches; and that becoming ill enough to die makes even the strongest-minded vulnerable to fear of becoming a burden on their loved ones. Sadly, we also see occasional loveless families where coercion to “die sooner” would certainly occur should the law allow it.

Similar experience explains why those disciplines of medicine most familiar with patients’ experience at the very end of life are those most opposed to a change in the law. This includes palliative medicine, geriatric specialists and GPs. Is this because we are all religious zealots? No. It is because we recognise that the need to accelerate death as a means to end suffering is almost never required, and that the number of people who would be vulnerable to requesting unwanted assisted suicide as an act of generosity to their loved ones is considerable.
Dr Kathryn Mannix
Consultant in palliative medicine

When my brother was dying from Aids, he said the palliative care doctor kept talking to him about spirituality and religion. As our parents had not had any of their children christened and my brother had rarely set foot in a church, he found it difficult and confusing at the end of his life to think suddenly about God. If anything, it frightened him.
Emma Dally


The GuardianTramp

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