When I first started out as a junior doctor on the wards, it was all about defying death. As doctors, we are taught to save lives or alleviate suffering through our medical expertise, but not to end lives. Those of us who were on the “crash” team would run like the wind as soon as our bleeps signalled a cardiac arrest. The most senior member of the attending team would usually coordinate the arrest and end resuscitation attempts after a period of time.
The assisted dying bill receives its second reading in the Commons on 11 September. If adopted, it would mean that a terminally ill patient – who has less than six months to live – could be prescribed and aided in taking a lethal medication that would end their life. The application would first need approval by two doctors, one of whom would be the attending medical practitioner while the other would be independent. They would assess the patient’s capacity to make an informed decision without coercion or duress. This would be followed by an application to the high court to grant approval to assist death. It would be the attending doctor who would be asked to prescribe and aid the patient until they died, but not administer the medication for them.Previously, the bill did not include involvement of a judge in the proposal.
It is no surprise that the majority of British doctors believe assisted dying should not be within routine medical practice but in specialised court settings. A recent survey of palliative care doctors showed that 82% opposed a change in the law.
As a GP I see many patients who are in their last days or weeks of life. Most, if not all, ask to be kept comfortable and symptom free. They ask for a natural death (without unnecessary interventions) and not to be resuscitated. I have never been asked by a patient to help them die.
Many terminally ill patients are under the care of palliative teams as well as their GP. This means that they are offered help to manage problematic symptoms such as pain, nausea, breathlessness or agitation. Patients and families can access support through their local hospice, and district or Marie Curie nurses. But end-of-life care is patchy across the country, with a need for greater investment to reduce health inequalities, particularly as more and more people with often complex sets of symptoms are dying at home.
The bill talks about patients who are expected to die within six months, but not others who are severely ill with prolonged debilitating conditions, and wish to die. However, not everyone who we would deem to have a poor quality of life wishes to die. I have seen patients who are paralysed, tube fed, catheterised and with no hope of recovery. Yet they still find their lives worth living.
There is the real possibility of coercion – whether implied or expressed – by friends, family and even health professionals when patients are seen to be a burden. Between 1998 and 2012, the US state of Oregon, which legalised it in 1997, witnessed a rise of more than 300% in assisted dying, and analysts reported that its health department was funding assisted suicide but not some cancer treatments. There have also been recorded cases of patients administering their prescribed lethal medications three years after being prescribed them. The vast majority of those questioned about their reasons for wanting assisted dying in Oregon talked of loss of autonomy, dignity and being a burden to others, and less of physical suffering.
But I can understand the argument for assisted dying, especially when I see people with dementia. I can (or I think I can) cope with physical frailty but it is the thought of losing one’s mind that troubles me most. Perhaps I, too, would want the independence to end my life at a time and circumstances of my choosing. But is dementia or another intractable condition even part of this assisted dying bill, which talks of capacity and death within fixed timeframes?
The proposed bill does not offer sufficient safeguarding for patients and doctors. Mental capacity can change depending on mood, physical distress or social hardship. There is always the risk that doctors will get it wrong. This risk of causing harm far outweighs any potential benefits.
Patients must have the trust and assurance that we are on their side. More thought needs to go into amending the bill further and looking at the practicalities of how assisted dying could be implemented, as there is no scope for this in routine medical practice. Assisted dying should not be the cheap alternative to high-quality palliative care.