Assisted dying law risks undermining our trust in doctors
RECENTLY in these pages, former Lib Dem leader Sir Vince Cable wrote powerfully about his late mother’s suffering from dementia and depression, and how it influenced his views on assisted dying. No one can doubt the strength of feelings when someone witnesses a loved one suffer at the end of their life.
Sir Vince is right to draw attention to the fact that we must continue to do more to ease the suffering of those with terminal illnesses. Part of this lies in improving palliative [pain relief] and end-of-life care, an area I know well, having worked as a palliative care consultant for many years.
In my experience, a simple answer does not solve the complex problem of how best to help relieve the suffering of those in the final stages of life.
The Daily Express’s Give Us Our Last Rights campaign backs following the likes of Canada and Belgium in legalising assisted dying.
But changing the law is no small matter. It opens a Pandora’s box of fundamental questions around the role of doctors and medical professionals, patient safety, and ethics.
ACTIONS to end a person’s life are entirely distinct from withholding and withdrawing treatment. In contrast, palliative care is about focusing support on those who need it and prioritising dignity whilst “relieving physical symptoms and any emotional and existential suffering or distress whilst a person dies”.
It is unclear how the process could ever be safely regulated.
In Belgium, the Netherlands, Switzerland and the US state of Oregon, restrictions on assisted dying have gradually relaxed.
Initially tight legislation has been widened to include anorexia and autism in Belgium, and in Oregon, “terminal” conditions now include arthritis. In the Netherlands, children of all ages can access assisted dying. It is also notoriously difficult to predict whether a patient has more, or less, than an arbitrary period left to live, particularly the six-month period favoured by campaigners in this country.
And there are fundamental ethical issues to consider.
If doctors are to be expected to assist in deaths, this would be a dramatic and irreversible shift in medicine’s philosophy and practice to do no harm.
Assisting suicide would have to become a medical duty for doctors, who would be integral to the procedure. If assisted dying were legalised, the doctors who implement it would have full responsibility, including when things go wrong.
Recent surveys have found fewer than five per cent of palliative care doctors are willing to be involved directly in assisted dying, and doctors with the most experience of end-of-life care are much less supportive of legalisation – 82 per cent of members of the Association for Palliative Medicine (APM) do not back a change in the law.
What of doctors who, for personal, ethical or religious reasons, would rather not take part? Experience from elsewhere suggests that “conscience clauses offer weak protection”.
What of the effect on those doctors and nurses who do participate? One 2019 study found that potentially half of all doctors who assisted in the death of a patient described suffering an emotional burden afterwards.
It would be helpful if the broader debate was more honest about the terms used. In reality, it is a process of doctors assisting suicide via the administration of lethal drugs, usually a large dose of barbiturates.
When they talk about relieving suffering they are not referring to high doses of analgesics administered to ease distress, they are talking about lethal drugs given with the intent of causing their patients’ deaths.
What if a patient given lethal drugs regains consciousness, or experiences distress or additional suffering? And what should clinicians do if the patient cannot complete selfadministration of the drugs?
HOW would the NHS cope ifs doctors and nurses are detained by an assisted suicide that lasts many hours or even days?
We would do better to build on the UK’s excellent record in hospice and palliative care, and pain and symptom control.
Thanks to a law change this year, the NHS will be required to ensure there are services to meet the palliative care needs of everyone for whom they have responsibility in an area.
Otherwise the risk is that not only would the availability of assisted dying present a complex clinical challenge, but it risks undermining the trust that bonds doctor and patient.
‘Assisted dying opens a Pandora’s box of fundamental questions’