Assisted suicide is not always as easy as suggested

EDITOR—Doyal and Doyal argue that there is no difference between assisted suicide, as requested by Diane Pretty, and the withdrawal of life sustaining treatment.1 However, there are many complex issues to be considered.

Firstly, how patients come to make an informed autonomous decision must be considered. Many patients with motor neurone disease fear a distressing death, but several studies have shown that this is rare, particularly with good palliative care.2 Moreover, assisted suicide is not always as easy and peaceful as is often suggested: a Dutch study reported complications, such as nausea and vomiting, in 7% of cases, and problems of completion, with longer times to death than expected, in 15%; doctors intervened and performed euthanasia for 18%.3 A decision for assisted suicide can be made clearly and autonomously only if such issues have been fully discussed.

Secondly, the reasons why people ask that their lives should be ended prematurely must be considered. One study suggested that in 80% of cases the reason is fear of the future (either of a distressing death or of being kept alive), and depression may be responsible for 14% of cases.4 These issues need to be addressed, particularly for a person with motor neurone disease who may have read of the possibility of a distressing death, often from the discussion of cases such as that of Mrs Pretty in the media.

The effects on all involved—the family and close carers, the health and social care professionals, and society itself—must also be considered. Many families find the discussion of assisted suicide difficult, and if complications occur then the memories are far from positive, with family members left with longlasting questions. Many professionals find it difficult to assist in the death of a patient, and one study showed that 24% of the …