Letters Law on assisted dying

Assisted dying versus assisted living

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d3184 (Published 25 May 2011) Cite this as: BMJ 2011;342:d3184
  1. Tom Koch, ethicist and gerontologist1
  1. 1University of British Columbia, Vancouver, BC, Canada V6T 1Z4
  1. tomkoch{at}kochworks.com

Tallis states that it is a fundamental principle of medicine “that you should be allowed to determine what is in your own best interest when you are of sound mind.”1 This is the consumerist view and not fundamental. The fundamental principles of medicine are to do no harm and to serve the health of the patient. Since the Greeks, doctors have used their knowledge to convince patients of what seems to be the best clinical treatment. That isn’t paternalistic, just good practice based on good knowledge.

The argument for “assisted dying” takes this off the table. It would say “Your choice,” even when, as clinicians, we might know that death is premature and unnecessary.

So we come to the question of what doctors do—simply respond to patients’ desires (even if wholly uninformed) or seek with all their powers to provide the best care and the fullest life for each patient who seeks medical attention?

If the last option is the answer then how do we fulfil the goal in cases of end stage distress? Tallis takes palliative care off his table here. His argument suggests to me that such care needs to be the centrepiece of the doctor’s offering.


Cite this as: BMJ 2011;342:d3184


  • Competing interests: None declared.


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