Legalisation of assisted dying does not harm palliative care, study concludes
BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d6779 (Published 24 October 2011) Cite this as: BMJ 2011;343:d6779All rapid responses
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Clare Dyer asserts that the legalisation of assisted dying does not
harm palliative care. The recent article from the European Association for
Palliative Care (EAPC) which she quotes does not reach this conclusion.
Within this report there is little substantive support, either in the
indicators of palliative care or within the scientific literature review
to indicate that the provision of palliative care is advanced by a change
in the law. The authors admit 'the difficulty in finding measures of
palliative care to allow meaningful comparisons'.
The EAPC article does however highlight the need for the continued
development of palliative care. It confirms the need for expertise and
skill in helping patients and families as they face end of life issues.
The authors stress the need to establish quality palliative care to all
who need it. This should be the priority before changing the law regarding
assisted suicide and euthanasia. The present law protects the vulnerable.
The EAPC paper notes that the countries with legalised killing at the
end of life have fewer fulltime palliative care doctors and 'the
involvement of palliative care is one thing but the degree of expertise
and experience is another'. Palliative care provision in Belgium and
Netherlands, two countries with a euthanasia law, still have 'important
improvements to be implemented' in palliative care.
The conclusion to the EAPC article is worth repeating, 'we recommend
that it is essential that nations that are considering legalising
euthanasia or assisted suicide establish equitable, accessible and
affordable palliative care and ensure a broad national structure for the
provision of palliative care services'.
Palliative care must be offered to all before a law that protects
vulnerable patients is reviewed.
Competing interests: Chairman of the Board of Directors of The Care Not Killing Alliance
Clare Dyer is wrong to state that Lord Falconer's Commission is
independent. At its Annual Representative Meeting in June the British
Medical Association, representing 140,000 British doctors, questioned the
stated impartiality and independence of the Commission on Assisted Dying,
supported the BMA leadership's stance in not giving evidence to it and
called on the BMJ Editorial team to present balanced and unbiased coverage
of the Commission.
Falconer's commission is unnecessary, unbalanced and lacking in
transparency. Nine of his twelve commissioners have publicly supported a
change the law to allow assisted suicide and the remaining three are
certainly not against it.
The BMA is therefore one of over 50 organisations which refused to
give evidence.
The motion, all five parts of which were passed by a clear majority
on a show of hands, reads as follows:
* 305 Motion by THE AGENDA COMMITTEE (Motion to be proposed by the
YORKSHIRE REGIONAL COUNCIL): That this Meeting:-
i) notes that the significant majority of members of Lord Falconer's
Commission on Assisted Dying are publically in favour of assisted suicide
and euthanasia;
ii) supports the BMA's stance in not giving evidence to the DEMOS
Commission on Assisted Dying;
iii) questions the stated impartiality and independence of the Commission
on Assisted Dying;
iv) requests the BMA Ethics Committee to make the Association's opposition
to assisted suicide and euthanasia clear to the Commission on Assisted
Dying;
v) requests the BMJ editorial team to present a balanced and unbiased
coverage of the Commission on Assisted Dying.
The study reported by Clare Dyer rightly notes throughout the methodological
difficulties, the differing health care delivery systems, and the varying
cultural contexts in the countries considered. This report, financed by
Demos for the Commission on Assisted Dying, adds nothing to the debate on
whether we should legalise assisted suicide or euthanasia.
Competing interests: Chair of Advisory Group of the Care Not Killing Alliance
No real conflict
An interesting contribution to the debate about assisted dying but
surely the main point is that palliative care and assisted dying have -
or should have - the same aim : to ease the overall suffering of the dying
patient so that death occurs in a timely and appropriate manner in the
place of the patient's choice. We would not argue against developing
surgical services for cancer in case it diverted resources away from
oncology but for how one might best develop a balance. Nor would we argue
against surgery as such because one day it will be unnecessary for many
cancers treated in that way now. The motives likely to make someone decide
on an assisted death are often not those amenable to conventional
palliative care and the argument that given enough resources palliative
care can remove any wish for an assisted death is unrealistic -
financially as well as ideologically.
Despite the remarkable progress of
palliative care in the past 40 years and the vast sums of money spent on
the last few weeks of life of dying patients, the pressure to allow
assisted dying has never been stronger. The present system does not
protect some of the most vulnerable - witness the decision of those who
feel obliged to shorten their lives , eg by going to Dignitas , whilst
they still have a quality of life. In the context of terminal care the
vulnerable are those who are obllged, come what may, to go with the
system and accept on balance what the caring team decides is best for
them. One only has to think of the arguments used to negate advance
decisions to realise just how unwilling many doctors are to pass any real
level of control to the patient. It is depressing that those who oppose
assisted dying just use "the vulnerable" as some sort of war cry , but
refuse discussion about how this undefined group might be protected. Even
the proviso that the best palliative care possible should be on offer
fails to satisfy them. It is not a debate based on reason.
Competing interests: Member of Dignity in Dying and Healthcare Professionals for Assisted Dying(HPAD