Re: Assisted dying
25 June 2012
In Dr Godlee’s editorial, she has highlighted that the recent poll commissioned by Dignity in Dying found that 62% of 1000 GP surveyed has supported neutrality on the issue of assisted dying, but did not seem to give as much weight to the survey of doctors’ attitudes on euthanasia and physician-assisted suicide done by Professor Seale in 2009 (Ref 1), which sampled a much broader spectrum of doctors, including neurologists, specialists in care of the elderly, palliative medicine and other hospital specialties, which showed that 65% doctors surveyed are against assisted dying.
It is true that the decision to changes in law with respect to assisted dying rests with the society and the parliament. However, it has been shown that despite repeated lobbying by the pro-assisted dying groups, we are nowhere near to legalising assisted dying, as shown by the defeat of Lord Joffe’s Assisted Dying for the Terminally Ill Bill in 2006 (which is closely modelled on the Oregon Death with Dignity Act), the defeat of Margo MacDonald’s End of Life Assistance (Scotland) Bill in 2010, and the endorsement of the DPP policy on assisted suicide. This is precisely because the law exist to protect the vulnerable, and it would be extremely difficult (if not impossible) to set up adequate safeguard to ensure that patients are protected adequately.
I respect personal autonomy and individual’s right to self determination, and have great sympathy for patients with terminal conditions who are suffering from unrelievable pain, be it physical or psychological. I also have great sympathy for Tony Nicklinson, the gentleman with locked-in syndrome who is campaigning for the right to die. However, as a member of society, I think there should be a limit to an individual’s choice when it has profound impacts on others. Changing the legislation to allow for physician assisted dying will have a wide impact on society, particularly a negative impact to the terminally ill and disabled. For those who have not entertained the idea of committing suicide, the legalisation of assisted dying may make the sick and vulnerable feel obliged to choose this option for the wrong reason, such as for financial reasons or for feelings that they are burden to their family or society and create a lot of anxieties. Furthermore, if we use individual’s right to self determination as one of the principle arguments for allowing physician assisted dying, there will invariably be cases whereby patients who are not terminally ill but have chronic conditions that cause them to suffer unbearably would also seek doctors help to end their life. We would be in real danger of the slippery slope.
Should assisted dying be legalised, it would be necessary for doctors to play a fundamental role in the process, be it assessment of the patient, prescribing a lethal medication or overseeing the suicide of the patient (and to deal with any complications that arises from botched suicide). One of our underpinning professional code is to ‘do no harm’ to patients. Patient entrust their health and life to us. If our role as doctors encompasses any form of intentionally killing of patients, it can irrevocably damage the doctor-patient relationship, and erode the trust given to us. It may have a particularly negative impact on vulnerable patients and make them fearful of seeking medical help from doctors. Therefore I think it is irresponsible for us to take a neutral stance on such an important matter.
1. Seale C. Legalisation of euthanasia or physician-assisted suicide: survey of doctors’ attitudes. Palliat Med2009;23:205-12
Competing interests: None declared
Kingston Hospital, Galsworthy Road, Kingston upon Thames, Surrey KT2 7QB
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