Giving dying people what they wantBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4982 (Published 13 August 2013) Cite this as: BMJ 2013;347:f4982
- Philip Berry, consultant physician1
Near the beginning of his personal view on legalising assisted dying, Noble states: “I recoil from the vision of a society where death is a therapeutic option.”1 This shows an instinctive reaction to assisted dying that may colour his analysis of risks and benefits. To make a patient centred policy we must put aside our feelings about death and our potentially distasteful role in it, and be guided by what dying people want. In most cases this will be comfort in familiar surroundings, which is often achievable. Sometimes, however, it will be the preservation of autonomy to the very end—the ability to pre-empt and avoid the lack of dignity that Noble regards as important but not vital (“Nor should the retention of dignity become a pre-requisite for continued existence”).
A recent paper on the death with dignity programme in Seattle reported that “the most common reasons for participation were loss of autonomy (97.2%), inability to engage in enjoyable activities (88.9%), and loss of dignity (75.0%).”2 Of the 114 people who expressed interest, 40 received a prescription and 24 died after taking secobarbital (quinalbarbitone). Retaining control over their own life seems to have driven the decision. Being a burden to their family did not feature.
A study of patients in Oregon and the Netherlands found no evidence that legalised physician assisted death or euthanasia had a disproportionate impact on patients in vulnerable groups. Those who received assisted dying seemed to enjoy comparative social, economic, educational, professional, and other privileges.3 One study challenged these conclusions,4 questioning the definition of vulnerability and highlighting a preponderance of older patients choosing assisted death, but others have shown that the typical profile is one of an aware and empowered individual.
Cite this as: BMJ 2013;347:f4982
Competing interests: None declared.
Log in using your username and password
Log in through your institution
Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
Sign up for a free trial