Head To Head

Should doctor assisted dying be legal?

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k562 (Published 07 February 2018) Cite this as: BMJ 2018;360:k562
  1. Terence English, former president of the Royal College of Surgeons1,
  2. Bernard Ribeiro, former president of Royal College of Surgeons
  1. 1Oxford, UK
  2. 2Hampshire, UK
  1. Correspondence to: T English tenglish{at}doctors.org.uk, B Ribeiro ribeirob{at}parliament.uk

It could help terminally ill people in pain who want control over how they die while protecting vulnerable people, says Terence English, but Bernard Ribeiro worries about a negative effect on the doctor-patient relationship

Yes—Terence English

Definitions are important, so we need to be clear what Lord Falconer’s 2014 Assisted Dying Bill aimed to achieve.1 This was to legalise assisted dying for the specific circumstance of a mentally competent, terminally ill patient who has requested it. Death would occur by self administration of drugs provided by a doctor should the patient’s suffering become intolerable during the last few days or weeks of life.

This does not include euthanasia, when a doctor ends a person’s life by giving the drugs, nor assisted suicide, when a doctor provides drugs for self administration to a person who is not terminally ill.

To be eligible, the bill stated that a patient should have a likely prognosis of less than six months and that the request should be initiated by the patient and no one else. In addition, the patient should have the mental capacity to make such an autonomous decision. Two doctors, working independently, should determine that these criteria have been met. Ideally, the first doctor would be the patient’s general practitioner or a specialist involved in his or her terminal care. Both doctors would need to be satisfied that the patient had been offered or received appropriate palliative care, and if there was concern about the presence of depression affecting mental capacity a psychiatric consultation should be sought. Finally, there was provision of a “conscience clause” for those doctors who, on ethical or religious grounds, were against helping a terminally ill patient to die. …

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