Assisted dying: the debate goes on
BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7518.0-d (Published 22 September 2005) Cite this as: BMJ 2005;331:0-dAll rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Whilst I welcome the debate which should help us crystallise our
thoughts on this subject, there is a disparity of space given to opposing
views. However this is compensated by the excellence of the article by
George, Finlay & Jeffery.
During my clinical career in paediatrics I cared for handicapped
children, and their families, in the community. A proportion of these
children died from causes related to their various conditions; but
invariably lived fulfilling lives up to their natural end.
Therefore I was particularly appalled by the report that therapeutic
killing had been extended to children in the Netherlands, so making any
talk of autonomy fatuous.
This leads me to personally endorse the statement that safeguards
have no ethical basis once any form of assisted suicide or therapeutic
killing is sanctioned.
Patricia Daymond FRCPCH.
Competing interests:
None declared
Competing interests: No competing interests
THE GUILD OF CATHOLIC DOCTORS
The Secretariat, Brampton House,
Hospital of St John and St Elizabeth
60 Grove End Road, London NW8 9NH
Registered Charity No. 1002374
From0208 741 5708:
Telephone: 020 7266 4246
Fax: 020 78064001
23rd September 2005
Editor,
It should be recognised that on the very day of our birth we join the
route to death. This uncomfortable notion has been often emphasised in the
past, but deserves recognition in the debate on assisted dying .The route
may indeed be limited for some, but the majority travel hopefully for many
years, particularly in this century. In previous centuries death was
frequently painful and unavoidable but with advances in medical technology
it has at least become manageable. Certainly the current debate serves a
useful purpose in that ‘death and dying’ is now discussed openly and the
prohibitions which Elisabeth Kubler-Ross did so much to overcome have now
been abolished .(1)
Under his heading of ‘Utilitarian defence of Euthanasia’, your
correspondent Torbjorn Tannsjo states that although effective palliative
care will keep patients free of pain, they may request euthanasia for
reasons other than pain. He rightly points out that some, who in their
prime were blessed with full autonomy over their lives, now find it
humiliating to ‘continue living, experiencing mental and physical decay’.
A request for euthanasia is often a cry for help or relief, rather
than a sincere wish to die. Almost half the patients in Oregon who
requested physician assisted suicide retracted their request after
initiation of treatment, such as adequate pain control, anti-depressant
medication or referral to a hospice.(2). However, among those who did not
receive active symptom control, only 15% changed their minds. (3)
It would thus seem, that before this legislation is passed, there
should be a deeper analysis of the issue, with better ethical
contemplation and less of the biased public surveys. With regard to the
BMA one would humbly suggest a greater analysis of the result of its two
day conference conducted in 2005, in which I took part. Most members,
with whom I associate, regard the decision taken in June this year as
entirely unrepresentative of the Association as a whole.
1. Elisabeth Kubler-Ross, On Death and Dying, Tavistock Publications, 11
New Fetter Lane, London EC4P 4EE
2. Ganzini L. et al. Physicians Experience with the OregonDeath with
Dignity Act. New England Journal of Medicine 2001; 344:605-607
3. Ibid..
Yours sincerely,
Dr. Peter Doherty,
Editor, Catholic Medical Quarterly.
Master. Dr Chris Harrison MBBChir, MRCGP, DGM, DRCOG. Secretary: Dr.
John Morewood MB., MRCGP., Registrar: Dr P Henshall, MBChB, FRCPCH, DCH.
Treasurer: Dr fan McD Jessiman, MA, MB, B Chir, FRCP
Competing interests:
None declared
Competing interests: No competing interests
Concern re risks to the vulnerable
I am very concerned at the risk to those who are vulnerable and feel
a burden in their frailty and dependance, and also the risk to my
relationship as a GP with my patients. Many years ago I accepted standards
when training that meant I could face a patient without him or her fearing
that my attitude to their illness might be coloured by expedience or the
pressures of those on whom they were dependant. I have had experience of
working with hospices and seen the way that a patients dignity can be
preserved without ending their life. Like most of my colleagues I have
seen 'bad deaths', but the step to legalise euthanasia or physician
assisted suicide, despite rigorous rules (The Netherlands have had rules)
will not just help that suffering, but will have a major effect on the
trust in the medical profession. It will also affect the attitude of some
in the professions regarding the desirability or acceptability to take
decisions on a much broader basis. The number of unregistered cases of
physician assited suicide in The Netherlands proves that the profession
are not immune to this risk.
The risk is obviously extended into areas of even greater concern by
allowing euthanasia in children, and those unable to make a decision.
Competing interests:
None declared
Competing interests: No competing interests