Assisted dying: what’s disability got to do with it?
BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3446 (Published 26 August 2009) Cite this as: BMJ 2009;339:b3446
All 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.
The BMJ and its professional audience very properly insist
that proposed interventions be evidence-led.Yet the reform discussed here
,(i.e. essentially the clarification and strengthening of law to protect
individual choice at the end of life )has been depicted by opponants as
both unenforceable and a threat to all people with disabilities.The most
relevant hard evidence available in this context is (1) that a big
majority of Britons support reform and (2) that a small number of people
with progressive disabilities ,such as my late wife, yearn, as law
abiding,courageous people of sound and non-suicidal mind, to be able to
make a considered choice about their own life.The law can readily be
tailored to this group.
Yet opponants repeatedly claim that all disabled people are gravely
threatened by the reform, that Parliament is incapable of drafting
legislation that can be enforced, and that British society consists of
dysfunctional families in which the young scheme to murder the frail and
dependent old, and would do so more successfully if the old had a legal
right to make personal choices. Bring on the evidence!We would never have
a ban on smoking if opposition of this kind were treated at least as
seriously as the medical science.
Competing interests:
None declared
Competing interests: No competing interests
You might all like to know my Staff Home Page has alerted me to Suicide Prevention Week:
"Suicide. Don't hide it. Talk about it."
The slogan?
Competing interests:
None declared
Competing interests: No competing interests
Tony Delamothe argues that it is "time for a carefully worded secret
ballot" of UK doctors, having reported that 79% of the general public in a
Harris poll believe in a 'right to die' for the terminally ill.
The need to clarify medical views on this subject was precisely what
motivated my own recently published survey of a large, representative
sample of UK doctors on this subject (1). The questions used were exactly
the same as those used in surveys of the general public in regular British
Social Attitudes surveys which, like the Harris poll, have demonstrated
substantial public support for the legalisation of assisted dying.
The survey showed that the majority of UK doctors are opposed to the
legalisation of euthanasia or physician-assisted dying, whether in cases
of terminal illness or not. There are some variations between different
groups of doctors, the most significant of which are whether a doctor is
religious or not. Doctors specialising in palliative medicine are the most
opposed, with doctors specialising in care of the elderly being the next
most opposed.
These findings are consistent with studies in several other countries
where careful comparisons of medical and public opinion have been done.
Yours, Clive Seale
(1). Seale, C. (2009) Legalisation of euthanasia or physician-
assisted suicide: survey of doctors’ attitudes Palliative Medicine 23, 3,
205-212
Competing interests:
None declared
Competing interests: No competing interests
What a refreshingly perceptive article from Tony Delamothe.
I am strongly supportive of the right of anyone disabled to have the same
choices as the able-bodied.
That means to me in this debate the right to choose the timing of death
for those suffering at the end of life.
No-one needs to participate who does not choose to do so whether disabled
or not.
Dr Liza Macdonald
Competing interests:
None declared
Competing interests: No competing interests
I agree with the gist of 'Assisted dying: what’s disability got to do
with it?' (August 26th), the disability lobby is always in danger of
hijacking these issues. However, as a patient and someone with a
disability it would be nice if medics were more vocal, the BMA has taken a
position of netruality in the past on euthanasia as have the Royal College
of Nursing.
Competing interests:
None declared
Competing interests: No competing interests
The disabled have been a disadvantaged group in our society for some
time, but this has changed greatly in the last decade or more. Yet the
opposition from this group to both Lord Joffe’s failed bill and to Lord
Falconer’s failed amendment suggest that the disability group remain
convinced that society does not value them and does not respect them.
There is a failure of the disability group to recognise that the Right to
Live and the Right to Die require equal support. We live in a society
where patient choice is one of the highest priorities, especially in the
health service. If there is true choice for desperately ill and terminally
ill to refuse treatment, then it seems illogical that these same patients
should not have a choice about when to die.
The attempted change in the law is about an individual who has capacity
and who is terminally ill making an informed decision for himself or
herself that they wish to die.
There is no evidence from Oregon State, USA, that the disabled group
have been abused where assisted dying has been legal for the past 10 years
Competing interests:
Board of Dignity in Dying
Competing interests: No competing interests
Let us be clear. The issue is about whether or not terminally ill,
mentally competent adults should be able to choose to receive help to end
their lives. Some disabled people may fall into that category. If so,
they should have the right to choose, along with everyone else.
However, when people like Baroness Campbell, who has stated publicly
that she personally does not want to have the right to choose, use the
fact of their disability to bolster their campaign to prevent anyone from
having the right to make the choice, then they should rightly be
criticized, and the BMJ should be applauded for providing a platform for
that criticism.
Competing interests:
Chairman of the Board of Dignity in Dying
Competing interests: No competing interests
Dear Sir,
The sense of doom over lives lost in Afghanistan was heightened by
the observations penned by Tony Delamothe (ON THE CONTRARY BMJ August 29,
2009). Why emphasise Baroness Campbell's desire to live? That is her
basic right. We live in a democracy.
Baroness Warnock's view of the disabled "the vulnerable about whom we
hear in my experience, all too much" was shattering.
Baroness Hale is the advocate who is serious about "protecting
autonomy". One wonders how much autonomy any of us has about anything.
You can refuse treatment in a NHS hospital. However you have no right to
demand treatment not considered in your best interests - no autonomy
there.
In October 1933 the New York Times disclosed the Nazi aims when the
Ministry of Justice issued a memorandum outlining its plan to authorise
physicians to end the sufferings of incurable patients "in the interests
of true humanity". Dietrich Bonhoeffer's psychiatrist father refused to
pursue the management of his vulnerable patients.
Results from polls do not decide government policy. That is why we
vote in general elections.
Yours faithfully,
Dr Mary Knowles
Competing interests:
None declared
Competing interests: No competing interests
The 'disabled' are not an homogeneous group with a unifying interest.
It is as ridiculous to speak of disability as 'heroic' as it is to exclude
us, and it is patronising for anyone engaged in this kind of social debate
to claim to be speaking 'on behalf of the disabled' the 'leaders' that
Tony Delamothe referred to are appointed to their lucrative jobs in
government quangos by politicians, They are not elected. While their
opinions are honestly held and need serious consideration, they are
personal opinions and do not accurately reflect the breadth of opinion of
the disabled community.
People with disabilities represent as wide a spectrum of opinions as the
able-bodied. People with disabilities vote Green or BNP in pretty much the
same percentages as society as a whole, the polls that have separated the
views of the disabled have found that opinions on assisted dying are
pretty much the same across society. This debate, the right of competent
adults to make life choices for themselves, needs to be debated honestly
and openly without recourse to spurious claims of disabled people opposing
the discussion.
I am involved as a 'simulated patient' at Leeds Medical School and in
various capacities on Nurse training courses in Yorkshire and my
experience is that other service users confirm the accuracy of the polls.
a majority in favor of a change in the law, some opposed and certainly
some serious concerns aboutt safeguards.
As a disabled women i am concerned that we are portrayed as capable,
competent and valuable members of society. I may make decisions others
disagree with even bad ones but i demand that my right to make them is
respected, the medical profession is beginning to consider patient choice
rather than 'doctor knows best' thinking, We don't need to be set back
decades by exchanging that for 'Baroness Campbell knows best'.
Competing interests:
None declared
Competing interests: No competing interests
A scheme for assisted dying
Dr Delamothe's review of the recent literature on assisted dying (BMJ 26 August 2009) indicates that there are important objections to changing the law which will have to be met.
The Objections
1) Ethical and Religious: These have to be accepted and those with these beliefs exempted from any participation.
2) A Scheme for Acceptance: Any concept would be best tested over a period of (say) two years with accurate documentation reviewed by an expert group. An initial scheme probably should be over rigorous to satisfy (as far as possible ) objectors. So it might be simplified at review.
Conditions to be fulfilled
1) Is the person of sound mind?
Certified by a GP and a consultant psychiatrist
2)Is the person depressed so as to affect the request?
The absence of relevant depression should be certified by an GP and consultant psychiatrist
3)The terminally ill: Are they receiving appropiate treatment?
This should be certified by a palliative care specialist or a GP
4)Is their undue influence from beneficiaries? (either from inheritors or those paying for care)
This should be certified by a lawyer and (maybe, initially) by a judge.
5) A record of these data and the means of death including any complications should be lodged with the reviewing group (See above)
This could be the responsibility of an Authorised Person--a doctor or lawyer probably.
These proposals would incur costs--fees--which might be met from charitable sources in the test period.
Competing interests:
None declared
Competing interests: No competing interests