Call for an evidence based debate on assisted dying
BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d4222 (Published 05 July 2011) Cite this as: BMJ 2011;343:d4222All 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.
Professor John Keown admits that there is an urgent need to improve
palliative and social care for the dying. That there is still such an
urgent need after 20 years of exhaustively debating the issues, may
explain the anxiety - and impatience - of any one of us who, in the
lottery of life, might come to face a distressing terminal illness with
the prospect of inadequate palliative and social care ... and not enough
money to escape to Switzerland.
Competing interests: No competing interests
I have to disagree with Collier who was dismayed by the outcome of
the debated motion at this years' ARM, along with the accusation that the
motion was contradictory1. The BMJ has been viewed by many as publishing
several high profile articles favouring assisted dying, whilst not
offering the same limelight to anti assisted suicide debates. This only
follows the general consensus of the popular press and television,
accumulating in the TV documentary by Terry Pratchett. However, the motion
debated had subtle differences not appreciated by Collier. Whilst the ARM
voted in favour of supporting the BMA's stance not to submit evidence to
Lord Falconers' commission, it did call for the BMA to make its position
clear on assisted dying, including to the commission. This does not equate
to submitting evidence, which will fall on deaf ears, as 75% of the group
are already publicly announcing they favour assisted dying. Instead it
calls for the BMA to voice its opposition as loudly as supporters, and to
call for a neutral stance is also flawed. Like all controversial topics,
there will always be some who do not agree with our associations stance,
but the majority do and that is what democratic organisations do, voice
the views of the majority.
Perhaps Collier and colleagues should be calling for a more balanced,
neutral commission rather than criticising the BMA for standing up for
vulnerable patients. One only has to watch the final moments of the
patient on the Terry Pratchett documentary to see that the selling pitch
of Dignitas that they provide a dignified death is flawed. How can denying
a patient a drink of water be dignified and the sounds of him choking were
heart wrenching, let alone the cold prompt by the clinic organiser to his
wife, telling her she can cry now. Perhaps I am naive as a young doctor,
but I went into medicine to save lives, not to end them.
1. Collier J. Call for an evidence based debate on assisted dying.BMJ
2011 343:d4222doi:10.1136/bmj.d4222
Competing interests: Member of the BMA who attended ARM and voting in favour of all parts of motion 305
The letter from Collier et al makes strange reading.
First, it calls for debate on so-called 'assisted dying' which is
'evidence based'. The issue has been exhaustively debated over the last 20
years and a wealth of evidence has been garnered, not least by two House
of Lords Select Committees and, more recently, by a Committee of the
Scottish Parliament. The issue has, frankly, been debated to death, and
the advocates of decriminalisation have repeatedly lost the argument. The
ongoing debate is, moreover, a distraction from the urgent need to improve
palliative and social care for the dying, the disabled and the
disadvantaged.
Secondly, it criticises as involving an 'inherent contradiction' the
motion that the BMA not give evidence to the so-called 'Commission'
chaired by Lord Falconer (a leading advocate of decriminalisation) but
that the BMA reaffirm its position. There is no contradiction. Is there,
for example, a 'contradiction' in a defendant pleading 'not guilty' and
declining to give evidence?
Thirdly, it suggests that because medical opinion is divided the
profession should adopt a 'neutral' stance. But a clear majority of
medical opinion continues to oppose decriminalisation (for sound reasons).
Why shouldn't the democratic process be followed on this, as on other
issues about which medical opinion may be divided?
Finally, the letter agrees that the media should question the
proposals of those who seek change. Yet the media are, broadly,
sympathetic to voluntary euthanasia and assisted suicide. (An audit of
BBC's television's output on this issue over the past 5 years would make
particularly interesting reading.) The fact that the case for
decriminalisation has nevertheless failed is further evidence of its
weakness.
Competing interests: No competing interests
Re:Talking to a brick wall
I watched and was very moved by Sir Terry Pratchett's recent
documentary on assisted dying. I felt a great deal of sympathy for the
predicament of 'Peter' who was rapidly deteriorating from Motor Neurone
Disease (MND) and chose to die, quickly, predictably and without
suffering, with Dignitas, somewhere outside Zurich. I simply did not
recognise Dr Samuels's curmudgeonly description of Peter's death, seated
peacefully beside his wife. To have provided Peter, at home in England,
with what he wanted, what he needed, that necessary prescription for
Nembutal, adequate for purpose .... would have been the act of kind and
compassionate doctors. I had always wanted to be a member of a profession
that treated people with kindness and compassion: of course, that was when
I was but a naive young man.
Competing interests: No competing interests