Intended for healthcare professionals

Rapid response to:

Observations Life and Death

What’s wrong with assisted dying

BMJ 2012; 344 doi: (Published 29 May 2012) Cite this as: BMJ 2012;344:e3755

Rapid Response:

Re: What’s wrong with assisted dying

Dear Editor

Two issues have been raised in responses to Iona Heath’s (1) outline of the difficulties she perceives with assisted dying. On each of these matters relevant research evidence exists.

The first concerns the spectre of malign or self interested relatives exerting pressure, which is dismissed by Goldberg (2) who asks where is the evidence for this, and by MacDonald (3) who says legislation can deal with such potential abuses. Cable (4) on the other hand points out that pressures to opt for an assisted death can be felt without overt coercion (which is more or less the argument put forward by Heath).

As long ago as 1995 Julia Addington-Hall and I published survey results (5) showing that family members who had cared for relatives who had died frequently felt that an earlier death would have been better. This was more likely to be the case with children of the deceased who found caring to be more burdensome and restricting of their own lives than did spouses. These relationships held true even when controlling for the level of suffering experienced by the dying person. Elderly women (who are less likely to have a spouse than elderly men) were particularly disadvantaged in this respect. They were more likely than elderly men with similar levels of suffering and symptom distress to be reported as saying they wanted to die sooner.

The second is the assertion by Hartropp (6) that health care professionals in the UK may be discouraged by current legislation from discussing openly their patients’ wishes for an assisted death. In 2006 I published results of a survey of UK doctors (7) which showed discussions of end-of-life decisions with patients were less frequent in the UK than in countries where assisted dying was legal.

As usual, in this highly polarised debate, the evidence is mixed in the degree to which either ‘side’ is supported. But evidence like this can help improve the quality of debate, even if it cannot finally resolve the issues.

For example, the finding about relatives means that it is hard to argue against the view that some kind of subtle pressure, difficult to detect by regulators of assisted dying, might occur; yet it does not resolve the argument of whether this potential harm is a lesser one than the harm done by allowing dying people to suffer in the absence of assisted dying being made available.

Yours sincerely,
Clive Seale
Professor of Medical Sociology
Queen Mary, University of London

1. Heath I. What’s wrong with assisted dying. BMJ 2012;344:e3755.
2. Goldberg D. Where’s the evidence for malign relatives, professionals, or carers? BMJ 2012 344:e4016
3. MacDonald L. Malign individuals would probably be identified with legislation BMJ 2012; 344:e4018
4. Cable RE. Doctors need to perfect the art of allowing patients to die with dignity BMJ 2012; 344:e4021
5. Seale C. and Addington-Hall J. Dying at the best time. Social Science and Medicine 1995; 40,5: 589-595.
6. Hartropp P. Legislation and debate are needed BMJ 2012; 344:e4020
7. Seale C. Characteristics of end-of-life decisions: survey of UK medical practitioners. Palliative Medicine 20, 7, 653-659

Competing interests: No competing interests

14 June 2012
Clive Seale
Professor of Medical Sociology
Queen Mary, University of London
58, Turner Street, London E1 2AB