My journey from anti to pro assisted dying

I support the move to make doctors’ professional organisations neutral about assisted dying.1 2 As a consultant in hospice and hospital palliative medicine for 27 years, I have, however, been fervently against changing the law in this respect. I remain sceptical about euthanasia (the deliberate ending of a life by an act performed by another person). But in recent years I have radically moved my position on assisted suicide—when a competent person acknowledged to be dying chooses to take a fatal dose of prescribed medication to end his or her own life.

A major factor in my shift has been professional visits to countries where assisted dying is legal. I spent a week in Oregon for the Commission on Assisted Dying meeting healthcare professionals, hospice volunteers, a high court judge, and patients.3 I am visiting professor at the University of Amsterdam, where I teach palliative medicine to hospital specialists and GPs. In both places good local palliative care coexists with assisted dying, as confirmed globally in a report by the European Association for Palliative Care.4 In some real cases of terminal suffering discussed with me in the Netherlands I have sometimes thought that British palliative care would have nothing more to offer—therapeutically or spiritually.

It is patronising to say that a few people should suffer unbearable distress and indignity because palliative care preaches that it values all lives—regardless of how meaningless they have become to their owners. It is inconsistent for palliative care to boast how it enables people to face the reality of dying and decide about place of care but then to deny choice for timing of death. Moreover, it is hypocritical to deny competent patients who are acknowledged to be dying the right to die in the manner of their choosing, while allowing doctors and nurses to choose when to place them on a so called care pathway, which often entails increasing sedation and withdrawing fluids—unintentionally leading to a protracted form of assisted dying, but one that is medically determined.