Assisted dying is not the same as euthanasiaBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3532 (Published 28 May 2014) Cite this as: BMJ 2014;348:g3532
- Ray Tallis, retired professor of geriatric medicine, Stockport
In a recent response to The BMJ the retired general practitioner Philip Hartropp raised a key point about the misleading nature of the leaflet from the campaigning group Care Not Killing circulated in a recent edition of the journal.1 Hartropp said, “The ‘FACTS’ put forward by Care Not Killing in their leaflet have evidently been chosen to divert the debate away from assisted dying to assisted suicide/euthanasia and away from sensible and evidence based arguments and into the realm of distorting and scaremongering.” He also pointed out that a consultation conducted by the Royal College of General Practitioners (RCGP) from May to October 2013 showed that between 42% and 50% of the college’s membership did not support the college’s current stance of opposition to assisted dying.
I would like to expand on his justified comments regarding the flawed RCGP consultation and to highlight other untruths in the Care Not Killing leaflet.
The leaflet made 12 references to “euthanasia.” It should be made clear that no attempts are being made to introduce euthanasia through parliament in England and Wales. Euthanasia is fundamentally different from what is proposed in Charles Falconer’s Assisted Dying Bill. Under euthanasia laws in the Benelux countries doctors can directly end a patient’s life, at the patient’s request, on the basis of a broad criterion of suffering—not necessarily linked to a terminal illness. In sharp contrast the assisted dying law, as proposed by Falconer and currently legal in the US states of Oregon, Washington, and Vermont, would mean that only mentally competent, terminally ill adults who had a prognosis of less than six months to live would have the choice to take prescribed, life ending drugs. To interchange the terms euthanasia and assisted dying is, to put it simply, wrong.
Alison Davis’ story, as described in the leaflet, is a moving one, and her defiance in the face of her conditions is humbling. Again, however, it must be made clear that her eligibility for an assisted death under the Assisted Dying Bill would have been questionable. One of the many stringent safeguards would be for two doctors to assess the patient independently and reach a consensus on the prognosis and other eligibility criteria. They would have to be very confident that the patient had a terminal illness and was likely to die within six months. Although Davis may have satisfied the criteria for an assisted suicide in Switzerland or voluntary euthanasia in the Benelux countries, these laws are categorically not what is being campaigned for in England and Wales.
Professor Andrew Sims is correct in stating in the leaflet that “assessment of mental capacity can be very difficult.” This is true in a small number of cases. This is why the bill contains the provision of referral to a psychiatrist in the case of doubt about capacity. In cases of real doubt, of course, assisted dying should not be undertaken.
Sims also quoted figures from Oregon, where an assisted dying law has been in place since 1997. He stated that the number of cases of assisted dying had risen by 430% over 14 years. The fact is that, after eight years during which the numbers slowly rose while the practice became embedded in end of life care in Oregon, the annual number of deaths each year from assisted dying has been, consecutively from 2008 to 2013, 60, 59, 65, 71, 85, and 71. The figures have remained reasonably steady over the past six years and actually went down last year. Further, physician assisted deaths have never accounted for more than 0.25% of all deaths in Oregon.
To stick with Oregon, Professor Rob George stated in the leaflet that 49% of people who had an assisted death in 2012 said they didn’t want to be a burden on family, friends, and caregivers. George failed to point out that the three biggest concerns at the end of life raised by those who had an assisted death were losing autonomy (93%), being less able to engage in activities making life enjoyable (89%), and loss of dignity (72%). His point that “only 28% cited insufficient pain management” serves to further highlight that palliative care, no matter how good it is, cannot always alleviate suffering. “Suffering” is a term that goes far beyond pain control alone.
Sims also raised concerns about coercion. If we again turn to Oregon, research has shown that patients requesting assisted dying were “strong and vivid personalities characterized by determination and inflexibility.” Furthermore, if we are worried about coercion, then surely we would want upfront safeguards to ensure that dying people were making an informed decision, in consultation with healthcare professionals? At present the law turns a blind eye to compassionate amateur assistance to die, with motive and consent being investigated after the person has died.
Brendan O’Neill’s argument in the leaflet regarding the Werther effect is a redundant one; under the current legal system many terminally ill people are committing suicide or attempting to commit suicide, and because of the particularly harrowing nature of these cases, media coverage is often widespread. Under the current legislation, or lack of it, people will continue to die in an unregulated and unprotected manner. Crucially, O’Neill is ignoring the fact that under an assisted dying law no more people would die but fewer people would suffer.
O’Neil also said that major disability rights groups in Britain (such as Scope) oppose any change in the law on assisted dying. This is true (although individual patient representative groups are neutral on the issue). However, as Hartropp explained, the stances of representative bodies are often in conflict with the views of their members. Indeed, in a recent poll of over 1000 disabled people 79% expressed support for assisted dying for terminally ill, mentally competent adults, and only 8% said they thought that disability rights groups should be opposed to a change in the law on assisted dying.2
In summary, this leaflet, the people quoted in it, and Care Not Killing as an organisation are deliberately trying to cloud the debate on assisted dying with misleading falsehoods, irrelevant statistics, and unnecessary scaremongering.
Cite this as: BMJ 2014;348:g3532
Competing interests: I am the chairman of Healthcare Professionals for Assisted Dying.