We must not deprive dying people of the most important protectionBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4311 (Published 03 July 2014) Cite this as: BMJ 2014;349:g4311
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Rob George rightly highlights the difficulty in giving a prognosis of less than 6 months to those requesting assisted dying. But why worry? Those who (the crystal ball subsequently reveals) would have lived for more than 6 months have gained more relief of suffering than those who would have died very shortly without assistance.
Competing interests: No competing interests
I would like to make 2 comments.
First, although we might legislate this to be carefully controlled and monitored, past experience with the abortion act might give cause to consider this as a possible thin end of a wedge.
Secondly, the case for it in the media is understandably made by reference to severely disabled people who are intelligent, articulate and have fully supportive families. Hearts and sympathies go to their very compelling cases. Unfortunately 40 yrs as a G.P. tells me many people are not like this. There is an enormous diversity of culture, intelligence, sophistication, emotional balance, etc. And not all these people get the same publicity. I am very concerned that for many this option may add a great emotional burden to them and their families and create uncertainty, division and anxiety at an already very stressful time. Like a medication that can help but can also do harm I wonder about the harm / benefit ratio.
I worry not passing the bill will deny peace to some but think it would remove a great burden of indecision, anxiety and perhaps guilt from a much greater proportion of the population.
Similar experience as in Oregon may be relevant but, without a very clear understanding of different demographics and culture both of the population and their doctors, perhaps care must be taken in the comparison. Also, I think it is true that, by the nature of records and publicity, where assisted dying is available, we hear more from the aspect of those who have taken up this option – though it must be difficult to judge the emotional cost to many of them. And it is unlikely we will know of those, the more silent majority, who for various reasons have not pursued this option but for whom its very presence has brought greater anxiety and so suffering. I wonder how the overall balance of effect on the population as a whole has been assessed.
On balance, and with a lot of regret, my feeling is that the genie is perhaps best left in the bottle.
Competing interests: No competing interests
Professor George always writes well when opposing assisted dying (AD) , and he highlights several issues which we need to try to resolve, but I remain unconvinced. In particular the length of survival in those who have discussed and accepted the possibility of an assisted death is a questionable argument against being able to discuss that option in the first place. One needs to know how those individuals viewed their survival. Did these patients regret having had the option of AD available? One of the longer term survivors would seem to have had inadequate assessment and then been left with access to the lethal prescription for longer than allowed by law, but chose not to use it. We need to be wary about such loopholes.
In many ways it is a pity that Oregon stopped recording details of survival – it is useful reminder about our fallibility where prognosis is concerned - but in itself that is not an adequate reason for rejecting AD. Where AD is not available, not everyone who survives an initial near death experience earlier in late illness welcomes this survival later on – “God gave me my chance and I failed to take it” as one person put it, later regretting having sought intervention when she might have died. Anyone looking after the really sick will know the true “surprise” question relates to those who are still alive after a year and there will always be those who survive despite the odds. This can apply to those who turn down a variety of anti-cancer treatments and these individuals will be eminently newsworthy, but a “miracles happen” approach is not enough to deny others the opportunity of a more timely and well-planned death. Just how we assess risk-benefit in the context of AD (or the withdrawal of therapy or other decisions likely to affect the timing of the death of patients) will sometimes be tricky but not a good enough reason for ducking the issue. These decisions have to be made as carefully and considerately as possible and involve the patient and family, but asking anyone to endure prolonged suffering at the end of life simply for the benefit of others and Society in general is something which I find hard to accept - unless that is their informed choice.
A major problem that is emerging in the UK currently as regards gathering evidence about end-of-life-care is that those leading inquiries are those where their strong religious faith could have a very real impact on how the evidence is managed. Firstly we had a Rabbi for the Liverpool Care Pathway, which was rejected despite the support of many in palliative care for the LCP in principle , and now we have a retired Bishop leading the look back as to whether opiates may have been used to ease the death of elderly patients in Gosport 20 or so years ago. This potential bias would scarcely be acceptable in any other sphere subject to public inquiry and reinforces the concerns which some of us have that any treatment which might shorten life is under threat. That in turn reinforces the need for an open parliamentary debate as to whether we need a change in the law to allow assisted dying.
Competing interests: Member of dignity in Dying