Choice in matters of life and death
BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4384 (Published 03 July 2014) Cite this as: BMJ 2014;349:g4384
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I was surprised by the logic, or rather lack of it, in Fiona Godlee’s editorial of 5th July (BMJ 2014; 349: g4384). In it she produces evidence that ‘austerity’ has negative effects on patients. I do not dispute this. However, she concludes, solely on the basis of the harmful effects of austerity, that health expenditure should rise. Then, with no trace of irony, she goes on to make the (very fair) point that the debate on assisted dying is “not a matter [solely] for doctors.” But then neither is health expenditure, since every extra pound spent on health is a pound not spent somewhere else in the economy – on education to produce better informed citizens, on lowering corporation tax to promote business, or reducing national debt to decrease ‘interest’ on repayment. Note that this does not mean that we should not increase the proportion of national wealth spent on health – not at all. I am simply saying that to focus exclusively on the (undoubted) benefits that would accrue from increased health expenditure without considering the opportunity cost, is not intellectually rigorous.
Competing interests: No competing interests
I struggle to understand why autonomy is hailed as the highest ethical standard? If a person would choose to say, commit a crime, we don't legalise that crime so as to allow them the 'right to choose'. By this I am simply stating that the fact that someone desires to choose something does not mean it should be permissable. I also struggle to understand the argument that because the majority of the public are claimed to by sympathetic to the arguments for assisted dying, that this makes it right? The public, with in most cases little understanding of ethics, culturally now separated form the realities of death, and with little experience of caring for the dying may well be swayed by emotive arguments; however, aren't GPs and hospital doctors who spend their lives caring for the vulnerable, supporting patients and relatives through end of life decisions, in a better position to make an assessment on what really is the right thing to do when someone asks to die? The request to end one's life is an expression of the 'hopelessness' that person is experiencing, and the appropriate response I believe is to offer the care, support, compassion that the individual needs. It is one thing to allow life to end, removing life prolonging treatment appropriately, it is another thing to make the decision to end someones life prematurely. Not only is to do so ethically wrong, it will lead us into an extremely dangerous position, where vulnerable people will have to question, not do they have the right to die, but do they have the right to live? Legalising assisted dying is equivalent to agreeing with those who feel hopeless, it is agreeing that their life does not hold value. And to deny any individual's life value undermines the foundation of this nation's heritage - that every life counts.
Competing interests: No competing interests
Re: Choice in matters of life and death
Last year the Confidential Inquiry into the premature deaths of people with learning disability (CIPOLD) found that, in a sample of 248 people who had died, 48% of the deaths were premature in that, with different decisions and care, they would have survived. Poor implementation of capacity legislation (underscored by a recent House of Lords report) and poor CPR decision-making played their part in the deaths. The recent RCP President bulletin asks the question posed by one fellow as to whether CPR in some situations should be called assault. In reality, it is poor and discriminatory decision-making that is the assault, something ignored in the recent support of assisted suicide by the BMJ's editors.
If the CIPOLD results are extrapolated to the UK, the rate of avoidable deaths is many times greater than that in the mid Staffs scandal. If this is happening in people with learning disability it is possible that it is also happening in other vulnerable patients. The BMJ's editorial on CIPOLD on 29 May 2013 was written by experts in learning disability. It is long overdue for the BMJs editors to stand alongside theses experts and fight for the rights of multitudes of vulnerable individuals.
Competing interests: 30 years in palliative and hospice care