Would judicial consent for assisted dying protect vulnerable people?
BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4437 (Published 19 August 2015) Cite this as: BMJ 2015;351:h4437All rapid responses
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I believe judicial consent for assisted dying would protect vulnerable people, and most importantly, would relieve unnecessary suffering for those in whom palliative care is, for whatever reason, inadequate. It would also allow more people to die comfortably and with more dignity in their own homes surrounded by loved ones. An acute hospital is not the appropriate place to end one's life, and neither in many cases is an old person's home.
My belief is based on personal experience, not only during years of practice, but also of my own parents' deaths. Of the latter one took place in an acute hospital totally lacking in privacy (not the hospital's fault - it was the wrong place), while the other was an horrendous drawn out death in great pain and indignity in a nursing home, where totally inappropriate interventions prolonged the agony over a 15 year period. That is something I do not want to go through myself, nor do I want the indignity of taking myself off to Switzerland earlier than need be in order to be able to make the journey.
If I have a right to a decent life, I should also have the right to a decent death also.
Competing interests: No competing interests
Having carefully read the article, I find Jacky Davis' informative, factual and well presented. Ilora Finlay's is unfortunately rather full of speculation, much of which is already countered by Jacky. The use of statistics is interesting - Jacky states that assisted deaths account for 0.3% of deaths in Oregon; Ilora states that assisted suicides there have risen seven-fold. Both statements are probably true, but do they refer to the same thing? If they do, the numbers are clearly very small. And it is inappropriate to leave out those who currently commit suicide here or who go abroad - small numbers again, but each number is an agonised human being, let down by the current system - or lack of it.
I note that neither author is a GP. Having spent a professional lifetime in general practice, I would observe that even in multi-doctor practices, GPs strive to give personal care, especially so for the terminally ill, sometimes even out of hours. I find it hard to believe that many doctors would involve themselves in such decisions if they had no prior knowledge of the patient. People who are terminally ill will already have had contact with a number of GPs and specialists, all of whom would have got to know them somewhat. I cannot believe that it is beyond the wit of Man to devise adequate safeguards - and the Oregon example seems to substantiate this.
Lastly, there is an almost separate question as to whether - and how - to involve the law. Maybe the old days of 'trusting the doctor' are gone - but I feel sure that for any doctor, the knowledge that their decision will be reviewed by a legal person before it is implemented would be a profound deterrent to any temptation to make a decision that is open to challenge. I take the point that each party may take spurious comfort from the other's involvement - but I feel that such involvement would make the doctor more, not less, careful.
Competing interests: No competing interests
I have been a GP for many years, and I have attended many patients in their last illnesses. In a few cases, but these were often the most distressing, the patient has asked for help with ending their life, and I have not been in a position to give it.
I totally agree that Ilora Finlay "cherry-picks" the data she uses. To my mind, the fact that, since Oregon law changed in 1997, an increasing number of those previously opposed to it have become supporters, is evidence that what those people feared would happen to vulnerable people has not come to pass. And I note that a large percentage of patients prescribed life-ending drugs in Oregon do not, in the end, use them. The knowledge that there is an available way out, if things get too much, is enough for many.
And I certainly agree that the voice of the patient should be heard in all this. It is my views as a health-care user that led to me making a decision to join HPAD. I would want to have the possibility of assisted dying available to me if I were terminally ill. Therefore, it is only consistent that I should be willing to help to provide such a service, if it were to become legal. It is apparent that more and more of my colleagues are coming to this conclusion, though inevitably lagging behind public opinion.
We are patients too. And one day, it may be ourselves who need this help.
Competing interests: I am a member of Health Professionals for Assisted Dying
All medicine involves uncertainty. Many treatments and operations fail and can increase patients' suffering but are justified by the fact that sufficient patients benefit. The majority of people in the UK have minimal religious faith and time and time again opinion polls have shown solid public support for doctors assisting patients to a dignified death if that is what patients request. Maybe some patients will die "in error" - and the evidence is pretty clear from countries where physician-assisted suicide is legal that this risk is very small indeed - but even if this happens occasionally is it not a price worth paying for patient autonomy in the modern age?
We make similar calculations in medical practice every day. Besides, I think it is a noble thing to do to bring one's life to an end so as to avoid being a burden to one's family. Why should the majority of people in our increasingly secular society (look at the declining figures for regular church attendance) be dictated to by a mainly Catholic, paternalistic minority who for reasons I have never understood - given their belief in an afterlife - are so opposed to euthanasia and abortion?
Competing interests: No competing interests
Ilora Finlay argues against the bill for Assisted Dying for the Terminally Ill.
Yet she muddies the water not only in her opening statement but throughout by referring to ‘assisted suicide’. She does not wish to acknowledge the fundamental difference between Assisted Dying for the Terminally Ill and assisted suicide. Does this show an unwillingness of Dr Finlay to face the swell of public opinion that people recognised that choice should be available for patients with a terminal illness.
Patients who request assisted dying are terminally ill and as such travelled along a road with family or friends, GPs, specialist medical, nursing and other health care professionals. As such the decision to request an assisted death is not a sudden ‘out of the blue’ choice but rather a wish when the quality of life has deteriorated to such a degree that the patient wishes his/her life to end. Surely it is time for opponents of Assisted Dying for the Terminally Ill to recognise that patient choice must be recognised and accepted especially when this is a truly informed choice taken over a period of time.
Dr Ilora Finlay's argument about decisional capacity is not a substantial argument. She, as a consultant palliative care physician, knows better than most that the majority of patients who have a terminal illness and have received palliate care and palliative treatment, have maintained their capacity to consent or refuse treatment. There is also a world of difference between being sad that one’s life is coming to an end and being clinically depressed.
Competing interests: No competing interests
Ilora Finlay's opposition to assisted dying is as myopic as it is absolute. She cherry-picks data like a politician in an attempt to 'prove' her point. She jumps from relative rates to absolute increases as needed and picks single points from complex questionnaires if the favour her argument. She uses examples from countries which have laws totally different from the proposed UK law. It's clear the argument is being lost when this type of anti-scientific discourse is required.
It is also clear that the Palliative Care community are largely opposed to AD which is tantamount to suggesting that they have created a perfect science that can deliver a death free of suffering for all patients. It is naïve in the extreme to take this view; in any case if it were true the debate would be a damp squib as no patient would ever choose AD. Palliative care, wonderful as it is, has a long way to go before it can achieve this goal.
The proposed law is sensible, moral and independent polling shows widespread backing by the public. The history of AD in Oregon shows that the potential problems such as a slippery slope fail to materialise in practice and this doctor is fully in favour.
Competing interests: No competing interests
The "Head to Head " on Assisted Dying indirectly highlights one particular issue. This is not really a medical matter. Doctors would be involved in the diagnosis and prognosis of a terminal illness. Beyond that it should be up to the individual concerned - with some legal-judicial oversight, to make their own decision.
A prescription would be needed but ways to provide it other than the normal route could be found if the normal doctor were unwilling.
Where is the patient voice in this discussion ?
Remember this is Assisted Dying - for people who are in the process of dying - perhaps better termed Self-controlled Dying, and has nothing to do with those not terminally ill.
There is overwhelming support among the Public for this measure - doctors should not stand in its way.
Competing interests: Member of Campaign for Assisted Dying
Re: Would judicial consent for assisted dying protect vulnerable people?
It is difficult to understand Baroness Finlay’s contention that “no serious evidence has been presented that the present law is in need of change”, in the face of the facts in Dr Davis' piece, including the massive public support for law change. However, undisclosed competing interests might help explain this puzzling statement. Assisted dying is, at heart, a moral issue and it would be helpful to have reassurance that there are no undisclosed conflicts of interest at play here, as has been suggested elsewhere.(1)
(1) http://www.theguardian.com/commentisfree/2014/jul/05/right-to-die-assist...
Competing interests: Board member Dignity in Dying and Healthcare Professionals for Assisted Dying