Intended for healthcare professionals

Rapid response to:

Head To Head

Should doctor assisted dying be legal?

BMJ 2018; 360 doi: (Published 07 February 2018) Cite this as: BMJ 2018;360:k562

Rapid Response:

Re: Should doctor assisted dying be legal?

There seems to be a flaw in most of the comments made by Bernard Ribeiro. Doctors may hold most of the cards but that does not mean we should use this power to thwart well thought out patient views. It is the patient who is anguished. The main role of doctors – and it is in the plural – will be in checking diagnosis, listening to the anxieties of the patient and looking for alternative approaches to help with management.

In the UK one anticipates that both doctors - but not all - and patients will prefer continued medical involvement in the subsequent steps as well. Ideally one envisages ADTI as part of optimal palliative and terminal care. Declining to listen to and engage in a discussion with a patient who wishes to explore the option of ADTI – and emphasis has been placed on the patient being the person to raise the subject - is very reminiscent of those doctors who decline to explore suicidal ideas with patients in case it puts the idea into the mind of the patient. I had thought that that view was long time-expired. It is only a minority of those who wish to explore ADTI who go on to take this option but the reassurance that it is available seems to have a very real value for the majority.

The most worrying view is that some of the argument used by Ribeiro apply almost equally to those refusing CPR or potentially life prolonging treatments and one suspects some blurring of “best interests” between those of the patient and personal views of the doctor. The clash between our duties to prolong life and avoiding unnecessary suffering was neatly summarised by Mahatma Gandhi in his comment that if his child was dying in agony from rabies he would not allow this to happen until all treatments had been exhausted – and one of those treatments would be ending life. In the present context we need to see end of life suffering as not just physical but extending to other distress which we cannot relieve including those essentially existential.

The principal thrust of those arguing for ADTI is that the cost in suffering does not always justify a few weeks of extra life – and dying at a time and in a place of one’s choice, as well as in the company of one’s choice , are added benefits. . The comparison with air line pilots is interesting (I have just returned on a transatlantic flight): yes , I want confidence in the pilo , but I want to choose my own destination.

Competing interests: Health Professionals for Assisted Dying

08 February 2018
Simon Kenwright
Rtd Physician
Stowting, Ashford