Intended for healthcare professionals

Head To Head

Should doctor assisted dying be legal?

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k562 (Published 07 February 2018) Cite this as: BMJ 2018;360:k562

Re: Should doctor assisted dying be legal?

Every jurisdiction that has legalised Assisted Suicide has implemented safeguards - but do they work? Can safeguards permit exceptions to the universal ban on assisted suicide in the UK without an unacceptable increase in risk and a slide down the ‘slippery slope’? What is an acceptable/unacceptable level of risk? Arguments can be found on both sides for and against the slippery slope depending on one's bias and hard factual evidence can he hard to obtain due to the nature of the evidence being sought and the implications of mis-use, abuse and criminality. However, what is agreed is that 'the risk exists and no-one appears to regard it as insignificant' and that it is 'aggravated by negative modern attitudes to old age and sickness related disability'. (1)
Terence English cites Oregon as an example to follow. Yet there have been reports where some terminally ill patients have been refused chemotherapy but have been offered physician assisted suicide instead as it is cheaper.(2) Is this really the type of healthcare we want to advocate? To kill off those we consider too expensive to care for?
There is plenty of evidence to show that safeguards frequently get transgressed, Once that door to Assisted suicide is opened it just gets wider and wider to include those with non-terminal conditions, minors and those just tired of living. Terence English is incorrect to state that fears are not warranted - indeed there is plenty of evidence to suggest the opposite.

It is not just doctors who are generally against Assisted suicide but also disability groups, aged care and religious adherents. It is also interesting that those doctors most involved with the terminally ill and elderly are the ones with the highest rates of being against assisted suicide - those who see that suffering day in and day out - also get to witness profound times of healing, reconciliation, awareness, evolution, growth and coming to peace with oneself and one's life that may not happen when it is glibly circumcised. In the history of mankind, the process of death and dying has been accepted as part of the journey of life and not something that we have control or jurisdiction over and to positively promote such a right is a major shift in our approach to and respect for the process of life and death. As it stands there is currently no legal 'right to die' and it makes a fallacy of suicide prevention programmes to consider that there should be such a right.

The ECHR was created in 1950 by the Council of Europe after the atrocities of the second world war and the Nazi euthanasia programmes which evolved to widespread extermination, to promote human rights and democracy and followed the UN’s declaration of Human Rights 1948 - yet now we have the Netherlands and Belgium euthanasia laws being investigated by the UN because of possible violation of UNDHR, and the risk they present to the right to life.(3)

There is no doubt there is a dangerous slippery slope encountered by decriminalising assisted suicide - one that is a retrograde step in the evolution of healthcare, medical ethics and mankind as a whole. It is telling that we are far removed from the value, preciousness and sanctity of life when we are so willing to dispose of it so readily.

There is much that can. still be done to improve the quality of palliative care, and our approach to healing and resolving emotional pain and existential angst in ways that are truly healing without resorting to killing patients as well as enhancing our whole understanding of life and death.

1) (2014) UKSC 38
2) http://www.foxnews.com/story/2008/07/28/oregon-offers-terminal-patients-...
3) United Nations. Report of the Human Rights Committee. General Assembly, Official Records Vol 1, 2009 New York http://ccprcentre.org/doc/ICCPR/AR/A_64_40%28Vol%20I%29_Eng.pdf

Competing interests: No competing interests

10 February 2018
Eunice J Minford
Consultant General Surgeon
Northern Health and Social Care Trust
c/o Northern Health and Social Care Trust, Antrim, N.Ireland