What readers thought about The BMJ’s articles on assisted dying
BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1558 (Published 09 April 2018) Cite this as: BMJ 2018;361:k1558
All rapid responses
Dear Editor,
I was active in the BMA for several years and knew Sir Sandy for about 40 years since the time when we were both members of the Council of the Society of Medical Officers of Health and Sir Tony Grabham even longer from Medical School. Enough introduction.
Most of my contemporaries are now deceased so this may be my last contribution. I had expected long ago that this topic would have moved on, but there seems to be some rigidity of thought and mixed up feelings. I do not want any further publicity, but I proposed a Motion for the next ARM. Some minor clarification in wording was made by Ton Kane to make it votable in sections. As you see the applicants represent the interest of the individual concerned and the doctors only give factual reports. The decision is a legal one. One has to start a process somewhere and I feel this could initiate a way forward.
Although I did go to an ARM in Brighton, I feel others must take up the cause now as I shall not be there. I did send emails to the Chair of the BMA Ethical committee and Professor Wendy Savage with this proposed Motion, but have not heard from either.
“that this meeting believes that there should be a legal process permitting the ending of human life in England, and in the devolved nations.
Such process should include:
i) The subject should be one applicant if competent, and there shall be another applicant holding an enduring power of attorney for the subject, otherwise two applicants each holding a similar enduring power of attorney.
ii) There shall be two independent medical reports, to be submitted with the applications, if possible one from a doctor with prior knowledge of the subject.
iii) The doctor’s reports will not contain any recommendation for further action.
iv) A legally qualified person, not employed by the NHS, will consider the applications and reports and will decide whether or not the life may be terminated.
v) A person properly trained and legally authorised to end life, and who is not employed by the NHS but who is responsible to the legally qualified person who determines the outcome of the application, shall act if approval is given.
vi) No person employed in any profession directly involving health care should be permitted to end life.”
This is limited, but, I hope, tight enough to be a start. It is high time we moved on somewhat. I wish you well in your endeavours.
John Sarginson, retired member of the BMA.
Competing interests: No competing interests
The question “What if a terminally ill patient decided on not having any clinical intervention, knowing that they would die?” if the patient “has capacity” [1] should be responded positively in accordance with the principle of informed consent. The assisted dying, which is quite another question, may be permitted only if integrity of medical personnel can be reasonably assumed [2] because it might be open to abuse [3]. All that should be clearly defind by the Law.
1. Amure LBO. Re: What readers thought about The BMJ’s articles on assisted dying. Re: What readers thought about The BMJ’s articles on assisted dying. BMJ Rapid Response 24 April 2018 https://www.bmj.com/content/361/bmj.k1558/rr-0
2. Jargin SV. Invasive procedures with questionable indications: Prevention of a negligent custom. J Surg Open Access 2017;3(5) https://www.researchgate.net/publication/321245511_Invasive_procedures_w...
3. Twisselmann B. What readers thought about The BMJ's articles on assisted dying. BMJ. 2018;361:k1558.
Competing interests: No competing interests
Assisted Dying.
Sir,
I was one of the guest speakers at a conference at my old college last week on “Ethics, The Law and Patient Choice".
One question I posed the delegates related to the Mental Capacity Act 2005 (MCA).
What if a terminally ill patient decided on not having any clinical intervention, knowing that they would die?
The question of course assumes the patient has capacity, and is well aware that they will die as a result. After all,
the MCA allows one to make ‘the wrong choice’.
No one could give me a satisfactory response.
Sincerely yours
Dr Larry B O Amure
BSc; DO RCPS; B Chir; AIHEA; PhD.
Cambridge.
24th April 2018
Competing interests: No competing interests
Currently the position of a doctor is quite intolerable if a sane suffering dying person already having optimal palliative care requests or indeed pleads for help to die.
According to our shameful law what can the doctor say other than 'I am afraid I cannot do that. You will have to wait for nature to take its course.'
In practice the doctor is very likely to expedite death with drugs.
UK doctors, the medical Royal Colleges and the BMA should be ashamed of allowing UK law to so clearly serve the anxieties of society and doctors and not the desperate needs of the patient.
Gradually the law is being changed in other countries to enable the doctor to give the needs of the patient absolute priority and provide truly patient-centred care.
Dr.Chris Burns-Cox
Consultant Physician (Retd)
Competing interests: No competing interests
Re: "So You Know Where I Am Coming From (SYKWIACF)" Prefaces Religious Belief Competing Interest
“So You Know Where I am Coming From (SYKWIACF)” Prefaces Religious Belief Competing Interest.
Most Editors of reputable Scientific Journals require authors to declare what they call “Competing Interest” or “Conflict of Interest” before their articles are considered for publication. Recently, the British Medical Journal’s editorials and obituaries Editor, Birte Twisselmann had an article with the title ”What correspondents thought about declaring religious belief as a competing interest” in which she summarized admirably the views of 40 debaters (26 May p 267) [1] on “What readers thought about the BMJ’s articles on assisted dying” [2]
Admittedly, in the British Medical Journal’s articles and comments with such ethical dimensions like Abortion or Euthanasia or Assisted Dying or Palliative Care which advocates that water be denied thirsty dying patients, or gene splicing in genomic research – in those articles the terms “Conflicting Interest” or “Competing Interest” neither adequately reflect what the good Editors of the BMJ are desirous to have authors convey to their readers nor what the latter (we the readers) often itch to know about the mind of the authors conveying to us their cogitations often based only on scientific reasoning.
I would have much preferred to preface “So You Know Where I Am Coming From” to what I sometimes gave as Competing Interests in my many BMJ comments on these matters of Ethics [See references 3 to 12 below] before my statement “Believer in The Lord Jesus Christ [Nuntsɔ Yesu Kristo]” which would have placed my Comments in an entirely different Category from those of a doctor with an interest in a Pharmaceutical Company that pays General Practitioners to prescribe Statins [13 14 15], or who may wish to lobby Parliamentarians to make it a law that Statins be put in drinking water for every UK household.
I usually spell out “Believer in The Lord Jesus Christ [Nuntsɔ Yesu Kristo]” to show not only that I am not ashamed of my views, but also that I am prepared to expose myself to ridicule from some very intelligent atheists (some of them half my age) to whom I dare to point out that doctors with the same intellectual capacity and achievements do often differ in their assessment of spiritual matters [16 17 18 19].
I would urge such bright atheists who deify Science, in other words who place Science on an inaccessibly lofty pedestal, to realize that History is far superior to Science when it comes to the validation of certain truths [20], and that there is such a thing as a supra-scientific realm [21 22 23]. The very helpful book of Nobel Prize winner Professor Sir Peter Medawar “The Limits of Science” [24] needs to be compulsory reading for every scientist, atheist or not. Also, I remind young researchers that Professor Lord Solly Zuckerman FRS advises all thinkers not to take everything an eminent scientist says as nothing but the truth. [25 26].
When it comes to matters not involving financial benefit or business connections, in declaring “Competing Interest” or “Conflict of Interest” is there any particular objection to my advocating the use of SYKWIACF which stands for “So You Know Where I Am Coming From” to preface my religious belief declaration?
SYKWIACF: Believer in The Lord Jesus Christ [Nuntsɔ Yesu Kristo]
felix@konotey-ahulu.com Twitter@profkonoteyahul
Felix I D Konotey-Ahulu FGA MD(Lond) FRCP(Lond) FRCP(Glasg) DTMH(L’pool) Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast, Ghana; Former Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies Korle Bu Teaching Hospital & Director Ghana Institute of Clinical Genetics, and 9 Harley Street, Phoenix Hospital Group, London W1G 9AL. [www.sicklecell.md]
1 Twisselmann Birte. What correspondents thought about declaring religious belief as a competing interest. BMJ 2018;361:k2174 [On line BMJ 2018; 361:k1558 April 09 2018]
2 Twisselhann Birte. What readers thought about the BMJ’s articles on assisted dying (9 April 2018) www.bmj.com/content/361/bmj.k1558 “The strongest argument against assisted dying among over 90 respondents from readers to our recent cluster of articles (www.bmj.com/content/assisted.dying) was that under no circumstances should doctors intentionally kill patients”.
3 Konotey-Ahulu FID. BMA AGM 2017 on Abortion – A damning verdict on my genetic defect and family members’ BMJ Rapid Response 30 June 2017 to Abi Rimmer and Rebecca Coombes on “BMA annual meeting: Doctors who carry out abortions should not face criminal sanctions, says BMA” 28 June 2017 BMJ 2017; 357: j1136 June 28 https://doi.org/10.1136/bmj.j3116 | www.bmj.com/content/357/bmj.j3116/rr
4 Konotey-Ahulu FID. Ethics of mitochondrial gene replacement is also ethics of acquired genetic inheritance. BMJ Rapid Response 19 November 2010
http://www.bmj.com/content/341/bmj.c6021/full/reply#bmj_el_244910
5 Konotey-Ahulu FID. Ethical issues in prenatal diagnosis. BMJ Clin Res Ed 1984; 289(6438): 185. July 21. doi:10.1136/bmj.289.6438.185-a 6143955
http://www.bmj.com/cgi/reprint/289/6438/185-a.pdf http://www.pubcentral.nih.gov/picrender.fcgi?artid=1441965&blobtype=pdf
6 Konotey-Ahulu FID. Refusing to provide a prenatal test for reducing later termination of pregnancy can it ever be ethical? BMJ Rapid Response November 20 2006
http://www.bmj.com/cgi/eletters/333/7577/1066#149662
7 Konotey-Ahulu FID. Antenatal sickle cell disease haemoglobinopathy screening. BMJ Rapid Response October 25 2010 [5 references]
http://www.bmj.com/content/341/bmj.c5243/reply#bmj_el_243447
8 Konotey-Ahulu FID. Antenatal screening for sickle cell disease and beta-thalassaemia. BMJ Rapid Response Oct 12 2010 [32 references]
http://www.bmj.com/content/341/bmj.c5132/reply#bmj_el_242914
9 Konotey-Ahulu FID. Doctor cleared of asking nurse to give fatal dose to dying patient: More honest nurses, please 17 September BMJ 2009; 339: b3812
http://www.bmj.com/cgi/eletters/339/sep15_3/b3812#220512
10 Konotey-Ahulu FID. Most religious followers support assisted suicide for the dying: Survey flawed through inadequate definition of "religious” and "terminally ill”. BMJ Rapid Response May 12 2013 www.bmj.com/content/346/bmj.f2855/rr/645095 - to Zosia Kmietowicz BMJ News www.bmj.com/content/346/bmj.f28555?sso 11 May: Most religious followers support assisted suicide for the dying
11 Konotey-Ahulu FID. Liverpool care pathway BMJ and Channel Four News: Majority expert choice does not mean best choice. March 8 2013 www.bmj.com/content/346/bmj.f1303/rr/634971BMJ Rapid Response to "Nine out of 10 palliative care experts would choose Liverpool care pathway for themselves” Krishna Chinthapalli BMJ 2013; 346: 1103 (March 2, pages 2-3)
12 Konotey-Ahulu FID. Scientists call for moratorium on clinical use of human germline editing: A déjà vu of Ethical Caveat! www.bmj.com/content/351/bmj.h6603/rr-0 Rapid Response 16 Dec 2015 to Dr Michael McCarthy’s “Scientists call for moratorium on clinical use of human germline editing”. BMJ 2015; 351:h6603
13 McCartney Margaret. Prescribing incentives feel grubby because they are. BMJ 2017; 357: j2695 (June 5 2017) “Financial incentives are rotten to the core. Money is used to make GP’s prescribe, and then to make us not prescribe”.
14 Chand Kailash. Statins guidance to GP’s is a victory for vested interest over evidence (Opinion). https://www.theguardian.com>jul>stati....
15 Sun Reporter. Patients rejecting Statins because they mistrust GP’s paid to prescribe them – study shows. May 22 2018 https://www.thesun.co.uk>news>patien...
16 Konotey-Ahulu FID. Is talking about God to be banned from clinical care? BMJ Rapid Response 2 June 2011 http://www.bmj.com/content/342/bmj.d3275/reply#bmj_el_261475
17 Konotey-Ahulu FID. Only fruitcakes believe in in GOD? Correction of inverted inheritance of solomonic genius. BMJ Rapid Response 12 May2011.
http://www.bmj.com/content/342/bmj.d2642/reply#bmj_el_260496
18 Konotey-Ahulu FID. The God Delusion title devalues sensible discourse. BMJ Rapid Response www.bmj.com/content/335/7629/1099.1/rr-0 October 19 2016
19 Konotey-Ahulu FID. Personal Answer to The Question "Do you believe in God?" [48 References] BMJ Rapid Response 20 January 2018 www.bmj.com/content/359/bmj.j4669/rapid to Savros Saripanidis “Do you believe in God?” Re: Kevin Barraclough “Do you believe in God? BMJ 319; doi.10.1136/bmj.7214.929a www.bmj.com/content/319/7214/929.2/rr-0 |
20 Konotey-Ahulu F I D. History versus Limits of Science: Is Solomonic genius a Y chromosome Phenomenon? Journal of Genetic Diseases & Genetic Reports 2014; 3: 2-3 http://bit.ly/1wyq5H53 http://dx.doi.org/10.4172/2327-5790.1000114
21 Konotey-Ahulu FID. The supra-scientific in clinical medicine: a challenge to Professor Know-All. doi:10.1136/bmj.323.7327.1452 Brit Med J 2001; 323(7327): 1452-1453 (22-29 Dec) http://www.bmj.com/cgi/reprint/323/7327/1452.pdf
22 Konotey-Ahulu FID. The soul is supra-scientific. BMJ Rapid Response 16 May 2008 www.bmj.com/cgi/eletters/336/7653/1132#195557
23 Konotey-Ahulu FID. The spiritual and the psychological in Clinical Medicine. (Personal View) BMJ 1977; 1: 1595 www.bmj.com/cgi/reprint/1/6076/1595.pdf doi:10,1136/6076/1595 June 15 “There is a vast area of man’s experience called the spiritual realm which neither Freudian psychoanalysis nor the scientific method can fathom…Approaches to scientific truth and spiritual truth are different. One scientist will read Dr Lloyd-Jones’ ‘Spiritual Depression: Its Causes and Cure’ with much profit while another, with the same qualifications, will find it unintelligible” See Lloyd-Jones DM. Spiritual Depression: Its Causes and Cure (Amazon’s Book Store www.amazon.co.uk>Spiritual-De ISBN 9780802813879 [One of top 100 Millennium Books]
24 Medawar Peter. The Limits of Science. Oxford University Press. 1985.
25 Zuckerman, S. Pride and Prejudice in Science. Aerospace Medicine 1974; 45: 638-647. [Also republished in Ghana Medical Journal 1975; 14: 52-60]
26 Dyer Clare. Journal agrees to retract paper after university found study was never done. BMJ 2013; 347:155 http://dx.doi.org/10.1136/bmj.f5500 September 5 2013
Competing interests: SYKWIACF: Believer in The Lord Jesus Christ [Nuntsɔ Yesu Kristo]