Intended for healthcare professionals

Re: Why I decided to provide assisted dying: it is truly patient centred care; response to Regnard et al (Feb 5th)

Can six senior Palliative Care (PC) consultants [1] really have ignored the main thrust of my letter?[2] Several senior Belgian PC physicians were prominent advocates of legalising Medical Aid in Dying (MAID); Dr Buchman's account of his conversion to pro-MAID is only the latest of numerous similar accounts from PC physicians. Where it is legal, many PC physicians have felt able to involve themselves, whether simply agreeing to refer patients or actually administering lethal medication. Some did so easily, others after much heart-searching; others still refused. The Australian survey I referenced is the most recent evidence that in most Western countries except Britain, PC physicians have a wide range of views about MAID and feel free to express them. Among mainly Arab and Muslim physicians, a similar spectrum of views exists,[3] though even passive euthanasia (something British PC physicians carry out every day) is a step too far for some. I asked not whether but why similar diversity is seemingly absent in British PC. Regnard et al did not answer.

I wrote that I ‘suspected’ that pressure from senior clinicians explained the total absence of pro-MAID expressions in British PC (Prof Ahmedzai’s brief, unrepeated excursion excepted). In reality I am almost certain of it, because My Death, My Decision knows of junior clinicians in PC who have been told that if they join MDMD or publicly express support for MAID, their careers will be at risk. That is why medical and nursing professionals will soon be able to both join MDMD and take part in the debate anonymously.

When abortion was debated in the mid-1960s, many gynaecologists opposed decriminalisation but many also argued for it. When the law changed, the dangerous complications of back-street abortion disappeared from casualty departments almost overnight. Few gynaecologists (or politicians) now argue for repeal, even if there is still debate about time-limits (as there is with MAID).

Finally, Regnard et al selectively quoted what Michael Irwin and I wrote about British PC physicians. We did indeed write that they were “in some very important respects, unfit—or at any rate, much less than ideal -” but the sentence continued: “- for a medical specialty that deals every day with human beings holding diverse views on one of the most important stages of our life.” No MAID campaigner doubts the value and importance of good PC, or the dedication and sincerity of its practitioners, any more than abortion campaigners doubted the need for good obstetric care. Successful campaigning for MAID has mostly happened in legislations that already had good PC facilities. When it legalized MAID in 2002, Belgium already had excellent PC. British PC physicians are unique in their anti-MAID conformity. Either it is enforced or it genuinely reflects a uniform world-view that is held by all British PC clinicians. Both explanations are surely worrying.They have not always “been too quiet [or] respectful and considerate of the views of others”, particularly of those ‘others’ who are their patients.

1. Regnard C, Davis C, George R, Oliver D, Anthony-Pillai R, Proffitt A. Rapid Responses to Buchman S. Why I decided to provide assisted dying: it is truly patient centred care, Feb 5th.

2. Brewer C. Rapid responses to Buchman S. Why I decided to provide assisted dying: it is truly patient centred care Feb 4th

3. Abohaimed S.S. Matar B. Al-Shimali H. Al-Thalji K. Al-Othman O. Zurba Y. Shah N. Attitudes of Physicians Towards Different Types of Euthanasia in Kuwait. Medical Principles and Practice. 2019. DOI: 10.1159/000497377

Competing interests: I have been active in the right-to-die movement for over 40 years and am Director of Campaigning (medical) for My Death, My Decision, a pro-choice organisation.

06 February 2019
Colin Brewer
Retired psychiatrist
My Death, My Decision
London SE1