Intended for healthcare professionals

Rapid response to:

Editorials

Assisted dying: a question of when, not if

BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n2128 (Published 09 September 2021) Cite this as: BMJ 2021;374:n2128

Read our coverage of the assisted dying debate

Rapid Response:

Too many unanswered questions about 'assisted dying'

Dear Editor

Your editorial (Editorial, BMJ, 9 September 2021) perpetuates myths about ‘assisted dying’ by making it sound like a well-established, evidence-based health care intervention. It is not.

The editorial also leaves many crucially important questions unanswered. How will legalisation of ‘assisted dying’ impact on end of life care? Will people be safe from abuse and coercion if they have mental health problems and/ or are already feeling a burden upon their families or health and social care services? How will two doctors assess a settled wish to die and a lack of coercion especially if they have not met the person before? Will prognostication of life expectancy be accurate? Are the drugs that will be used safe and effective?

Contrary to your assertion that there are no reports of negative impacts on palliative care services in jurisdictions where physician assisted suicide and/ or physician administered euthanasia are legal, there is in fact increasing evidence of significant negative impact including pressure for Canadian hospices to deliver ‘medically assisted deaths’ or lose their statutory funding. None of these jurisdictions collect or report data necessary to determine if people choosing to consider ‘assisted dying’ are safe from abuse and coercion. Several legislatures have expanded eligibility criteria to include people without decision-making capacity. Prognostication is notoriously inaccurate; we get it wrong sometimes over hours and days let alone months. The combinations of drugs in high doses used to achieve physician assisted suicide have not been submitted to scientific scrutiny. The scanty evidence available on how people die after ingesting these lethal drugs suggests that they can cause unpleasant symptoms and death is not necessarily immediate or certain2.

For all these reasons we should heed what health care professionals from Canada, Oregon and Belgium are saying (https://youtu.be/ANS-7P2zcRk; https://www.youtube.com/watch?v=0nvJo15CCuA) and not follow their example.

1 Gerson SM, Koksvik GH, Materstvedt LJ, Clark D. Assisted dying and palliative care in three jurisdictions: Flanders, Oregon and Quebec. Annals of Palliative Medicine; 2020

2 Oregon Death with Dignity Act: annual reports. http://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH...

Competing interests: No competing interests

10 September 2021
Carol L Davis
Consultant in Palliative Medicine
University Hospital Southampton
Mailpoint 86