Assisted dying: MPs hear evidence from doctors as Westminster mulls changes

Differing views from palliative care

Owler’s comments on palliative care were in response to concerns raised by Roderick MacLeod, a palliative care specialist who opposes assisted dying based on his 30 year career, including periods working in Australia and New Zealand. He retired from practice in 2019, before New Zealand legalised assisted dying in November 2021.

“Requests for a hastened death are not uncommon in palliative care,” MacLeod told MPs. “What I know from my own practice and the practice of my colleagues is that after a length of time in the palliative care service, those requests for hastened death melt away.”

He said feedback he had from colleagues still working in palliative care was that it was now harder for them to have meaningful discussions with patients who expressed wishes to hasten their death because specialists are “fearful of stepping outside the law by being seen to be attempting to change somebody’s mind.”

But Chandana Banerjee, a US physician who is associate professor of hospice and palliative medicine at City of Hope National Medical Center and a provider of Medical Aid in Dying in California, challenged this view. “My own practice with patients has allowed me to have conversations on a much deeper level with them,” she said. In her written evidence to the committee,3 Banerjee said that in her experience, patients who acquire drugs to end their life don’t use them. “Simply having the prescription or drugs at hand allows them the peace of mind knowing they have the option to use them.”

UK moving slowly

Polling4 suggests almost three quarters of people in the UK (73%) support changing the law to allow doctor assisted suicide for people with a terminal illness, and a growing number of medical organisations have adopted neutral positions in recent years (see box).

Yet of the four UK nations, only Scotland has a bill currently going through parliament that would enable assisted dying for terminally ill adults.

Portugal recently became the latest country to pass legislation making medically assisted euthanasia legal,5 following countries including Belgium, Canada, Germany, Luxembourg, the Netherlands, and Spain. Others like Australia, New Zealand, and some US states have legislated for more restricted forms of medically assisted dying that are limited to people close to the end of life.

Giving people autonomy

Owler told MPs that when his committee drafted instructions for the legislation that was introduced in Victoria, the debates were similar to those currently happening in the UK. “There was a lot of controversy, but by the end of the process the act of passing the legislation was not the controversial high profile media story that it was at the start,” he said.

Owler said his committee and politicians heard “very powerful testimony” from the coroner, families, and first responders that had a big impact on their thinking when they were considering potential law changes.

He described cases of terminally ill people taking matters into their own hands by ending their lives using firearms or hanging. “In Victoria about 50 people a year were taking their lives in quite horrific ways,” he said. “That’s the sort of path that we were trying to stop with this legislation. It’s about understanding people’s autonomy, their decisions, and their choice about the timing and the manner of their death when they are suffering and when they are dying.”

What role should doctors play?

In the context of the BMA’s shift to a neutral position on assisted dying in 2021, the panel was asked what role doctors should be playing in the debate.

Owler said that local branches of the Australian Medical Association typically adopted a neutral approach and contributed in “a very constructive way” to the development of the policies around the legislation. His committee tried to design legislation so that it wasn’t seen as “a fringe activity” but was simply part of good clinical practice, he said. “We want to make sure that the ties between patients and their doctors are still there. We’ve got to recognise that some people make a conscientious objection and respect their views, but we want to keep those relationships intact, including with palliative care.”

Checks and safeguards

The committee also heard from Kyam Maher, a member of the legislative council in the parliament of South Australia, who introduced the state’s voluntary assisted dying legislation in 2020 before it became law in 2021.

Maher said the three years of data from Victoria suggested that the changes were working well in terms of operating safely and lawfully, and in terms of the increasing the number of people seeking to access voluntary assisted dying. Feedback was “overwhelmingly” positive from the public and the medical profession. “There is no mood to go back. Of course, there will always be opponents and although we respect their opinion it’s important that access be maintained and that people have a choice about the timing and manner of their death.”

Maher added, “If there is any frustration in terms of the legislation, it’s that the process to access the drugs is onerous and that can be difficult for some patients. But in some ways it has purposely been made difficult because we want to make sure that all of those checks and balances are in place.”

US perspective

The two US physicians who gave evidence presented contrasting views on law changes that have been enacted in 10 US states.

Lydia Dugdale, a primary care doctor and director of the Center for Clinical Medical Ethics, Columbia University, who is opposed to any form of medically assisted dying, told MPs that hastening a patient’s death was “not consistent” with her view of what medicine is, and suggested that third parties rather than physicians should be responsible for dispensing the lethal drugs.

Banerjee disagreed. “I consider it a medical practice. It is optional and highly regulated, which makes me comfortable as a provider because I know there are multiple checks and balances along the way to make sure that patients are using it appropriately.”

Dugdale said she was concerned about the lack of oversight once drugs are dispensed. She warned that US states may later relax laws to remove some checks and balances, which she argued had happened in Canada and made it too easy for people to access assisted dying.

But Banerjee said that from her perspective working in California, there is a “highly regulated” environment in the US that is “not the same as what happens in Canada or Switzerland” because it was not euthanasia and there were a higher number of checks and balances at every step.

“If the UK was to look at implementing some form, they should do it the way the US has, with the appropriate guardrails in place,” she said.