Intended for healthcare professionals

Rapid response to:

Letters Assisted suicide

Time for safety and consistency

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3137 (Published 04 August 2009) Cite this as: BMJ 2009;339:b3137

Rapid Response:

Ethical argument should lead legislation not the reverse

I felt it important to respond to the reply to my letter as I am
always bemused by arguments that begin with a statement of self-proclaimed
superiority. Julia Cumberlege is of course entirely correct that the law
should not be used to deal with the detail of complex moral issues such as
physician assisted suicide. It is a very blunt tool.

However, currently accepted practice (such as the doctrine of double
effect) allows whatever appears to be lawful medical practice at the end
of life to go unquestioned; there are no stops, checks or balances in
place. It occurs in a regulatory vacuum. Unmasking inappropriate practice
relies on someone both recognising its occurrence and reporting it.

An obligation to accurately document the reasoning behind the
treatments given, or withheld, at the end of life, together with formal
audit, would improve this situation. Whilst this is recognised as best
practice legislation does not demand such detail.

With regard to the trust developed between a clinician and their
patient it is indeed essential for good care. This trust has nothing to do
with the either the patient or clinician’s personal views. It is built
upon mutual respect and a demonstration by the clinician of a respect for
their patient’s autonomy. Facilitating the actions that follow from the
choices made by a patient who has chosen to end their life in a controlled
manner is nothing more than an demonstration of that respect.

If we accept Julia Cumberlege’s argument, our ethical choices are to
be limited by the ability of our legislative bodies to frame laws that
place wisdom & judgement at the heart of end of life decisions.
Perhaps it is naïve, but is this not the legal tail wagging the ethical
dog?

Competing interests:
None declared

Competing interests: No competing interests

13 August 2009
Peter-Marc Fortune
Consultant Paediatric Intensivist
Royal Manchester Children's Hospital