Should doctors have a neutral position on assisted dying?
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Medical ethics
Should doctors have a neutral position on assisted dying?
Discuss ethical issues with the Medical Ethics department of the BMA and the Institute of Medical Ethics. Please note, the views posted here do not necessarily represent the views of the BMA or the IME
The editor the BMJ Fiona Godlee is backing a call for leading UK medical bodies to stop opposing assisted dying for terminally ill, mentally competent adults, and has said that the debate on assisted
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Forums » Open clinical » Medical ethics » Should doctors have a neutral position on assisted dying?
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Should doctors have a neutral position on assisted dying?
posted at 14/6/2012 12:38 PM BST
on bmj.com
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First: 7/4/2011 Last: 20/5/2013 |
The editor the BMJ Fiona Godlee is backing a call for leading UK medical bodies to stop opposing assisted dying for terminally ill, mentally competent adults, and has said that the debate on assisted dying is akin to the debates around abortion reform in the 1960s when the main medical professional bodies were against changes in legalisation but that concerns over botched terminations eventually led to change. She says that the inevitable consequence of the societal move towards greater individual autonomy and patient choice will mean that this will become a decision which should be made by society and parliament and not by doctors. http://www.bmj.com/content/344/bmj.e4075 The BMJ has published some articles about the call to allow assisted dying. There is the very moving account by Dr Tess McPherson, who describes how her mother Dr Ann McPherson really suffered: She had become tolerant to morphine after taking it for two years. She needed her dressings changed at least twice a day. Even at this point she was generous in love, always describing my dressings as the best. She felt ill in a way that only dying people can feel, and she knew that she would never feel any better. She resented life now. She no longer enjoyed seeing people, could no longer eat or walk, and could barely talk. But she did manage to express that she felt “bloody awful” and would rather be dead.” http://www.bmj.com/content/344/bmj.e4007 The Healthcare Professionals for Assisted Dying (HPAD), wants the BMA and royal colleges to move their position from opposition to neutrality. A poll commissioned by Dignity in Dying of 1,00 GPs found that 62% supported neutrality and support from the public is at around 80% Dr Godlee adds: “it may take a while, and it may not happen until we properly value death as one of life’s central events and learn to see bad deaths in the same damning light as botched abortions.” |
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Re: Should doctors have a neutral position on assisted dying?
posted at 14/6/2012 11:45 PM BST
on bmj.com
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Posts: 2042
First: 12/3/2010 Last: 20/5/2013 |
No joking. Every doctor can arm themselves with the means to end their own lives, painlessly. As long as the drugs last long enough, or you don't, when the Grim Reaper comes, not knocking on the door but sticking his scythe's point in your joints or bowel or heart, you can thumb your nose at him. But if they don't or you do, you are left to the kindness of strangers. Let's hope Dr.Goodlee is right, and the dreadful harpies that would keep us going beyond our wishes can be kept at bay. John |
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Re: Should doctors have a neutral position on assisted dying?
posted at 15/6/2012 12:00 AM BST
on bmj.com
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Posts: 3045
First: 27/3/2012 Last: 20/5/2013 |
Medical bodies like the BMA and other Royal Colleges should take a neutral position on assisted dying. Patient choice, especially the mantra ' no decision about me, without me', are key concepts today. Although we are saying patients should be more in control of their own healthcare and the decisions that go with it, this should not include decisions about their death. |
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Re: Should doctors have a neutral position on assisted dying?
posted at 15/6/2012 3:34 AM BST
on bmj.com
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Posts: 2947
First: 10/3/2009 Last: 29/4/2013 |
Our Green Party is proeuthenasia and there are some doctors on board with this too. However, the Labor (Democrats) and Liberal Party (Republicans) are against it but with a significant proportion of the population now for it. Even same sex marriage is a stumbling block so we are unlikely to see euthanasia passed in federal parliament in the near future. i think better palliative care and pain management facilities is the answer as the palliators use the poppy to ease people out of this world just as the poppy is used to ease them into this world. I think most people fear a prolonged painful death more than death itself and dyspnoea to me is pain. We should opt for better pain and palliative care services not killing people.
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Re: Should doctors have a neutral position on assisted dying?
posted at 15/6/2012 8:53 AM BST
on bmj.com
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Posts: 1264
First: 13/4/2010 Last: 20/5/2013 |
Although we are saying patients should be more in control of their own healthcare and the decisions that go with it, this should not include decisions about their death. As someone who is openly campaigning for a change in the law I have to ask the simple question - why not? |
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Re: Should doctors have a neutral position on assisted dying?
posted at 15/6/2012 8:58 AM BST
on bmj.com
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Posts: 1264
First: 13/4/2010 Last: 20/5/2013 |
In Response to Re: Should doctors have a neutral position on assisted dying?: Our Green Party is proeuthenasia and there are some doctors on board with this too. However, the Labor (Democrats) and Liberal Party (Republicans) are against it but with a significant proportion of the population now for it. Even same sex marriage is a stumbling block so we are unlikely to see euthanasia passed in federal parliament in the near future. i think better palliative care and pain management facilities is the answer as the palliators use the poppy to ease people out of this world just as the poppy is used to ease them into this world. I think most people fear a prolonged painful death more than death itself and dyspnoea to me is pain. We should opt for better pain and palliative care services not killing people. Posted by Odysseus Odysseus my friend - not for the first time I have to disagree and, again not for the first time, here is my post on the matter; To my mind it's not enough just to reconsider the way we think of and deal with death. I think we also need to change the way we allow people to deal with their own death. I have been unlucky to endure the ultimate personal experience of death from cancer on more than one occasion so I speak from my heart as well as my head. I have always been uneasy with what I perceive as a degree of hypocrisy in our cultural and political attitudes to this "thorny" issue. There are those who advocate not just physician-assisted suicide but out and out euthanasia. For me this is far more than just a subtle semantic difference and I cannot support the latter. My loved ones went through traumatic terminal stages. If either had asked for help end their distress I would have wanted the professional dealing with them to be in a position where they could act with care, kindness, compassion and humanity without the threat or fear of losing their livelihoods and going to prison. There are those that say the desire of some to end their own life reflects inadequate palliative care but to me this is just a smoke screen. We have outstanding palliative care services in Scotland. But I have first-hand experience of how even the best palliative care couldn't stop the hair loss, the faecal incontinence and the intractable vomiting caused by chemotherapy; it couldn't stop the bloatedness, facial swelling and debilitating muscle weakness caused by steroids; it couldn't stop the personality changes caused by brain radiotherapy; it couldn't stop the overwhelming loss of dignity which distressed so much; and it couldn't stop those left behind witnessing all of this. All of these resulted in great distress at the end of life. Now I come to what I see as the hypocrisy of the whole debate. At present, of course, we actually DO allow people the right to die. But this is a passive choice in the form of refusing to have treatment. That right to refuse, even in the face of overwhelming evidence that refusal will result in death, is protected in law and also regarded as unchallengeable by politicians and society as a whole (taking into account all the safe guards around mental health issues). We demand far fewer hurdles or safeguards for that decision than are being proposed for the Scottish End of Life Bill. So if you can have autonomy and chose to end your life by refusing treatment why can't you chose to end your life in an active way? If someone has reached the end of the road of toleration when suffering a terminal disease why are we so averse to giving them the means to end their own life peacefully, painlessly and in a planned time and place of their choosing with their family, friends and loved ones around them? Why at their greatest time of need do we deny them their most fundamental human right - autonomy? Why do we allow them fewer rights than a pet dog? I am not some kind of evangelist or fundamentalist who thinks "I am right and everyone else is wrong". I love living in a democracy where speech is free and we are mature enough to have different views over sensitive subjects without blowing each other up because of those differences. I think everyone involved in this debate needs to move away from and, ideally, avoid using anecdotes and scare stories. We can all quote distressing individual cases that help support our view (as I have done above) but I am not convinced that helps lead to constructive debate. Rather, I fear, it entrenches things. So let's grow up and have a grown up debate. All too often the discussions around physician-assisted suicide are often lumped in with issues such as the rights of the disabled and capital punishment but this is not helpful either. I disagree that the concept of a competent individual wishing to chose the timing and circumstances of their death in a terminal situation is linked to saying that a disabled life is not worth living. I find the former position completely understandable whilst the latter view is abhorrent to me. As for capital punishment, the real issue there is that it is anti-justice and all about retribution. The mark of any good legal system is that any punishment can be reveresed or pardoned if the conviction is subsequently found to be unsafe. Capital punishment by definition precludes such reversal and is therefore wrong in my view. I have to emphasise again that I am in favour of some kind of change in the law as I do not find the current situation acceptable or desirable - for me the staus quo is not an option. Although the numbers may be small the current legislation does, in my view, cause some people unnecessary distress and suffering and I find that inhumane. And what evidence is there that the Bill proposed in Scotland, with it's multitude of measures to avoid coercion, will result in vulnerable individuals (whoever and however they are defined) being forced into ending their lives? That concern, if you'll forgive me saying so, does sound a tad paternalistic to me. When it comes to the professional organisations - the BMA and the RCGP - I am a member of both these organisations but I do not agree with their current stances opposing a change in legislation and I have made my case in person to both (but I accept their current democratic decision). In my ideal world "assisted end of life" would be a rare event. Indeed, some of the evidence suggests that when such an option is legally available people are less likely to avail themselves of it. In other words, because they have the safety net of that option they tend to persevere longer with other options. I know this is controversial but I can see the logic in it. I was at a talk about 2 years ago where the speaker, who was opposed to any change in the law, basically said there was no place for autonomy in this discussion. I disagree with that quite profoundly. I do not think autonomy is the be all and end all of course. Sometimes we do over-rule individual autonomy for the sake of a greater public health good - we have compulsory seat belts or we have bans on smoking in public places for example. But not all autonomy is the same. When it comes to end of life decisions where a person of sound mind has made a decision to end their life and that decision is supported by the other people directly affected by the decision - family and friends - then, in those circumstances, I do believe autonomy trumps all. I am sorry to sound like a stuck record but I am clear in my own mind that if I have a terminal condition and I am suffering intolerably either physically or emotionally I should be free to end my life at a time and place of my choosing with the people I love around me should they wish to be so. And I think that a civilised society should be prepared to supply me with the support, means and mechanisms to do so. The status quo is out-dated and unsustainable and does not reflect the vieww of the majority of society in the UK (although I accept it does, at present, reflect the majority view of the profession). There are clearly large numbers of people out there who feel that the current provision for end of life decisions is insufficient for the needs and I do not believe we can or should continue to simply ignore their views. So I want assisted end of life to be considered in very strict circumstances. As I have said before, for example, if the person themselves is incapable of carrying out the final act then that would automatically disqualify them. In the end of the day no doctor would be forced to participate which would immediately put quite marked limitations on the availability. At present we effectively have a situation where professionals have a large (and, sometimes, larger) say on where and how terminally ill people die and I for one do not think that is right. |
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Re: Should doctors have a neutral position on assisted dying?
posted at 15/6/2012 9:25 AM BST
on bmj.com
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Posts: 324
First: 23/12/2011 Last: 3/5/2013 |
A very emotive post SkyeSteve. I agree with many of your points. The issue of assisted suicide is a strange one as we are told so much about patient autonomy yet this is something that is roped off and sealed behind 20ft of concrete as something that should never happen or be touched or be discussed or be advocated. Assissted suicide should never be a first option or a second option or a third etc etc. Only EVER the final final final option where all hope is lost and nothing more can be done. Our lives are a series of choices that we must make and I do not see why this should be different despite the weight and seriousness of the choice you are making. As Skyesteve says, if we have the option to refuse treatment then we should also have that option. HOWEVER, I also (paradoxically) agree that 'First, do no harm' is also important for us all to remember when considering what stance to take on this issue. Finally to get back to the original question: DOCTORS should most definitely have a neutral poisiton on it and whilst we are all displaying the fact we have opposing views- however I think it is important that we persuade patients that this should only ever be last chance saloon. But thats just what I think. :) |
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Re: Should doctors have a neutral position on assisted dying?
posted at 15/6/2012 1:12 PM BST
on bmj.com
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Posts: 958
First: 15/7/2011 Last: 15/5/2013 |
As a non medic I am of the opinion that Doctors should enter this debate from a neutral position. However it is quite clear that Doctors holding religious views would probably find it very difficult to be neutral because their faith almost certainly would value the sanctity of life. Can the UK create legislation to enable assisted suicide to be legal within confines of specific circumstances and without giving free reign to evil doers or limiting the truely kind who wish to allow an individual to end their life with dignity?. The answer, I believe is yes. It will be complex. Law is a rather blunt object to deal with fine issues but law makers have learned that preparation, testing, enacting and reenacting laws takes time. Loop holes spring up where it was thought water tight. Oddities are thrown up which could barely have been anticipated and powers which did not initially appear too wide can subsequently be proven to be so. I think a Law Commission should be set up to examine all the issues involved in assisted dying. It of course must have intellectual lawyers but must also have medical and nursing staff and others from the populus to investigate and contribute to the information gathering. It would certainly take some considerable time but would need to be thorough - there is no quick fix. Importantly, in my view, its results (whatever they are) be enacted by whichever party is in power through primary legislation without cross party squabbling. Perhaps this is rather pie in the sky thinking but grown adults can do this if they really want to. |
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Re: Should doctors have a neutral position on assisted dying?
posted at 15/6/2012 2:22 PM BST
on bmj.com
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Posts: 2042
First: 12/3/2010 Last: 20/5/2013 |
I find it very worrying that the original article by Tess McPherson and Steve's testimony, which are not unique, tell us that people still die in pain. It has for long been a tenet of the Hospice movement that analgesics including opiates will be titrated against the patient's need for pain relief, and that treatment that relieve pain will never be withheld because it endangers their already short remaining life. Is that still how hospices work? If not, where has that humane and necessary lesson from Dame Cicely Saunders gone? Which makes me more determined not to rely on strangers, but to be ready with my own means John PS In looking up Dame Cicely, I realised that as well as DBE and OM she was not only a nurse and FRCN, but also FRCP and FRCS, which are inferior honours! Who else was ever so multiply qualified? |
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