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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Ask not for whom the bell tolls...
posted at 15/6/2012 10:50 PM BST
on bmj.com
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Posts: 2952
First: 10/3/2009 Last: 25/5/2013 |
Perhaps the missing bit here is good empathic medicine; that intimate one-to-one contract between patient and doctor and not between Health Department or state and doctor. This, in my experience, is the missing and unsaid bit of the equation which cannot be legislated for. as legislation is a jack hammer when all is needed is tweezers. It is too subtle for the law which cannot legislate about love, faith, hope and all that makes life worth living. These things are transcendent; immaterial but not immaterial. A good doctor can read between the lines and knows when to "pull the pins" but not in a gross way like a private execution. It is execution as we are executing death. That knowing wink in my patient's eyes or a squeeze of my hand is all I need. We have talked about this before. It is subtle. I have had the same reassuring response from priests and persons ministering to their faith; their belief system and many have no particular faith observe the same rules, the same behaviour.
it is not, "Nurse, bring me the Big Needle and close the curtains." I have done a palliative care course and seen my father who was a country GP in practice all through my formative years. His favourite saying was "Where there's life, there's hope." Hope in what you may say. I just say, "Hope" which is a brother of love and faith. Perhaps hope to see breakfast in the morning or to see one's wife and one's children by my bedside again. Hope to have a better night's sleep or to have that nice young nurse tomorrow as she has been on night duty this week. One's world contracts down when one is dying. it shrinks into important minutiae. My father was no church goer but was a dignified man and ethically grounded who loved his patients and who silently wept when they died just like I do for this is not a case of the death of a patient but our own death. He'd go quite for a few days. He felt it. I wrote a book about him he had such an effect on me. Death must be dignified. This is one part of the script we write and we are too the players. I sometimes wonder about the euthanasia zealot-doctor and their own unfinished business. Perhaps this is their way of dealing with their own fears about death and their need for control of something cosmic and universal in nature; mortality which is the yeast of life bringing good wine from their own death. How dull life would be were we all immortal. The bells tolls for thee; not just your patient regardless of your credo. Perchance he for whom this bell tolls may be so ill as that he knows not it tolls for him; and perchance I may think myself so much better than I am, as that they who are about me and see my state, may have caused it to toll for me, and I know not that. The church is catholic, universal, so are all her actions; all that she does belongs to all. When she baptizes a child, that action concerns me, for that child is thereby connected to that head which is my head too, and ingrafted into that body whereof I am a member. And when she buries a man, that action concerns me. All mankind is of one author and is one volume; when one man dies, one chapter is not torn out of the book, but translated into a better language, and every chapter must be so translated. God employs several translators; some pieces are translated by age, some by sickness, some by war, some by justice; but God's hand is in every translation, and his hand shall bind up all our scattered leaves again for that library where every book shall lie open to one another. As therefore the bell that rings to a sermon calls not upon the preacher only, but upon the congregation to come, so this bell calls us all; but how much more me, who am brought so near the door by this sickness. There was a contention as far as a suit (in which piety and dignity, religion and estimation, were mingled) which of the religious orders should ring to prayers first in the morning; and it was determined that they should ring first that rose earliest. If we understand aright the dignity of this bell that tolls for our evening prayer, we would be glad to make it ours by rising early, in that application, that it might be ours as well as his whose indeed it is. The bell doth toll for him that thinks it doth; and though it intermit again, yet from that minute that that occasion wrought upon him, he is united to God. Who casts not up his eye to the sun when it rises? But who takes off his eye from a comet when that breaks out? Who bends not his ear to any bell which upon any occasion rings? But who can remove it from that bell which is passing a piece of himself out of this world? No man is an island, entire of itself; every man is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friend's or of thine own were. Any man's death diminishes me because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee. . . . from Meditation 17 by John Donne |
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Re: Should doctors have a neutral position on assisted dying?
posted at 16/6/2012 12:52 AM BST
on bmj.com
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Posts: 2952
First: 10/3/2009 Last: 25/5/2013 |
My other concern is as follows; At present one does not need a doctor to be born into this world. A nurse, midwife or paramedic does this. One does not need a doctor to prepare a person for burial. In my country we call them undertakers as we don't yet call them funeral parlour but funeral directors. Nurses are now doing more and more of what was once done by the GP and this has been the subject of discussion on this site. London taxi drivers have to acquire a thing called "The Knowledge"; an exhaustive knowledge of the streets of the city. And so, the medical profession has been entrusted since the days of Hippocrates of Cos with The Knowledge of the human condition from conception to death. Taxi drivers in my city have to be told where to go as they do not have The Knowledge. The bar has been lowered. We too may lose The Knowledge and be directed to go where the state and passengers will to go. If we go down this path one day we may see " Patient Facilitation" teams (PFTs) which will be run by palliative care nurses, paramedics with a certificate in PF or even the odd disaffected medical officer with a euthanasia bee in his bonnet which will be called in like the MERT Team (Medical Emergency Response Team) with their crash cart of poisons , IV giving sets and forms, and accompanied by the odd disaffected clergyman and a state legal representative to make sure the fifteen pages of triplicate green paper are filled out correctly. Yes, this will reduce ALOS (average length of stay), improve bed turnover and "facilitate" the transitional state from life to oblivion. We will be side-lined as we have forsaken The Knowledge. So bring on the Brave New World of euthanasia in the 21st and off to the 22nd century. Bring it on....
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Re: Should doctors have a neutral position on assisted dying?
posted at 16/6/2012 5:40 AM BST
on bmj.com
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Posts: 2952
First: 10/3/2009 Last: 25/5/2013 |
Once the ship slides down the greased slipway, there is no heading back. It will never be recalled or put back high and dry on the slip. It will be forever in deep water but yet in social storms may run aground on the shoals of imprudence, abuse and impropriety. |
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Re: Should doctors have a neutral position on assisted dying?
posted at 16/6/2012 12:38 PM BST
on bmj.com
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Posts: 1791
First: 7/3/2009 Last: 25/5/2013 |
I am for palliative care doing all we can to ease the pain and suffering of a patient. It is against my ideas of who we are to actually do something to put an end to someones' life. So, yes, ease pain, allow sleep and let things take their course. Since we dont have a "suffermeter" to know what threshold is the one above which it is "acceptable" to assist ones' wishes to die, we can't take active measures. We are to save lives and to ease suffering, but not to play fate and end them. |
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Re: Should doctors have a neutral position on assisted dying?
posted at 16/6/2012 12:59 PM BST
on bmj.com
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Posts: 4
First: 1/6/2012 Last: 31/8/2012 |
I think that patients deserve the right to decide to end their life when there are few benefits with continuing their existance here on earth; i.e. the terminally ill, along with many other examples. However, making assisted death legal is scary - ending life in an active way is a decision that should be made by the individual, and performed by others. You can't go back on this decision, and it can seem...wrong almost, as society is so used to the concept of preserving life. It is the right thing to do though, and the government should take steps to slowly introduce assisted death into healthcare. For example, only make it legal for a limited type of situations in which patients may request assisted death, then expand. There should be meetings with the patient and their families/friends with appropriate healthcare professionals, and forms which should be simple. Doctors should be practising with the patient's best interest in mind. This doesn't always take a neutral stance, and they are going to have to live with consequences of any decision made. As doctors are people which are part of society and are involved with patient healthcare, they should have a say. I don't think a neutral position is required.
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Re: Should doctors have a neutral position on assisted dying?
posted at 16/6/2012 1:17 PM BST
on bmj.com
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Posts: 185
First: 13/10/2009 Last: 25/5/2013 |
John D - Precisely my point. The poppy is no longer to be seen as a means of shortening life. It was certainly used in this respect in the past , ie that use is now out-of-date. Sorry if you misunderstood. Of course it could still be used to cause death -- it could even be used in assisted dying - but there seems general agreement that any drug used for legalised AD should not be one in common use. As it is non-palliative care doctors have become anxious about giving adequate doses for pain relief - but then perhaps the palliative care folk want to corner the market in pain relief and dying? |
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Re: Should doctors have a neutral position on assisted dying?
posted at 16/6/2012 3:23 PM BST
on bmj.com
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Posts: 2
First: 16/6/2012 Last: 1/7/2012 |
i can not even conceive of such an option..every patient regardless of their disease ,its severity,or even its prognosis goes through some levels of despair while he compares the present situation with days of health and wealth.on the other hand no one is capable of setting a threshold after which we are morally allowed to wean someone of his life,there is no clear cutpoint,,,,,,,,,but i should admit that there are many individuals whose suffering is even impossible to imagine ,let alone.... |
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Re: Should doctors have a neutral position on assisted dying?
posted at 16/6/2012 4:29 PM BST
on bmj.com
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Posts: 1271
First: 13/4/2010 Last: 23/5/2013 |
In Response to Re: Should doctors have a neutral position on assisted dying?: I became a medical student to learn how to save life, not take it. Definition of treatment: medical care given to a patient for an illness or injury: e.g. I’m receiving treatment for an injured shoulder Death is not a treatment. Posted by David.Jones Dave - your defintion of treatment is narrow and, if you will forgive me, naive. Perhaps if you read my previous long post again you will have a better understanding of the issues at hand. I am not saying that you will agree - I am not even asking you to. I am just asking, as one fellow human being to another, to try and understand why some of us feel that the status quo is broken and results in unnecessary suffering for some. I nursed my wife through 18 months of suffering and continued to work full-time as a GP at the same time so I don't think anyone can question me exercising my duty of care |
Forums » Open clinical » Medical ethics » Should doctors have a neutral position on assisted dying?
