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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Re: Should doctors have a neutral position on assisted dying?
posted at 21/6/2012 8:01 PM BST
on bmj.com
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Posts: 181
First: 13/10/2009 Last: 24/5/2013 |
I cannot see that the tragic case of Turing (currently the subject of a documentary to celebrate the anniversary of his birth) , tried according to a bad law of his time , has any relevance as to whether the BMA should remain neutral on assisted dying. Except in that we have moved on in that respect and now it is time to move on in giving dying patients greater choice in the circumstances of their death. Lord Joffe is one of the driving forces behind the push in recent years to allow some form of assisted dying for the terminally ill. He is a human rights lawyer (repesented Mandela) and his Bill was in no way capricious or arbitrary - even those opposing him recognised the quality of the document. The use of lethal injection in a few areas of the USA is also irrelevant to the present debate. |
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Re: Should doctors have a neutral position on assisted dying?
posted at 27/6/2012 12:51 PM BST
on bmj.com
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*Moderator*
Posts: 1450
First: 7/4/2011 Last: 24/5/2013 |
The BMA annual conference debated the question of being neutral on assisted dying for terminally ill but mentally competent patients. The motion was not passed. Here's a brief description of arguments posed: In the For camp, Ray Tallis pointed to recent public opinion polls, which showed that 80% were in favour. However, there were concerns from Dai Samuel that a change to neutrality would mean that whilst society directed the implementation of the policy, this could open up doctors from being prosecuted. Another speaker said that a neutral stance would not erode patient trust but actually enhance it because the doctor and the patient would be working together to ensure a good death. In Oregen, USA, where physician-assisted suicide is legal, this has seen a 4.5 fold increase since 1998 of terminally ill patients being helped to die. However, Tallis pointed out that this is only an increase from 16 to 64 people. Others argued that the richer patient can fly to Dignitas in Switzerland and end their life but that those who cannot afforf this are condemned to suffer. The argument basically boiled down to the fact that the premise of the motion was flawed. In as much as the BMA should be neutral and that it should be for society to decide. The BMA representatives argued that you cannot be neutral on such an issue, that doctors are part of society and this decision does involve doctors because it is doctors who will be ultimately be aiding the terminally ill patient with this process. Furthermore, Hamish Meldrum said he would rather have a vote on being for assisted dying rather than neutrality because it excludes doctors from the argument. |
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Re: Should doctors have a neutral position on assisted dying?
posted at 27/6/2012 1:04 PM BST
on bmj.com
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*Moderator*
Posts: 1450
First: 7/4/2011 Last: 24/5/2013 |
One speaker said that for doctors to be told to be neutral was counterintuitive and that the idea for society to decide was an odd line of thought. Because if we applied this logic to other motions such as alcohol, captial punishment etc, then This reminded me of a recent documentary on BBC4 about capital punishment, where the Liberal elite of the UK were influential in abolishing capital punishment, whilst the majority of the public still wanted it to deal with criminals such as Brady and Hyndley. I'm not directly saying that society shouldn't make a decision on assisted dying but the idea of giving society choice over matters of life and death might not always be the best idea. If society did vote in favour of assisted dying then it is doctors who would be aiding or serving patients' wishes. I think this presents an interesting situation where the doctor's point of view can be trumped by the patient (it is their life after all) but that a doctor may have to comply with a patient's wishes, even if they did not agree with them. And ending life could be seen as a counterintuitive act to some doctors. |
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Re: Should doctors have a neutral position on assisted dying?
posted at 27/6/2012 2:42 PM BST
on bmj.com
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Posts: 1271
First: 13/4/2010 Last: 23/5/2013 |
If society did vote in favour of assisted dying then it is doctors who would be aiding or serving patients' wishes. I think this presents an interesting situation where the doctor's point of view can be trumped by the patient (it is their life after all) but that a doctor may have to comply with a patient's wishes, even if they did not agree with them. And ending life could be seen as a counterintuitive act to some doctors. In Scotland at least, the proposed end of life bill ensures doctors are free to opt out - there will be no compulsion - just as we currently have with termination of pregnancy. |
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Re: Should doctors have a neutral position on assisted dying?
posted at 29/6/2012 4:12 PM BST
on bmj.com
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Posts: 225
First: 15/5/2012 Last: 22/5/2013 |
In Response to Re: Should doctors have a neutral position on assisted dying?: On a related but not quite on the subject is a column by Victoria Coren who I am jealous of because she can play poker. She argues that doctors should not be gatekeepers to drugs and that we should be treated as adults who can get drugs off of pharmacists and sign disclaimers. She gives the example of her doctor who won;'t let her be on the pill at the age of 35 beause she smokes. her line is that she knows there is a risk but not as much as there is from smoking so she'll take it thanks. She also says Ask yourselves, doctors: if you had to consult officials before buying a car, who said you weren't allowed one because it increased your chances of driving into a tree, how happy would you be to pay tax for that service? .... We can only imagine what hell must be suffered by the terminally ill who are denied access to the potions (not invented by doctors, but guarded by them) which could gently end their trauma. So, here's my solution to everything. Let pharmacists allocate drugs, as well as selling them. Make it impossible to sue over any side effects from taking them wrongly (which is, surely, the doctors' fear). Treat people like adults: tell them the risks, show them the instructions, let them overdose if they want to." Posted by luisad I am sorry, I do not agree with your solution. 1) Pharmacist did not go to medical school and cannot prescribe 2) A physician is responsible for the treatment . I would absolutely hate it if my patient overdosed. Safety is paramount to me. 3) You cannot get away by adopting the attitude: this is the discussion we had, this is how you take it, now pay me and go do what you want, as I am not responsible. Unfortunately, life is not all that simple. |
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Re: Should doctors have a neutral position on assisted dying?
posted at 17/8/2012 10:18 AM BST
on bmj.com
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Posts: 59
First: 9/3/2009 Last: 9/11/2012 |
Now that Tony Nicklinson has lost his court battle, it is more necessary than ever for doctors to be sidelined on this very important issue. Doctors have a clear conflict of inbterest as they are committed to saving life. But this is not in tune with what some patients and the general public want. Therefore tany future law must be drafted to exclude doctors as far as possible (difficut though that might be) and doctors shopuld not have have any udue influence on the process. |
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Re: Should doctors have a neutral position on assisted dying?
posted at 12/10/2012 4:04 PM BST
on bmj.com
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Posts: 154
First: 19/1/2012 Last: 18/5/2013 |
I went to a fascinating debate last night by Lord Falconer (Chair, Commission on Assisted Dying) and Professor Nigel Biggar (Regius Professor of Moral and Pastoral Theology, University of Oxford) called ‘At the End of the Day’ hosted by King’s College London. I’ve just started a Medical Ethics and Law Master degree at King’s and am doing a module on ‘Ethics at the End of Life’ so I thought I’d better go. As with all brilliant debaters, I found myself utterly convinced by one and then the other equally, and I’ve ended up still not sure! One thing I do worry about is how we would decide what constitutes extreme and unbearable suffering, and whether we would end up on a 'slippery slope' to including more and more things. Clearly no-one wants anyone in the terminal stages of an illness like cancer to be in pain or distress, but good palliative care, pain relief and sedation should be able to alleviate this. I wonder how we would cope for example with a rejected asylum seeker who doesn’t want to return home, and has no hope for the future of any improvement, or with an 80 year old lady who has lost her husband of 60 years and is physically fine but has been grieving for over a year? Or from my own specialty, whether we would consider assisted dying for someone with a 30 year history of anorexia nervosa whose BMI has never been consistently within normal range, and who has been in and out of hospital their whole life, and has a poor quality of life and life expectancy? We also spent a long time discussing what the word ‘dignity’ means – which I had never even considered until yesterday though we medics use it all the time – ‘dying with dignity’, ‘it’s undignified to be left on an A+E trolley all night’, ‘restraint on a psychiatry ward is undignified’. We spoke about whether ‘dignity’ is about ‘extrinsic’ factors – appearance and outward behaviour, for example not being incontinent or left agitated or in a state of undress, or is it more about ‘intrinsic’ things, i.e. being able to make choices autonomously about one’s own life? More info about the event is at: http://www.kcl.ac.uk/newsevents/events/eventsrecords/2012/September/at-the-end-of-the-day.aspx |
Forums » Open clinical » Medical ethics » Should doctors have a neutral position on assisted dying?
