COMMENT
Assisted dying as a necessary end-of-life option
On Wednesday 13 October, a public meeting was held at the King’s Fund in London to launch Healthcare Professionals for Change, a group independent of, but allied to, Dignity in Dying. The new group, which already has over 200 members, is chaired by the Oxford GP Dr Ann McPherson CBE, and has amongst its supporters Sir Iain Chalmers, Harriet Copperman OBE, Sir Terence English and Professors Ray Tallis, Charles Warlow and Graham Wynyard
H
ealthcare Professionals for Change is campaigning for a
change in the law that will allow healthcare professionals to assist dying in adults of sound mind - competent to make decisions - who are terminally ill and who have made it clear that they no longer wish to live. The group feels that to deny such provision to patients who are suffering unbearably from a terminal disease for which there is no prospect of improvement is unfair and unkind, not to say inhumane.
The group’s first objective will be to work to help change medical culture. Society should recognise that dying is inevitable and is part of life. For those with terminal conditions, the dying process is not a failure of the patient nor necessarily one of the healthcare team. It only becomes a failure if the patient suffers an undignified death.
Since dying in these
circumstances is not a failure, help in dying should be thought of as assisting dying and not assisting suicide. Currently, such negative terms are deeply embedded in legal speak so in addition to referring to dying in such circumstances as suicide, the patient is seen as the victim and anyone who might have helped as the suspect.
These words are loaded with strong negative judgmental connotations. Simply changing these words and replacing them with words that are more neutral will help alter our culture and inevitably aid sensible debate.
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Another theme of the culture change will be to make assisted dying a topic about which healthcare professionals and patients feel free to speak. At the moment it is often a closed subject. Clearly this position is unreal, silence is not an option. Healthcare professionals owe it to their patients to discuss the issues seriously.
Second, the group will work to help change the law. At the moment, healthcare professionals can indirectly hasten death through the withdrawal/withholding of treatment or via the principle of ‘double effect’.
In this instance a drug is given to achieve a beneficial effect (for morphine – pain relief) but through an unintended but foreseeable side effect (respiratory depression) the patient dies.
However, direct and deliberate assistance to die, at the patient’s request, is illegal, rendering the assister liable to prosecution. Accordingly, the Suicide Act 1961, as amended in 2009, states that a person commits an offence if they do an act capable of encouraging or assisting the
suicide or attempted suicide of another person or an act intended to encourage or assist suicide or an attempt at suicide.
More recently, in an attempt to clarify the application of the law, Keir Starmer, director of public prosecutions, told prosecutors that while there may be circumstance where lay persons might escape prosecution, he specifically stated that assistance by healthcare professionals (medical doctors, nurses, other healthcare professionals, professional carers [whether for payment or not], or persons in authority) would be a factor in favour of prosecution.
In addition to not permitting any direct help, healthcare professionals must not encourage or assist the victim to commit or attempt to commit suicide by providing specific information via, for example, a website or publication, nor provide a physical environment in which to allow another to commit suicide. All this makes offering or providing terminally ill patients any help to die, illegal and subject to prosecution. It is this draconian set of laws that Healthcare Professionals for Change want to modify.
The third of the group’s objective is to change medical practice. Assisted dying should be just one of many options at the end of life. It should complement end-of-life care, as it does in other jurisdictions that have legalised and regulated assisted dying. The group believes that terminally ill adults who want an assisted death should be supported to die where and when they chose within safeguards. The patient would be the person who would administer to themselves the medicine. It would be for the relevant healthcare professional to provide the medicine.
Our goals are clear but will take time. There are those who are opposed to change, amongst whom are the medical colleges, and the reasons are probably a mixture of conviction, ignorance, fear and inertia and all can be difficult to overcome.
On our side is the knowledge that the majority of patients in the UK are in favour of such provision and that in countries where it has been introduced the scheme has not been abused.
My own feeling is that the campaign will be successful - delaying the inevitable simply forces more people to take drastic action without medical support or to suffer against their wishes at the end of life.
Joe Collier, MA MD FRCP is emeritus professor of medicines policy and deputy chair of Dignity in Dying’s Healthcare Professionals for Change group
Nov/Dec 10
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