Assisted dying: opening the flood gates or controlling the flow?

6361735901_c7cd4383b5_zDr Damien Bezzina is  a doctor at a large university hospital in the Midlands; he has a special interest in the care of older people, and holds a Diploma in Geriatric Medicine from the Royal College of Physicians. In this blog, he discusses the fallout from last year’s Falconer Bill on assisted dying.

I was watching the news on the 18th July 2014 when I heard about another Private Member’s Bill on assisted dying, put forward by Lord Falconer. A leading campaigner made the comment “Less suffering, not more deaths” and it made me think whether this is a true statement.

I believe strongly in care of the dying, and feel that we, as a medical profession, still widely miss the mark on ensuring we provide excellent care for patients who are coming to the end of their life. However, I’m not yet convinced that introducing an assisting dying law in the UK healthcare system as it stand is a good thing .

Our system is not set up to manage this type of process, and at the moment I don’t believe assisted dying has enough common support from doctors. Without the majority supporting it, the process will become undignified and possibly even cruel.

I understand the principles of assisted dying from the campaigners’ view, but I do not fully believe that they understand the ethical dilemmas faced by doctors. Even if you do not consider this a problem (perhaps because we are paid to deal with ethical dilemmas), there is still the long lasting pressure put on relatives to support their loved ones’ decision to have assisted dying.

Maybe you could compare this to a patient”s wish not to receive CPR or a specific type of intervention. This alone causes family members immense strain; if the decision to take someone’s life is made, it would potentially cause great harm. I am sure many readers will feel that loved ones would support a patient’s decision to ease the suffering, but are we ready, and do we have the support systems in place for families?

We all know that dying is unpredictable at best. I have no doubt that at some point patients with terminal illness will all feel that their life is too much for them and their loved ones, but as medical professionals we need to remain focused on the realities: often, when we decide that a patient has entered the final phases of dying, we turn out to have got it wrong.

If we are talking about a patient in their very last hours or days with complete irreversible cause, then some might say that assisted dying would help reduce suffering.

However, as has happened in public cases, patients have also sought euthanasia for conditions that will leave them incapacitated at some point in the future. I wonder how many doctors would be happy to assist in the death of a patient who is currently is not in the final hours of their life?

This is the question we should ask ourselves before standing up and saying we are ready for assisted dying in its broadest form.

Links of interest:

Copy of the assisted dying bill
http://services.parliament.uk/bills/2014-15/assisteddying.html

Royal College Physicians Audit 2014 on Care of the Dying patient
http://www.nhs.uk/news/2014/05May/Pages/Audit-of-NHS-care-for-the-dying-published.aspx

New approach to care of the dying – June 2014
https://www.gov.uk/government/news/new-approach-to-care-for-the-dying-published

Image credit: Wayne Wilkinson, via Flickr.

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