Assisted dying - is it time?

You've probably never heard of the MP Rob Marris. Neither had I until he set in motion a private members' bill on assisted dying. He's not the first - Lord Falconer has been a passionate supporter of the right to die for years, but his Bill ran out of time before the election. That meant this bill was the first time MPs had voted on the issue for 18 years.

I have taken a keen interest in the debate for the last decade. I spent five and a half years writing a book - The Welcome Visitor - on the ethics of dying with the broadcaster John Humphrys. One small chapter of the book was devoted to assisted dying - yet when we were interviewed, it always proved the main focus. John Humphrys is a master of the art of interrogation - and my discussions with him made me examine every value I as a doctor espoused.

The proposed bill had strict safeguards to prevent it being abused:

  • It would only apply to people who had been assessed by two doctors (one who looked after them, one independent) as being likely to die within six months
  • They would have to prove they were not only mentally competent, but also that they weren't going to change their minds.
  • If there were any doubt about their mental capacity they would need to be referred to a psychiatrist to make sure either way
  • They would need to have received the best palliative care, but still want to end their lives despite this
  • A high court would have to approve the decision
  • And while a doctor would write the prescription for the fatal dose of medicine, the patient would have to take it themselves, rather than being given it by the doctor. Finally, any doctor who had a conscientious objection to being involved would have the right to opt out.

There are important differences between assisted suicide and euthanasia. In euthanasia, a doctor ends your life. In assisted suicide, someone helps you die but it is you who performs the final act. It might seem a small distinction, but it makes a major difference. With the right safeguards in place, it means the patient is in control of their own destiny.

Perhaps it's not surprising that MPs on both sides felt strongly. What is much more surprising was that the bill was defeated so soundly - by 118 votes in favour to 330 against. 74%MPs voted against the bill, even more than the 72% who opposed it in 1997.

Yet many of their arguments have been soundly disproved since the last vote by the experiences of the State of Oregon in the USA, which legalised assisted dying in 1997. The regulations in place in Oregon are almost identical to those proposed under the Assisted Dying Bill. Opponents argued that there would be an ever-increasing flood of 'victims', pressured to end their lives by relatives who felt they were a burden. In Oregon, 99.7% of people do not die in this way, and the figure has remained remarkably steady. There has not been a single case where abuse of the option has been shown.

Some of the arguments used were, in my view, absurd scaremongering. I've heard opponents claim that introducing this bill would result in funding to our wonderful hospices being cut, putting at risk the end of life care for those who don't opt for assisted dying. Does this mean Granny might be left to die in agony so that someone else can swig a lethal potion? Absolute nonsense - 99.7% of people who die in Oregon have not chosen to change the way they die, so no NHS funder could possibly argue that there would be less need for existing services. What's more, Oregon and other parts of the world which have assisted dying in some form are world leaders in providing, and funding, end of life care.

Perhaps they were following the wishes of the voters who elected them? Clearly not - a 2012 YouGov Poll showed that 81% of adults supported assisted dying with the safeguards the bill proposed. Maybe their opposition was based on respect for churchgoers? The same poll showed that 82% of Church of England believers and two thirds of Catholics also supported it. In fact, a separate YouGov poll in 2013 found that 78% of regular churchgoers and 62% of strongly religious people were in favour.

I have spoken to many people on both sides of the argument, and I have a suspicion, shared by many supporters, that opponents who do have religious arguments are hiding these, and preying on our anxieties about a 'slippery slope' towards ever-increasing pressure to put ourselves forwards for assisted dying. Dr Richard Horton, the editor of the medical journal the Lancet, sums up this behaviour beautifully in his article 'Fibbing for God'.

I have been a GP for many years, and I have looked after countless patients in the last weeks and days of their lives. Sometimes we have achieved a really 'good death' - and I count my mother's among them. I use the word 'achieve' deliberately - often good deaths take much preparation, with support services on standby, out-of-hours health services alerted and 'just in case' drugs for relief of pain in place before they're needed. But I am also aware that sometimes, despite all the best efforts of me and my colleagues, people do not die as they would want. They may be in pain; they may hate the indignity of it all. Whatever the reason, they are robbed of the end they would want.

I believe passionately that in exceptional (and only in exceptional) circumstances, some patients simply cannot have a life they believe is worth living despite all the efforts of our extraordinary palliative care teams. I believe our current two tier system - where only people who can afford to have the option of taking themselves off to Dignitas in Switzerland - is unfair. I do not for a moment believe that I, or any of my colleagues, would be tempted to make do with a lower quality of care if people had another option.

I believe it is time for us to recognise the will of over 80% of our population. I only wish our politicians offered them the same respect.

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