Care of terminally-ill patients and their rights to a dignified life, and death, are becoming increasingly complex. The recent controversy over assisted dying and the right of a patient to choose assisted suicide rightly focuses on the patients concerned, but there are other considerations perhaps receiving less media coverage.
When caring for patients with chronic, debilitating illnesses, it’s clear that care is delivered by teams of practitioners. The general practitioner, hospital consultant, physiotherapist, specialist nurse all have their own professional relationships with their patients, and their families. Each provides a valuable perspective on the management. How does the concept of assisted suicide work in this healthcare setting?
If a legal framework for physician assisted suicide was drawn up, it is difficult to see practically how it would work inside this group of professionals where the normal logical hierarchy for decision-making on treatment would not exist. Personally as a doctor working inside one of these groups, how does assisted suicide consider the perspectives, concerns and disagreements between colleagues, team members, patient and family members? If a spouse objected to assisted suicide, should this change a decision that should be centred about a patient?
Another important principle is capacity, and mental health. How can I be sure that this patient is not depressed, that their circumstances will not change in the future? What if the disability was less severe, but equally upsetting for the patient? What if there was an element of mild cognitive impairment? What if the patient’s capacity to discuss and argue the case for assisted suicide changed through deterioration in cognitive function? I have more questions, and none that I can answer satisfactorily.
I found heartening to hear the discussions in the media about the use of micro-blogging sites like Twitter, which were giving patients the ability to voice their own perspectives. These insights help us to understand personal stories behind the mainstream media coverage. Everything must be done to assist, ease and mitigate the pain, discomfort, indignity and distress suffered by patients with what are immeasurably difficult personal circumstances. These issues aside, I personally and professionally would and could not place a cannula, draw up the medication, connect the syringe driver, or activate a computer assisted drug delivery system that would end the life of a patient. I believe the vast majority of my colleagues would feel the same.