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Keep Assisted Dying Out of Healthcare

Assisted Dying and the Role of Mainstream Healthcare

KADOH provides evidence on why assisted dying should be separate from mainstream healthcare

Keep Assisted Dying Out of Healthcare

Is committed to achieve

Choice
Statutory and transparent separation of healthcare and assisted dying
Safety
Professionals caring for your health and comfort will only influence that aspect of your care.
Protection
Decisions made with you about assisted dying will be legally protected and monitored
Dignity and compassion
Individuals can continue with their chosen care options
Justice
Fair and legally protected treatment for all those who struggle to give voice to their wishes
Care
Respecting individuals' wishes in a compassionate, dignified way that protects their rights

Is there a safer alternative to medically assisted dying?

YES
If  assisted dying is legalised the answer is:

A statutory socio-legal model for assisted dying

A socio-legal model would
1) Have decisions made by a statutory authority who would appoint multidisciplinary panels and monitor all parts of the process.
2) Make the UK the first in the world to provide scrutiny during the decision-making process.
3) Be outside mainstream clinical care
4) Ensure all requests are heard by skilled legal and clinical experts
5) Enable healthcare professionals to opt-in as opposed to having to opt-out
6) Ensure a central reporting system transparently monitors the process

Assisted dying should NOT be part of mainstream healthcare.

Important Considerations

Critical Considerations for Healthcare Professionals and Organisations on Assisted Dying

1.

►Who will have the responsibility to assess and confirm the patient meets eligibility criteria, including capacity, a fixed wish to die and that no coercion has taken place?

Fact: Most healthcare professionals are not trained to detect coercion

2.

►How will organisations ensure ‘assisted dying’ discussions are not taken by junior, inexperienced or untrained staff?

Fact: healthcare services are already stretched and exhausted. Experienced staff are in short supply

3.

►Who is responsible for excluding a reversible anxiety state, depression or other mental health problem?

Fact:  Healthcare professionals commonly miss treatable depression

4.

►Are there doctors willing to prescribe assisted dying drugs off-licence?

Fact: No drug regulatory authority anywhere in the world has approved assisted dying drugs and doses. Consequently, very few doctors are willing to do this (1-2% in Canada, Oregon and Australia).

5.

►Which pharmacy will dispense these drugs? ►Where will these drugs be securely stored? ►Who will prepare the drugs for ingestion and administer an antiemetic beforehand?

Fact:  dispensing, preparing and administering assisted dying drugs demands careful monitoring and recording. This is missing in many jurisdictions

6.

►Who will be present during the drug ingestion and stay with the patient until death? ► Who will ensure that all relevant policies are in place and being adhered to? ► Who will ensure there is documented informed choice about complications? ► Are there sufficient human resource services to deal with patient concerns or complaints? ► Will additional staff be brought in to ensure the care of other patients is not jeopardised?

Fact:  Estimates of work invovled in each assisted death vary from 15 to 60 hours

7.

► How will staff ensure patients are not confused as to the nature of end-of- life care services available to them?

Fact:  some medical assisted dying jurisdictions (eg. Canada) are insisting all services must offer and practice assisted dying on their premises. Assisted dying-free care is no longer a choice in these jurisdictions.

8.

► What protocols exist if a patient develops myoclonus, seizures, vomiting, aspiration or should an assisted death fail? ► What family support will be available in the event of a prolonged death?

Fact:  Nearly 1 in 10 assisted deaths in Oregon have a complication and yet protocols for managing those problems are uncommon and often incomplete.

9.

► Will staff be allowed to exert conscientious objection throughout the entirety of the process? ► Will training on providing physician-assisted suicide be mandatory? ► Will a personal view on physician-assisted suicide become a criterion in staff selection? ► Are there sufficient counselling services to support staff taking part?

Fact:  the impact on healthcare professionals can be profound with nearly a quarter suffering longterm psychological consequences.

10

► How will the organisation’s stance on physician assisted suicide be made clear to staff, patients and patrons to ensure there is no misinformation? ► Is the team and organisation prepared to allow their staff to attend a physician-assisted suicide at home? If so, would the organisational insurance indemnity cover this practice? ► Will professional and organisation indemnity cover assisted suicides on-site, treating complications or staff assisting in the patient’s home? ► Who will ensure relevant policies are in place and adhered to? ► Is the communications team ready to answer media questions?

Fact:  The impact on organisations is considerable.

Evidence

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FAQs

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Breaching the stalemate on assisted dying: it’s time to move beyond a medicalised approach

Quote By BMJ

"If there is a change in the law, an enhanced de-medicalised approach has much to offer. Doctors could instead focus on becoming more confident in having compassionate conversations when responding to requests for assisted dying and better support patients in a holistic manner. A de-medicalised approach to assisted dying should be carefully considered in the UK."