1. Well over half of practising UK doctors do not want to be involved in assisted dying.
Could this create conflicts and damage working relationships in your team?
If you are a healthcare professional and,
whatever your views on assisted dying,
please consider the 5 questions below.
For information on what your team should consider
if AD is legalised see here.
For a video presentation click here
For key references see here
Fact: of those expressing an opinion, 58% of practising BMA doctors do not want to prescribe drugs for assisted suicide and 70% do not want to prescribe euthanasia drugs.
Between 30-50% of doctors describe an emotional burden or discomfort about participation in assisted dying.
[Sources: BMA Survey 2020; Pressures on GPs providing assisted dying; Burden of paticipating in AD]2. Canada, Oregon, Belgium and the Netherlands have all expanded their criteria for assisted dying.
Are UK doctors ready to discuss assisted dying, regardless of the prognosis?
Fact: UK campaigners are asking now for there to be no prognostic limit in any future legislation allowing assisted dying.
[Source: Right to Die Campaign]3. Healthcare professionals are already struggling to cope with safeguarding legislation.
Could assisted dying safeguards cause similar difficulties?
Fact: the 2005 Mental Capacity Act was a milestone in protecting decisions made by individuals with capacity and on behalf of those lacking capacity.
More than a decade later, healthcare professionals are still finding it difficult to comply with its legal safeguards. Abuse continues of older people and people with a learning disability.
[Sources: House of Lords select committee; CIPOLD inquiry; Action on Elder Abuse]4. Assisted dying is cheaper than providing care
Is it right that assisted dying would be funded in an NHS which has to ration treatment or care?
Fact: In the UK, over 320 people each day need palliative care but fail to access the care they desperately need.
[Source: Hospice UK Strategy 2017-2022]Fact: According to a health economic assessment published by Scottish health economists in 2020, the authors claimed that “the benefits to the individual patients who choose assisted dying may in fact be outweighed by the broader benefits to society through reduced resource use and the improved potential for organ donation.”
[Source: p69 in Clinical Ethics]
Canada estimates that in 2021 assisted dying could save C$149 million Canadian Dollars (£89 million).
[Source: Cost estimate for Bill C-7]5. Individual patient choice and autonomy are important, but involving doctors to decide on assisted dying sacrifices that autonomy.
How confident do you feel at detecting subtle signs of coercion or fluctuating capacity?
Fact: Doctors do not make ‘life or death’ decisions- they advise on treatments by sharing decisions with patients. Judges, such as those in the Court of Protection, are trained in making objective and accountable assessments about an individual's request to have their life ended. In addition, judges are trained to correct legal errors.
[Source: Role of doctors in assisted dying; Court of Protection; Whistle blowers]Keep Assisted Dying Out of Healthcare
Is committed to achieve, for all:
Real choice
Real and transparent separation of healthcare and assisted dying
Real safety
Professionals caring for your health will only influence that aspect of care.
Real Protection
Decisions made with you about assisted dying will be the remit of the legal system
A real NHS
Real pressure to achieve better access to palliative care support and care
Real dignity and compassion
Individuals can continue to choose their preferred place of care
Real justice
Fair treatment for those who do not have their own voice
Real care
Respecting individuals' wishes in a compassionate and considered way
Is there an alternative?
If assisted dying is allowed the answer is:
A Civic model for assisted dying
A socio-legal model would
1) Have decisions made by a legally accountable body (who would order the required drugs)
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 medical reports are only about the patient's medical condition
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.
CIVIC is SAFER
Quote
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.
See: BMJ Sept 2023