Assisted dying

This is a tricky subject, and one that I have avoided so far, but the UK news today is full of the report of the Commission on Assisted Dying. According to the report, doctors should be allowed to help terminally ill people to kill themselves. The report goes on to say that strict guidelines should be introduced to ‘protect the vulnerable’.

The report states that current law on suicide in the UK is ‘inadequate and incoherent’  and needs reform. The commission was not supported by the British Medical Association (BMA) who refused to take part stating ‘The BMA believes that the majority of doctors do not want to legalise assisted dying’

I was chatting to a colleague earlier about this topic and he very wisely said  ‘I don’t think anyone can really  comment about this subject unless they have direct experience of someone close to them being terminally ill’  Wise words indeed. The problem is, of course, that if you have had such experience, your views are likely to be highly polarised and passionate.

And this is where, as a hopefully rational commentator, I must be careful. Sadly, according to the above criteria, I do qualify to comment on this topic, after my beloved husband, Bob, died of cancer. It is this personal experience that means that the report from the commission angers me greatly. The report states that a person first of all would have to be terminally ill to be considered for assisted suicide under its proposals. The group has defined that to ‘qualify’ for assisted death, a patient who has less than 12 months to live.

And thereby lies the first, insurmountable hurdle. 12 months to live according to who? In July 1999, my husband was given 6 months to live. Shocking, devastating and very frightening for a man literally in his prime with a family and to enjoy and so much living still to be done. Luckily, Bob chose not to accept the time limit suggested and lived for a further three and a half years. Most of that time his quality of life was good, and during those years he kept his business going, celebrated the birth of a new grandson, saw his girls blossom and walked one daughter up the aisle. This story is not unusual, and sadly there are also cases where survival is actually much less than expected. But who really knows?

The report goes on to suggest that a patient who chooses assisted death ‘should  be acting under their own steam and not be mentally impaired in any way’.  This is an equally unworkable recommendation. Who could differentiate between a frail and elderly patient with all their faculties who chooses to die from one who is privately under great pressure from their family for a convenient passing? And how do you define mental impairment in these cases?

I fully support the comments of Baroness Finlay of Llandaff, who chairs an all-party parliamentary group that opposes legalised euthanasia, ‘It is one thing to define the end of life for treatment purposes, quite another to do so for supplying lethal drugs for suicide’

I applaud the courage of any person, body or group who attempts to address the difficult and emotive issue of assisted death. But I would prefer to see more effort, publicity and resource focussed on end of life care.

The phrase ‘die with dignity’ saddens me greatly. A better phrase, normally used in end of life care circles is a ‘good death’. Like a ‘good life’ – this can mean very different things to different people. Palliative care is vastly improved and following  a patient’s wishes regarding level of sedation an pain relief, whether they are at home or elsewhere and a whole host of other considerations is paramount. Knowing how to speak to terminally ill patients and their loved ones also requires training and expertise. These areas would benefit greatly from investment, funding and recognition. But for a clinician to ask ‘do you want to die?’ is a bridge too far in my opinion.

Let us focus on assisted life, not assisted death.