The BMJ debates assisted dying, urging the BMA to change their stance

Assisted dying is a contentious issue, with the debate surrounding it as fierce as ever. It is legal, to a greater or lesser extent, in only a handful of countries worldwide due to the complexity of the debate and gravity of the decision. A series of articles published recently by The BMJ explore this issue, examining the social, legal and ethical considerations that have to be made before assisted dying can be brought into law.

Included in the articles is a call for the British Medical Association (BMA) to change its stance opposing assisted dying. Jacky Davis, Consultant Radiologist, states that in a recent doctor’s survey, the majority of doctors in the UK support assisted dying legislation, along with 80% of the British public. She argues that the detachment between BMA policy and public opinion and “undermines the BMA’s credibility, and its continuing opposition excludes it from the public debate.”

Sarah Jessiman, a terminal cancer patient, wants assisted dying to be legalised to prevent her having a long and unpleasant death.

 

 

I would draw huge comfort from knowing that I could say ‘enough’ when I can no longer endure my illness, so I can die at home, supported by the people I love most”

Sarah Jessiman, terminal cancer patient

The state of Oregon in the US legalised assisted dying in 1997 and it has largely been considered a success. The fear of creeping changes to the legislation that broaden the criteria for assisted dying, such as permitting non-terminally ill patients to have an assisted death, haven’t been realised. The partnership between the law and patient care has demonstrated that assisted dying is not a replacement for palliative care, but rather an option for terminally ill adults. Bobbie Farsides from the Brighton and Sussex Medical School argues that health professionals should stop fighting assisted dying and instead “think about how they would negotiate such a future in the best interests of their patients.”

The complex legal and ethical nature of assisted dying is highlighted by the case of Adam Maier-Clayton in Canada. He suffered from somatic symptom disorder, a psychiatric condition that left him in crippling physical pain, described as being like “burned with acid”. In 2016 Canada legalised physician-assisted dying, however, strict criteria have to be met. Because somatic symptom disorder is a mental illness, it isn’t covered under the new law. Unable to take the pain, Adam eventually left home one day and never came back, taking his own life in a motel, away from the comfort of family and friends. This sparked fierce debate from both sides, with proponents arguing that the law unfairly discriminates against people with mental illness, stating that they suffer just as much as people with physical conditions. Opponents fear that people with mental illness will too quickly look to suicide as a way out before all other options are exhausted, causing them to make a rash and uninformed decision.

Terrance English, a retired cardiac surgeon, believes that as long as sufficient safeguards are put in place to protect palliative care and prevent the abuse of patients and the system, the proposed legislation can “provide both safety for the majority and an option for that relatively small number of people who would wish for this degree of control over their final days.”

However Bernard Ribeiro, another retired surgeon, argues that assisting patient dying is not an appropriate role for doctors as they have a duty of care and it undermines doctor-patient trust, “is a matter for the courts, not for the consulting room.” Sabine Netters highlights another, often overlooked, issue: the emotional strain that assisted dying places on the healthcare professionals involved, going against the very meaning of being a doctor. “The debate about assisted dying tends to focus on medical and legal aspects,” she writes, “but little is said about the emotional impact on the professionals involved.” The system can also be open to abuse and misuse, for example, patients may feel pressured into assisted dying due to guilt of the burden they have placed on their friends and family.

 

 

The BMJ supports the legalisation of assisted dying… we believe that this should be a decision for Society and Parliament, and that medical organisations should adopt at least a neutral position to allow an open and informed public debate"

Dr Fiona Godlee, Editor in Chief of the BMJ