For the last 30 years 75-82% of the British population have consistently stated they support a change of legislation to allow a choice of an assisted death for terminally ill, mentally competent adults. Comment Editor Mirela Ivanova speaks with Paul Teed, a junior doctor in A&E about assisted dying, and the role played by students in this debate.
M: Why is now the right time to discuss this?
Assisted dying is set to be a very topical subject this year (and no, I’m not talking about Coronation Street plots) as two important events take place in 2014. Firstly, the Supreme Court will deliver a landmark ruling in two cases that is hoped will bring much-needed clarity to the law on assisted dying in England and Wales, particularly regarding the issue of what doctors can discuss with patients.
Secondly, a bill proposed by Lord Falconer to decriminalise assisted dying under certain very carefully defined safeguards will be debated in the House of Lords. This is an issue on which opinions haven’t changed over these 30 years; it will not go away.
With this in mind I joined Healthcare Professionals for Assisted Dying (HPAD) to add my support. Yet, with such high levels of support in the general population I have been surprised to see a complete lack of strong voice from students and junior healthcare professionals.
M: Why the apathy?
This is an issue that future healthcare professionals will be confronted with and to that end we should be making our opinions known. As a group we have been taught endlessly about rational, evidence based decisions but regarding assisted dying, education is usually framed in the form of a debate, one set of opinions versus another. What seems to be missing is the actual evidence, the facts of what is happening already.
M: Is it happening?
Direct medical assistance to die is already happening (with an estimated 1000 deaths per year), countless dying people attempt suicide behind closed doors (some with compassionate amateur assistance) or dehydrate and starve themselves to death due to having nowhere else to turn to. Roughly one person every fortnight travels to Switzerland to die at Dignitas and the law, as it stands, turns a blind eye.
It seems to be ok if you control your own death so long as you do not ask a healthcare professional for advice or support. A new law would provide greater protection to potentially vulnerable people. Upfront safeguards such as a detailed and independent examination of a dying person’s motives, an assessment of mental capacity and exploration of additional support options in advance rather than an investigation or checks after someone dies.
M: The opopsition to euthanasia is still very much rooted in the logistics of its organisation. What would you look for in an Assisted Dying Bill to avoid malpractice and manipulation of the vulnerable?
An Assisted Dying Bill would ensure that two doctors must separately examine the patient and their medical records and independently decide that the patient has four things: a terminal illness with a prognosis of six months or less to live, mental capacity, all of the information about their end-of-life care options, and the ability to make a voluntary and informed decision without pressure.
M: And what about concerns that this practice will cause a sudden surge in cases of assisted dying?
A similar legal framework already exists in Oregon, USA, where it has worked effectively and safely for 15 years. There has been no slippery slope, with assisted deaths reamining stable at around 0.2% of all deaths per year. Eligibility never extended beyond terminal illness and no pressure exists for such a change.
It has only helped to increase uptake in palliative care services and 40% of those who obtain life-ending medication never use them, simply taking comfort from having the option. An assisted dying law would not legalise assisted suicide for the non-dying or legalise voluntary euthanasia where a doctor administers the life-ending medication.
M: How do you think this issue should be made a more intergral part of public debate?
It is vital that students and junior professionals speak out within the upcoming debate. For example, whilst the Royal Colleges of Nursing and Psychiatry hold neutral positions on assisted dying (seeing it as a matter for society and parliament to decide), other royal colleges and the British Medical Association stand opposed.
These positions are inconsistent with the idea of patient-centred care and the principle of ‘no decision about me without me’. There are many ways of expressing your opinion. Dignity in Dying is the national campaign organisation and HPAD is free to join for healthcare students or those qualified in healthcare professions.
Unbearable suffering, prolonged by medical care, and inflicted on a dying patient who wishes to die, is unequivocally a bad thing. An assisted dying law would not result in more people dying, but in fewer people suffering.