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An assisted death is a right for all

Introducing the Assisted Dying for the Terminally Ill Bill is crucial if decisions are to be placed in the hands of all patients, argues Dr Chris Cooper

Introducing the Assisted Dying for the Terminally Ill Bill is crucial if decisions are to be placed in the hands of all patients, argues Dr Chris Cooper

We all know that life is finite, but death is a subject people prefer not to think about, which means finding out how someone wants to die in advance is often difficult.

I'd like to consider what can be done to preserve the rights of individuals to die as they choose, particularly those given a shorter length of time to live as part of their diagnosis and prognosis.

I'd like to live healthily for as many more days as possible. But if I should be faced with death far sooner than anticipated, I hope to deal with it pragmatically and with dignity.

For me, the worst-case scenario would be one in which I would want to cease living because of my illness, but either wasn't allowed to do so by law, or hadn't put in place a plan to allow it to happen if withdrawal of treatment was required.

The Assisted Dying for the Terminally Ill Bill is still under discussion but its introduction remains a real possibility. As a society we have learned to respect the rights of individuals to make choices for themselves. Medical theory, research and practice show us that some terminally ill people experience severe emotional suffering in addition to the physical. Yet there are plenty of cases where people are kept alive against their will, sometimes dragging out their pain, simply in order to extend life.

A slippery slope?

A common argument against assisted dying is that it would put us on a slippery slope, with vulnerable groups of people at risk from death without their consent. But research in Oregon and Holland – where physician-assisted dying is legal – has found no evidence to support this.

More than 200 doctors signed a letter to The Guardian in support of assisted dying last year on the day the BMA voted to revert to a position of opposition to it.

Dignity in Dying, the organisation campaigning for greater patient choice at the end of life, commissioned a survey on GP attitudes in June 2006. It showed 30% of GPs would be willing – if the law permitted and subject to a range of safeguards – to write a prescription to assist a patient to die.

A Pulse survey in May 2007 suggested that figure might have increased, with 42% of GPs saying they would be willing to help a terminally ill person to die if it was legal.

One change I believe has not been trumpeted enough is the Mental Capacity Act, which came into force on 1 October. The law applies to every citizen aged over 16 and, when utilised, gives people the right to be much more in charge of their futures.

Decisions to refuse treatment in such circumstances should be respected, so long as the patient has capacity. The law applies even if a doctor personally believes refusal of treatment is unethical.

Although enforcement of the Mental Capacity Act is a breakthrough, it cannot disguise the fact 54% of complaints to the NHS are about end-of-life care4. The system fails the complex needs of dying patients and fails to recognise that each person has different needs.

People who oppose the Assisted Dying for the Terminally Ill Bill often argue that legalisation of medically assisted dying for the terminally ill would damage standards of palliative care.

But in Holland and Oregon the opposite has been true, with standards actually improving. People faced with death by a terminal illness sometimes gain peace of mind simply by knowing medically assisted death is an option. Research from Oregon shows only one in 200 people who enquire about it actually take it up. Oregon has been voted the second most desirable state in which to die in the US.

The introduction of the Mental Capacity Act shows real progress has been made in patient choice, but I believe the Assisted Dying for the Terminally Ill Bill is also needed. More end-of-life situations will then be dealt with in a dignified and legally safe way, with decisions placed in the hands of all patients, rather than just those who shout loudest.

Every patient should have access both to excellent palliative care and the option of a medically assisted death.

Dr Chris Cooper is a GP trainer in Islington, north London, with a particular interest in mental health issues

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