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GPs go forth

GPs must find their voices for assisted dying debate

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Last month, Lord Falconer gave a First Reading of a bill that would ‘enable competent adults who are terminally ill to be provided at their request with specified assistance to end their own life; and for connected purposes’.

Before considering the Bill itself, though, this question must be answered: should doctors have a collective voice in this debate? 

Just as the Assisted Dying Bill approaches its first hearing in the House of Lords, two of the most influential doctors in the UK have argued publically that our professional bodies should not hold a view on this issue.

Editor of The BMJ, Fiona Godlee, and former RCGP chair Professor Clare Gerada reason that it is for Parliament, not doctors, to decide the rights and wrongs of assisted dying. Therefore, they argue, the BMA and the RCGP should change their stance from opposition to a change in the law, to a neutral position.

Dr Godlee has also made a significant move in this debate by proclaiming the BMJ to be in favour of a change in the law, while Professor Gerada made the case for neutrality lin the BJGP last year. (She also reiterated this view recently on Twitter).

Professor Gerada claimed that her view was not more or less valid by virtue of her having been RCGP chair, and that the RCGP collective view ‘should not trump that of the man on the Clapham omnibus’. And as editor of one of the most influential UK journals, Godlee has not hesitated to make her views known. 

No-one is arguing that doctors should decide this issue: that is Parliament’s job. But neither the BMA nor the Royal Colleges are trying to decide the law. They are simply opposing a change in it.

There are many voices to be heard in this debate, of course, not least patients who would seek to end their own lives as a result of any change to the law, and their families. There are also ethicists, legal experts and certainly the man on the street who should all be listened to.

But doctors are the only ones to see both the suffering of both those who would wish to end their lives, and the vulnerability of those who may be affected by a change in the law. We are neither judge nor jury, as it were, but expert witnesses. As a profession we have a diversity of opinion, but our duty to stand up for vulnerable people has so far kept the profession opposed to any form of euthanasia, and is arguably one of the most important roles doctors have in society.

It will come as no surprise that I am not in favour of assisted dying - I know many doctors hold an opposite view with equal passion. But even if we disagree on the contents of the Bill, surely other GPs will agree that we have a vital role in this debate.

GPs must not be so falsely humble that we are silent, or so overwhelmed with the stresses of general practice that we fail to speak out. Our patients deserve more than that, especially those who cannot speak up for themselves. 

Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68.

Readers' comments (15)

  • The nail that sticks out the most gets hit the hardest

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  • "GPs must find their voices...." Yeah right ...... & when is that EVER going to happen??

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  • Is anyone actually thinking about how the law would be practically implemented if it came into being ? As a GP will I be expected to home visit, prescribe and oversee in the middle of all else I do? Presume patients will be given choice for dying at home at a time of their choosing. Or will specialist teams organise this presume likely private sector. I took Hippocratic Oath. Will I be able to choose not to be involved ?
    What happens to life insurance policies ?
    How on earth do we protect the vulnerable from choosing or being encouraged towards dying by misguided family and healthcare workers.
    I have overturned several DNACPRs from recent hospital admissions because clinical situations have changed.
    The law changing is one thing the practical implementation is quite another

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  • The recent BMJ article asserts that a change in the law on assisted dying is the right thing to do and that most people want it. When we encounter an individual in distressing circumstances with a terminal illness and facing uncertainty about symptom control and loss of dignity, assisted dying seems like a logical and compassionate solution. As has also been suggested, it is not for doctors to decide, but society as a whole.
    But as doctors we will be asked to carry out this act. There is little room for wholesale ambivalence here. It is the duty of the medical profession to give its considered opinion on what the pitfalls of such an approach could be as well as the benefits and to consider any unintended consequences both at an individual and at a societal level.
    In 2014, British society is not good at dealing with death. For some it is seen as a medical failure and that every attempt should be made to preserve life whatever the situation. Hence the debate and palpable suspicion surrounding DNACPR and our difficulties in allowing natural death where this is appropriate, caring and dignified. We have also seen serious problems with the implementation of very well intentioned guidance on end of life care as with the Liverpool Care Pathway. How can we be reassure that implementation of this law would be any better?
    The demise of medical paternalism and the rise of patient autonomy should be celebrated. However, we must be careful as a profession to remain advocates for patients, not devolving all responsibility for decision making to them when they are vulnerable and seeking the help that expertise and experience can offer. Decision making should be shared, not shifted.
    We must remember that there are a large number of people who are terminally frail? What of them?
    As Martin rightly says, we cannot duck this issue. Will we do this, or not? I, for one, will not.

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  • . .? Gattaca

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  • This is debate that DOES need to be had. I know many doctors who feel it should be there as an option for the terminal patient rather that sometimes months of misery and pain for the patient and the relatives/carers. A blanket NO from our supposed leaders is now out of order. Just as with abortion (and hopefully 7 day working) this has to be voluntary for the doctors involved to do, and not a part of every doctors day to day work.

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  • Whatever your views on the pros and cons, the rights and wrongs, the proffession must ensure that not only the patient is protected, but that the healthcare proffessionals involved throughout are as well - be that through acusation or mental health.

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  • The editors of BMJ which include the 'patient editor' state that the BMJ takes a certain view on assisted dying....this is quite a dangerous move when only the voice of those at the top of the BMJ hierarchy is heard -.obviously there will be some working at the BMJ who oppose the proposal of assisted dying but are unable to voice their opinion..BMJ it seems also has the ear of politicians such as Joffe - is it a coincidence that two more members of the house of lords are also coming out in favour of his bill now? -but these meetings and discussions are not being published in BMJ.shame on them for lack of transparency in that respect.

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  • Fiona Godlee's opinion is only her opinion. Mine is completely different. I can see no point at all, none whatsoever in months of agony with dying inevitable. We all have to die sometime. I see no merit in spending the last months in pain and suffering personally and for patients. I cannot bear to watch them suffer emotionally and physically without any possibility of recovery or mitigation, if they do not wish it at all.

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  • Until we have "gold standard" palliative care services across all sectors of the health service then offering euthanasia is not offering the patient true choice. The fear of pain and loss of dignity in dying added to the knowledge that services are not adequate skews the choice of the patient. We all have seen 'good' deaths and not so good ones; getting services right would lessen the need for euthanasia but also would open the pathway to allow it.

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