Our view on assisted dying has changed, and so must the law
It’s time for the College to take a neutral stance on assisted dying, writes Dr Sarah Wookey, so that politicians can make the law more compassionate towards those facing death
As a teenager I used to help out in my father’s office. I got on well with Ian, his senior colleague, who remained a friend of the family after he retired. Ian developed stomach cancer when I was about sixteen. He was, uncharacteristically for the seventies, frank, funny and articulate about his disease, its effect and his prognosis. One day my father and I were invited to have lunch with him. He was clearly uncomfortable and didn’t eat much but seemed at ease with himself. He died the next day.
Two days after his death a letter arrived for us. It contained a photograph of Ian, standing in his garden, waving goodbye to us, together with a letter thanking us for being with him on the last day of his life. I discovered that, when he first learnt of his diagnosis, he asked his doctor, who was an old friend, if he would help him to die when he felt it was the right time. He had called his doctor the evening after our lunch. I have no idea who his doctor was, but I felt and still feel that he fulfilled his duty of care to Ian admirably.
I couldn’t help him
Twenty years after Ian’s death, and now working as a GP, I looked after a man dying of pancreatic cancer. For the last few weeks of his life, despite the best efforts of our excellent local palliative care team and district nurses, he found his symptoms intolerable. Like Ian he was clear-sighted about his illness. About three weeks before his death he asked me if I thought the symptoms he found so unbearable would get better. He then asked me if there was any way of shortening his life. I had to tell him that I couldn’t help him, assisted dying being illegal. His symptoms continued to worsen until his death.
A few years later I developed cancer myself. Amongst the mixture of emotions I experienced at the time was a feeling of frustration that I couldn’t arrange for a trusted person to help me to die at a time of my choosing were I to become terminally ill. That was many years ago but I remain haunted by the fear that I may have to go through an experience similar to that of my patient.
College must stay neutral
As the lynchpin of many patients’ care it is vital that GPs engage with end-of-life issues, including assisted dying. The fact that the RCGP has decided to consult its members on the position they should take on assisted dying reflects the need to have this important discussion, and I would urge as many members as possible to engage with it before it closes. GPs hold a range of opinions on assisted dying, with around 30-40% of doctors believing assisted dying should be available as part of end-of-life care, so the most appropriate position for the college to take is one of neutrality.1,2 The RCGP’s current opposition to assisted dying blocks constructive and open discussion of the issues for both patients and practitioners.
If the RCGP takes a neutral position, Parliament can decide on the matter for society as a whole, and the college will remain in a position to advise whether or not it becomes legal. Individual GPs will remain able to express their opinions as individuals whether for or against, and if assisted dying were to be legalised, would have the option not to participate through conscientious objection. It is important that the RCGP reflects the views of its members on this ethical issue, and polling shows that the majority of doctors, 62%, believe their representative bodies should be neutral on assisted dying.3 I hope that the current consultation will reflect this, ensuring that no members are alienated from their college.
Look abroad for lessons
I’ve been a GP for nearly 25 years, so have been involved with many patients at the end of their lives. In that time there have been only a handful of requests for help to die. From the experience of other countries where assisted dying is legal and regulated, the number of terminally ill patients who decide to request help to die is quite small. There is a much greater pool of people out there, people like me, who are able to take comfort from the knowledge that the option is there, even if they decide not to take it up.
For example, in Oregon where assisted dying has been legal since 1997, assisted deaths of terminally ill patients make up just 0.2% of deaths each year.4 In addition to this, around 40% of those patients who receive a prescription which would enable them to have an assisted death actually do not chose to carry it out, instead taking comfort knowing they have the option should they need it.
My personal and professional experience has led me to become a member of Healthcare Professionals for Assisted Dying (HPAD) – and to believe that assisted dying for terminally ill, mentally competent adults should be available as a choice alongside high quality palliative care.
I would urge all GPs, whatever their views on the issue, to participate in the RCGP consultation before it closes in October.
Dr Sarah Wookey is a GP in Banbury and is on the steering committee for Healthcare Professional Assisted Dying.
1 Lee W, Price A, Rayner L and Hotopf M (2009) Survey of doctors’ opinions of the legalisation of physician assisted suicide. BMC Medical Ethics 10 (2).
2 Seale C (2009) Legalisation of euthanasia or physician-assisted suicide: survey of doctor’s attitudes. Palliative Medicine. 23: 205-12.
3 Doctors.net (2011) online survey. GFK Healthcare for DiD.
4 Summary of Oregon’s Death with Dignity Act (1998-2012)