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At the heart of general practice since 1960

Should the RCGP drop its opposition to assisted dying and become neutral? No

Dr Rhona Knight argues that legalising assisted dying will increase elder abuse, and effectively legalise euthanasia

Imagine the following dystopian picture of Britain in 2021:

‘The number of people choosing to die by euthanasia rose by 13% last year to just over 15,000, an increase of 118% in just six years.1

‘Now 2.8% of all deaths in England and Wales are by euthanasia.2 To this must be added the 2,500 people, women more than men, who died by assisted suicide.3 Continuous deep sedation until death has likewise shown a dramatic 50% increase in the last 5 years. In 2020 it applied to 12.3% of all deaths.4

‘The role of the doctor has now changed. For millennia doctors, following in Hippocratic footsteps, were seen as carers and not killers.

‘Now they are seen as harbingers of death, more concerned with their income and health care budgets – after all a dead patient is a cheap patient. Doctors today have an ever expanding role hastening people to an early “wanted” death. For any patient with a disability, or chronic disease, death is now a routine therapeutic option.’

This picture is, in fact, based on the most recent data on end-of-life practices in the Netherlands and Switzerland.

Recently the media has been full of traumatic stories from people wishing help to end their lives. Reading these, many worry that this may also be their future, fearing loss of autonomy, dignity and of being a burden.5 Superficially, the argument that people should be free to choose death seems both reasonable and morally right. If more proof is needed, one just needs to turn to the views of key celebrities like Patrick Stewart and Terry Pratchett. High profile calls for more liberal assisted dying laws fuel demand – the Werther effect as it’s called - and implicitly convey that there is such a thing as a life not worth living.6

A popular argument supporting assisted suicide is the patient’s right to choose, closely followed by arguments about the limits of palliative care. A little further behind are the arguments about the cost of healthcare in the last few months of life and the health impact of an aging population.

In 2010 Martin Amis feared a ‘silver tsunami’, for which he suggested that a euthanasia booth, a martini and a medal should be waiting for any frail elderly person who decides to relieve the world of their presence.7 But if this is all so cut and dried, why are the medical profession including the British Geriatric Society, the Association for Palliative Medicine and the RCGP, opposed to assisted dying? And why are the main disability rights groups also opposed?

GPs must stay opposed

Doctors are in a privileged position, knowing the uncertainty of both diagnoses and prognoses. We also know that the rare requests to end life are usually driven by fear, which, if addressed, usually results in the requests being withdrawn. We understand the implications of assisted dying for the vulnerable who, feeling that they are a burden, may feel pressurised into an early death. After all, it is said that where there is a will, there is an anxious relative, and elder abuse is a sad reality as are exhausted carers in need of support. The quality of care to many vulnerable patients is already substandard, and one just needs to look at the Francis report to see how our elderly are often discriminated against in current NHS structures.

We also know the power of the slippery slope – and data from the Netherlands does nothing to reassure us. Neither does the promise of safeguards in a society that cannot currently protect children from abuse by their own families.

Legalising assisted suicide will effectively legalise euthanasia. What happens if the medication does not ‘work’, or if the person wishing to die cannot take the medicine, or press the button? Justice will demand equal access to death as a right for both able-bodied and disabled patients. And what of a competent 14-year-old? She can take the Pill or have an abortion without her parents’ consent. Could she also be helped to die? The slippery slope is well-oiled and ready to be used. It would then not take much for assisted dying to extend to those without capacity: those with dementia, in PVS, children with severe disabilities.

Good medical practice is not defined by the zeitgeist. As doctors we have responsibilities that transcend time and place, which we ignore at society’s peril. We only need to look to history to see what happens when doctors abdicate responsibility and become complicit in regimes that identify and end the lives of those living lives deemed to be ‘unworthy of life’. I am glad that the RCGP opposes assisted suicide. When we know the implications, do we really want to see the headline ‘GPs for assisted suicide: the largest medical college drops its opposition’? As doctors we have a societal responsibility to be trustworthy, to advocate for the vulnerable, to ensure our expertise is heard, and to ensure that doctors stay as carers and do not become killers.

Dr Rhona Knight is a GP in Leicester with an interest in ethics.

References

1 Dutch News. Euthanasia requests rose in 2012. 2013.

2 There were 499,331 deaths registered in England and Wales in 2012 (ONS. Statistical bulletin: Deaths Registered in England and Wales, 2012.

3 Daily Telegraph. Almost 300 assisted suicides in Switzerland per year. 27 March 2012.

4 Onwuteaka-Philipsen B, Brinkman-Stoppelenburg A, Penning C et al. Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey. The Lancet 2011.  

5 Oregon Public Health Division. Death with Dignity Act. 2011.

6 Niederkrotenthaler T, Voracek M, Herberth A. Role of media reports in completed and prevented suicide: Werther v. Papageno effects. Br J Psychiatry 2010;197:234-243. doi: 10.1192/bjp.bp.109.074633

7 Daily Telegraph. Martin Amis calls for euthanasia booths to deal with ‘silver tsunami’. 24 Jan 2010.

Further reading

Dignity in Dying. http://www.dignityindying.org.uk/

Care Not Killing. http://www.carenotkilling.org.uk/

Readers' comments (5)

  • The title of this piece leads the reader to think there might be a discussion regarding the issues surrounding the complexities of a professional body having a “stance” on an ethical debate that society at large is demanding. It leads us to expect issues regarding whether a body representing a large group of people with diverse viewpoints can actually have a collective viewpoint on ethical matters rather than medical matters. It doesn't though, why not? Is it because the democratic and logical answer to these issues is neutrality?

    The piece then goes onto mention euthanasia and killing, very different from the consultation by the RCGP regarding Assisted Dying and is “effectively” misleading. Nor (and I have to admit that I'm shocked and appalled to have to say this), does child abuse. We are then invited to imagine a dystopian vision whereby Dr Knight cannot choose the right choices for other people, and yet its Assisted Dying that is linked to murky regimes that have nothing to do with the debate but everything to do with emotive fear rather than care. I propose another dystopian picture of Britain. In this picture best interests are dictated and autonomy sidelined. Where 2500 people are denied or ignored, left to have part of their suffering unmet, not even allowed the comfort to talk things through. Where their death is abandoned to grey areas in law and is preferable to INCREASED safeguards and standards at the end of life, for both themselves and their doctors. Where the “evidence” in the debate is selectively used from different systems (Swiss and Dutch) in comparison to the one being proposed in the UK, yet ignoring the positives from those systems that are more similar (Oregon). This is Britain: 2013. If Dr Knight is truly worried about financial pressures causing deaths of patients, shouldn't she be arguing for greater safeguards, oversights and standards, not less as currently stands?

    Do we want to see the headline “GPs drops its opposition to Assisted Dying”? Ask the near 80% of the population that say yes.

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  • Clearly if there is to be a proper discussion of this important issue it is imperative that we all use the correct definitions, without this the discussion is confused and inaccurate and the conclusions are not likely to follow logically.

    Assisted Dying: permits mentally competent adult who have a diagnosis of a terminally ill who are suffering unbearably despite receiving optimal palliative care, to receive medical assistance to die at their considered and persistent request, at a time of their choosing after meeting strict legal safeguards. Assisted suicide: permits chronically ill or disabled adults who do not have a terminally ill to be given medical assistance help to end their lives at a time of their choosing. Voluntary euthanasia: permits terminally ill adults, the chronically ill or disabled adults to have their lives ended by another at their request.

    Much of the discussion refers to assisted suicide and euthanasia where the title refers to assisted dying, so is not relevant.

    Doctors and Healthcare Professionals have a duty to provide patient centred dignified care at all times. Clearly if a patient with a diagnosis of a terminal illness having received optimal palliative care makes a considered and persistent request to receive assistance to die earlier then their disease allows the caring and humane action to be taken is to provide for this autonomous choice within the unyielding legal safeguards. Reliable surveys demonstrate that over 80% of society supports a change in the law to allow Assisted Dying. Surely it is not for Doctors or others Healthcare Professionals to attempt to control the law by opposing a proposed change in the law, but for Society to decide.

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  • Over 80% of the population are not responsible for implementing 'assisted dying', and the 80% quoted are the 'sharp elbow' minority who make the big noise. Optimum palliative care is only rarely unsuccessful, with 3 plus years of palliative care experience, I never had the event of a patient asking to have their life terminated. I am absolutely in accord with the RCGP.

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  • Asking Drs not to have or voice an opinion on assisted dying and its implementation is hugely dismissive. If society is going to ask a Dr to intentionally put in place, through their actions, something to bring about the end of someones life the very least I would expect is for Drs to have an opinion and voice.

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  • "Now 2.8% of all deaths in England and Wales are by euthanasia." really? Where did this come from? Who is doing this?

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