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The RCGP must adopt a neutral position on the assisted dying debate

Professor Sir Sam Everington

As the RCGP asked its members for their views on assisted dying for the first time since 2013, I found myself reflecting on the terminally ill patients I’ve cared for throughout my career.

I’m a GP in the East End of London. We provide a comprehensive service for all of our patients who are terminally ill, with a multidisciplinary team meeting every month to proactively manage and support them.

This team includes our phlebotomist, GPs, Macmillan nurse, social workers, district nurses and the social prescribing team, all of whom ensure that as much as possible is planned and predicted to ensure comprehensive and personal support to everyone who needs it. This minimises pain and suffering, and ensures we deliver on the personal wishes of patients.

I give all my terminally ill patients my personal NHS email address and my mobile phone number. They can call me at any time, and because they’re far more in control of their terminal illness, they have a far better experience and outcome.

The pain of bereavement within their family is also significantly reduced - they’re proud about giving their nearest and dearest the greatest gift: a peaceful end.

Everything we do helps patients to have their choices delivered, and significantly reduces their suffering.

Sadly, 47% of patients still die in hospital with their terminal illness, despite the fact that most would choose to die at home. Even when primary care provides a perfect service, it’s sometimes not enough.

Some of this is the fault of the system, but some of it is the fault of the law.

Our College needs to adopt a position that allows GPs to engage in the assisted dying debate

Over 30 years as a GP, I’ve seen a small number of patients suffer, despite our best efforts. Some of these patients, of sound mind, would choose to end their suffering, to end their life on their terms.

We’re trying to give patients choice about where they die. Terminally ill patients should also have a choice over how and when they die.

I understand some doctors who would find it impossible to facilitate such a request. I think I am one of those doctors.

But I would equally argue that this is about patient choice, and I know there are honourable doctors who are willing to help those who want this option.

All GPs should strive to have honest conversations about death and dying, and that’s exactly what the introduction of an assisted dying law would bring about, even though international experiences tells us that just a tiny percentage of dying people would go through the whole process.

Terminally ill people should be at the very heart of the debate on assisted dying, and, as GPs, we have a duty to listen to their views.

Continuing to actively oppose a change in the law (the RCGP’s current position) puts the College at odds with our dying patients, a majority of whom believe doctors’ organisations should be neutral on or supportive of change.

It also leaves us lagging behind other medical organisations, such as the Royal College of Physicians, which dropped its opposition in favour of neutrality following a member survey earlier this year, and the Royal College of Nursing, which has been neutral since 2009.

Sadly, our position carries on the idea that the doctor knows best, rather than seeing ourselves as family doctors who are there to support and care for patients throughout their lives.

Our College needs to adopt a new position that allows GPs to engage constructively in the assisted dying debate, represents the range of views held by patients, and put them at the front and centre.

I believe that neutrality is the only position that can do this.

Professor Sir Sam Everington is chair of London's 32 CCGs and a GP in Tower Hamlets

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Readers' comments (17)

  • No. The law acts a a safeguard for those vulnerable, often elderly people who think they are a 'burden' to people by staying alive. These people need protecting and the law does that albeit imperfectly. Many patients get depressed, if their quality of life is poor, and may feel like not wanting to continue, but then, as we have all seen in clinical practice, the depression can lift and people may change their mind

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  • David Banner

    Re Soren

    A robust policy would avoid your understandable slippery slope concerns.
    - ONLY those patients with full capacity, with a proven terminal illness, and with less than 6 months to live according to the opinion of 2 doctors, would be allowed to make this choice.
    - no doctor would ever be pushed into signing a form if they morally object
    - simply being old, depressed or demented would not be justification enough.
    - The Netherlands have operated this compassionate policy for decades.
    - terminal patients are already voting with their feet, dragging their exhausted bones to Zurich, paying thousands and risking prosecution of caring relatives just for some final control and dignity.
    I sincerely hope that this option is available by the time I become terminally ill. I still find it astonishing that we (rightly) allow the right of termination at the start of life , yet still block it at the end, condemning poor patients with zero hope of improvement to a dragged out, painful , undignified end that we would never force on our beloved pets. We at least deserve the same rights as our cats and dogs.

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  • A bit like their neutral stance of the assisted death of General Practice then!.

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  • As David Banner alludes, if I were to treat my pets the way the law demands that I treat patients, I would be in court for cruelty for denying them the relief of a painless death. And yet we continue with this debacle of moralistic patriarchal "we know best" which resolutely ignores the wishes of the individual. With proper safeguards in place, as per Holland, we can give *those that want it* the dignified, painless death they wish for. For the RCGP to maintain its didactic stance is typical of an organisation bereft of any real connection with the population it should rightly be supporting. Neutrality is the only moral stance; allow the individual to make choices in accordance with the individuals beliefs and wishes.

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  • I support the choice of patients to end their suffering by physician assisted death. Currently it takes at least 3 months to arrange a physician assisted death in Switzerland and at a cost of £13,000. There are many safeguards to respect. Even though a nice home birth may seem like a good idea up until the moment it isn't, a nice home death may seem like a good idea up until the moment it isn't. Not all experiences around life events such as birth and death are under our control, no matter how skilled and resourced we may be. Personally I would prefer to die by a method of my own choosing under certain circumstances. The majority of the public agree with this stance and although many doctors would not like to aid patients in this situation there are some that would. Medically assisted abortion is the killing of a little person at the very start of their unlived life who has no choice in the matter. Physician assisted suicide is the killing of usually an old person or at least adult who has lived their life, wants to die because they consider living unbearable, or who is afraid of a painful, protracted, undignified death. They may also wish to spare their relatives anguish by witnessing such a death. Why abortion is considered to be a woman's right up till 24 weeks gestation and is becoming decriminalised and physician assisted death is considered medically abhorrent and a criminal offence defies logic. Other countries and certain US states have already overcome safeguarding issues so we don't need to figure it all out from scratch. Doctors and patients who do not want a physician death and prefer to have a natural death may continue to do so. They should not impose their religious or moral stances on those who don't.

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  • Cobblers

    Soren kierkegaard | Locum GP10 Dec 2019 7:23pm.

    Pseudonym a case of nominative determinism?

    Søren Kierkegaard was a Danish theologian, poet, social critic and religious author.

    Hmmm. Maybe a COI addendum SK? Such as "probable Christian" whose philosophy would espouse allowing people to die like a dog, no, worse than a dog, as, at least the vet would put the dog to sleep.

    Having a neutral stance would allow the RCGP to disavow either side of the argument and should be the default position.

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  • doctordog.

    Any volunteers to become your local Dr. Death?

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  • Cobblers cobblers - although you do sound lovely x

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  • Having worked in a hospice as a GPST1 and seeing how it is morphing into a "cottage hospital" makes me hope to god the option to end life of poor quality is available should I need it.

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  • Do we still believe in patient choice? How many times have we heard patients say it does not work but it just makes me drowsy and when they are too drowsy we all pretend that the person is not in pain. Uncomfortable but I think the sufferer should make the decision as it is their body and their suffering at the end of the day. Do it like the abortion consent. 2 doctors.

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