Facing death: the courage GPs may need on assisted dying

With the assisted dying bill going to another vote this week, editor Sofia Lind reflects on the passing of her mother and the role GPs will need to play in this national conversation

In October 2017, I watched my mother die in a way I wouldn’t wish on anyone.

She had survived open heart surgery the year before and had lived with COPD for years, but pneumonia tipped the balance. She was admitted to intensive care (in my native Sweden), where she spent a week lucid but intubated. She was unable to speak, in pain, and clearly frightened. One day near the end, she managed to cough out a few words: ‘I want to die. I want to die.’

She would eventually be allowed to, but not – I believe – in the way she would have hoped.

Eventually, the ICU team decided to withdraw life support but the end was far from peaceful. She was moved to a dim, low-staffed ward. Morphine was rationed. She wasn’t allowed water, just swabs to moisten her tongue. She died slowly, over a long night, essentially by suffocation. Her lungs had been described to us as glued to the back of her ribs.

We were there, but sometimes I wish I hadn’t been. I believe she deserved better.

This experience feels especially relevant now, as MPs are due to debate and vote on the assisted dying bill tomorrow – a proposal that could profoundly reshape how we approach the end of life (although even this bill would not have helped my mum).

It is an incredibly complex issue, and GPs find themselves right in the middle of it – whether they want to be or not.

Doctors are trained to preserve life, not to end it. The principle of ‘first, do no harm’ still carries enormous weight. And the legacy of Harold Shipman casts a long, dark shadow. So it’s not surprising that the profession approaches this debate with immense care – and rightly so.

But we must also acknowledge that there are many bad deaths happening now. Surely that, too, must be part of the conversation.

The bill would allow assisted dying for terminally ill, mentally competent adults with a prognosis of six months or less. It includes multiple safeguards: two independent doctors, a waiting period, oversight. Still, it would place GPs in morally difficult terrain.

In our latest Pulse survey, GPs were fairly evenly split on the issue, with many undecided. Around a quarter said they would be willing to support patients who choose this path. Others were firmly opposed.

Whatever your view, one thing is clear: if the bill passes, GPs may be drawn into new roles – assessing eligibility, making referrals, helping patients weigh their choices. And that won’t be straightforward.

But GPs are already at the forefront of these conversations. You know your patients better than anyone. You are the ones they turn to when they’re scared – and when they want the truth. You already navigate difficult decisions on their future health every single day.

There are important concerns about coercion, inequality, and protecting vulnerable patients. There’s also the risk of damaging trust – of patients fearing they’re seen as burdens. These are all valid, and they must not be dismissed.

But we can’t forget the other side of that coin. We can’t ignore the bad deaths.

My mother didn’t fear death. She was a pragmatic atheist and a woman who acted when others hesitated. I remember one summer, my cousin’s cat injured a mouse and then lost interest. My mum – in wooden clogs – ended the mouse’s suffering with one swift step. ‘It would have been cruel not to,’ she said. Another time, she stopped the car after hitting a hare and used the jack to end its pain.

She believed in life, and she believed in mercy. Her final hours had neither.

I’m not calling for rushed legislation. And I’m not suggesting that any doctor should be forced into a role that conflicts with their principles. But I do believe GPs – who are trusted, thoughtful, and already grappling with these questions – have a crucial part to play in this national conversation.

It will take sensitivity. It will take care. And above all, it will take courage.

Sofia Lind is editor of Pulse. Find her at [email protected] or on LinkedIn