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
Well said Sofia. Finding a path to allow those who want an assisted death, while protecting people against coercion, is necessary to prevent the terrible suffering, that is sometimes perfectly foreseeable, despite attempted palliative attempts.
Sofia’s harrowing experience sounds all too familiar. Sweden has good palliative care and currently difficult to believe UK ranks higher. I think we need an independent arbitration panel of post hoc evaluations to ensure that the Bill continues to act as intended – overseeing the decisions panel.
I’m sorry to hear of your difficult experience, but I have to disagree.
It takes courage to go against the (apparent) zeitgeist, but working in the NHS, we should, as we see daily the shortcomings and abuses, that will ultimately lead this bill to facilitate harm and abuse against some of our most vulnerable patients. Sadly, elder abuse and neglect are common, for myriad societal reasons, and an assisted death would often be the easiest, most cost effective option. When I was a medical student, I was advised it was rarely good to choose the easiest option in complex situations. I think this applies to assisted dying, in many cases. Caring is often hard and very costly, but we should do it.
The main problem with this bill is the fact it is being introduced at a time when general practice is on its knees with PCNs that have outsourced a lot of the palliative care work and home visits away from GPs. Continuity of care is at an all time low especially with the elderly.
This bill needs to be brought back in a few years time when the new GP contract has been agreed which will hopefully have reinstated some of the old values of general practice and we may then feel more comfortable in knowing and understanding our patients and their families
having been a GP for 40 years I firmly believe the UK has to catch up with the rest of the world and look after its dying elderly whether with good hospice care or an assisted death when requested and justified. An interesting and very relevant statistic that the parliamentary review team found was that 80% of those requesting an assisted death in other countries were already under hospice care. …
Scottish bill here and it’s a mess
https://www.parliament.scot/-/media/files/legislation/bills/s6-bills/assisted-dying-for-terminally-ill-adults-scotland-bill/introduction/bill-as-introduced.pdf
Read 18(2) 19(2) and 20(2)
Not with a bargepole I’m afraid and I’m not against the idea!