Should the law on assisted dying be changed? No
BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1883 (Published 21 April 2011) Cite this as: BMJ 2011;342:d1883
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
The dilemma faced by Health Care Professionals in caring for patients
with terminal illness was cogently presented by Professor Tallis, and the
sanctity of life by Kevin Fitzpatrich. The sentiments expressed by
Professor Tallis will doubtless resonate with both clinicians engaged with
Care of the Elderly and carers of those with chronic debilitating illness.
As a current student of the Open University, I am minded to recall the
transcript of Lord Devlin's Maccabean Lecture in Jurisprudence entitled:
"The enforcement of morals", in which he contended that criminal law
should be used against behaviour generally condemned as immoral. The
experiences of the population of Oregon run counter to the slippery slope
hypothesis and the issue of the trust vested in doctors is reinforced by
patient experience in the Netherlands.
But what of the rights of the terminally ill, distressed individual as set
against the moral feelings of the rest of society and inconsistencies in
the application of the law amongst members of the European Union?
The European Convention on Human Rights whilst not entrenched in our
Constitution, none the less cites the Right To Life under Article 2 as an
inviolate positive right protected by law. A multi-cultural, multi-
disciplinary European wide debate on this key issue is surely long overdue
before Government initiatives further fracture the delivery of holistic
patient based care.
Competing interests: No competing interests
I agree with Professor Tallis
I believe the law should be changed subject to safeguards
1)Adequate palliative care services should be available.
2) Certification of sound mind by a consultant psychiatrist and patient
GP.
3) Certified no undue pressures by heirs by appointed solicitor.
4)Only nominated (By the GMC) practitioners should prescribe or
administer or supervise treatments.
Competing interests: No competing interests
Inherent in the arguments about protecting those seen as "vulnerable"
is the suggestion that this group should not be allowed to refuse
potentially life prolonging treatments. This viewpoint has been raised in
the past in relation to the refusal of ventilation. Perhaps the question of
ventilation was not discussed with Baroness Campbell in the most
sympathetic way, but that is very different from trying to remove her
right to refuse it. Her views are personal and do not seem to be shared by
most of those considered to have a disabiity.
Competing interests: Member of Dignity in Dying
When he argues that older, disabled people's lives are under threat when a law would permit euthanasia, then he uncritically cites Lord McColl, who apparently has said: "Many elderly people in the Netherlands are so fearful of euthanasia that they carry cards around with them saying that they do not want it." However, an empirical foundation for this claim is not, and cannot be given. To my knowledge, no such anti-euthanasia cards exist in the Netherlands. What does exist is a living will ( the so-called 'levenswensverklaring') which is distributed by the Christian Dutch Patient Association (NPV). In this living will a person can express his or her wishes regarding end-of-life medical and nursing care in case of incompetence. Amongst others, the person may indicate that active life termination by him or her is considered not to be an acceptable option.
It is not known how many people actually have completed such a living-will. Lord McColl's quote is both incorrect and overly suggestive.
Competing interests: No competing interests
Fears for disabled people's rights with regard to assisted dying do
not seem to be justified by evidence.
Patient choice and autonomy should be upheld until death. If that
includes an advance decision in favour of assisted dying, this should be
respected.
'First do no harm' should mean 'do not cause suffering in order
simply to prolong life'. Rather, 'act with compassion and end suffering,
even if this shortens life when prolonged suffering and/or death are
inevitable'.
Public opinion should decide this law (not religious beliefs or
misplaced 'protection').
Competing interests: I have written on the Dignity in Dying website
Dear Mr Fitzpatrick,
Thank you for your letter in the BMJ discussing the euthanasia
debate. I would like to share my appraisal of your comments, as I feel
you misrepresented the debate somewhat.
Your opening statement is that euthanasia will endanger patient
safety and therefore reduce health-seeking behaviour amongst vulnerable
patients, citing as your evidence an anecdote from your colleague,
Baroness Campbell.
As a healthcare professional I understand that patient safety is of
utmost importance, but I do not think it is fair to represent autonomous
patient decisions to end their own suffering as an affront to patient
safety.
Furthermore, Baroness Campbell's experience was clearly harrowing,
but is simply an example of extremely bad medical practice. The argument
to legalise euthanasia does not give doctors the legal right to make
quality of life decisions on a patient's behalf. This is a misleading
statement that will only increase the scaremongering and misunderstanding
surrounding the euthanasia debate.
Your later statement that "many elderly people in the Netherlands
carry cards stating that they do not want euthanasia" simply reinforces
that irrational fear and misunderstanding exist around the euthanasia
debate - something you seem to be contributing to.
A crucial aspect of good medical care is empowering the patient,
respecting their autonomy and personal sovereignty. Should we not allow
patients to make their own decisions free of duress or arbitrary laws with
no evidence base? Because assisted dying is illegal we are committing
some patients to a drawn-out, painful, undignified death, against their
will. Why? Because 'death is inevitable but assisted dying is not'?
Competing interests: No competing interests
Should the law on assisted dying be changed?
May 19, 2011
Sir/Madam
Re: Should the law on assisted dying be changed?
I read with great personal interest as a retired physician the "Yes"
and "No" arguments (BMJ, 7 May, 2011 p.1002).
Surely, K. Fitzpatrick has it all wrong in stating that "-- euthanasia
would reinforce the judgement of the value (of life) of another, clearing
the ground to take away lives based on a moral judgement rather than
medical fact.)
To me this is a complete misunderstanding of the argument.
It is definitely NOT the judgement of "others" as to whether life is worth
living or not but that of the person concerned and no one else.
Fitzpatrick's arguments sound as if a change of law would mean "forced"
euthanasia based on the value judgement of others, and this is clearly not
so.
The point on "the threat will (italic my own) extend to the lives of
older,disabled people too" is totally with out evidence or support as
Raymond Tallis rightly argued, and I cannot agree more that "It is one of
the fundamental principles of medicine that you should be allowed to
determine what is in your own best interest when you are of sound mind."
This does NOT mean anybody else who determines but you.
I think that it is a dreadful disgrace to humanity that the British
couple, Don and Iris Flounders had to purchase pentobarbital from Mexico
(presumably having to travel there to get it) in order to end their own
lives as they wished to. I also applaud the fact that the wife wanted the
same without being terminally ill, as it is her own judgement as to
whether "life is worth living" or not. And if they botched it up without
professional help, who is to bear the responsibility, the medical costs
and the suffering then, those who refuse to legalize requested, supervised
assisted dying?
Yours sincerely,
May Zimmerli, Muttenz, Switzerland
Competing interests: No competing interests