Past the stage when ‘doctors know best’

Lord Ribeiro states that only one in seven GPs (in a 2015 survey of 1,000) ‘would consider doctor-assisted suicide if it were ever to be legalised’. (I presume that he meant that they wouldn’t consider getting involved in the procedure rather than choosing it for themselves.)

Firstly, we are given no details of the survey so there is no way to find out who conducted it, for whom it was conducted, how those who were surveyed were chosen, what questions were asked, and why only 1,000 were surveyed when there are about 167,000 GPs in the UK. The result he quotes against doctor-assisted suicide shows a far greater opposition than any other surveys so that at the outset one has to query its accuracy, because it smacks of cherry-picking the desired result.

In the medical profession the BMA has been the main opposition to assisted dying, having in 2006 voted on and decided against it after a debate at their Annual Representative Meeting. As Mrs Starkey pointed out, only a few hundred doctors attend ARMs, usually between 400 and 500. The fact that the BMA represents only 57% of all doctors might suggest to even the most stalwart supporter of the BMA that this was hardly a representative sample of the medical profession in the UK, but on that basis the BMA has determinedly stuck to its opposition ever since. Because of increasing opposition from doctors to the BMA’s stance, it has increasingly been urged to adopt a neutral position on assisted dying as it is unable to provide a true representation of the medical profession on the matter. Despite this it continues to stick its head in the sand and refuses to change. So great has the hostility become to the BMA’s refusal to adopt a neutral stance that even its house journal, the BMJ (British Medical Journal), has come out against the BMA and has supported the call for a referendum on assisted dying amongst all doctors in the UK [BMJ Editorial, 8/2/2018].

That the BMA (and Lord Ribeiro) might be out of date in their attitudes is shown by a poll in October 2017 in which 700-plus doctors on a doctors’ website (‘www.doctors.net.uk’, with 227,000 active members out of a total of 280,00 doctors in the UK) voted on whether they supported ‘assisted dying’ or not. Of the 700-plus who responded, 55% were in favour of ‘assisted dying’ with 43% against [Davis, BMJ 7/2/2018], somewhat different from Lord Ribeiro’s anonymous poll. I would suggest that, if nothing else, severe doubt must be cast upon the out-of-date survey upon whose figures Lord Ribeiro is relying.

Secondly, for the Association of Palliative Medicine to be against ‘assisted dying’ is not surprising. Their members provide a vital service of which they have every right to be proud and I have no doubt that most of them would oppose assisted dying as not being an appropriate solution to a terminally ill patient with symptoms that they should, in most cases, be able to deal with. They, no doubt, feel that assisted dying is inappropriate since they (the specialists) can deal with all their symptoms. This, of course, is only the view of (presumably) the majority of palliative care doctors, but there are many eminent members of the association who accept that their specialty and assisted dying are not mutually exclusive [Farsides, BMJ 7/2/2018].

Palliative care is not for everybody. Unfortunately, it cannot treat all aspects of a person’s distress, which to a degree is driven by his/her character. The vast majority of us would prefer to live as long as we comfortably can. A very small number, however, are not as others and don’t want a medicalised death; they want to go as naturally as possible in their own home in their own bed, even if it means taking some tablets to end it all a bit before they might have done had they decided to have palliative care. For them, if living comfortably for as long as possible means having cannulae in the arms, gastric tubes up the nose and down the throat and having the indignity of being unable to drink without assistance or go to the toilet without needing assistance to get there and back and to have their bottoms wiped, then some will decline the option and decide that, when they get to that stage of dependence on others, then it is time to call it a day. Palliative care cannot deal with that.

If the person refuses the full panoply of palliative care or if the full panoply of palliative care has failed to sufficiently alleviate their suffering, what next? Do the palliative care doctors simply say, ‘I’m sorry, Mrs Le Poidevin, we can’t do any more for you’ and move on to the next patient? Of course they don’t; but what would they do if the patient then asks about assisted suicide?

I know it’s late in the day for this debate but perhaps one of the local palliative care practitioners might enlighten us should we ever pass this way again.

I think that Lord Ribeiro is being paternalistic and presumptuous when he declares portentously that ‘In the UK we trust our doctors to make medical decisions that are in our best interests’. He has not once considered what the dying person thinks, showing a complete disregard for the most important individuals who should be at the centre of this debate.

When we talk about assisted dying we have reached that point in our lives when, despite the doctors’ best efforts to control the disease and its distressing symptoms, we are dying a ‘bad death’ and at this juncture doctors know infinitely less about what the dying person requires than does the person himself/herself. When talking about assisted dying we are past the stage of our lives when ‘doctors know best’. Doctors should accept that while some of them may have felt themselves to be at ‘centre stage’ of the action when dealing with the disease and its illnesses, when it comes to how the person dies the doctor’s part is less than a walk-on role. As Mrs Starkey says, ‘I am sick to death of these people (AKA doctors) making decisions for me and the people I love’. Dying people are the only ones who know what is in their individual best interests, what is needed, and what the decision should be for when and how they wish to die. At this juncture, the doctors should bow out gracefully as they have played their best on the dying person’s behalf but inevitably they have lost the fight against the disease that is killing them. They have no more to offer.

Dying people should be awarded the dignity and right to die as and when they please.

DR THOMAS R. LEE,

(MB, BCHIR (CANTAB), FRCP, MRCPCH)

Les Salines, Le Vallon, St Martin’s, GY4 6DN.