Photo credit: CC0 Public Domain
Several articles published today by the BMJ address the assisted dying debate, where terminally ill people close to death, suffering and the sane could, subject to precautionary measures, ask about medications they would take to end their lives.
The views expressed are the authors' own and do not reflect the position of any organization with which they are associated.
Lucy Thomas is a public health advisor who also works closely with patients with life-limiting diseases and their families. That experience has led her to wonder why assisted death is viewed as a medical solution to a medical problem, and to propose radically de-medicalize the debate.
She points to studies showing that physical symptoms do not predict the desire to hasten death, or predict it poorly, while depression, hopelessness, and the perception of being a burden are the strongest predictors.
She argues that responding to a patient's expressed desire to end life radically differently, depending on whether or not he has a serious illness or disability, institutionalizes discriminatory attitudes about the relative worth of different lives.
She states that "with medical criteria for an acceptable end-of-life and with doctors as arbitrators and administrators, medically assisted death extends medical authority rather than enhancing patient autonomy, with deeply harmful unintended consequences."
So what happens when we question this deeply medicated perspective, she asks?
She believes that a change outside of the medical framework "puts the fundamental ethical and practical dilemmas at the center and enables a serious discussion on how society should respond to those with intellectual abilities and a consistent desire to end life prematurely." .
Discussions should include philosophical questions such as: For example, what constitutes a rational decision to end one's life, as well as more practical questions of how to judge whether an individual's desire to end one's life is a response to circumstances that should be questioned rather than accepted predict that someone's desire to end life could never be undone, and if society legalized end-of-life aid, who would be best able to provide it?
As with any problem as complex as this, there are no easy answers or easy solutions, concludes Thomas. "Acknowledging this profound complexity could be the first step towards a more constructive debate."
In a second article, Paul Cosford, Medical Director Emeritus at Public Health England explains how incurable lung cancer has led him to re-examine his personal views on assisted death.
"I never wanted to be an advocate for a change in the law in favor of assisted death," he writes. "I have always thought that the law is too blunt an instrument to deal well with the complexity of such difficult moral and ethical issues."
He points out the dangers – that assisted death becomes an expectation, not just an option in certain well-defined circumstances, and that the lives of people who are seriously ill, have disabilities, or just differ from the norm may be is devalued.
These are real concerns, he says, but believes it is time to look again. "We need to put firmly entrenched positions on each side of the debate aside and be open about the problems people face at the end of their lives," he writes.
"We have to understand why rational, law-abiding people sometimes feel compelled to travel to Switzerland for such care and often don't tell their families why they are leaving. And we have to understand why their relatives are sometimes prosecuted afterwards, because they help them. "
"This certainly tells us that our current arrangements are inhuman," he concludes. "I would like to help with such a review, among other things."
More open-minded and constructive conversations about choosing the end of life are also something that general practitioner Dr. Calls for Zoe Norris in a linked opinion article.
She acknowledges that doctors are knowledgeable about this important issue, but says: "We need to ensure that the full spectrum of opinion is represented and we should not allow our contributions to the debate to drown out those of others, especially our patients . "
Regardless of our personal views, "we cannot ignore the voices of those who have witnessed firsthand the terrible things that can happen when we deny people choice and control over their deaths," she writes. "I believe that as doctors it is our duty to listen to them."
"The BMJ supports the legalization of assisted death," says Dr. Fiona Godlee, editor-in-chief. 'The vast majority of the UK public is in favor, and there is now good evidence that it works well in other parts of the world to continue to provide care to patients who want and are sane.
"We believe that this should be a decision for society and parliament, and that medical organizations should at least take a neutral stance to enable open and informed public debate."
Arguments in favor of assisted dying are "stronger than ever," says the BMJ
Essay: Demedicalization: Radically reformulating the debate about assisted death, www.bmj.com/content/371/bmj.m2919
Essay: Die Bank: Considerations for an incurable diagnosis and control at the end of life, www.bmj.com/content/371/bmj.m3716
Opinion: Last Rights is in favor of assisted dying, blogs.bmj.com/bmj/2020/10/01/z… e-for-assisted dying
British Medical Journal
Is it time to reshape the assisted dying debate? (2020, September 30th)
accessed on September 30, 2020
This document is subject to copyright. Apart from fair treatment for the purpose of private study or research, no
Part may be reproduced without written permission. The content is provided for informational purposes only.