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Dying for a discussion

28 September 2012

TWO new Health Ministers have called for an overhaul of the law on assisted suicide. But, away from the politicians, what does the discussion sound like at the clinical coal-face?

I am at a governance meeting in a hospital, somewhere in England, discussing a patient who has requested that his ventilator be turned off. It is a sad story, but we are not here to grieve or weep; we are here simply to decide whether it is legal to do so. After discussion, the patient is deemed competent under the Mental Capacity Act 2005, and, after due process, permission to die is granted.

I turn to my doctor friend, surprised. "This is quite legal," he reassures me. "Competent patients can refuse any treatment, whatever the consequences, so long as they are fully informed. In fact, to continue treatment after refusal could be construed as assault."

"What if a patient is deemed not competent by the Mental Capacity Act?" I ask over coffee and cake in the hospital canteen.

"Then the doctor must act in his or her best interests," he tells me. "The role of relatives is to help the doctor ascertain what the patient would have wanted. It's not the relatives' decision to stop treatment, although obviously you'd want them in agreement with your course of action. Likewise, if a patient wants to commit suicide, that, too, is legal."

"Hang on a moment," I say. "If suicide is so easy, why do people need to go abroad to die?"

My doctor friend stares out of the window for a while, and then replies. "Those are different cases. Such patients may be deemed competent, and wish to die, but they're physically unable to do this for themselves, and, crucially, they're not receiving life-saving treatment which they could refuse."

I seek clarification. "So, just because they can't get their hand to their mouth, everything's different?"

"Precisely," he says. "In that situation, it's illegal for anyone, medical or not, to act with the prime intention of helping them die. A doctor must not give treatment with the prime purpose of shortening life. You can give a drug that you know will shorten life, so long as its prime purpose is something else. It's called the doctrine of 'double effect'. But that's why high-profile cases have gone to Holland and Switzerland. Assisted suicide carries a sentence of up to 14 years in this country."

"So that is the law," I say to my medical friend, as we stand in the hospital car-park. "But what about your personal views?"

"Personally," he says, "I think assisted suicide is a very reasonable request for some patients, but I'm in a minority. The profession remains against it for various reasons, but the doctors' own ethical and religious views are often quoted. Doctors with a strong religious faith are usually against it. Sounds more like good old-fashioned paternalism to me."


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