Angela Tilby: assisted dying and the doctors

08 February 2019

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THE Royal College of Physicians (RCP) has always been staunchly opposed to assisted dying. But this may change. The College Council is preparing a new poll of its members on whether to adopt a “neutral” stance on the issue.

The Council seems to have already made up its mind, as it is to require only 40 per cent of its members to vote against maintaining the status quo: considerably less than a simple majority. If the RCP does adopt neutrality, it would it become easier to pass legislation that permitted assisted dying, which is currently punishable by up to 14 years’f imprisonment (although current guidelines protect relatives).

The Campaign for Dignity in Dying says that 82 per cent of the general public support the choice of assisted dying. No doubt their lobbyists have been at work, and it is possible that some doctors may feel that they are morally obliged to bow to the manifest will of the majority.

The views of doctors are important because, if assisted dying becomes legal, it is doctors who will have to implement it. Anyone training in medicine will have to be willing, even if only occasionally, to provide death on request. This should make us uneasy.

We know already that there are a few doctors, and others in the medical profession, who seem over-willing to hasten death in their patients. The Harold Shipman case is the best-known example, and it has not been forgotten. I think of a troubled elderly woman who was in considerable discomfort, who said that she wished Dr Shipman could pay her a visit. She wanted to die, but she wanted someone else to be responsible.

This is very human, but it significantly changes the unspoken contract between doctor and patient. In the Netherlands, where assisted dying and euthanasia are both available, one in 35 deaths is assisted. There is less investment in palliative care, and there is some evidence that patients can feel pressure to request an assisted death.

Assisted dying is not euthanasia: doctors are required only to prescribe, not actively to administer. But prescribing death still does something to a doctor’s self-perception, and to the way in which he or she is perceived by others. In a recent article in The Guardian, a doctor opposed to assisted dying described his response to a request for a lethal prescription. He had said to his patient that it was freezing cold outside, and that, if he wanted to die, he should go and sit in the garden with a bottle of whisky. He was quite prepared to attend to his body the next day, but not to disobey his conscience.

Suicide is suicide; when we ask others to do it for us, we are asking them to shoulder a responsibility that should only, in the end, be ours.

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