Why is The BMJ misrepresenting assisted dying?
BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2492 (Published 14 October 2021)
- Claud Regnard, retired consultant in palliative care medicine1,
- Rob George, professor of palliative care2,
- Amy Profitt, head of medicine3
Hurley and colleagues’ promotion of the proposed assisted dying bill in England and Wales ignores the obstacles.1
In last year’s BMA survey, a majority of doctors were unwilling to prescribe the necessary drugs.2Will we end up like Oregon, where a tiny proportion of doctors prescribe (one writing 31 prescriptions in 2020)?3 Every legislature has shortened or removed cooling off periods and expanded their criteria beyond a six month prognosis, some allowing or currently discussing assisted deaths in people with mental illness, learning disability, and autism and in children.
Conscientious objection will become little more than a fig leaf, as in Canada.4 Legalising assisted dying in Oregon has had no effect on the persistently rising rate of non-assisted suicides.5 Finally, there is a dearth of research into the safety and efficacy of assisted dying drugs.6
Legislatures such as Oregon’s are not “strictly monitored”1: few data are collected, the decision making is not monitored, and any documents are destroyed after a year.7 Other legislatures collect even fewer data. Palliative care and assisted dying do not have a cosy relationship: interactions can be ambivalent or divisive. In 2012, two thirds of Oregon hospices had policies that prevented them or their staff from participating in assisted deaths.89
Expecting patients to relinquish their autonomy to two doctors deciding behind closed doors is paradoxical. This cannot provide the legitimacy that patients and their families are demanding, yet Hurley and colleagues seem to believe that these secret cabals are an acceptable safeguard. If it comes to pass, assisted dying should be solely a judicial, not medical, decision.10
The reality is that safeguards elsewhere have been viewed as a barrier to autonomy and will be discarded in time. Even after 15 years we struggle to implement crucial safeguarding legislation, the Mental Capacity Act. Thinking we will do any better with assisted dying legislation is delusional.
Rob George is also elected councillor, Royal College of Physicians, London. Amy Profitt is also president of the Association for Palliative Medicine.