Assisted dying bill may lead to coercion, doctors warn
Katie Gibbons
Tuesday October 26 2021, 12.01am, The Times
If assisted dying is legalised people may be coerced into signing away their lives, according to doctors who treat terminally ill patients.
In a letter to The Times, experts from hospitals and universities highlight problems in the US state of Oregon and in Canada, where assisted dying is legal.
They write: “As palliative medicine doctors and academics with decades of experience caring for terminally ill people, we are concerned at the paucity of evidence supporting the Meacher bill to legalise assisted suicide.
“Evidence from Oregon shows how assessment of capacity for assisted suicide is influenced by the individual values of assessing clinicians, something that is almost impossible to mitigate against.
“Patients seeking assisted suicide often have significant psychosocial distress, making them at increased risk of coercion and abuse; Oregon’s most recent official report shows that 53 per cent of patients who died under the state’s Death with Dignity Act reported feeling a burden on their families, friends or caregivers. Pain and fear of pain were less frequently cited.”
The letter continues: “In Canada emerging evidence shows that the medical assistance in dying law can worsen the quality of death, creating strain between patients and their families and impairing effective symptom control, leading to patient and provider distress.”
It concludes: “Legalising assisted suicide, without strong evidence of the effectiveness of proposed safeguards, is unwise and unsafe.”
Signatories include Dr Carol Davis, a consultant in palliative medicine at University Hospital Southampton NHS Foundation Trust; Professor Katherine Sleeman, of King’s College London; Professor Miriam Johnson, of Hull University; Dr Idris Baker, of the Ty Olwen Hospice in Swansea; Professor Mike Bennett, of Leeds University; and Professor Anthony Byrne, of Cardiff University.
The bill proposes that only terminally ill patients with full mental capacity who are expected to die within six months be eligible for an assisted death.
ASSISTED SUICIDE BILL
Sir, As palliative medicine doctors and academics with decades of experience caring for terminally ill people, we are concerned at the paucity of evidence supporting the Meacher bill to legalise assisted suicide. There is a lack of evidence that the suggested safeguards are either effective or verifiable. Oregon’s reporting relies on simple forms filled out by single doctors, without any scrutiny of how the pre-death assessment was conducted.
Mental capacity, an important safeguard, often fluctuates and is affected by illness, depression and medication in complex ways not yet fully understood. Evidence from Oregon shows how assessment of capacity for assisted suicide is influenced by the individual values of assessing clinicians, something that is almost impossible to mitigate against.
Patients seeking assisted suicide often have significant psychosocial distress, making them at increased risk of coercion and abuse; Oregon’s most recent official report shows that 53 per cent of patients who died under the state’s Death with Dignity Act reported feeling a burden on their families, friends or caregivers. Pain and fear of pain were less frequently cited.
In Canada emerging evidence shows that the medical assistance in dying law can worsen the quality of death, creating strain between patients and their families and impairing effective symptom control, leading to patient and provider distress. Patients and families can become fearful of palliative care, thinking it leads to a hastened death. This led some hospices in Canada to refuse to provide “assisted suicide” in the scope of their service. These facilities have had their funding threatened or withdrawn.
High-quality evidence should inform legislative proposals. Legalising assisted suicide, without strong evidence of the effectiveness of proposed safeguards, is unwise and unsafe.
Dr Carol Davis, Consultant in Palliative Medicine and Clinical End of Life Care Lead, University Hospital Southampton NHS Foundation Trust; Professor Katherine Sleeman, Laing Galazka Chair in Palliative Care, King’s College London; Professor Miriam Johnson, Professor of Palliative Medicine and Director of Wolfson Palliative Care Research Centre, University of Hull; Professor Irene J Higginson, Professor of Palliative Care and Policy, Cicely Saunders Institute, King’s College London; Dr Idris Baker, Consultant in Palliative Medicine, Ty Olwen Hospice, Swansea, and Honorary Senior Clinical Lecturer Swansea University Medical School; Professor Mike Bennett, St Gemma’s Professor of Palliative Medicine, University of Leeds; Professor Anthony Byrne, Consultant in Palliative Medicine University Hospital Llandough, Penarth, and Honorary Professor, Cardiff University; Professor John Ellershaw, Professor of Palliative Medicine, University of Liverpool; Professor Karen Forbes, Professorial Teaching Fellow in Palliative Medicine, University of Bristol; Professor Rob George, Professor of Palliative Care, King’s College London; Professor Fliss Murtagh, Professor of Palliative Care and Associate Director of the Wolfson Palliative Care Research Centre, University of Hull; Dr Claud Regnard, Honorary Consultant in Palliative Medicine, St. Oswald’s Hospice, Newcastle-upon-Tyne; Professor Paddy Stone, Marie Curie Chair in Palliative and End of Life Care, University College London; Professor Mark Taubert, Professor of Palliative Medicine, University of Cardiff; Professor Robert Twycross, Emeritus Clinical Reader in Palliative Medicine, Oxford University, and Head, WHO Collaborating Centre for Palliative Care, 1988–2005; Professor Derek Willis, Consultant in Palliative Medicine and Visiting Chair in Palliative Medicine and Bioethics, Chester University
