Public attitudes to assisted dying appear to be changing, but what do doctors think? If there’s a change in the law, it will be doctors who are prescribing or administering life-ending medication.
Dr Aneez Esmail is a Royal College of GPs council member. He has 30 years of experience as a GP and is also Emeritus Professor of General Practice at the University of Manchester.
He believes that doctors’ views on assisted dying are, indeed, changing. “Without a doubt they are, and partly we are being driven by the public on this. What I’ve found is patients are more willing to have the discussion, which has made doctors more willing to talk about it.”
Assisted dying has recently been high on the UK news agenda. Several celebrities , most notably Dame Esther Rantzen, have been sharing their support for it. The Daily Express and Dignity in Dying have started a petition to support Dame Esther’s call for a parliamentary debate. To date, it has more than 120,000 signatures. Also, parliament’s Health and Social Committee is due to publish its long-awaited report into assisted dying early this year.
Two-Thirds of the Public Support Assisted Dying
A recent poll in 2023 found that 65% of people in the UK think it should be legal for a doctor to assist an adult of sound mind and with less than 6 months to live to voluntarily end their own life. It also found that 61% of people believe it should be legal for a doctor to administer life-ending medication.
Assisted dying proposals are currently being debated in Scotland, the Isle of Man, and Jersey. Medically assisted dying is legal in Canada, the Netherlands, Switzerland, Belgium, and some US and Australian states.
What Do Doctors Think?
The British Medical Association changed its position on physician-assisted dying in 2021 . It had been opposed to it but now takes a neutral stance. The move followed an extensive survey of its members.
It found 50% of doctors would like a change in the law to allow physicians to prescribe life-ending medication for terminally ill adults of sound mind with less than 6 months to live to administer themselves. 39% were opposed to a change in the law and 11% were undecided.
When it came to a doctor administering the life-ending medication, 37% supported it, 46% were opposed, and 17% were undecided.
The Royal College of Physicians also takes a neutral stance on the issue. Its last survey in 2020 asked members and fellows if they would support a change in the law on assisted dying. 40.5% said they would, while 49.1% said they wouldn’t.
The Royal College of GPs continues to oppose assisted dying. However, in 2023 it gave the greenlight for a working group to be set up that would think through the practical implications should the law change.
Esmail, who is a board member of Dignity in Dying, believes the RCGP view is out of kilter. He told Medscape News UK: “No doctors’ organisation should be opposed to assisted dying. Doctors need to be engaged in the debate, as we play a big part in looking after patients who are dying. It’s not right that we should be cut out of these discussions.”
Palliative Care Is Enough
Opponents say there is no need for it. “When we provide the highest quality of palliative care, there’s no requirement for assisted suicide,” explained Alistair Thompson, spokesperson for the campaign group Care Not Killing.
He told Medscape News UK that, when surveyed, “Those doctors who deal with people at end of life, palliative care, general practice, oncology, and trauma, they still oppose changing the law on assisted suicide. Whereas the doctors in other specialities, like adolescent mental health, dermatology, and occupational health were overwhelmingly in favour.”
But Esmail doesn’t share that view. He was originally opposed to assisted dying but changed his mind. He said: “Through my own experience of looking after my patients, I saw the limits of palliative care and it didn’t always relieve suffering to the extent that would have benefited my patient. The public has led the way on this by saying we want to have more options available to us.”
“We are talking about a very few numbers. It might only be 1% of all of the patients who are dying. It’s only when palliative care fails or the patient says I don’t want that anymore that there would be that discussion,” he added.
Safeguards
One of the arguments against assisted dying is that safeguards aren’t strong enough.
“There are some chilling case studies in places like Canada where safeguards are eroded over time and doctors are put under huge pressure to carry out in effect state-actioned killing of patients against their judgement,” said Thompson.
He added: “In Canada, according to their own data, people are citing reasons like loneliness and inability to get social care as the reason for their choice to have a medically assisted death.”
Doctors Could Opt Out
If a change in the law is ever allowed for assisted dying in the UK, it would never be compulsory for all doctors to agree on it in principle or for all doctors to carry it out.
“Most of us who are for assisted dying are very clear that this is a personal choice, you shouldn’t be forced to do anything. It’s a bit like abortion, if you are opposed to it, you just direct your patient to someone else. That is the position we would develop with assisted dying,” explained Esmail.
In all jurisdictions around the world where it is legal, doctors are not forced to implement it. “Doctors choose whether or not they want to be involved. I’m a GP and because I look after dying patients as part of my job, I would certainly be willing to help patients if the law allowed me to do so. But I also know some of my colleagues wouldn’t. You shouldn’t deny patients the option just because you are opposed to it,” said Esmail.
Debate
It looks increasingly likely that MPs will debate assisted dying in the next parliament. Any proposed law would likely be brought as a Private Members’ bill rather than by a political party.
Thompson welcomes any debate: ” It’s a really important issue, and afterwards we could move on to the more important issue of how we fund a system of palliative care that is under huge pressure.”
Esmail said: ” For far too long people haven’t wanted to talk about dying, as it’s uncomfortable. But there needs to be much more honest discussion about giving people a good death.”
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