Iain Lawrie

Life or assisted death: the doctor’s dilemma

The so-called assisted dying debate is again generating more heat than light.  Once again, we have the British Medical Journal – which is not, as some may suppose, the house journal of the BMA – ranting and raving that the law needs to be changed.  This is a long-standing obsession of the BMJ’s editorial staff.  It is not the view of the BMA.

There are really two questions here.  One is whether the law should be changed to license doctors to supply lethal drugs to terminally ill people for use in suicide. The other is what, if any, role doctors should play if the law were to be changed.

If any such law were to be built around specific medical conditions, doctors obviously would have a role to play.  It would be for them to diagnose the patient’s condition, offer an opinion on its likely outcome and suggest possible treatment options.  In a 2015 survey of 1,000 GPs, 39 per cent said they would be prepared to go that far – but no further.

The difficulty, which most doctors recognise, is that deciding whether someone should qualify for legalised ‘assisted dying’ involves much more than diagnosis and prognosis. Even these can pose challenges – prognosis of terminal illness is in many cases little more than guesswork.  But compared with assessing other criteria – such as whether there is a settled wish to die, whether there are any external or internal personal or family pressures at work in the background, whether the patient’s judgement is being impaired by depression or despair – the medical part is relatively straightforward.

It is these personal, family or social judgements on ‘assisted dying’ that doctors are just not qualified to make.  We simply do not live in a world in which all doctors know their patients well, have been regular visitors to their homes and met their families and have talked with them at length about their values and feelings. 

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