Dr Aneez Esmail says it is becoming increasingly clear that a law change on assisted dying in the UK is not a matter of if, but when – and GPs need to be prepared for it
A recent survey on physician-assisted dying, conducted by Doctors.net.uk, is the latest to confirm that there are a range of views on the issue within the medical profession. Out of the 1,000 GMC-registered doctors who responded, 45% backed a change in the law, while 48% said they were opposed to it.
But ultimately, whether or not the law on assisted dying changes is a question for politicians, not doctors. The more important question is not are we as doctors for or against assisted dying, but what role would we be willing to play should this become a legal option for our patients?
A clear majority of survey respondents (58%) said that they would be happy to provide information or have a discussion with a patient about assisted dying, while 37% said they would be willing to go further and write a prescription for life-ending medication if they met the eligibility criteria and safeguards.
These results are thought-provoking, but perhaps it is difficult to predict how we as doctors would react to an assisted-dying request until we are faced with one ourselves. Dr Jo Scott-Jones, a GP in New Zealand who voted against the law change in New Zealand’s 2021 referendum because of his belief that more palliative care would eradicate the need for this debate, has since changed his mind and written about the ‘immense privilege’ of supporting people with assisted dying.
Around 250 million people around the world have access to some form of assisted-dying law, which as of November 2023 includes all states across Australia. And in all jurisdictions, doctors have a central role to play in the process. In US states such as Oregon and California where they have adopted the same model of assisted dying that is proposed in the UK – for terminally ill, mentally competent adults – assisted deaths represent less than 1% of total deaths. This suggests that the number of doctors who would be willing to support their patients through an assisted dying request in this country would far outstrip the number of dying people who may want to use the law.
Of course, it is only right that there should be provisions in legislation to allow doctors to conscientiously object from supporting their patients, but the latest survey highlights that it is equally important to ensure that the significant number of doctors who want to conscientiously participate in the law have the training, guidance and support they need to do so.
This is particularly relevant for GPs. Palliative medicine is the speciality that is often most vocal about assisted dying, which has led to a toxic culture around the issue according to some of its members. Yet official data from Victoria, Australia – where assisted dying has been legal since 2019 – shows that while more than 80% of applicants access palliative care, a clear majority of doctors who are registered to provide assisted dying come from general practice.
The RCGP recently voted to establish a working group to look at assisted dying in more detail. The idea is not to rehash arguments about whether law change is right or wrong, but instead to explore the practical implications and help the college be in a position to support its members should the law change.
This is essential work as it is becoming increasingly clear that a law change on assisted dying is not a matter of if, but when for the British Isles. Last November, an assisted dying bill in the Isle of Man – tabled by GP Dr Alex Allinson – passed its first major hurdle. Meanwhile, Jersey has already approved the principle of law change and proposals will be tabled for debate this year. A bill is currently being prepared in Scotland, and the Commons HSCC will soon report on the findings of its year-long inquiry into the issue.
Politicians are clearly feeling the pressure to act in the face of growing claims that not only is the current blanket ban on assisted dying cruel, but it is also failing to protect people. Indeed, Labour leader Sir Keir Starmer said before Christmas that there were ‘grounds for changing the law’.
Gone are the days when the medical profession could stand in the way of patient choice, with the BMA and most royal colleges dropping their policies of opposition to assisted dying in favour of more representative and respectful policies of neutrality.
But the medical profession still has a vital role to play in this debate, whatever our personal views or willingness to participate in the law may be.
Dr Aneez Esmail is emeritus professor of general practice at the University of Manchester and board member of Dignity in Dying, an organisation campaigning for a change in the law on assisted dying
I’m ready with my conscientious objection. Enough moral injury working in the NHS knowing that better care is available but not the resources to deliver. Not paid enough to deal with my feelings about bumping poorly people off.
having seen a few patients suffer horribly despite the hospice best efforts I support a change in the law purely out of compassionate grounds. Its a fallacy to say no one would suffer if only hospices had more resources. I find it incomprehensible that the hospice movement is so set against a law change.
I am also a practicing christian and there is a growing trend amongst those of faith to see the humanity in giving people choice.
Our MPs need to step up and show more sympathy and compassion and support change.
Im sorry but we are way too busy to take on yet a another job.
If only we had a consultant in palliative care (like in the old days)
This is an excellent article that doesn’t take sides but asks us to prepare for what seems like an inevitable change.
Provided we don’t slide down a very slippery slope (hello Canada), then giving terminally ill patients with full capacity and less than 6 months to live (as verified by 2 doctors) the option of a dignified death is clearly coming down the pipe whether we like it or not.
Many of us have experienced harrowing times for patients and families in those agonising final weeks. And the PTSD for close relatives on 24 hour “death watch” can last many years.
But I have also witnessed 2 close friends in Holland, both with terminal cancer, given the dignity of choosing their time of passing, with family and friends gathered together in a very moving and uplifting experience.
At present only the wealthy few can afford the one way ticket to Zurich, the world is changing, and ageing Boomers will continue to demand what should be a basic human right. And Boomers are used to having their way.
And whilst I’m all in favour of a woman’s right to choose, it does seem bizarre that we can abort endless thousands of healthy foetuses at the start of life, yet deny the chosen timing of death for a wretchedly ill terminal patient at the end.
Obviously individual GPs must retain the right to refuse, but I would expect a law change before the decade is out, so the profession needs to be prepared.
Two horrible unfairnesses exist currently, 1. Only the wealthy can afford the services of Dignitas, yet it has tacit approval, witness the dearth of assisted suicide arrests, and 2. The necessity for those chosing this route to travel abroad for help rather than dying in their own home. HMG sort it out now. And @Jonathan H above – so refreshing to hear a truly compassionate voice from a Christian, when my impression is that the stick-in-the-muds in Government and The Lords are religiously motivated.
As I have said many times in the past, if I treated my animals in the way which the law insists I treat human beings, I would be in court for cruelty.
Bodily autonomy for the patient and professional autonomy for the medic. Those who do not wish to participate need not, whilst for those who agree with this can engage. Isn’t that what being human is all about? Having differences of opinion and yet living (and dying) comfortably along side one another?