Gone are the days of 'doctor knows best'. If you go back 30 or 40 years, doctors knew everything and patients were given little information and not encouraged to ask questions. Now all of the national guidelines include patient voices, and toolkits and resources are provided to help inform patients.
In everywhere from hospital to general practice, patient voices have to be included in planning and delivering healthcare. All providers are expected to engage proactively with patients, and this is something the CQC expects to see during inspections.
Why can't patients choose how they want to die?
As a GP, my role is to give my patients information and let them choose how they want to manage their health. I support them to make countless decisions about their care and treatment throughout their lives based on their values, preferences and concerns. So why don’t they get to choose how they want to die?
While we wouldn’t think twice about telling a patient about the possible side effects of a medication they might take for their blood pressure, we revert to a paternalistic approach about death. You can choose what tablets to take, what tests to have, what operations you want, how you give birth – but you can’t choose your death.
The RCGP - which is currently opposed to a change in the law on assisted dying – is conducting a survey of its members to gauge their views on the issue. This is an opportunity for us to practise what we preach in all other areas of medicine and put our patients and their views first.
As a GP, I am rarely there at the moment of death for patients who die at home. But I am called out beforehand when they become agitated; when their pain is uncontrolled. I am the one ringing the Macmillan nurses, and the palliative care team to ask for their help. I am the one their family members come to with their grief, saying they will never forget how their loved one died.
Death is complicated to manage
Family members and patients aren’t told the reality of normal death in today’s NHS. It is complicated to manage and symptoms depend hugely on what a patient is dying from. It is unpredictable and doesn’t respect working hours, so in the middle of the night when a loved one develops terminal agitation and family members face the choice of sitting waiting for hours until someone can come and give medication, or ringing 999, it is unsurprising many are so terrified that they reach for the phone.
'You wouldn’t let your dog suffer like this' is a phrase I have heard from patients and family members, some of whom have struggled with their symptoms, but some of whom simply want control back and a choice. They want to choose their death, not just where it might happen.
Excellent, properly funded and fully staffed palliative care can help hugely with symptom control and to support patients and families. The fact many hospices receive little or no funding from the NHS is a travesty. But even the best death in the best place happens without the patient’s right to choose.
A recent YouGov survey of people with advanced or terminal illness found that 85% said their trust in doctors would either stay the same or increase under an assisted dying law. We need to trust them, too.
The Royal College of Physicians and The Royal College of Nursing are neutral on assisted dying. This allows them to engage constructively in the debate while putting the views of their patients first. I hope the RCGP will follow suit.
Of course medical professionals should have a voice in these important discussions, but we must realise that the time when we could oppose law change, and tell dying people we know best about the options they should have at the end of life, has come to an end.
- Dr Norris is a GP in Yorkshire and a member of Healthcare Professionals for Assisted Dying (HPAD)