In reading Dr Norris’ viewpoint ‘Why the RCGP should change its stance on assisted dying' a number of thoughts came to me regarding the RCGP consultation on its members views onthe issue of assisted dying.
Having graduated in 1987, I might be classified as of the generation of doctors who ‘knew best’, but my vocation always felt as it carried a duty of care and the responsibility of service.
Increased patient information and a shift in culture promoting patient choice is correctly welcomed and I support Dr Norris’ statement: ‘As a GP, my role is to give my patients information and let them choose how they want to manage their health.’
However, extending this to actively supporting and participating in a person’s death at a time of their choosing, rather than alleviating suffering is more than an extension of our role individually in a patient’s life and in the professions place in society: this is a huge shift in a doctor’s duties ethically and legally.
Impact on doctor/patient relationship
It will surely involve major changes in the law, which could have serious consequences for the doctor/patient relationship. ‘First do no harm’, is frequently bandied about and whatever the origin, it is a maxim that means patients can hold us to the highest and most transparent of motives.
Death is an emotional time for families and it is essential that the trust of the patient and their carers is never eroded but there are also the wider implications. How do we deal with those in particularly vulnerable groups, the psychologically unwell, those unable to express intention? How do we discern if choice is free and informed
End-of-life care raises difficult legal and political questions.
Thanks to the legacy of the formalised hospice movement started in the UK, palliative care is centred on addressing all of the patient’s and family’s needs from physical to the emotional and spiritual. Dying patients are not dictated to by doctors and nurses but are encouraged to articulate their wishes through empowering patient centred initiatives, such as advance care planning and the ReSPECT process.
The approach to assisted dying in much popular journalism tends to be superficial and simplistic. The reality is not so.
Reports from countries, such as Holland and Belgium, which have adopted legislation for assisted death, indicate that the much-maligned 'slippery slope’ argument against it is, in fact, supported by emerging evidence. It is well nigh impossible to maintain an approach to assisted dying which keeps it within strict guidelines and firm control.
Supporting palliative care
The best interests of the person must be at the heart of our deliberations. Is assisted dying to be promoted at the expense of the palliative care hospice movement? Is assisted dying the optimal way to care for the whole person? Would not support for a better, well resourced societal approach to a person's death and dying be more in keeping with the traditions of our profession?
I have just completed a short data collection on the advanced care planning information available in patients’ notes at the OOH service I work in and GP workload means this information is often not available electronically in advance, because these discussions take time.
I would rather the RCGP sent a strong positive message to the profession, society and politicians that we want to actively promote great care to people from cradle to grave, through resourcing advanced care planning, than being neutral on any issue – especially one involving life and death.
- Dr Harrington is a GP in East Sussex. This article represents Dr Harrington's personal view.