It is clearly a difficult one, but surely one that we need to get right. Interestingly the state consistently providing the best palliative care in the USA is Oregon, both Oregon and Washington allow assisted dying. A number of countries have enacted legislation to provide terminally ill people with the choice of an assisted death, within legal safeguards. These safeguards have protected vulnerable people whilst ensuring that terminally ill patients do not suffer unnecessarily against their wishes.
Whilst the debates continue and the 2010 revised guidelines now make a clear distinction between compassionate acts to assist someone to end their own life and malicious encouragement or assistance of suicide, what actually happens? As far as I can tell the options are firstly palliative care – this can control most of the physical pain of diseases such as cancer in most patients. This is not an absolute given and it depends on individual circumstances and whereabouts. Whether delivered in a hospice, at home or on a general hospital ward will greatly influence how this goes. I have been witness to good deaths and bad deaths, this is a real bug bear of mine. There are no second chances it has to be done well and anything less than that is unacceptable. I think some are scared of using high doses of drugs for pain, this taboo really needs to be broken down and their use compassionate. The doctrine of the double effect recognises high levels of medication can suppress breathing, but allowing someone to die in pain rather than accept this side effect, in my mind is unthinkable.
The second option is to go down the Dignitas route. Whilst Parliament decides what to do with current legislation this is an option which several have taken. Ludwig Minelli the founder of Dignitas has helped over 1000 people to end their lives, interestingly according to his research 80% of those given the ‘green light’ to go through with assisted dying do not, this is in keeping with figures from Oregon. Minelli firmly believes that once you give someone the freedom to talk about assisted dying this reduces their desire to go ahead with it. He also believes offering the option gives people peace of mind that they are not ‘condemned to linger on’ should the suffering become unbearable.
I personally believe the Dignitas option to be a good one, allowing patients the respect, compassion, autonomy and dignity they deserve. What I object to is that these patients have to travel to Switzerland to find it.
What I now hope for is a change in law to allow assisted dying in certain circumstances, to provide a safe means of dying with checks and balances against abuse or coercion. Patients, families and loved ones facing tough choices deserve this. Whilst waiting for common sense to prevail we can work on providing good palliative care regardless of our specialty.
[i] Andrew Eastaugh, GP Southwald