My experince as a doctor leads me to oppose making assisted suicide any easier under the law
Assisted dying will be debated in parliament on Tuesday for the first time in a generation. A number of legal cases have seen repeated attempts to change the law on assisted suicide, but it remains a criminal offence for an individual to encourage or aid the suicide of a terminally ill person in England and Wales. However, guidelines were introduced by the director of public prosecutions in 2010 recommending that people helping loved ones to die should not always be prosecuted. The motion to be debated by parliament will seek endorsement of the DPP guidance. Many MPs will use the opportunity to call for a full review of the issues and laws surrounding death and dying.
Before qualifying as an NHS hospital doctor, I was a strong supporter of people with terminal and progressive illnesses being given greater power over when to end their lives. Who was I to stop someone with a terminal illness from ending their life when they had expressed a consistent wish to do so?
But an experience as a junior doctor changed my views. Alice (not her real name) was a woman in her 40s with advanced multiple sclerosis, no longer able to speak, and completely dependent on family and carers for all her activities of daily living. She was regularly admitted to hospital with chest infections, and on this occasion had been admitted with a pneumonia that was not responding to antibiotics. She was clearly in great pain and distress.
Conversations with her family suggested that much as they loved and cared for her, they believed her illness was at a stage where medical treatments were prolonging her suffering. Her husband said "she would never have wanted to be like this". The palliative care team were called to provide specialist care and advice for what was likely to be the last days of Alice's life.
Against all odds, Alice pulled through, and left hospital. Several weeks later, I met her husband again at the hospital shop. He told me the involvement of the palliative care team meant that she and her family had received specialist care and support in the community. He said he felt guilty for having even questioned the value of contemplating the end of her life.
This goes to the heart of the debate about assisted suicide. As a doctor, I have sometimes wanted to have done things a little differently, to help my patients with the benefit of hindsight. With assisted suicide, death is final. No changing of decisions – and the potential for a lifetime of guilt and regret.
Alice and her family's experience also reinforced to me how advanced care planning, and home support for patient and family, can help to preserve dignity and relieve pain and distress during terminal illnesses.
We would like to assume that caring relatives and friends are wholly motivated by compassion when wanting to assist a loved one to die, but it would be naive to assume that this is always the case. I have seen bedside squabbles between siblings around the time of an older patient's death, and there is usually money involved. Any widening of the law on assisted suicide could be abused, and undue pressure brought to bear – particularly on vulnerable older relatives.
A change in the law directly supporting the legalisation of assisted dying would run the risk of increasing pressure on the terminally ill and people with disabilities to end their lives. Given the need to protect vulnerable patients, I doubt whether a law on assisted suicide can be effectively written into legislation.
Instead of contemplating any change in the law, we should be focusing on the development of high-quality palliative care for patients and their families, to ensure that end-of-life care continues to meet the needs of the terminally ill.