Should doctors be involved in assisted suicide? One of the so-called safeguards of Kim Leadbeater’s Terminally Ill (Adults) End of Life bill, is that two doctors must agree that, as well as having only six months to live, a patient is mentally capable of making the decision and is not being coerced. Yet there are voices questioning whether doctors should be involved at all.
Palliative care doctor Lucy Thomas told the Radio 4 Today programme on 28 January: ‘My view is that we should demedicalise assisted dying and completely separate it from the healthcare process’ [BBC Sounds, at approximately 8.47 am. Available until 26 February 2025].
Dr Thomas supports assisted suicide and she would like to see ‘non-medical volunteers’ carrying out the process. This is what happens in Switzerland where lay people and organisations are involved in assisted suicide. ‘Ending someone’s life is not a medical procedure,’ stated Dr Thomas. ‘Providing standard lethal doses of toxic chemicals doesn’t require any medical knowledge and skills.’
Alarming approach
Dr Thomas is not the first person to promote this alarming approach. In 2023 the British Medical Journal (BMJ) published a paper on demedicalising assisted suicide, which the authors saw as a ‘way forward’ to legalising the practice in Britain. Their idea was that a board should be set up to consider applications for assisted suicide, comprising a lawyer, an ethicist and a healthcare professional (not necessarily a doctor).
The authors argue that because doctors generally do not want to be involved in assisted suicide, it would be better situated outside medicine. A 2020 survey by the British Medical Association revealed that: ‘Fifty-four percent of surveyed members said that they would not be willing to actively participate in the process of administering life-ending drugs, should it be legalised. A quarter (26%) said they would, and one in five (20%) were undecided on the matter.’
Risk of coercion
In particular, psychiatrists in Britain generally do not want to participate in mental health assessments for assisted suicide. But a demedicalised scenario could by-pass psychiatric assessments and allow relatives and loved ones to be part of the decision-making process. However, that would open the door to such motives as financial gain and burden, issues that would not necessarily influence a psychiatrist’s assessment. It would also increase the risk of coercion.
It would also be better for assisted suicide to be outside healthcare settings, say the authors of the 2023 article, in order to allay worries that medicine could be corrupted and people would come to mistrust their doctors. But SPUC consultant Dr Greg Pike points out: ‘Corruption and loss of trust are arguably happening already, and even if assisted suicide were situated outside the medical system, doctors would still need to be involved to some extent and so medicine would still be implicated in assisted suicide.’
Conscientious objection
Demedicalising assisted suicide is also proposed as a way of side-stepping the issue of having to accommodate medical professionals with a conscientious objection. The argument is that if assisted suicide is demedicalised, doctors would be able to tell any patient who asks for it that they can’t help because assisted suicide is not part of the healthcare system. (It’s important to note that assisted suicide can no more be classed as healthcare than can abortion.)
However, on the basis of what happens in other places where assisted suicide is legal, doctors in Britain with a conscientious objection would be unlikely to get involved in assisted suicide. Dr Pike notes that, despite the overall reluctance of the profession, in Canada and Australia a small number of doctors have made assisted suicide and euthanasia their speciality. It is an ‘open secret’ in Canada that patients wanting to receive MAiD (Medical Assistance in Dying) simply go to a right-to-die organisation to be put in touch with a ‘euthanasia doctor’. This could be the trajectory here if Kim Leadbeater’s bill reaches the statute book.
More medicalised not less
Dr Lucy Thomas would like to see medically unqualified people helping sick and dying people to take lethal tablets. But Dr David Albert Jones of the Anscombe Centre in Oxford argues that, where assisted suicide and euthanasia are legal, they are becoming more medicalised not less. Part of the reason is that, where this is legal and given the choice, patients prefer a doctor to give them a lethal injection, rather than taking pills themselves. Getting the doctor to kill you saves you from having to undertake the final act yourself. Ironically, despite the clamour for bodily autonomy, when push comes to shove, people don’t want to die by their own hand. Dr Pike agrees: ‘This is true in Canada and Australia and underscores a desire for medical paternalism which will keep assisted suicide and euthanasia mostly within medicine.’
While Kim Leadbeater MP and her supporters are trying to lull MPs and the British public into a state of security that the medical context of her bill adds rigour and safety, Dr Thomas wants to take it out of a medical context. This is certainly a mixed message but also somewhat sinister. The 1967 Abortion Act was ushered in via a private member’s bill, with ‘safeguards’ assured by medical oversight. But 58 years on, doctors are now barely involved in by far the majority of abortions.
DIY assisted suicide
Despite this desire for doctors to be involved, could we eventually see ‘DIY’ assisted suicide? Dr Pike thinks this is possible: ‘It is notable that in recent years abortion has become increasingly demedicalised with the decline of surgical abortions and their replacement with at least partially demedicalised abortions in the form of pills by post, promoted as self-managed abortion at home with minimal involvement from a medical professional. Perhaps if assisted suicide is legalised in Britain, something similar might happen.’
While we need to be alive to all the arguments around assisted suicide, in the end the real issue is not how this inhumane practice is administered and delivered, but rather that it should not be legalised in any shape or form.
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