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Joe Collier: Help to allow terminally ill patients to die

20 Oct, 10 | by BMJ Group

Professor Joe CollierIn the UK surveys show that the public at large believe that, within carefully delineated safeguards, doctors should be allowed to assist intellectually competent adults with terminal illness to die when and where they wish. At present such action would be illegal. With this in mind, on Wednesday 13th October, a healthcare group was established to lobby for change. At the launch, the three objectives of the group, which is called “Healthcare Professionals for Change” and is chaired by Dr Ann McPherson who herself has a terminal illness, were set out.

They are: 
 
First, to change medical culture. Society should recognise that dying is inevitable and is part of life. For those with terminal conditions, the dying process is not a failure of the healthcare team or the patient – but it does become a failure if the patient suffers an undignified death. Moreover since dying in these circumstances is not a failure, help in dying should be thought of as assisting dying and not assisting suicide.

Second, to change the law. Healthcare professionals can indirectly hasten death through the withdrawal or withholding of treatment or via the principle of “double effect,” but direct and deliberate assistance to die, at the patient’s request, is illegal. The law must change to provide safeguarded greater choice at the end of life, ensuring that within reason the wishes of terminally ill, mentally competent adults are respected.

Third, to change medical practice. Assisted dying should be just one of many options at the end of life. It should complement end-of-life care, as it does in other countries that have legalised and regulated assisted dying. Those wanting an assisted death should be supported by their healthcare professionals to die when and where they choose, within safeguards.

There will be a lot of opposition to change and I expect the campaign will take many years. In my view change will ultimately come, and I would prefer this to be sooner rather than later. Anyone interested in knowing more about the group, and possibly even joining it, can contact it through http://www.healthcareprofessionalsforchange.org.uk/.

Conflict of interest: I am the Healthcare Professionals for Change group’s deputy chair.

Joe Collier is emeritus professor of medicines policy at St George’s, University of London

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  • A_spurrier

    I am an R.N. In the course of my work I am frequently frustrated, angered and saddened, at our treatment of terminally ill patients.
    Yes, Death is a part of living. There comes a time when we are unble to withstand any more investigations, treatment, venflons, scans, long lines, short lines and anything else that some medics care to throw our way!
    How refreshing to read about death being discussed in a positive way. Ofcourse it is our responsibility to assist patients to a dignified, painfree, peaceful death. Something that I dare say we would all hope for.Presently, certain constraints within which we work can prevent what many of us would deem to be 'best practice' when caring for patients at the end of their lives.
    Surely, there is such a thing as a 'good death'. We've all witnessed the negatives, and said to each other how wrong it is that suffering should be prolonged.I hope that this group can influence change which in turn will improve care for those at the their most vulnerable.

  • Damian

    Joe, As ever an article which is both clinically and philosophically relevant.

    In my four months running a care of the elderly firm at ward level, I have seen much needless suffering which some dying patients go through before they finally expire.

    Even the liberal use of syringe drivers etc. is unable to quell this.

    As such, I can only agree that if regulated in the right way for patients and doctors – perhaps with an opt out such as exists for abortion – such a change in law, culture and practice seems permissable.

    I do not feel that such a shift in practice would be, as some say, the antithesis of medicine but indeed the epitome of it: to reduce human suffering always.

    Damian

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