Noel Conway, a terminally-ill man who wants to be helped to die, recently lost his legal challenge at the Court of Appeal. Conway, a 68 year old lecturer, dying from motor neurone disease, says he feels “entombed” by his illness. He can only move his right arm, head, and neck, and is dependent on a ventilator for up to 23 hours a day. He is asking for the right to a “peaceful and dignified death.” His lawyers are seeking a declaration from the courts that the current law is incompatible with Conway’s human rights, an outcome which would see Parliament come under significant pressure to enact some form of assisted dying legislation. Conway has vowed to appeal the court’s decision, and wants his case to be heard at the Supreme Court.
The position of the medical profession has been very influential in political debates and legal decisions about assisted dying in the UK. The British Medical Association’s opposition to assisted dying is frequently quoted, and the Court of Appeal’s decision makes nine separate references to the BMA. But what does the case teach us about the possible role of the medical profession in the assisted dying debate?
Issues considered in the judgement which are relevant to doctors are the implications of law change on trust in doctors, recruitment, and the potential complications in assisted dying protocols. Can the capacity of a dying person be assessed? How can doctors explore the possibility of coercion in the medical decisions patients can legally make now? Or to what extent does uncertainty exist around what a person with motor neurone disease may experience when their ventilation is withdrawn?
The Court of Appeal was forced to find answers to these questions by negotiating the often conflicting opinions of individual doctors, some of whom have found their impartiality in the assisted dying debate come under increasing scrutiny. These are medical questions that the medical profession as a whole should be able to answer. They are too important to simply leave to individuals who passionately argue for or against legislation.
We know that 82% of our patients want the option of assisted dying, but we as a profession aren’t listening to them, instead putting ourselves in direct conflict with public opinion. Of course people express sincere concerns, but there is no evidence base for them and no justification for those concerns to be the sole focus of the debate.
International experiences suggest there is no justification for us to stand in the way of our patient’s wishes. Legislation in Oregon for terminally ill, mentally competent adults has been in place for 20 years. Hawaii recently joined California, four other US states, and Washington DC in adopting similar laws, as has Canada and the state of Victoria in Australia. The debate about AD is here to stay, and the waves are now lapping at the shores of the UK. Guernsey recently debated AD, Jersey is likely to try soon. Like votes for women, the movement is unstoppable, and even those opposed concede that it is now just a question of when and not whether. We as doctors can accept the evidence base, listen to our patients, and join the debate, or find ourselves on the wrong side of history. Noel Conway, dying of motor neurone disease and dogged in his quest for a “peaceful and dignified death,” is representative of what the majority of our patients want.
A doctor writing about her involvement in AD in California echoed the feelings of many when she quoted her own mother:
“To have the option of medical assisted dying among all options provides unimaginable peace of mind and empowerment”
100 million people worldwide now have access to AD. It is no longer credible for opponents of AD to claim it cannot be implemented here. It’s time to ask ourselves what damage we are doing to our reputation by denying our patients this comfort.
Jacky Davis is a consultant radiologist, campaigner for the NHS (founder member of Keep our NHS Public), co author of the books NHS For Sale and NHS SOS, and a member of the BMA council. She is also chair of Healthcare Professionals for Assisted Dying. She has written this blog in a personal capacity. You can follow her on Twitter @DrJackyDavis.
Competing interests: I am a member of BMA council, a board member of Dignity in Dying, and chair of Healthcare Professionals for Assisted Dying.