As doctors we have a duty to listen to these views, argues Zoe Norris
In an endorsement of a new book launched this summer, the celebrated author Julian Barnes tells us “If you think you know what you think about assisted dying, pause for a moment. Read this urgent, cogent, necessary book—and then think again.” I would go further. The book in question, Last Rights: the case for assisted dying, written by Sarah Wootton and Lloyd Riley of Dignity in Dying, should be required reading for every patient and doctor. I want this new book—and its powerful stories of how our current laws fail people—to prompt more open-minded and constructive conversations about end-of-life choice in this country.
This summer also marked the first anniversary of assisted dying legislation in Victoria, Australia—the first state in the country to do so. The Victorian Parliament changed the law after an Inquiry into End-of-Life Choices found that the status quo was “untenable” and did not reflect Victoria’s “values and social needs.” Previously the assisted dying debate had played out in much the same way as it has here, with attempts to change the law being blocked by those who held what were ultimately unjustified fears about the negative impact of law change.
The last fifteen months or so in Victoria have shown that assisted dying works. The Victorian Health Minister has said assisted dying is operating as intended, and the independent body responsible for reviewing and monitoring assisted dying reported in February that all cases have been compliant with the law.
Of course it is these perspectives—those of dying people and their loved ones—that we should take particular note of. Nia Sims has scleroderma and does not want to have the agonising death she witnessed her father experience. Of knowing she will now have the option of assisted dying should she need it she said: ‘[It] allows me to connect in a more meaningful and caring way with my own fragile, crumbling body. It has freed me from planning future suicide and given me headspace to get on with living.’
Western Australia has since voted to legalise assisted dying and a similar law is being put to a public vote in New Zealand in October with results expected in early November, after its Parliament passed a Bill late last year. 150 million people around the world now live in places where assisted dying is legal.
Here in the UK, Last Rights reminds us of the cruelty that our own dying citizens endure. Just as Victoria took a thorough, impartial look at the functioning of their ban on assisted dying, we should too. I support calls for a Parliamentary Inquiry into the impact our current law is having on dying people, their families and the people who care for them.
I understand my colleagues have a range of views on this topic; some insist the law we have is broken and others claim it is working perfectly fine. Those on both sides of this debate should welcome the opportunity to have their conflicting claims scrutinised, but to do this we all need to learn how to contribute our expertise in a constructive way.
I welcomed the Royal College of Physicians’ decision last year to adopt a neutral stance on assisted dying after a survey of its members found opinion was much more divided than previously thought. Being able to speak on behalf of doctors who oppose and support assisted dying—as well as those who have not made up their mind—has empowered the RCP. I expect its contributions to a Parliamentary inquiry will carry more weight as a result.
A more recent survey by the Royal College of GPs returned comparable results, highlighting a remarkable shift in opinion amongst GPs since 2013. The percentage of GPs wanting their College to oppose law change fell from 77% to 46% in just six years. The College has been threatened with legal action unless it reconsiders its decision to stick with its existing policy in spite of this clear appetite for change in the membership.
The BMA also surveyed its members on assisted dying earlier this year, the largest survey of medical opinion that has ever been conducted on this issue in the UK. The BMA has said a debate on its policy will be postponed until 2021, but it is not yet clear when the survey results will be made public. Debate at the BMA may have been postponed, but public debate continues and knowing what doctors think about this issue is a vital piece of information.
It is worth noting that a group of hard-line opponents of assisted dying went to extraordinary lengths to stop the RCP publishing the results of their survey in a legal challenge that ultimately failed. Doctors should never be intimidated away from our pursuit of the truth and I hope the BMA will publish its survey results as soon as possible.
Nobody denies that doctors have expertise to offer on this important topic, but we must ensure the full breadth of opinion is represented, and we should not allow our contributions to the debate to drown out others’, especially not those of our patients. Regardless of our own personal views, we cannot ignore the voices of those who have witnessed first-hand the horrific things that can happen when we deny people choice and control over their death. Last Rights amplifies these voices, and I believe as doctors it is our duty to listen to them.
Zoe Norris, GP, Yorkshire
Competing interests: Member, Healthcare Professionals for Assisted Dying.
Clarification added 26 August 2021: There were two legal challenges brought against the RCP’s move to neutrality. The first was dismissed by the court in March 2019. The BMJ has been made aware by the claimants that the second legal challenge was dropped in March 2020 after the RCP clarified that it did not support a change in the law.