It is more vital than ever that we have data to support the debate on assisted dying

In May 2021, Matt Hancock, the then Secretary of State for Health, commissioned the Office for National Statistics (ONS) to inject fresh evidence into the assisted dying debate. [1] The ONS has been asked to investigate how many dying people in the UK take their own lives and how many travel abroad to access assisted dying. This will help us to understand what effect, if any, the UK ban on assisted dying has on these cases. This is an encouraging development that should be welcomed by all. The debate about possible UK legislation for assisted dying has never gone away and is about to pick up again. Not only are jurisdictions considering changing their laws, but Jersey will debate whether assisted dying should be legalised after a citizens’ jury said it was in favour of changing the law. The matter is also currently being debated in the House of Lords in the form of a private member’s bill put forward by Baroness Meacher. The subject is emotive and the debate often polarised, with more heat than light being generated. Those who support assisted dying legislation want to see more light shed on the subject. Those who argue that the status quo is good enough should be confident of putting their claims to the test.

The blanket ban on assisted dying in the UK undoubtedly forces many terminally ill people to take matters into their own hands and it is right that society—and the medical profession especially—be forced to confront that reality. At the moment we believe from evidence in the UK and in other countries that as many as 1 in 7 suicides may be related to terminal and serious illness

My brother took his own life when dying of renal cancer. [2] He had a very good palliative care team, but he didn’t want to see out the final weeks of his illness and risk the suffering he had witnessed others endure. Concepts of autonomy, control, and person-centredness—which we try so hard to embed in every other area of medical practice—inexplicably became more elusive to him the closer he got to death. The current law did not protect him; it drove him towards a lonely, violent end. It robbed him of the opportunity to die in peace with his family around him. Instead the family have to live with the knowledge of his tragic death

MPs must respond with a sense of urgency once the evidence of the impact of the current law is put before them. While their historic trepidation has come at a cost to many, what it has afforded us is the benefit of learning from those who have already adopted legislation. Ten states in the US, soon to be four states in Australia, as well as New Zealand, Canada, Spain, and other European jurisdictions have grasped the nettle. A bill is being scrutinised in Ireland.. Scotland will be next. The blueprints are out there.

More and more laws are being passed and not one has yet been repealed. A law has been in place in Oregon for 24 years. The Oregon Hospice and Palliative Care Association withdrew its case against the law and pledged to respect the rights of dying Oregonians to have this option available to them. No national or state medical body is campaigning to overturn assisted dying legislation. [3]

Yet despite being able to learn from the extensive scrutiny and evidence of safe practice overseas, opponents of assisted dying continue to base their opposition on speculation. [4,5] They fear what “might”, “may,” or “could” happen. There is no question about their sincerity, but their fears are hypothetical. Meanwhile the everyday suffering of the terminally ill is real. The vast majority of people—in the UK and in places that already have laws in place—recognise that we don’t have to choose between better end-of-life care and better end-of-life choices. An assisted dying law is an opportunity to address both simultaneously.  

Evidence is vital. For too long the assisted dying debate has been conducted on opinion rather than fact. Opponents of assisted dying have always declared with confidence that doctors opposed such legislation without any evidence to support it. When the BMA proposed conducting its first ever survey on assisted dying there were some doctors who voted against it. But we are an evidence based profession. It is vital that we know what doctors think about one of the big ethical questions of our time. We now know from the survey that more UK doctors personally support law change (50%) than oppose it (39%) and the majority (61%) have called on the BMA to adopt a supportive or neutral position on the issue. [6] A debate to define the BMA’s future approach is taking place at the ARM on the 14 September. 

MPs have called for the public debate to be informed by the “best statistics.” The BMA survey results have forced people to question their long-held assumptions about the status quo. It is to be hoped that the evidence from the ONS will do the same and that the information will be available in time for the forthcoming debate in the House of Lords.  

Jacky Davis, consultant radiologist. 

Competing interests: I am a member of BMA council, a board member of Dignity in Dying, and chair of Healthcare Professionals for Assisted Dying.

Commissioned, not peer reviewed