Agenda: Why, as a physician, I oppose assisted dying
I AM a palliative care specialist and I believe Scotland must not introduce assisted dying.
Palliative care aims to give people with life-limiting illness the best possible quality of life. As a palliative care doctor I help people live, not die, and am taken aback by MSP Liam McArthur’s Assisted Dying Bill. He thinks assisted dying is complementary to palliative care. Like many other trainee palliative medical consultants, I want no part in assisted dying.
The proposal is for the doctor to prescribe lethal medication to a terminally ill patient to enable them to take their own life. I fear some may be misled to believe a change in law is needed for people with terminal illness to ask for chemotherapy to be withdrawn or refuse cardiopulmonary resuscitation. These choices are already legal.
Furthermore, the consultation contains glaring omissions.
It fails to provide an accurate explanation of how natural dying is experienced for the majority of people, and sensationally emphasises rare, catastrophic possibilities.
There are dying people with difficult to control systems – the complex cases I treat. However, most people do not experience uncontrollable suffering while dying. The consultation states that “11 Scots a week die badly in spite of [palliative] care”. On average 1,200 die per week in Scotland, this means that more than 99 per cent of dying people do not die badly.
Secondly, the consultation fails to mention most people who request assisted dying, in countries where it is legal, do not do so due to uncontrolled pain or other physical symptoms. Most request dying for psychological suffering from the fear of dying, or for social concerns, such as a fear of being a burden on others.
Thirdly, the bill assumes a guarantee the person will have a compassionate pain-free death. But there is no evidence such processes exist.
Doctors must do no harm. In practice, patients may refuse a treatment which the doctor believes will help them but they may not demand a harmful treatment.
Assisted suicide will have a profound effect on healthcare. Doctors have a moral and legal responsibility to make a patient aware of choices available. Assisted dying means every doctor-patient interaction for terminally ill people will need to mention this choice, which is likely to have a negative, if not coercive effect, on some.
Moreover, we can tackle much of the perceived need for assisted dying by spreading wider awareness of natural dying and palliative care. People should understand that, as Dr Kathryn Mannix, the palliative medicine consultant and writer, says, dying will probably not be as bad as you think.
I do not wish to practise medicine in a society which responds to someone wishing to end their own life by giving them the means to do so. I wish to work towards the alleviation of suffering, so the person can enjoy the best possible quality of life.
Dr Shaun Peter Qureshi is a physician most recently based at the Beatson Cancer Centre in Glasgow, specialising and training to be a consultant in Palliative Medicine. He researches, teaches, publishes and gives presentations nationally and internationally, on end-of-life care.
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