Let's talk about assisted dying

Fiona Godlee, editor, BMJ
fgodlee@bmj.com

Two more people— the conductor Sir Edward Downes and his wife—travelled from the UK to Switzerland this week to die at a time (though surely not a place) of their own choosing. Their final journey to the Dignitas facility came just days after the House of Lords said no to providing immunity from prosecution for people who help relatives or friends travel abroad for an assisted suicide (doi:10.1136/bmj.b2797). The Lords’ decision followed a similar vote at the BMA’s Annual Representative Meeting last month (BMJ 2009;339:b2699).
In an interview with the BMJ (doi:10.1136/bmj.b2868), Lord Falconer, the architect of the defeated legislation, told Clare Dyer that he was motivated by the thought that people would rather die alone in a strange place than expose their loved ones to the risk of up to 14 years in prison. "The idea of dying alone struck me as horrific," he says. He decided to tackle what he saw as "an anomaly."
Assisted suicide has been legal in Switzerland since 1940, and unlike in Oregon, the Netherlands, and Belgium, where it is also legal, there is no requirement to be a resident or to have a physician in attendance. So far about 115 Britons have died in assisted suicides in Switzerland, and no one has yet been charged for helping them die abroad. In the BMA’s recent debate Ilora Finlay argued that the current law works well. "It has a stern face and a kind heart," she said (BMJ 2009;339:b2699).
As reported by Dyer, the debate in the Lords shows the extent to which any softening of the legislation is seen as a slippery slope towards allowing assisted suicide in the UK. Supporters of Falconer’s amendment say that immunity for helping people travel abroad can be kept separate from the law on assisted dying. Falconer is considering fighting on with a private member’s bill in October or November. Meanwhile, why do we fear the slippery slope? The latest YouGov poll suggests that the public is more in favour of assisted dying than are politicians and doctors.
According to Ann McPherson, more than 800 people in the UK have signed up with Dignitas.
McPherson, an Oxford based GP, is herself dying of cancer. In her personal view (doi:10.1136/bmj.b2827), she writes about how hard it has become, post-Shipman, for doctors to respect the wishes of terminally ill patients. Surely, she says, fear of overstepping guidelines must be tempered with the need to listen to the patient’s own wishes. McPherson is unusually attuned to patients’ views, as co-founder of DIPEx, a groundbreaking video database that systematically records patients’ experiences (http://www.healthtalkonline.org/). She makes a moving plea for a rational discussion about assisted dying. Part of the problem, she says, is that those deciding on the questio n of assisted dying are not facing immediate death themselves, an expertise she now bravely claims. She writes: "Surely now we are a culture that has developed enough humanity to provide the choice and still protect the vulnerable."
Cite this as: BMJ 2009;339:b2883