Why doctors oppose Falconer: a medic explains
by Oxford Students for Life
The author is a medical student currently at Oxford University.
The major organisations representing UK medical professionals have raised their voices in resounding opposition to Lord Falconer’s assisted dying bill. But why? Do they not care about suffering patients? While their position may continue to strike Lord Falconer’s supporters as odd, it turns out that, given their specialized knowledge about care at the end of life, they have very good reasons for opposing the bill.
The medical profession has always understood itself as a healing profession – and intentionally facilitating someone’s death is strikingly contrary to that goal. As put by the Royal College of Physicians: ‘Assisting suicide has been clearly and expressly outside our duty of care since Hippocrates and must remain so for the integrity of these professions and the public good’. The RCP is pointing out that assisted suicide is not medicine and if a physician is asked to participate in assisting a patient’s death, the request must be denied.
Treating assisted dying as ‘just another medical procedure’ threatens the integrity of the profession, insofar as the profession aims at health. Hippocrates included an explicit prohibition on the provision of deadly drugs for precisely this reason. If an explicit commitment to healing patients is lost, medicine is at risk of losing its way as a profession. It is the unwavering commitment to the health of her patients that gives the doctor a privileged position in society and the trust of her patients.
Consider also that the modern hospice/palliative care movement began in the late 60s – less than 50 years ago. Since that time palliative care has become much more widely available, physicians have refined it as an art, and they know that it will continue to improve. In a recent conversation, a palliative care physician told me that in his experience patients who express an interest in dying ‘if things get bad’ are afraid more than anything else. Once he explains that he will not be shy in using medications – pain relievers and others – to alleviate their symptoms, their fear subsides and they stop enquiring about being helped to die.
Medical professionals are resolved to continue to improve palliative care as an art so that the fears that often drive patients to ask about assisted dying can be better quelled with the promise of effective palliation. It is crucial that, while physicians realize that even with the best palliative care some may still be resolved to pursue suicide, ‘helping their patients to die’ is off the table, as it is out of the scope of their profession. Instead, their focus is on getting better at relieving pain and other symptoms and caring for their patients attentively at the end of life.
Moreover, while the bill attempts to build in protections for the vulnerable – based on prognosis, depression screens, etc. – doctors know better than anyone that these simply are not effective enough to provide reliable protection. Whatever the rationale for identifying having 6 or fewer months to live as the point at which a patient may choose assisted suicide, doctors know that providing a prognosis is more like predicting what Germany’s goal total will be over the course of the World Cup than it is like calculating how long it will take for a drug to be cleared from circulation. There are too many variables for it to be reliably precise.
A number of studies have reinforced this – and the further away one gets from the end of life the less accurate predictions tend to be. Whether or not the expected time remaining should be treated as important, physicians approach their estimates with humility and realize that it is shaky at best to base policy on them.
Even more importantly, doctors realize that they cannot reliably do what the bill asks them to do – screen out depressed patients. Depression comes with an impaired sense of judgment and often feelings of despair. Those who are depressed are ‘not themselves’ and thus, when they have suicidal ideation, it is our duty to protect them from themselves – not to facilitate self-harm. The legislation tries to combat this danger through screening, but screening for depression is not at all like measuring cholesterol, blood pressure, or blood sugar. The screening tests are based on patient responses and while somewhat reliable in patients who do not have an agenda, a depressed person set on gaining assistance in committing suicide could easily dupe the test. It would only require fairly basic knowledge about depression. Physicians – psychiatrists in particular – are aware of this and realize that even the best screening methods we have are unable to correct for this. As such, doctors are very much justified in pointing out that, even if it tries, the bill cannot reliably protect those with mental illness – thus making the legislation unsafe.
As we have seen, physicians have very good reasons for opposing Lord Falconer’s assisted dying bill. They recognize their profession to be one of healing and are unwilling to undermine its integrity by permitting the medicalization of suicide and codifying it in law. Their objections are also based on a strange mix of confidence and humility – confidence in their ability to improve palliative care and humility in recognizing their own limitations. Physicians realize that they are being looked to not only to irrevocably alter their profession, but also to ensure safeguards that they simply cannot provide.
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