Should the law on assisted dying be changed?

03 May, 2011

Assisted dying is a complex issue with strongly held views on both sides of the argument.

On bmj.com, two experts go head to head over whether the law in the UK should be changed to make assisted dying legal.

Former Professor of Geriatric Medicine at the University of Manchester, Raymond Tallis, has changed from a position of opposing assisted dying to advocating a change in the law. He is also Patron of the organisation Dignity in Dying.

He says his previous view was based on incorrect assumptions including the view that better palliative care can always alleviate unbearable suffering. With 35 years of working in geriatric medicine behind him, Tallis says that doctors increasingly have to resort to sedating patients to control pain, and that good palliative care does not mean legalised assisted dying is not needed.

To support his view Tallis says that 90% of patients in Oregon who requested assisted dying came from excellent hospices. And in Belgium, increased investment in palliative care was introduced just before the euthanasia laws.

He also argues that assisted dying laws would not erode trust in the medical profession – indeed a survey of nine European countries puts the level of trust in the Netherlands at the top.

He talks about his previous concern that assisted dying would be offered to or imposed on vulnerable people, but says that the Oregon experience points in the opposite direction, with an under-representation of those who are traditionally thought of as disempowered who seek help to die.

Tallis maintains that while only a few individuals would require assisted dying, many more would be comforted from knowing it is available if necessary. He concludes that "living well includes dying well and supporting a dying person who seeks assistance to die is an expression of this."

At the opposite end of the spectrum, Kevin Fitzpatrick, a researcher from the organisation Not Dead Yet and someone who is also disabled, says doctors should not be put in the position of deciding which lives are worth living.

He refers to a Dutch doctor who said the clinical team agonised all day over the first case of euthanasia, but the second case was easier and the third case was a piece of cake. Fitzpatrick says he has heard reports that many elderly people in Holland are so frightened about euthanasia that they carry cards saying that they do not want it.

Fitzpatrick argues that "disabled people, like others, and often with more reason, need to feel safe" and that legalising assisted dying would threaten disabled people's "well-being, continuing care and management and life itself."

He concludes that the issue is complex and involves deep moral questions but that "the lives of many disabled people depend on resisting attempts to introduce a law legalising the intentional act of killing."

Source: BMJ