Month: December 2014

Don Brand writes

Excellent Reith lecture this morning on medical approaches to end-of-life and what’s wrong with them (doctors too busy giving patients information, don’t ask them questions and listen to the answers. But the lecturer, a distinguished Indian/US surgeon, touched very briefly on assisted dying in the lecture, and this was opened up in the discussion. Chairman of Dignity in Dying in the audience, taking the party line, but a very measured response from the lecturer – he gave the view that it might be cruel to withhold the AD option for the small number of people who really were suffering intolerable and un-relievable pain and distress, and mentioned that AD was available in a number of US States. But he went on to quote the figures for Oregon, that less than 1% of people requested the prescription, and half of them chose not to use it; and compared that with the position in Belgium and the Netherlands, where the figures were around 4%, and the commonest reason people gave was that they didn’t want to be a burden. He felt this was very dangerous, and indicated that  doctors had got too much power and responsibility in their systems. He was arguing strongly for supporting people to take control of the decisions in the final stages, asking questions that will enable them to say what they want and, as important, what they fear might happen; letting them decide whether and when to discontinue treatment; and making sure the option is available of going home with hospice services.

At the end of this part of the Q&A, the chair asked if anyone in the audience wanted to offer a different view from the DiD consultant, and nobody did. “Cowards” was the lecturer’s quiet response.

A survey of the fellows and members of the Royal College of Physicians (RCP) has shown that a majority of respondents still do not support a change in the law on assisted dying. This broadly reflects the overarching result of the RCP’s 2006 survey, although the number taking this position has fallen. The RCP recognises that this is a difficult and personal issue for doctors and society, and therefore RCP Council felt it was important to consult fellows and members.

The current UK legal position is that assisting another person’s suicide is illegal.

The 2014 survey asked fellows and members four questions on the issue, covering their own personal opinion, and for the first time, a separate question on whether they believed the RCP as an organisation should have a position.  The survey included the exact wording of the question RCP first asked in 2006, so that the results could be directly compared to track changes in opinion.

The questions and answers are as follows:

1. Do you support a change in the law to permit assisted suicide by the terminally ill with the assistance of doctors?

Yes                                                                      2168        32.3%

Yes, but not by doctors                                          684         10.2%

No                                                                      3858        57.5%

2. We ask you to consider the following statement: ‘(We) believe that with improvements in palliative care, good clinical care can be provided within existing legislation, and that patients can die with dignity. A change in legislation is not needed.’ Do you agree? (The question asked in 2006)

Yes                                   4179        62.5%

No                                   2507        37.5%

Answers from 2006 survey for comparison:

Yes                                   3741        73.2%

No                                    1327        26.0%

Although there is still a majority opposing a change in the law on assisted dying, there has been a 10.7% decrease in the percentage of members and fellows holding this view since the survey was last conducted in 2006.

3. What should the College’s position be on ‘assisted dying’ as defined in the RCP’s consultation document.

In favour                                  1649        24.6%

Opposed                                   2972        44.4%

Neutral/no stance                      2076        31.0%

4. Regardless of your support or opposition to change, in the event of legislation receiving royal assent, would you personally be prepared to participate actively in ‘assisted dying’ as defined in the RCP’s consultation document.

In favour                                   1432        21.4%

Opposed                                   3904        58.4%

Neutral                                     1345        20.1%

A similar question was asked in 2006, and regardless of support for change, the percentages of those prepared to personally participate actively in a process to enable a patient to terminate their own life were very similar to the above results and were as follows:

In favour                                   18.9%

Opposed                                   59.4%

Uncertain                                  19.4%

Dr Andrew Goddard, RCP registrar and senior officer with responsibility for professional matters, said:

These results give us a basis for our position on assisted dying and for responding to proposed legislation, now and in the coming years.  Whilst there is still a majority against a change in the law, we recognise there has been a shift in opinion over the past eight years, and will continue to engage with members and fellows on this issue.