MDMD Campaign Policy Director responds Dominic Lawson

My Death, My Decision’s Campaign Policy Director, Phil Cheatle, responds to the Daily Mail’s Dominic Lawson. 

Today, the Daily Mail published an article by Dominic Lawson, criticising the Royal College of Physicians (RCP) decision to poll their members on assisted dying. His article misses some important points.

One example, is Mr Lawson’s insistence that: “assisted dying already exists in this country: it is called palliative care and takes place in hospices across the land.” Another is his claim, that: the issue is whether doctors should be required to perform [assisted deaths] if any of their patients request it”, or that the very notion of assisted dying requires a doctor to breach their Hippocratic Oath.

Palliative care is undoubtedly an important choice for anyone at the end of life, and My Death, My Decision firmly supports its work. However, whilst MDMD recognises the importance of its benefits, we also believe it is important to recognise its limitations. Palliative medicine is ill equipped to help those who fear a loss of dignity, or loss of autonomy. Not all pain can be palliated, and worse, people are unable to say “enough is enough I just want help to die peacefully”. More significantly, it offers very limited help those who suffer from degenerative neurological conditions such as dementia (which accounts for one in eight deaths in the UK).

On the issue of “requiring” a doctor to directly participate in someone’s assisted death, MDMD firmly supports the notion of conscientious objection. Although 45% of UK doctors already believe that a form of assisted death occurs in the UK, and 55% of UK doctors already agree that the law on assisted dying should change, MDMD recognises that an important minority of doctors are opposed. As with all questions of conscience, My Death, My Decision would never “require” a doctor to assist in someone’s wish to die, and would respect their right not to participate. Similarly, when Mr Lawson suggested that the very notion of assisted dying would “breach [a doctor’s] Hippocratic Oath”, it appears that he overlooked the modern articulation of the medical profession’s practice oath which now reads: “I will respect the autonomy and dignity of my patient”. A striking statement, considering that it is unclear how refusing the peaceful death requested by a patient after careful consideration of the options, when their future quality of life for them lacks the level of dignity they would wish, “respects the autonomy and dignity” of the patient.

Amongst Mr Lawson’s other objections to changing the law on assisted dying, is a concern that many patients “can come under subtle (or not so subtle) pressures from relatives who stand to benefit from such ‘assisted suicide’”. This is an important concern, and it is right for Mr Lawson to raise it. However, as important as this concern is, there are three significant considerations to be drawn out from the issue of coercion.

Firstly, it is likely that a much larger percentage of dying people already experience a form of coercion, through the strong social pressure to “keep on fighting”. Many individuals who suffer unbearably want to die peacefully, but often feel forced to accept medical treatment to stay alive.

Secondly, as Mr Lawson himself notes, there is already an absolute right, without any recourse to scrutiny, for someone to refuse life-sustaining medical treatment. Therefore, if it were true that unscrupulous relatives are motivated by a desire to pressure their elderly relatives to end their lives, it is unclear why there is no evidence of individuals being pressured into ending their life by removing treatment. Indeed, in most cases, grieving relatives are likely to pressure their loved one into staying alive longer, as opposed to pressuring them into ending their lives.

Finally, medical professionals are well versed in identifying coercion and ensuring that individuals can make fully informed decisions. However, MDMD believes that it is important that we continue to develop and improve good practice to detect and avoid pressure and coercion relating to all end-of-life planning decisions and choices – accepting or refusing treatment, making advance decisions and statements of wishes, as well as (when legalised) requesting a medically assisted death.

If you would like to add your own comments to Mr Lawson’s article, it can be found here.