Medical Views

BMA to poll members on assisted dying

MDMD is greatly encouraged in its campaign by the news that both the BMA and RCGP are to consult their members on their view of assisted dying. Precise details are yet to be announced and we will follow these developments closely.

Earlier this year the RCP poll resulted in a move from opposed to neutral, reflecting the divided views of its members. In the run up to that vote, those opposed to a change in the law mounted a very vocal opposition campaign in the hope of preventing the RCP changing its position. Their views do not represent the majority of people in the UK – the patients – who want to exercise choice over their own end of life as part of the patient-centred healthcare they expect. A MDMD poll recently demonstrated very strong support for various forms of assisted dying, including those covering people with early stage dementia and people who were incurably suffering but not expected to die within a short period of time.

In the past some doctors have expressed concern that an assisted dying law that uses a life expectancy prognosis as one of its criteria would be very hard for them to implement. Last year this concern was used by Scottish doctors to successfully argue for a broader definition of “terminal illness” in Scotland. When Canada passed its Medical Aid in Dying legislation it was limited to those whose “natural death has become reasonably foreseeable”. Both these examples show ways in which this particular medical objection can be overcome. MDMD support these moves, though we also campaign for assisted dying legislation to apply to those who are incurably suffering whether or not they are “terminally ill” – people like Paul Lamb, Omid T, Debbie Purdy and Tony Nicklinson, whose plight caused ex-Archbishop of Canterbury Lord Carey to change his view to support a change in the law on assisted dying.

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Death of MD.MG’s Distinguished Member Dr Michael O’Donnell

My Death, My Decision was saddened to hear recently of the death of Dr Michael O’Donnell, a distinguished member of our Medical group and an active supporter of assisted dying. As Michael proudly recalled in his short CV when he joined us, “the British Medical Journal said ‘not to have read Michael O’Donnell’s World Medicine was to have been incomplete as a doctor’.” He edited World Medicine for 16 years. Its influence lay in the fact that it was the only non-academic medical journal read by both GPs and hospital doctors but Michael himself regularly came top of the poll in elections to the General Medical Council, where he was a leading voice for much-needed reforms. As a medical student, he wrote and acted in reviews and his friendly manner made him a popular choice for several regular radio and TV programmes

In 2010 following the far-from-peaceful and dignified death of his wife, he wrote a powerful article for the BMJ in support of assisted dying. Our thoughts go out to his friends and family.

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Doctors vote for the Royal College of Physicians to adopt a neutral position on assisted dying

Today, doctors voted to change the Royal College of Physicians policy on assisted dying to neutral and not oppose any change in the law.

In responding to whether the Royal College’s position on assisted dying should change, 43.4% voted to continue opposing a change in the law, 31.6% voted in favour of assisted dying reform, and 25% voted to adopt a neutral position.

A clear majority of 60% or more, would have been required for the Royal College to either oppose or support a change in the law.

In 2014, when the college last voted on this issue, 44.4% of doctors voted against assisted dying reform, 24.6% voted in favour of supporting assisted dying reform, and 31.0% voted for the college to adopt a neutral stance. Following this survey, the Royal College opted to oppose all further attempts to change the law, unlike in 2008 when it adopted a neutral stance.

This means, that although the numbers opposing assisted dying have not significantly changed since 2014, there has been a strong increase of those who believe the Royal College should support assisted dying reform from 24.6% to 31.6% and a majority of the Royal College voted against continuing a policy of opposition.

The Royal College of Nursing, Royal Society of Medicine, and Royal College of Psychiatrists have also adopted neutral positions the legalisation of assisted dying.

The figures come a week after the best-selling neurosurgeon Dr Henry Marsh, women’s right advocate Professor Wendy Savage, and acclaimed researcher Dr Iain Chalmers announced the formation of a new medical group, to campaign for a change to provide those who are either terminally ill or incurably suffering the right to an assisted death.

Earlier this week a report from the campaign group Dignity in Dying revealed a hidden network of links between anti choice lobbyists and groups who had been opposed to the Royal College’s decision to poll its members.

The RCP survey also revealed that 40.5% of doctors individually support a change in the law to permit assisted dying, a 25% increase since 2014 when only 32.3% of doctors supported a change in the law.

The Royal College will now wait until its annual general meeting later in April, before announcing any change in the its official policy.

Colin Brewer, Chair of the campaign group My Death, My Decision Medical Group said:

“For some time now, fair-minded medics have wondered and worried about the real organisations orchestrating campaigns against assisted dying and claiming to do so in the name of the medical profession. Some palliative care doctors have been bullied into silence, whilst a vocal and well-funded minority of opponents have questioned the legitimacy of this poll and attempted to sway its outcome. Some of their funds appear to have come from right wing religious extremists in the USA. Happily these attempts have failed.”

“These results are a welcome step towards a more compassionate and common-sense law, which improves trust between patients and their doctors.”

Phil Cheatle, Director of Campaign Policy at the campaign group  My Death, My Decision said:

“These results reflect a wider trend across our country and a growing support for the legalisation of assisted dying. An overwhelming majority of the public now support changing the law to help those who are either terminally ill or incurably suffering.  As this poll demonstrates, opinion is moving; other countries are moving. Other medical colleges now need to move too in order to reflect the changing nature of ageing and death and the changing attitudes of those who are dying.”

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Acclaimed Doctors Call Upon Parliament To Stop Ignoring Assisted Dying Reform

A new medical organisation in favour of assisted dying has been formed in the UK and will work to change the law on assisted dying to allow people in the UK who want the option of a safe and dignified assisted death.

Announced in a column in the British Medical Journal today, “MDMD Medical Group” (MD.MG)has been formed by a group of leading UK doctors. In the article, the best-selling author Dr Henry Marsh, women’s right advocate Professor Wendy Savage and acclaimed researcher Sir Iain Chalmers disputed claims that “pro-choice doctors” opposed changing the law on assisted dying, and called upon Parliament not to ignore the many people in the UK who want the option of a safe and dignified assisted death.

The new group, which is open to any pro-choice clinical professional, will be the first medical organisation in the UK advocating to allow mentally competent adults, who have incurable health problems and an intolerable quality of life, to have the option of a medically assisted death. The group will be Chaired by Dr Colin Brewer and joins the right to die organisation, My Death, My Decision.

In the letter, the three doctors write “as with earlier medical debates about contraception and abortion, [assisted dying evokes] strong feelings on all sides”, but, that, regardless of one’s view “the debate about legalising Medical Aid in Dying (MAID) in Britain is not going to stop”. They claim “whatever form legislation eventually takes, doctors will be the professionals most involved in enabling patients to have more control over the manner and timing of their death” and it is therefore essential for them to “revisit the fundamental issues of patient autonomy and choice”.

In a 2018 editorial, the British Medical Journal declared its support for changing the law on assisted dying and reported that over 55% of UK doctors agreed or strongly agreed that the law should change. A survey by Medix found that 45% of UK doctors believe that some healthcare professionals already assist with the death of patients.

The announcement comes after the Royal College of Physicians polled it’s members on whether it should change its policy on assisted dying reform, and news earlier this month that Jersey’s government will begin looking into whether the law on assisted dying should change.

Recently a new poll released by My Death, My Decision  found that 93% of the public now consider assisted dying acceptable for those who are terminally ill in at least some circumstances, and 88% consider assisted dying acceptable for those suffering with Alzheimer’s in at least some cases, provided this was before they lose mental capacity.

Drs Marsh, Savage and Chalmers go on to say that “in Britain, and in several American states that have legalised assisted dying, there is a debate about whether the right to die should be restricted to patients with terminal illnesses, or be extended to those suffering from medical conditions that are intractable, intolerable and have no prospect of relief from an early natural death.” The letter highlights several British citizens in that category who have attracted “wide public sympathy and support”, such as Omid T who suffered from multiple systems atrophy and ended his life last October by medically assisted suicide in Switzerland, and Tony Nicklinson who suffered from locked-in syndrome and ended his life by starvation in 2012.

Following the High Court’s ruling against Omid T on a preliminary issue, and the Supreme Court’s decision not to grant Noel Conway permission to bring a case in December of last year, the group aims to encourage parliament to explore the “full spectrum of pro-choice views” and change the law to help those who are either terminally ill or incurably suffering”.

The new Chair of My Death My Decision Medical Group, Dr Colin Brewer has said:

“For some time now, doctors and nurses have watched with increasing despair, as the interests of their patients were sidelined and attempts to reform assisted dying faltered. All too often we have watched as debates about the right-to-die were confused by misinformation and myth. We believe it is now necessary for the voices of strongly pro-choice doctors and nurses to be heard.  Our organisation hopes to provide a voice for those clinicians, and the balanced medical perspective that this debate has lacked.”

“The majority of doctors and nurses now believe that the law against assisted dying is unacceptable. Those who face incurable suffering as well as those who are terminally ill, deserve the option of a peaceful, pain-free and dignified death, but instead of strengthening the doctor-patient relationship, the law gags doctors and prevents them from engaging in open conversations.”

My Death, My Decision’s Director of Policy, Phil Cheatle, said:

“The fault lines in this debate have become clear.  We know that an overwhelming majority of the public believe that the law on assisted dying should change, and that the medical profession stands with that of the compassionate majority.  It is time for our decision-makers to heed their voices and legalise assisted dying, otherwise they will remain on the wrong-side of this debate.”

“My Death, My Decision welcomes MD.MG and is excited for such a distinguished group of clinicians to have joined our campaign for a more compassionate approach to dying in the UK. The current law prohibiting assisted dying is unacceptable. It is time for the UK to adopt a more compassionate law, which balances both the need for strong safeguards and a respect for human dignity.”

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American Family Physicians Association (AAFP) changes position on medical aid in dying

In October 2018 it is reported that the American Academy of Family Physicians (AAFP) broke ranks with the American Medical Association (AMA) by adopting a position of “engaged neutrality” on assisted suicide and euthanasia.

At its Congress of Delegates in New Orleans the AAFP, the second largest component society of the AMA with more than 131,400 members voted to adopt a position of “engaged neutrality” and to reject the use of the terms “assisted suicide” or “physician-assisted suicide”. “Through our ongoing and continuous relationship with our patients, family physicians are well-positioned to counsel patients on end-of-life care, and we are engaged in creating change in the best interest of our patients,” said the AAFP president Michael Munger, a physician from Kansas.

This is important in the UK because the BMA radically opposes assisted dying, whereas the BMJ has come out in favour of putting it to the vote, to show the true picture amongst British doctors.

Often it is the minority groups such as ‘Care Not Killing’ which shout the loudest. I once heard a story of a Methodist Minister trainee student who wrote his sermons out in full with notes in the margin. On one occasion one of his colleagues happened to come upon one of these sermon transcripts and was amused to read in the margin ‘weak point, shout louder’.

In the UK. nurses are the largest group of care providers for the terminally ill, so it is not surprising that following an extensive and detailed consultation process with their members, the Royal College of Nurses moved in 2009 to adopt a neutral stance in relation to assisted dying for people who have a terminal illness.

It is time the BMA followed suit and stopped giving politicians an excuse against seeing reason and voting for legislation allowing Assisted Dying for the terminally ill and those suffering long term incurable health conditions which have reached a stage of relentless suffering, provided this is their own persistent wish.

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Talking about Dying – More than Meets the Eye?

Recently the Royal College of Physicians (RCP), in a widely reported statement, called for doctors to start talking about death earlier. It followed from a report, “Talking about Dying”, which found only 4% of patients talk to their doctors about dying or benefit from advanced care planning.

“Too many patients are being admitted to hospital without ever having discussed serious issues like DNACPR (do not attempt cardiopulmonary resuscitation) or their ceiling of treatment despite chronic, life-limiting conditions and frailty. We act on default because we don’t know what the patient wants.” – Medical Registrar cited in the report

Stating that open dialogues, although sometimes “challenging”, were essential to good medical practice the RCP identified three barriers to end of life conversations: culture, confidence and practicalities.

On culture, the RCP found a systematic gap between patient’s expectations and clinical practice. In particular, they found whilst 77% of patients would prefer being told if they had less than a year to live, a majority of doctors preferred not discussing the topic. The report also found that “death [is widely viewed] as a failure” amongst the medical community, and a culture exists which prevents patients from discussing the acceptable limits to treatment. Indeed the report found many doctors believe their role is to “cure all ailments”, thus meaning that they believe they should always “do something to help [even if it resulted] in unnecessary aggressive treatment”.

On confidence, the report found that at all levels doctors feel unprepared to talk about dying. Specifically, the RCP found that junior doctors feel most unprepared, because they often lack opportunities to practice end of life conversations and consequently feel worried about initiating them.

Finally, on practicality, the report found most doctors were unclear at what stage conversations should begin. Additionally, doctors were unclear which healthcare professionals should be responsible for conducting end of life conversations. Indeed, many staff admitted “they were reluctant to start conversations … if they could not finish them … themselves”.

“There could be a whole population of people who, even at 60 years, may not want resuscitation. If we don’t ask them, they’ll just get it. This should be a routine conversation with every single person.” – Trainee Doctor cited in the report  

The RCP report stated that these barriers were a serious concern, because doctors “need to be equipped to offer patients honest conversations about what they can expect in the future, [and] to give [patients] choice and control over the remainder of their days”. Their report highlighted five main benefits to open conversation about death:

  1. Early planning often improves a patient’s quality of life and mood
  2. Early planning often reduces the need for aggressive treatment later
  3. Early planning improves a doctor’s ability to deliver a patient’s wishes
  4. Early planning often enables better pain relief for a patient
  5. Early planning can in some cases extend a patient’s life

Consequently, the RCP recommended a raft of proposals to improve the dialogue between doctors and patients. For example, they recommended better training for undergraduates, a public awareness campaign and a better understanding of an end of life conversation’s purpose. The RCP stressed, that conversations should not be considered singular events, but rather understood as a continuing process of “encouraging a patient to think about their preferences”.  Interestingly, the Royal College also suggested conversations should not begin in the last phases of someones life, but could and should begin at any point.

MDMD strongly endorse these conclusions. We promote these discussions with medical professionals both as part of possibly refusing medication and as part of end of life planning using advance decisions to refuse treatment, advance statements of wishes to guide “best interests” decisions, and lasting powers of attorney for health and welfare. We also strongly encourage discussion with family and close friends. These discussions can help both the person whose life will soon end, and those who they will leave behind.

In the light of this report, and the excellent book “Being Mortal” by Atul Gawande, which touches on similar topics and the over-medicalisation of our care for the elderly, perhaps the medical professions should get initial conversations started long in advance of any serious illness, during routine medical check-ups in people’s 60’s and 70’s?

Two factors indicate that “Talking about Dying” may signal a subtle shift in the Royal College of Physicians in this direction.

1) Good End of Life Planning “is not just about high quality palliative care in the last weeks or days”.

Throughout the RCP’s report palliative care examples were heavily drawn upon to evidence their claims. Indeed, the report even went so far as to ultimately conclude that physicians find end of life conversations difficult, because “there are not enough palliative care specialists”.

Despite this, “Talking about Dying ” is important, because it signals that the Royal College of Physicians may be moving away from a simple insistence that good palliative care is all that is required.

My Death, My Decision welcomes this movement. Palliative care is an important end of life choice, and it brings relief to a very large number of suffering individuals. However, it is important to acknowledge that for all its benefits, palliative care is not sufficient for everyone, in all situations. Palliative care is principally a pain oriented form of treatment. Thus, it is limited in the extent it can help individuals who fear a loss of dignity and autonomy. Without the option of an assisted death, should they eventually need it, some people quite understandably fear that their end of life will be intolerable for them. This fear alone can prevent them having a good death.

We believe that palliative care and assisted dying are neither alternatives nor antagonistic options. Experience in parts of Belgium has demonstrated, for over a decade, that the two can work in tandem. My Death, My Decision would encourage any future change in the law to adopt a similarly integrated approach.

2) Doctors are uncomfortable with diagnosis of less than 12 months to live

Another interesting aspect of “Talking about Dying”, was the Royal College’s frank admission that “Professionals are often reluctant to initiate conversations about the end of life because they are not sure that the patient will die within the next 12 months”.

MDMD fully understands that it is impossible for doctors to make accurate predictions on life expectancy. They should not be expected to do so, not in relation to when to start conversations about end of life treatment, nor in relation to eligibility for welfare benefits, nor in decisions as to whether someone might be eligible for an assisted death. Patients and legislators need to accept this too.

Patients wanting to discuss end of life options, should not be refused a conversation merely because an accurate life expectancy assessment is impossible, regardless of any timescale. MDMD believes that those suffering from non-terminal illnesses, such as Locked-in Syndrome or Multiple Systems Atrophy, are entitled to the same conversations and choices as those whose end of life is sooner and more predictable.

The Royal College of Physicians seem to reflect a wider trend of doctors pushing back against  a rigid 12-6 months time frame. For example, in Scotland it was recently decided that “terminal illness”, as it applies to the right to certain benefits, is now determined by doctors without any need for an estimate of life expectancy. Further, in Canada the Medical Assistance in Dying law there is applicable to those with a “reasonably foreseeable death”, again with no specified time limit.

An area that “Talking about Dying” doesn’t cover, but should, relates to a patient’s wish for a meaningful conversation about assisted dying. Without this doctors can never have the sort of open, honest “Talking about Dying” conversations which some patients wish for. In this sense the doctor patient relationship is currently broken and needs fixing by giving doctors the freedom and professional protection to:

  1. discuss options like medically assisted suicide in Switzerland, refusal of food and drink, and rational suicide. Even if they cannot assist in these options.
  2. provide documentary evidence of the patient’s condition together with medical records. Patients should not fear discussing their well-considered options in case doctors attempt to withhold that essential information as a method of frustrating a patient’s attempts to arrange a medically assisted death abroad.
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Videos from Healthcare and Secularism 2018 Conference

In October 2018, the National Secular Society and the Secular Medical Forum held a joint conference on Healthcare and Secularism. The final two talks concerned assisted dying and the right to die. Both talks were excellent. Videos of the talks are available on YouTube and are embedded here with some description and comments.

1. Dr. Jacky Davis – An Update on Assisted Dying – One hundred million people now have access to it, why can’t we?

Jacky Davis is the Chair of Healthcare Professionals for Assisted Dying (HPAD). Jacky is also a consultant radiologist at Whittington Hospital; a member of the BMA Council and of the BMA ethics committee; and a board member of Dignity in Dying.

The talk makes many excellent points – especially in covering why it is so difficult for the BMA to change its approach on assisted dying. Policy is decided by an annual conference of only 300 people. The BMA have so far refused to hold a ballot of all their members on whether to adopt a neutral position on assisted dying. MDMD strongly endorse Jacky’s calls for the BMA to hold such a vote.

Of particular interest to MDMD is Jacky’s description of a public debate in Gloucester which she took part in prior to the 2015 Marris Bill debate in the House of Commons. She said “I was in a position I often find myself in. I was being attacked because they [the audience] didn’t think that our position on assisted dying went far enough.”

Jacky went on to discuss criticism of the 6 month criterion. She dismissed, as “another straw man”, the argument used by some, that the difficulty of accurate prognosis was a reason for not changing the law. She then described those who wish to be able to have a medically assisted death: “These people are not people who want to commit suicide. These are people who want to live as long as they can, until they don’t want to any more.”

One really positive suggestion Jacky put forward was with the practicalities of doctors working with an assisted dying law. She estimated that, extrapolating from the situation in Oregon, each GP practice would expect to see one patient who wanted as assisted death every 7 years. GPs might reasonably be concerned that they wouldn’t know how to deal with such rare events. Jacky suggested regional teams of trained experts who GPs could work with.

2. Dr Michael Irwin – When will MARS (Medically Assisted Rational Suicide) land on the UK?

Michael was Medical Director of the United Nations; chairman of the Voluntary Euthanasia Society prior to it changing its name to “Dignity in Dying”; and a past president of the World Federation of Right-to-Die Societies. He founded the Society for Old Age Rational Suicide in 2009 and was its coordinator until 2015, after which it was renamed “My Death, My Decision” (MDMD). Michael is a patron of MDMD.

Michael picked up on a number of points made by Jacky, saying “I’m very much is favour of the Oregon Bill, but as a start, it should go much further.”

Michael discussed some different approaches to defining “terminal illness”, contrasting a GMC reference to “dying over the next 12 months” to the Oregon Bill’s 6 months, and the situation in Scotland where a recent change to benefit legislation replaced a 6 month “terminal illness” criterion with an evaluation by doctors on a case by case basis without requiring an estimate of life expectancy.

Michael pointed out that there is currently uneasiness in Oregon over their 6 month criterion with moves to expand it to cover longer term degenerative diseases.

MDMD Conclusions

These are two very experienced campaigners, both with a strong medical background. It is fascinating to hear both the common ground and the differences in their views. From MDMD’s perspective Jacky’s defence of the 6 month criterion does not stand up to serious scrutiny, although it may be a realistic political compromise in the UK and elsewhere in the short or medium term. We recognise that is has provided an important option to millions of people around the world – which we in the UK do not have.

However, dismissing the difficulties of accurately giving a life expectancy prognosis as a “straw man” seems too simplistic. Even without the moral dilemma of assisted dying, Scottish doctors found the criterion unacceptable and successfully pressed for this to be removed as a criterion in benefit assessments. If this is the case for benefit assessment, why not also for assisted dying?

Even more importantly, MDMD fully agrees with Jacky’s statement that the people who should be allowed access to medical assistance to die are “… people who want to live as long as they can, until they don’t want to any more”, (when this is due to the intolerable and incurable medical conditions they face, which even the best palliative care cannot alleviate). But Jacky’s description includes high profile cases like Tony Nicklinson, Debbie Purdy, and Omid T. None of these people could be helped by the Oregon-style law she advocates. In addition, some of those in early stage dementia fit her description, while they retain mental capacity – people like Alex Pandolfo who plans to go to Switzerland to end his life when his condition becomes unbearable for him. They face the later stages of dementia when mental capacity will be lost, but are also ineligible for help from an Oregon-style law. Dementia is now the cause of 1 in 8 of all deaths in England and Wales – and nearly 1 in 4 deaths of women over 80, according to the latest ONS data.

In her final interview, in December 2014, Debbie Purdy, who worked closely with Dignity in Dying in her campaign work, said “I think Lord Falconer, in saying that if you’re within the last six months of your life, misses the point that Tony Nicklinson, myself, Paul Lamb – the people whose cases have all been public – all have to face decades of a life that we don’t consider acceptable, and that is the thing I find hardest.” Michael Irwin, together with MDMD, Friends at the End and Humanists UK, very clearly support Debbie’s point of view. Jacky Davis failed to explain why she advocates an approach which wouldn’t help people like Debbie, while at the same time arguing for “people who want to live as long as they can, until they don’t want to any more”, to have the option of a medically assisted death, which is just what Debbie wanted. With this approach, we expect that Jacky will continue to hear the views she described from her audience in Gloucester.

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Scottish Parliament removes time limit in definition of “terminally ill”

MDMD are delighted to learn that the Scottish parliament has removed any time limit from its definition of “terminally ill” in their Social Security (Scotland) Act 2018.  The story was reported by the BBC and the Guardian.

The Guardian article states “There were a number of significant last-minute amendments to the legislation, including the removal of any time limit on terminal illness. It was brought by the social security minister, Jeane Freeman, after senior medical professionals called for its inclusion. Current rules for disability benefits and universal credit say a patient must have six months or less to live before their illness is classed as terminal.”

In the debates over right-to-die legislation, “terminal illness” is also one of the possible criteria that has been considered, and is used in some jurisdictions such as Oregon and other US states where assisted dying is legal, (but not closer to home in Switzerland, the Netherlands or Belgium). In the right-to-die context in the UK the medical community have argued that a 6-month criterion is impossible for them to accurately determine, and would make the working of right-to-die legislation impossible for them. It is good to see this medical argument now being applied to other uses of the 6-month criterion, if only limited to Scotland at present.

The relevant wording from the Scottish Act is “… an individual is to be regarded as having a terminal illness for the purpose of determining entitlement to disability assistance if, having had regard to [guidelines issued by the Chief Medical Officer], it is the clinical judgement of a registered medical practitioner that the individual has a progressive disease that can reasonably be expected to cause the individual’s death.”

Given that dementia is the leading cause of death in England and Wales, it seems clear that dementia should now qualify as a “terminal illness” in Scotland, for this legislation, at least by the time that it seriously impacts a person’s ability to live independently. MDMD has always argued that dementia should be considered an acceptable reason for requesting a medically assisted suicide, by someone who still retains mental capacity, and that consequently any six-month criterion is too restrictive. The change in interpretation of “terminally ill” in Scotland is a small sign of movement towards a better understanding of this issue. We hope that in England and Wales, senior medical professionals will follow their Scottish counterparts in causing a similar redefinition.

We hope that those organisations campaigning for a change in the law on assisted dying in Scotland will now broaden their campaign to fully embrace the new Scottish definition of “terminally ill”, if their policy does not currently endorse this. This would help gain the support from those in the medical community in Scotland who argued for the redefinition.

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Should we be able to choose our own death?

The BBC Ideas website has recently added a short video titled ‘Should we be able to choose our own death?’. Although MDMD had no part in its making, it demonstrates one really good way of achieving our goal.

It is a personal opinion piece by philosopher Nigel Warburton. He starts by asking us to imagine a world where we get what we all deserve: a good death. He then continues to describe his utopian vision of “Good Death Centres”.

The safeguards he proposes are well aligned with those of MDMD. To receive medical assistance to die at one of Warburton’s proposed “Good Death Centres” the applicant must satisfy the following conditions:

  • Undergo thorough psychological examination and counselling by trained experts with experience in end of life situations.
  • Have sufficient mental capacity to make a life-ending decision
  • Demonstrate a genuine desire for a medically assisted death
  • There must be a good reason, such as a painful terminal illness or the first signs of dementia
  • The person must have a well informed understanding of their situation and the alternative options available

As the video says at the end… “Its a comforting thought”.

Another comforting thought is provided by palliative care doctor Kathryn Mannix in her video ‘Dying is not as bad as you think’ in the same BBC Ideas series. MDMD agree with her that death needs to be talked about more and no longer be treated as a taboo subject. Mannix describes a peaceful, natural death. For those where this sort of death comes quickly, without a large amount of trauma, distress and loss of dignity leading up to it, Warburton’s Good Death Centres are not necessary. However, Mannix doesn’t give information about the likelihood of various causes of death, and of having the sort of good death she describes. We know, for example that in England and Wales dementia is now the leading cause of death, and that many more people die with it than of it. People who have witnessed people dying with or of dementia, often say that they would not wish to die that way themselves. Other causes of death are discussed here.

MDMD suggest that the truly comforting thought is to have both options well funded and available: excellent palliative care, with the safeguarded option of a medically assisted death, if this is necessary for the patient to have what they consider to be a good death, in their particular circumstances.

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MDMD Founder Dr Michael Irwin Discusses His End-of-life Plans

The Sunday Times today published an article on the end of life plans of MDMD founder Dr Michael Irwin. (The organisation he founded was the Society for Old Age Rational Suicide, SOARS, which democratically chose to change its name to My Death, My Decision in 2016.)

In the article Dr Irwin explains how, when he feels he is ready, he wants his doctors to be able to give him increasing levels of sedation, in order to ease any pain and suffering. He wishes to enter “continuous deep sedation” which, coupled with his refusal of artificial feeding and hydration, will result in his hastened death. He believes this approach is legal in this country under the doctrine of “double effect”. MDMD discuss this approach in more detail here. The story has been echoed in other papers including the Daily Mail which has free online access.

A survey conducted for the Sunday Times by YouGov found that 67%, of the 1,650 people asked, “think doctors should be allowed to give terminally ill patients enough pain medication to hasten their death”. Unfortunately it is not clear from the article how dependent this finding is on “terminal illness”, nor what the respondents understood by this phrase. (For example, is “terminal illness” taken to include dementia, now the leading cause of death in England and Wales?) The article does say that the percentage rose to 74% when considering responses of the over 65 age group – those more likely to have had first hand experience of the dying process of their parent’s generation, and hence be aware of how unpleasant and prolonged the dying process can be.

Dr Irwin is consulting with the GMC on precisely what doctors may be able to do within the law, and calls for an open discussion of the issue. He says “it is necessary to be honest and generally to regard it as ‘slow euthanasia’ carried out under the doctrine of ‘double effect'”. The GMC has responded saying that doctors would need to seek advice from clinical and legal experts. Surely both doctors and patients need clarification of this issue, given that almost 75% of people close to the age where they may face this situation think this should be an available option. MDMD will watch this story with interest as it unfolds.

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