by Dr Carol Davis
Thursday, 21
October 2021

The Assisted Dying bill is based on shaky evidence

Baroness Meacher’s proposed 'safeguards' are unsafe and unwise
by Dr Carol Davis
Credit: Getty

The calls of the ‘assisted dying’ lobby for legalisation often make it sound like a well-established, evidence-based healthcare intervention. It is not.

Baroness Meacher’s current Assisted Dying Bill, heading to the Lords tomorrow for a second reading, proposes broad ‘safeguards’ for assisted suicide. But there is a worrying lack of evidence that they are effective or verifiable. For one, increasing evidence in jurisdictions where physician-assisted suicide is legal shows that palliative care services are being detrimentally impacted. Physicians have reported that patients are hesitant to enrol in palliative care and hospice services for fear that they promote euthanasia. Based on the concerns of patients and practitioners, some hospice facilities in Canada have refused to incorporate the practice within the scope of their services.

These hospices have had their statutory funding threatened or withdrawn. Reports have suggested that ‘medical assistance in dying’ may reduce Canada’s annual health care bill by up to $138.8 million. This sends a worrying message that assisted suicide is an economic practice and is preferable to investing in palliative care; inevitably this would increase pressure on those in our society who already feel they are a burden.

Patients who request assisted suicide often experience significant mental health difficulties and may be at a higher risk of coercion and abuse. Of the patients who received assistance in dying in Oregon in 2020, 53% reported “feeling like a burden on their families, friends or caregivers” as an end-of-life concern. While another study found that one in six patients who received a prescription for lethal medication met the criteria for a diagnosis of depression. Yet fewer and fewer patients in Oregon are being referred for psychiatric assessment, demonstrating the weakness of safeguards in legislation to protect the most vulnerable.

Of concern is that the proposed eligibility criteria for assisted suicide are elusive and vague. They also provide no reliable safeguards against abuse. First, ‘mental capacity’ is a deceptively simple concept; clinical assessment of capacity is complex and influenced by the individual experiences of assessing doctors. Indeed, several legislatures have expanded eligibility criteria to include people without decision-making capacity.

Secondly, prognostication is notoriously inaccurate; we get it wrong over hours and days, let alone months. The proposition of a six-month prognosis is no better than a guess, potentially inaccurate by years. Finally, the combinations of drugs in high doses used to achieve assisted suicide have not been submitted to scientific scrutiny. The scant available evidence on how people die after ingesting these lethal drugs suggests that they can cause unpleasant symptoms and that death is not necessarily immediate or certain, reportedly taking up to four days.

The picture painted by these problems exposes the legalisation of assisted suicide as an extraordinarily superficial proposition riddled with unanswered questions surrounding its safety and implications.

Legalising ‘assisted dying’ without addressing these questions, and in the absence of robust evidence on the effectiveness of proposed safeguards, is both unwise and unsafe.

Dr Carol L Davis is a consultant in palliative medicine

Join the discussion

  • There is a subtle conflict in philosophy (and perhaps some perceived professional competition) between some some palliative care physicians and some physicians who participate in providing medical assistance in dying (MAiD). Up to a point, these medical interventions are mutually exclusive. But again, a patient can choose which medical treatment they want, at what stage of the deterioration of their health.
    I don’t know whether the UK Bill will become law, either as drafted or as amended, but there seems to be a growing international recognition that it is not the role of government to compel a person who has the mental capacity to consent to MAiD to continue living with what is to that person intolerable suffering. The slogan in Canada has been “My death, my choice.”
    One important philosophical question, therefore, is setting the appropriate balance between state control and private personal agency in circumstances of intolerable suffering near, or in anticipation of your death.

  • If we died to escape pain maybe it was our lot to have endured it, maybe it is our atonement, or our chance to get through things and accept our life’s choices – and to FORGIVE others for their harms to us.

    If you were sitting at the bedside of someone dying in pain, would you say ‘maybe it is your lot to endure it, or maybe it’s your atonement’?

  • The whole “life at all costs’ is such a juvenile attitude to death – as if people just cannot accept that ALL HUMANS WILL DIE !

  • To get involved in the discussion and stay up to date, become a registered user.

    It's simple, quick and free.

    Sign me up