Survey on Euthanasia and Assisted Suicide

In our last issue (CMQ, May 2003) we presented the main findings of the survey. A final question in the survey was, Any Comments? Participants were invited to register in some detail their views on the problem as a supplement to merely answering the questions. We have been given a copy of their comments: they provide interesting insight into the opinions of a great variety of doctors. In the first section the comments of those opposed to euthanasia and assisted suicide are presented while the second section includes those in favour.

Section 1

Perceived quality of life with terminal cancer varies according to the stage of their illness. I think any active form of assisted suicide or euthanasia is unnecessary given good palliative care services. The press misrepresents euthanasia as withholding palliative treatments such as opiates. More education for the medical profession is necessary for optimal symptom control.
As a practising Christian I am totally opposed to any form of euthanasia, but not in favour of prolonging life to its absolute maximum regardless of the prognosis or circumstances.
As a psychiatrist I am very concerned about being placed in a position of having to decide about someone having the capacity or mental
health to decide on assisted suicide or euthanasia in our poorly resourced NHS there are bound to be depressed elderly patients who are killed rather than actively treating them for depression etc.
As always it is the thin end of the wedge. Holland very clearly demonstrates this.
As a medical student I was very affected by a seminar I attended on euthanasia where someone from EXIT came.
I thought his motives were sinister.
As an old age psychiatrist I would be very unhappy about any change in the current legislation, as depression in older people is very common particularly if they are physically unwell. Studies indicate the diagnosis is often missed or untreated. Also studies have indicated that when an underlying depression has been treated patients who previously had wanted intervention changed their minds.
As doctors our calling is to relieve suffering and prolong life. It is not to end life. I cannot be a doctor and end life deliberately. There is a difference between allowing someone to die and ending their life.
Beware the bed manager on performance related pay.
Changing the BMA position on euthanasia and assisted suicide would be disastrous for the medical profession and our society. It is morally wrong to take another person's life.
Considerable further debate over the moral and ethical issues needs to occur. Much more can be done to improve the care of the dying and terminally ill. Until these services are funded and provided to the highest standards, patients will remain fearful of end of life symptoms - and pressure to introduce euthanasia and assisted suicide will persist. It is a scandal that we are unable within NHS healthcare to establish appropriate, comprehensive and effective services in this most important area. Much more needs to be done, much more funding and development of appropriate services needs to be achieved.
Don't go with the pressure, it is the thin end of the Dutch wedge!
Euthanasia is unnecessary and not a doctor's role. We can give strong analgesia and sedatives, and if the patient dies we can be happy that we looked after them without actively hastening their demise.
I am a consultant haematologist aged 48 and terminally ill with Ca stomach. From personal experience I know circumstances change - I had always said I would not have palliative chemotherapy - but I changed my mind when discussing it with my 15 year old son. I would like euthanasia to be available to me but with effective palliative care hope it will not be necessary.
As a Hospice medical director, my views may be altered by environment. Also involved with the D Pretty case but still feel that AS and euthanasia should not be legalised.
I believe that a request for assisted suicide and most advanced directives are born out of public
ignorance about what is available and what can be done near the end of life to relieve suffering and allow a dignified death.
I feel the real pressure for euthanasia comes from people with degenerating diseases not really from patients with terminal cancer.
I was a member of the working party which formulated current BMA policy. To date I can see no reason to change this. Far too few of my colleagues seem to understand the current situation, ethical or legal, with regard to advanced directives and the right of competent patients to decide their own treatment. Far more discussion and education are required within the profession before it would be safe or sensible to consider any changes to either the law or the profession's ethical position.
I think the legalisation of euthanasia would seriously undermine the relationship of trust between the doctor and many old/seriously ill patients. All the reasons cited by the 94 Lords report to keep it illegal still apply. Nothing in the intervening years has materially changed except a slight shift in public opinion - and this has never been a good basis on which to change the law, especially if it is likely to endanger vulnerable minorities.
If euthanasia were legalised I would find it difficult, after a life-time trying to prevent death, to change my mind set to causing it.
If euthanasia were legalised I would have to consider whether I could continue in the medical profession.
The Dutch model shows us that legalising euthanasia is `the thin end of the wedge'. Very quickly lives are ended beyond the scope of the law. I am strongly opposed to euthanasia to the point that I would forfeit my career to oppose it. I do, however, support a patient's autonomous right to advanced directives.
The Remelink report in Holland in the early 90s showed a massive amount of involuntary euthanasia despite clear guidelines to the contrary in Dutch Law. Elderly patients there are in terror of being killed once they have become a bother. There is an official state sponsored report into the topic and it makes horrifying reading. We must not embark on this slippery slope just because of the emotional argument.
There is a vast difference between assisted suicide/euthanasia, and withdrawal of life supporting treatment, which is not well made in the popular press/media. In my speciality, the withdrawal of renal dialysis when the patient wishes, or comorbidity dictates, is relatively common and (we believe) not illegal. Actually injecting someone with potassium etc. is completely different.
This is a legal and ethical minefield. It should never be within the medical profession's remit to formally end a person's life. In general practice we are all familiar with easing a patient's passing in a way that is dignified and appropriate. Legalising in this area would be intrusive not only on the doctor-patient relationship but would irredeemably damage what we are currently able to do.

Section 2

Assisted suicide is an inevitable consequence of the aging society. The only issue is to how it is regulated. My generation will not accept the status quo that exists today to prevent them from hastening death in a painless and controlled way. I am against doctor - administered euthanasia. There will always be ways for the person or their nominated next of kin to administer any medication.
Autonomy is the key factor. Wherever a patient is clearly able to make an informed, competent and free decision over their own life they should be allowed to do so. It is conceivable that in some circumstances they should be helped to carry out the outcome of that decision even if it means they end their life.
I think there may be reason for a change in the legislation surrounding euthanasia. There is a strong argument for assisting people who are dying.
Euthanasia already exists in that it is now possible to starve or dehydrate patients by removing assisted feeding. Is this any different from removing feed to a newborn baby who is equally dependent on others for their existence?
Euthanasia is rational, is a personal decision, and expresses the suffering of the patient. As a doctor I would like to be able to relieve that suffering, of course after careful and multi disciplinary deliberation in order to assure against not causing more damage to the patient than good.
Euthanasia will eventually be legalised.
I abhor peg tube feeding in terminal neurological or geriatric situations. It is inhuman.
We put animals out of their misery from compassion. It is dangerous ground, but we must be courageous enough to be compassionate. Just because we have the technology to keep people alive does not mean it is the right thing to do. Sometimes we make our own ethical nightmares by stopping nature having her way and then having to make moral decisions such as withdrawing treatment down the line. The problem is not helped by the emotion in the arguments, which people find it very hard to go beyond to find reason. I think there needs to be more honesty about what medicine can do, and its limitations. Difficult for all of us, but we have the intelligence and must use it for the good. A good death with dignity is a memory that relatives value far more than some of our assaults eg. CPR.
I am prepared to withdraw assisted sustenance for the purpose of reducing patient distress.
I feel that patients should have the right to assistance in ending their lives with very careful safeguards eg. responsible witnesses to their request. However, I do not think it should be carried out or prescribed by the medical profession. Deaths from O/D are sadly very common whether from over the counter medicine or prescribed. Relatives etc. could administer this.
I think euthanasia/assisted suicide might be responsible in a few well defined situations, end stage neurological disease.
I think each case for assisted suicide would have to be considered individually by medical, legal and lay people. Making a decision about helping someone to end their life will never be easy, nor should it be, but I do not believe that allowing a person to die with dignity (which does not happen very often in our hospitals at the moment) would be an acceptable thing for a doctor to do in the event of a change in the law.
The time, has come to think rationally and judiciously to relieve terminally ill patients of their agony.
To deny assisted suicide to a competent adult with no depressive illness is a monstrous tyranny and denies their autonomy. In my experience only a few patients ask for this. The much bigger problem of euthanasia which is never discussed, is with those patients whose lives end sooner than they might because of lack of resources eg. not enough dialysis places, not enough surgeons and theatre time to do coronary by-pass operations, not enough resources in stroke unit development etc.
Unfortunately I do change my mind about this. Recent publicity of cases of assisted suicide in Switzerland have made me think it should be legalised - in very specific circumstances.

The above is a selection of some of the comments made. There are many more and the high number of them indicates the interest this survey managed to arouse. If any would like a complete copy of the replies please apply to the Guild Office.