End-of-life doctors won’t end lives

Data published this week deals a blow to campaigners vying for legal assisted suicide in Scotland. Survey results from the Association for Palliative Medicine (APM) suggest that most Scottish palliative doctors would refuse to participate in assisted deaths. Close to half of those surveyed also said they’d resign if their employer chose to offer assisted suicides alongside conventional care. The study – involving 40 per cent of general and specialist palliative medics in Scotland – makes it eminently clear that ‘assisted dying’ would result in collateral damage to end-of-life care.

Respondents stressed that the provision of care to all patients would be harmed by an ‘assisted dying’ law. A “large majority” of doctors interviewed – 9 in 10 – said the practice would “negatively impact palliative care services” and “compromise access to care by vulnerable groups”. Almost 8 in 10 said legal ‘assisted dying’ could lead to healthcare decisions being “influenced by cost savings”. This includes professional decision-making about health and social care, and decisions by families weighing end-of-life options.

Nine in ten doctors also stated that legal ‘safeguards’ would not protect vulnerable patients from harm, with the same proportion saying coercion of patients is unavoidable. The APA states: “Safeguards are key to protecting vulnerable people. Evidence [shows] that safeguards have been repeatedly weakened or removed in every jurisdiction that has introduced assisted dying”. It adds: “Legislation is not static: evidence shows that single case rulings and doctors’ changing practice can rapidly undermine safety for the vulnerable.”

It is arresting that people who deal with death day in, day out are so strongly opposed to assisted suicide. If there was any group that might think the practice is necessary to avoid ‘bad deaths’, it’s palliative doctors. But they refute calls for ‘assisted deaths’, and often criticise campaigners’ claims about the end of life. I’ve spoken to an esteemed palliative expert, who said patients are entering her hospice scared and upset because of the rhetoric of assisted suicide groups. She reassures vulnerable people that well-resourced end-of-life care is effective.

What’s also striking is how little palliative doctors have been consulted by those vying for ‘assisted dying’ in Scotland. The APM notes that during 2022, a Medical Advisory Group was set up by Liam McArthur MSP to explore the implementation of assisted dying within healthcare. The APM adds that a report by this Advisory Group “did not address the likely impact of this legislation on doctors working in Specialist Palliative Care”. This seems a glaring omission by proponents of law change, given the knowledge palliative doctors have.

In past years, we have seen decision-makers devise highly controversial legislative proposals with activists, illustrate support for them by gathering selective ‘evidence’ from those who already agree with them, and ignore sound warnings against their plans. Given the literal life or death consequences of the assisted suicide plans shortly to be considered, it is imperative this doesn’t happen. MSPs must follow the evidence very carefully. At this early stage, they’d do well to take note of the fact most end-of-life experts won’t end lives in the way proposed.

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