Assisted dying underplays the enormity of killing someone.
Dr Carol Davis who has been a Palliative Medicine Consultant for 31 years working in Southampton, and until 2 years ago visited the island many times over a 13 year period as a Visiting Consultant in Palliative Medicine to Jersey.
She was interviewed by the JEP for an article published on Saturday 23rd March 2024 in which she highlighted some aspects of the debate and discussion about ‘assisted dying’ that are perhaps considered less often than the very tangible issues relating to safeguarding.
To me, using the term ‘assisted dying’ to describe euthanasia and medically assisted suicide underplays the enormity of either killing someone or enabling them to end their own life and sugar coats it. It also engenders confusion. A 2021 on-line survey in the UK asked the public what was meant by the term assisted dying. 43% correctly defined it as administering lethal drugs to people with less than 6 months to live; 42% thought it meant stopping life sustaining treatment and 10% providing hospice type care. 5% didn’t know. This is particularly concerning given that it tends to be people who think they know something about a subject who respond to such surveys. For these reasons, in this article I will use the terms ‘doctors intentionally ending life’ or ‘medically assisted suicide and euthanasia’.
There is a proposal to change the law and licence doctors to intentionally end people’s lives in The Isle of Man. One hundred and eight doctors responded to a recent survey about this. They were equally split between doctors working in the community, mainly GPs, and in the hospital. Three quarters were against legalising assisted dying/ euthanasia in the Isle of Man. Over half thought the proposed legislation would have a negative impact on recruitment and, very worryingly, a third indicated that they would consider leaving the island if such legislation was passed. It is a shame that a similar survey has not been conducted on Jersey.
They are not alone. The Royal College of Physicians (London) does not support change. There is no support from the British Geriatrics Society and continued opposition from the Royal College of General Practitioners, the World Medical Association, the UK Association for Palliative Medicine of Great Britain and Ireland and doctors in many other UK specialities.
Although the British Medical Association (BMA) has declared a neutral stance, at a recent national meeting of BMA consultants this motion was passed: ‘This conference notes the ongoing media and political pressures to legalise assisted dying in the UK, and the assumption that this will be carried out in health care facilities. It further notes the clear evidence from the BMA’s assisted dying survey, which shows that most doctors, and an even greater majority of consultants, are unwilling to either be involved in the prescribing of drugs for assisted suicide or in performing euthanasia. It reaffirms the Hippocratic principle of doing no hurt or damage to our patients and refusing to administer poison to anyone.’
The building blocks of doctor-patient relationships are trust that my doctor will not harm me and that they will advise and guide me. And yet, if medically assisted suicide and euthanasia are legalised, it will be hard for doctors to avoid the risk of sending the message to that ill person that ‘ending it all’ is the right option instead of exploring why they feel bleak and doing something about it. As highlighted in the 2023 Danish Ethics Council review of euthanasia, licencing medically assisted suicide and euthanasia by law sends the message that ending your life is an appropriate thing to consider if you are old, terminally ill or perceive yourself to be suffering. That changes the dynamic of that person’s relationship with their family as well as with their doctors and other health care professionals and increases the chance of that person thinking that they should either take lethal drugs to prematurely end their life or seek euthanasia.
In the Australian state of Victoria, doctors are struggling both to reconcile their role in killing someone or helping them to kill themselves and to complete eligibility assessments. Doctors there have estimated that at least 60 hours of medical time are required to assess each person contemplating medically assisted suicide. For Jersey, taking a conservative estimate of 45 deaths by medically assisted suicide and euthanasia per year, that amounts to 337 working days per year, but this does not take account of all the time spent by other health and social care professionals relating to those requests. We need to ask ourselves whether that is feasible and how much health care professionals will be pulled away from fulfilling their core roles.
Reports from the United States and other jurisdictions indicate psychological damage in up to half of doctors who participate in intentionally ending life with long-term consequences in up to a fifth. There has been remarkably little attention paid to the impact on health care professionals other than doctors and yet some ill or disabled people are much better known to, for example, a physiotherapist or a clinical nurse specialist. This needs much more consideration both in terms of time spent on this and the effect on those professionals.
The States of Jersey does not yet have a fully worked up suicide prevention plan. The legalisation of medically assisted suicide and euthanasia normalises suicide. In those jurisdictions where medically assisted suicide and/or euthanasia have been legalised (which account for only 2.5% of the world’s population – 200 million people out of a world population of 8.1 billion), other suicides have not reduced (contrary to claims that they would) and have increased in some jurisdictions, especially in older women. Surely a prerequisite of even starting to consider the legalisation of medically assisted suicide and euthanasia is a fully resourced, well established island-wide suicide prevention strategy? It is important to bear in mind that the island’s mental health services are already under-recruited and over-stretched.
Evidence from other jurisdictions is that palliative care funding reduces (as in New South Wales) or growth in palliative care services stalls (as in Belgium and the Netherlands) once medically assisted suicide and/ or euthanasia is legalised. . On the surface of it, medically assisted suicide and euthanasia are cheaper than palliative care, although there are hidden costs, and palliative care suffers when both are embedded in healthcare. Contrary to claims, many in such jurisdictions do not get access to specialist palliative care. If someone is referred to palliative care services because they are contemplating a medically assisted death, then that referral is too late.
The financial recovery programme for Jersey’s health and social care needs to save money this year as the budget was £24million overspent last year. In addition, the Dementia Strategy is yet to be published and there is no allocated funding to help support this. The Suicide Prevention Strategy is not complete. Jersey Hospice Care has a very depleted specialist nurse workforce in the community and in Jersey General Hospital due to difficulty in recruiting to those posts.
Whatever you think about the rights or wrongs of legalising medically assisted suicide and euthanasia, there are some really important questions to ask yourself. Is this really the right time for Jersey to be considering legalising doctors to intentionally end people’s lives? To date how much has been spent on exploring this? What will be the impact on your health and social care services, including mental health and palliative care services, and what effect would legalisation have on recruitment to these services? What are the anticipated costs of establishing the infra-structure required to try and make any system for providing medically assisted suicide and euthanasia as safe as possible? These questions are in addition to those about how to make any proposed safeguards work. Given the recent Canadian calculations of the likely medical error rate relating to assessment of eligibility for euthanasia, how safe is safe enough?
You and your parliamentarians need to consider all the consequences of legalising medically assisted suicide. The breadth of the impact on Jersey’s health and social care simply do not favour the legalisation of medically assisted suicide and euthanasia.
No legal situation is perfect, but your current law is the safeguard for patient welfare and safety, and the probity of the doctor-patient relationship. Rather than invest even more in creating a new infra-structure for medically assisted suicide and euthanasia, I urge you and your parliamentarians to build on Jersey’s health and social care system including mental health and supportive and palliative care services, complete and enact both a suicide prevention and dementia strategy, reinforce island wide advance care planning initiatives and improve shared decision making. This would be a better use of resources than moving to a system of medically assisted suicide and euthanasia under which frail, vulnerable or ill people could easily be abused and which is bound to negatively impact your health and social services.
Improve the care, there is no need to change the law.