Assisted suicide

Question 1

How can you manage a situation where a patient requests help with assisted dying

Answer 1

Avoid any action that may be considered to assist, facilitate or encourage suicide

Advice on

• a fatal dose
• antiemetics to use in relation to planned OD
• suicide abroad

Facilitate

• suicide abroad
• contact with groups who may be able to assist with organisations who promote assisted dying

Provide literature on
-aspects of assisted suicide

Question 2

Can a patient request their medical records to seek assisted dying abroad

Answer 2

Patients have the right to access their own health records under GDPR without a reason

Can be done regardless of whether the doctor knows or suspects that the medical records may be used abroad for assisted dying

Question 3

How to respond to a patient who requests help in dying

Answer 3

Listen and acknowledge request
Respond honestly to their questions

Be clear about the law - 14 years of imprisonment for anyone assisting

Provide information on the lawful clinical options available

• option of no treatment
• pain relief
• symptom control only when necassery
• if they have capacity, they can refuse medical treatment, food, fluids

Explore thoughts and feelings

• encourage them to share with others around them
• counselling or therapy if you think they would benefit

Address their concerns

• other practical measures to improve patient quality of life
• advance decisions?

Involve other colleagues or members of MDT

Do not abandon patient

Question 4

Legal framework on assisted dying

Answer 4

Euthanasia - deliberate act to end patient’s life
-murder or manslaughter

Assisted suicide - assistance or encouragement of someone to end life
-homocide

Suicide Act 1961 S2 - prohibits acts that encourages or assists the suicide of another => 14 years imprisonment

Question 5

Key arguments for physician assisted dying

Answer 5

Even universal access to palliative care, unbearable physical/emotional distress is inevitable

There are eligibility criteria, safeguards to protect patients in countries where PAD is legal

Guidance for EoL practices already contain safeguards to ensure decisions are made voluntarily, coercion is detected and vulnerable people are detected

People go to Dignitas in Switzerland anyway but this is only an option when they have the resources and are well enough to. Family and friends end up suffering the consequences

Public support is high

Everyone should have control over where and how they die but need medical support and advice
Doctors should not be able to impose personal beliefs on patients who would like PAD. Doctors could be protected by a conscientious objection clause to those who do not wish to participate

Question 6

Key arguments against physician assisted dying

Answer 6

Societal impression that elderly, seriously ill, disabled individuals ought to consider assisted dying

Impossible to endure decisions are truly voluntary, detect coercion or family pressure

Universal access to high quality palliative care can help alleviate distressing symptoms associated with dying

Doctors are supposed to support patients to live well until they die, not to deliberately being about their deaths

May undermine patient doctor relationship. Some patients who feel their lives are undervalued may give up, seeing death as an easy solution