As a doctor, I find it challenging to reconcile the idea of authorising or consenting to life-ending medication even when legally justified (Cabinet minister Liz Kendall says she will vote for assisted dying, 14 November). My entire training has been centred on preserving life. During the ongoing deliberations, decision-makers must consider several critical points carefully.
First, advancements in medicine have enabled patients with severe illnesses to live longer, often through supportive and definitive therapies that slow disease progression, prioritising life preservation over hastening death.
Second, doctors undergo extensive training to save lives and should never be compelled – whether through external pressures or professional obligations – to participate in or make decisions regarding assisted dying. If society deems assisted dying necessary, it could train individuals specifically for that purpose in a relatively short period without involving physicians, whose primary role is to heal.
Furthermore, the UK healthcare system operates under a shared decision-making model. Patients are fully informed of the risks and benefits of their treatment options and have the right to consent to or refuse therapies. An individual mentally capable of requesting assisted dying is also capable of choosing to decline life-prolonging treatments and instead opt for comfort care, allowing the disease to take its course. In this context, involving doctors in providing life-ending measures is contradictory and ethically problematic.
A do not resuscitate (DNR) order is a valid option for patients who do not wish to undergo life-sustaining interventions. If patients cannot make such decisions, their relatives may request a DNR order.
Finally, it is essential to note that “terminal illness” is not an absolute definition. There are numerous documented cases where patients considered moribund have made unexpected recoveries. This underscores the uncertainty inherent in prognostic labelling and emphasises the potential for recovery, even in seemingly hopeless situations.
Chula Goonasekera
Preston, Lancashire
• I support the proposal that, subject to conditions, a patient who is expected to die within six months should have the right to request an assisted death (The assisted dying bill: what it means for patients in England and Wales, 11 November). But I am concerned that the process for making a terminal prognosis, which may well occur at an earlier stage, may be insufficiently rigorous.
After a recurrence of cancer, I was advised to have palliative treatment, aimed at extending life rather than possible cure. The surgeon told me that, while a further operation was an option, his feeling was that it was not the better course, although it was not clearcut. I asked for a second opinion, from a different hospital, which he supported. The second, and a third, opinion favoured an operation, successfully performed well over two years ago at the original hospital. While risk remains, it is diminishing, and my quality of life in the intervening period has been excellent.
I was bold enough to request a second opinion, but medical friends tell me that is unusual. I therefore propose that every terminal prognosis must be subject to a second opinion from a suitably qualified doctor at another hospital. The mere right to a second opinion is not enough. Should that be done, it seems likely that other patients will be allocated to a treatment path that does not inevitably lead to the proposed eligibility for an assisted death.
Jonathan Haydn-Williams
Richmond, London
• I am on my second cancer, and this one really is terminal. My bowel cancer 12 years ago turned out not to be terminal. This one is in the spine, and is being controlled by regular chemotherapy since it was discovered about three years ago. The words “cancer” and “terminal” didn’t shock us this time like it did 12 years ago.
Some days are good, some are grotty. There are times when I happily go to sleep and think wouldn’t it be nice not to wake up. But then, I can have changes of mood within an hour – presumably because of all the drugs I’m taking, – and decide that life is worth living.
I am reasonably intelligent and compos mentis, but my changes of mood make serious decisions like assisted dying unreliable.
Eric Foxley
Nottingham
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