The argument that the legalisation of assisted suicide in Oregon in 1997 has not started a “slippery slope” is dangerously misleading (‘Slippery slope’ fears over assisted dying have echoes of abortion debate, 24 November). While Oregon’s eligibility criteria have changed little, their interpretation has widened and safeguards have been relaxed. Oregon’s law, like Kim Leadbeater’s proposed bill, allows assisted suicide for adults with a “terminal illness that will lead to death within six months”. Interpretation of “terminal illness” has expanded such that physicians have prescribed lethal drugs to people with anorexia and arthritis.
As for safeguards, Oregon’s 15-day “waiting period” (similar to that proposed in Kim Leadbeater’s bill) ceased to be mandatory in 2020. The following year, exemptions were made in one in five cases; the year after that, one in four. In the first three years after Oregon’s law passed, 28% of those seeking assisted suicide were referred for psychiatric evaluation; in 2022, only 1%. It is also worth noting that in the first year after Oregon’s legalisation passed, 13% of patients seeking assisted suicide cited fear of being a “burden” as a motivating factor. In 2021, that figure stood at 54%. Sick, elderly and disabled people are not burdens. They are, like every person, valuable. Like every person, they need and deserve care – not lethal drugs.
Katherine Backler
Oxford
• I have looked after approximately 50,000 dying patients in my career. Fewer than 20 have asked for help to go to Dignitas in Switzerland; to my knowledge, none went. Kim Leadbeater’s terminally ill adults (end of life) bill has no mention of a proper palliative care assessment first. Many calls to die can be resolved without terminating a life.
The bill states that patients with a prognosis of less than six months are eligible. Research shows how poor even experienced doctors are at prognosticating, often getting life expectancy very wrong.
As drafted, the bill allows for the medical assistant to be in the room next door, leaving the patient potentially to be pressured by family and carers if they are wavering. Not all families are loving and benign.
No mention is made about the death certificate recording the medical assistant’s name for later scrutiny. I have met doctors who are happy to help people die; without that audit trail, we would be setting up a legal route for the next Harold Shipman.
I have grave concerns about the bill based on my experience. The answer to a good death is better palliative care as a priority.
Dr Julia Riley
Consultant in palliative care
• Having read the article by Diane Abbott and Edward Leigh, I would like to endorse their concerns about vulnerable people (Our politics could not be more different – but we’re united against this dangerous assisted dying bill, 20 November). I have worked in the field of adult social care and dealt with cases of the abuse of elderly people, many of which concerned financial abuse. I think this bill would offer a further means for abuse to occur, and I am aware that prevention and detection of such abuse is very difficult.
I hope that this bill will not be passed and that the needs of severely and terminally ill people will be met through proper palliative care services.
Janet Evans
Llandudno Junction, Conwy
• As doctors, we took an oath to first do no harm to our patients. Though modern medical schools eschew this oath, the principle of primum non nocere remains ensconced as a pillar of good medical practice. Doctors take a dim view of other doctors intentionally harming their patients, which is why the case of Harold Shipman “putting an end” to his elderly patients filled everyone with revulsion. Surgeons, of course, cut patients. However, this is not with the intention of harm but to heal. And yet, if you wanted to trust someone with killing a patient humanely, who would you call?
GPs will receive requests to “sign off” on patients thought to have less than six months to live. Realistically, who would be able to argue that someone is ineligible? Where would the line be drawn? Could a 20-year-old severely depressed patient be as eligible as a bed-bound nonagenarian with end-stage dementia? And when would a need for assisted dying become an obligation?
Of course the benefits of having patients assisted to death would be numerous. We would no longer need to monitor some of our chronically ill patients. If palliative care beds aren’t available, we could offer death instead, granny dumping in A&E will be a thing of the past, and hospital beds could be unblocked by offering death as a management option. However, each time we visit a chronically unwell, frail old patient at home, would they think of it as a visit by captains of the merchants of death? Would they trust us with their lives?
Dr Stuart Reiss GP in London, Dr Basilio Hernandez GP in Oxford
• Your article (What are the key issues in the assisted dying bill debate?, 22 November) makes the worryingly common mistake of overemphasising the role of hospices and palliative care specialists in end-of-life care provision.
An increasing number of people die outside hospital in the UK. Most are looked after by community nurses with the support of GPs, backed up by specialist palliative care teams who advise when necessary – luckily it usually isn’t necessary to involve them, in my experience. If, as taxpayers, we want to improve community palliative and end-of-life care, our first priority should be to invest more in community nurse teams, where recruitment and retention are extremely challenging.
Of course, improving access to specialist palliative care would be good, too, especially services that provide advice and care in people’s homes, but please can commentators stop talking as if the need for good end-of-life care either should or could be met by “all-round hospice care”, as Gordon Brown (Spending time with people in their final days showed me that we need not assisted dying, but better end-of-life care, 22 November) appears to think?
Louisa Polak
Retired GP, Bury St Edmunds, Suffolk
• The main argument in favour of the assisted dying bill has been based on cases where people have suffered extreme pain. The bill itself, however, does not address this issue. (The only reference to pain is in the requirement for a review of the working of the act in five years’ time.) There is instead a huge leap from arguing that without the bill people will suffer great pain, to saying that anyone with only six months to live may have medical support to end their life. As many have argued, the first response to suffering should be to improve palliative care. The reliance on an expected lifespan of only six months is in any case weak – such prognoses are not always reliable.
The whole concept, which also underlies the withdrawal of full care at end of life, seems to be that if there is only a short while to live, why not go now? This is a gross misunderstanding of life. As in many other matters, the principle of supply and demand applies. If a commodity is in short supply, it becomes more valuable. If you only have a few months to live then every day becomes more important. This is true not just for the patient but for those around them who can share their company.
Suicidal intentions are generally seen as a mental health problem that needs to be addressed. Why is this any different in the (presumed) last six months of life? Practically anyone who is facing a terminal diagnosis is going to feel depressed and this is going to distort their decision-making. Yet for many there may well still be good days to be had, visits and phone calls from family and friends being the most obvious. If in a period of depression the patient has been helped to end their life, those good days will never happen.
Raymond Smith
Dorking, Surrey
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