Everyone Needs Care – Not Deadly Drugs | Helped to die

The argument that the legalization of assisted suicide in Oregon in 1997 has not started a “slippery slope” is dangerously misleading (Fears of ‘Slippery slope’ over assisted dying echo the abortion debate, November 24). While Oregon’s eligibility criteria have changed little, their interpretation has been broadened and safeguards 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”. The interpretation of “terminal illness” has been expanded so that doctors have prescribed lethal drugs for people with anorexia and gout.

As for security measures, Oregon’s 15-day “waiting period” (similar to that proposed in Kim Leadbeater’s bill) ceased to be mandatory in 2020. The following year, a dispensation was made in one in five cases; the following year, one out of four. In the first three years after Oregon’s law was passed, 28% of those seeking assisted suicide were referred for psychiatric evaluation; in 2022, only 1%. It’s also worth noting that in the first year after Oregon’s legalization passed, 13% of patients seeking assisted suicide cited fear of being a “burden” as a motivating factor. In 2021, that was the number was at 54%. The sick, elderly and disabled are not burdens. They are, like any person, valuable. Like any person, they need and deserve care – not lethal drugs.
Katherine Backler
Oxford

I have cared for approximately 50,000 dying patients in my career. Fewer than 20 have asked for help to go to Dignitas in Switzerland; As far as I know, no one went. Kim Leadbeater’s terminally ill adult (end of life) bill makes no mention of a proper palliative assessment first. Many prompts to die can be resolved without ending a life.

It appears from the bill that patients with a prognosis of less than six months are eligible. Research shows how bad even experienced doctors are at prognosticating, and they often get life expectancy very wrong.

As drafted, the bill allows for the physician assistant to be in the next room, leaving the patient potentially pressured by family and caregivers if they falter. Not all families are loving and benign.

There is no mention of the death certificate recording the medical assistant’s name for later examination. I have met doctors who are happy to help people die; Without that audit trail, we would create a legal route for the next Harold Shipman.

I have serious 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

After reading the article by Diane Abbott and Edward Leigh, I would like to join their concerns about vulnerable people (Our politics could not be more different – ​​but we are united against this dangerous euthanasia law, 20 November). I have worked in the field of adult social services and dealt with cases of abuse of the elderly, many of which involved financial abuse. I believe that this bill will offer an additional means for abuse to occur, and I realize that preventing and detecting such abuse is very difficult.
I hope that this bill is not passed and that the needs of seriously and terminally ill people will be met through proper palliative care.
Janet Evans
Llandudno Junction, Conwy

As doctors, we took an oath to do no harm to our patients first. Although modern medical schools avoid this oath, the principle of primum non nocere remains entrenched as a pillar of good medical practice. Doctors take a dim view of other doctors who deliberately harm their patients, which is why the case of Harold Shipman who “put an end” to his elderly patients filled everyone with disgust. Surgeons cut the patients, of course. However, this is not intended to harm, but to heal. And yet, if you wanted to trust someone to humanely kill a patient, who would you call?

GPs will receive requests to “opt out” of patients thought to have less than six months to live. Realistically, who would be able to argue that someone is not eligible? Where should the line be drawn? Could a 20-year-old severely depressed patient be as eligible as a bedridden nonagenarian with end-stage dementia? And when does a need for euthanasia become an obligation?

Of course, the benefits of having patients assisted in dying would be numerous. We would no longer need to monitor some of our chronically ill patients. If palliative care beds are not available, we could offer death instead, granny dumping in A&E will be a thing of the past, and hospital beds could be freed up by offering death as a management option. But every time we visit a chronically ill, frail old patient at home, would they think of it as a visit from the 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 overemphasizing the role of hospices and palliative care specialists in end-of-life care.

A growing number of people are dying outside hospital in the UK. Most are looked after by community nurses with support from GPs, backed up by specialist palliative care teams who advise when necessary – fortunately, it is not usually necessary to involve them in my experience. If we as taxpayers want to improve palliative and end-of-life care in the community, our first priority should be to invest more in community nursing teams, where recruitment and retention are extremely challenging.

Of course it would also be good to improve access to specialist palliative care, particularly services that provide advice and care in people’s homes, but commentators can refrain from 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 last days showed me we don’t need help dying, but better care at the end of life, November 22) seems to think?
Louisa Polak
Retired GP, Bury St Edmunds, Suffolk

The main argument for the euthanasia bill has been based on cases where people have suffered extreme pain. However, the bill itself does not address this issue. (The only reference to pain is in the call for a review of the law’s operation in five years.) Instead, there is a big leap from arguing that without the bill people will suffer great pain to saying that anyone with just six months living can have medical support to end their life. As many have argued, the first response to suffering should be to improve palliative care. Confidence in a life expectancy of only six months is weak in any case – such forecasts are not always reliable.

The whole concept, which also underlies the withdrawal of full care at the end of life, seems to be that if there is only a short time to live, why not go now? This is a gross misunderstanding of life. As in many other relationships, the principle of supply and demand applies. If there is a shortage of an item, it becomes more valuable. If you only have a few months left to live, then every day becomes more important. This applies not only to the patient, but to those around them who may share their company.

Suicidal ideation is generally seen as a mental health problem that needs to be addressed. Why is this different in the (supposed) last six months of life? Virtually anyone facing a terminal diagnosis will feel depressed and this will distort their decision making. Even so, for many there can still be good days to be had, where visits and phone calls from family and friends are the most obvious. If the patient during a period of depression has been helped to end his life, the good days will never happen.
Raymond Smith
Dorking, Surrey