Most people in our society wish to see assisted dying legalised in the UK. And so, correctly, it is a current matter of debate in the Houses of Parliament.
Today, the Terminally Ill Adults (End of Life) Bill is due to return to the House of Commons. Various proposed amendments will be discussed concerning the detail of how assisted dying would be carried out – including which safeguarding steps are needed.
One amendment which has not (yet?) been considered is whether doctors should be the ones administering the lethal drugs that are required to end an individual’s life.
In almost every country which has legalised assisted dying, it has fallen to the doctor to prescribe and administer these drugs. It has been assumed that the doctor is the best person for this role. They have a relationship with the patient, a knowledge of diagnosis and prognosis, a respect for autonomy and an ability to assess the patient’s state of mind. While all of this is true, the assumption that doctors should be the ones to assist in dying needs to be questioned for two reasons , as we have argued in the Journal of Medical Ethics .
Firstly, adding this function to the duties of a doctor is so counter to their overall purpose that it risks undermining the defining role of the profession. Secondly, doctors do not have all the skills that are needed to assist dying – a new, specific profession is needed for this important task.
The primary purpose of a doctor is to prevent and treat illness. We are trained to diagnose, to predict, to communicate and to treat, in line with the patient’s wishes. Sometimes the treatments can cure the disease, sometimes they can only alleviate symptoms, or extend the timeline of the disease, but all are intended to help patients to “live well until you die”.
The Terminally Ill Adults (End of Life) Bill has doctors involved at four stages of the assisted dying process. The first three of these (to listen to and understand the individual’s concerns and reasons for wanting assistance; to assess the capacity of a patient to decide to end their life, and to provide evidence in terms of the individual’s condition, prognosis and treatments) fit within the established professional role.
However, the bill requires doctors to assist in the death itself – by prescribing and providing the lethal drugs.
Fundamental to the vows we have all made as doctors for the last 2000 years has been to do no harm: this is what medical students sign up to and what patients expect of us. Administering lethal drugs would be counter to that vow – and risks influencing those who apply to do medicine, how doctors are trained, how we interact with patients and how we are regulated.
Of course, the legislation accounts for conscientious objection, which is critical given that about half of the profession does not support the role of the doctor in assisted dying. But we think this is the wrong way around: doctors should not have to “opt out” of assisting death, but they should be allowed to “opt in” – and receive specific training for the role.
In fact, we argue that rather than shoehorning in an already established profession (doctors) to meet the need for assisted dying, we should think imaginatively about what skill set is needed – and establish a new professional role, with specific training, research and regulation.
Skills for an Assisted Dying Pratitioner (ADP) would include not only assessing capacity and administering drugs and symptom relief, but understanding the dying process – and having deep knowledge of the diversity of cultural and religious needs around death.
It would include training in how to support loved ones during and following a death – and provide bereavement support as part of a holistic care for the dying patient. Doctors could apply and train to become ADPs, but the training would also be open to others.
As a society, we have recognised the importance of respecting someone’s wishes to control the timing and character of their death. This should extend to careful consideration of who is best placed to help with this: we need a specific role for this very important duty.
Sally Barker is a resident doctor in the NHS with a recent MA in Medical Ethics and Law from King’s College London. Zoë Fritz is a Consultant Physician in the NHS and an Associate Professor in Medical Ethics and Ageing at the University of Cambridge
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