NEWS: Call for clarity on assisted dying

As reported by GP Online, in a landmark report, MPs urge medical bodies to provide clearer guidance to doctors on handling requests for medical reports from patients seeking assisted dying abroad, amidst growing debate on the issue

The recommendation forms part of the House of Commons health and social care committee’s report on assisted dying, which was published on Thursday following a 14-month inquiry that received more than 68,000 responses from members of the public.

The final 124-page report does not make any recommendation on whether the law on assisted dying should change and instead is intended to act as a ‘comprehensive basis’ for any future debate in parliament on the issue, the committee said. It provides extensive evidence on the experiences of other countries that have legalised assisted dying, including hearing from doctors practising in those places.

However, the report did make a number of other recommendations, including calling on the government to provide additional funding to deliver improvements in palliative and end-of-life care, and develop a national strategy for ‘death literacy and support’, which would help healthcare professionals better support patients and their loved ones following a terminal diagnosis.

The report also said that if assisted dying were legalised in future there would need to be provisions to allow doctors or other healthcare professionals to choose not to be involved in the process.

Assisted dying

Assisted dying is currently being considered in both Jersey and the Isle of Man. Meanwhile, a bill proposing legalising assisted dying is due to be debated in the Scottish parliament at some point this year.

The committee said it was ‘increasingly likely’ that at least one jurisdiction among the UK and Crown dependencies would allow assisted dying ‘in the near future’, and the government needed to prepare for how it would deal with any divergence in legislation.

The report highlighted that between 2015 and 2022 258 UK citizens went to Dignitas in Switzerland for an assisted death – although it said there was ‘no sure way of knowing how many UK citizens choose to end their life abroad through assisted dying’.

To access Dignitas, individuals need one or more up-to-date medical reports. However, the committee said current BMA guidance suggests doctors do not provide reports to facilitate assisted dying, while the GMC says providing access to medical records should not be considered as assisting someone to end their life. The committee heard evidence that medics were concerned they could be subject to legal charges if it was deemed they had helped a patient have an assisted death.

‘Although it is not illegal to provide medical reports in this circumstance, it does not seem to be entirely clear to doctors what they are allowed to do,’ the report said. ‘We would welcome revised guidance from the GMC and the BMA enabling doctors to assist their patients.’

Palliative care

As part of the inquiry, the committee also heard from relatives of people who had taken their own lives after being given a terminal diagnosis. The report said there was a ‘pressing need’ to understand how to better provide mental health support and guidance for people living with a terminal illness.

The report concluded that access to palliative and end-of-life care was often ‘patchy’ and more should be done to ensure there was ‘universal coverage’, including improved access to hospice care at home, more specialists in palliative care, and better end-of-life pain relief.

The inquiry heard evidence that up to 90% of people with a terminal illness will likely have palliative care needs at the end of their life, but just 50% of people dying currently receive this care.

However, the report warned that improvements to end-of-life care would not be possible ‘unless they are adequately funded to keep up with demand’, and questioned the current funding model for hospices – that receive only a third of their funding from the government – which it said was ‘unsustainable’ and meant some could be at risk of closure.

The report noted that several jurisdictions that had legalised assisted dying had seen an improvement in palliative care.

Public support

Polling by YouGov last year for the organisation Dignity in Dying, which campaigns for assisted dying, found 75% of the British public supported legalising assisted dying for mentally competent terminally ill adults, while just 13% opposed it.

Opinions within the medical profession have also shifted in recent years. In 2021 the BMA dropped its official stance of being opposed to assisted dying and adopted a neutral position.

The RCGP remains opposed to assisted dying, although the last survey it carried out on the issue in 2020 showed a significant shift in support for assisted dying when compared with a similar poll in 2013. Last year the college set up a working group to look at the practical implications of any change in the law on assisted dying.

Chair of the health and social care committee Steve Brine said: ‘The inquiry on assisted dying and assisted suicide raised the most complex issues that we as a committee have faced, with strong feelings and opinions in the evidence we heard.

‘We intend the information and testimony we present in our report today to have a lasting legacy and be a significant and useful resource for future debates on the issue. We’re particularly grateful to those who shared very difficult personal stories. The accounts were enormously helpful to us as we considered the issues involved.’

Dignity in Dying said the report showed it was now a matter of ‘when not if’ the law changes.

Chief executive Sarah Wootton said: ‘If MPs take just one thing from the mountains of evidence heard in this inquiry, it’s that the current law on assisted dying is unsafe and woefully inadequate. Palliative care is simply not enough to give everyone a peaceful death, forcing terminally ill Britons to contemplate taking their own lives or seek compassion in Switzerland.

‘Maintaining the status quo in the face of so much obvious, devastating harm – while assisted dying laws continue to work safely overseas – is the most dangerous decision that Westminster could make.’