Clive Seale’s follow up to earlier research into end of life practice (Hastening death in end-of-life care, Seale, 2009), published this week in Social Science and Medicine, found that over a third of doctors say they have given drugs to terminally ill patients, or withdrawn treatment, knowing that it would or intending to shorten their life.
Seale found, when looking at 3000 deaths, in 211 cases (7.4%), doctors gave drugs or stopped treatment to intentionally hasten the patient’s death. In 825 cases (28.9%), doctors made a decision on treatment that they knew would probably or certainly hasten death. Further to this, one in 10 patients asked their doctor to help them to die.
The research found that a doctors’ religious belief and views on assisted dying impacted on how they treated patients at the end of their life, with doctors who said they were religious or opposed the legalisation of assisted dying being less likely to report that they had acted to hasten a patients’ death.
Interestingly the research showed that there was no evidence of a ‘slippery slope’ in the practice of continuous deep sedation. The groups of people who are traditionally considered to be vulnerable were no more likely to be sedated than other groups.
This research highlights several areas of concern for Dignity in Dying. The first issue that the Seale research raises is patient choice. At Dignity in Dying we campaign for choice and control at the end of life, the key being that it is the patients’ choice, not the choice of the doctor. The second issue of concern is the existing ethical fudge which permits the refusal of treatment and terminal sedation, but not assisted dying. In some cases, where palliative care cannot be effective, the most compassionate option would be the choice of an assisted death. This would remove the need for a doctor to make life ending decisions on behalf of their patient. We are also deeply concerned that this research indicates that some doctors are putting their own beliefs above the wishes and clinical needs of their patients.
There is a clear need to shine a light on end of life decision making, and we hope that the Government will respond to the many issues that the Seale research highlights, as well as the consultation the DPP is doing on a prosecution policy for those who compassionately assist a loved one to die, by launching a commission into assisted dying and existing end of life practice.