There are few issues more controversial, more divisive.
Assisted dying polarises opinion.
But it’s a difficult conversation that needs to be had because ultimately death affects us all.
Even if you are fortunate enough to never be directly impacted by an assisted death you will almost certainly be indirectly affected if the End of Life Bill passes into law.
It would be the biggest social change to British society many of us would ever see in our lifetimes.
And after patients and their immediate families, it’s the country’s doctors who will be the most affected by any change in the law.
Like society, the medical community is divided on the issue.
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One senior doctor said: “It’s like Brexit, but worse.”
Another told me: “Emotions are running high”.
These are the milder, reportable comments.
There is bitterness and mistrust. The deep-rooted anger leads to each side accusing the other of deliberately spreading misinformation, “what-iffery” and “shenanigans” in the lead-up to the final vote next week.
We asked two senior doctors to share their views on assisted dying with us and each other.
Dr Mark Lee is a consultant in palliative care.
“I have worked in this field for 25 years and looked after thousands of patients at the end of their lives. I am against the assisted dying bill because I believe it poses risks to patients, to families, to doctors and to palliative care.”
‘We can get this right’
Dr Jacky Davis is a consultant radiologist and a campaigner for assisted dying legislation in this country.
One of the arguments put forward by opponents of assisted dying is that Britain ranks highest among countries in its delivery of palliative care. And there is no need for such a radical change in end of life care.
It is not an argument Dr Davis accepts.
She said: “The status quo at the moment means a number of people are dying bad deaths every day. 300 million people around the world have access to assisted dying and more legislation is in the pipeline and no place that has taken up a law on assisted dying has ever reversed it. So we can learn from other places, we can get this right, we can offer people a compassionate choice at the end of life.”
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Dr Lee accepts palliative care has its limitations but this is a result of underfunding. This national conversation, he argues, is an opportunity to address some of those failings and improve end of life care.
“I think the NHS currently is not resourcing the situation enough to be able to provide the patients with the choice that they need to get the care that they needed and that is because they are not getting the choice and because palliative care is patchy. But in my day-to-day work, and I’ve worked in palliative care for 25 years, normal death is peaceful, comfortable, and does not involve people dying in pain.”
“I absolutely agree with Mark,” Dr Davis responded. “The vast majority of people will die a peaceful death and do not have the need for an assisted death. And I absolutely am with him that palliative care in this country has been treated abysmally. Nobody should have to hold a jumble sale in order to fund a hospice. That’s terrible.
“What I didn’t hear from Mark is, while the vast majority of people will die a peaceful death and have got nothing to fear facing death, there are people who have diagnoses where they know that they are likely to face a difficult death and will face a difficult death.
“What are you offering to the people who aren’t going to die a peaceful death? And what are you offering to people who are so afraid that that’s going to happen that they will take their own lives or will go abroad to seek an assisted death?”
Concerns about pressure on NHS
One important voice that has been missing from the national assisted dying debate is that of the NHS.
Senior leaders will not speak on the issue until the fate of the bill is decided. And its understandable why. It is not clear what role the health service would have if the bill passes.
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Dr Lee warned that his NHS colleagues were “extremely worried”, going further to say assisted dying would “break the NHS”.
He added, that the country’s already under-pressure hospice sector would struggle to cope with staff “walking away from the job if they are forced to be involved in any way”.
Dr Davis refuses to accept these warnings, arguing that the challenge to the health service is being overstated.
“I think it’s really important to take a step back and say this would be a very small number of deaths. And this is very small in terms of the other things that are coming through big drug discoveries, big new surgeries, all the rest of it this would be very small in terms in terms of money.”
The two doctors did agree on one thing. That every patient is entitled to a pain free and dignified death.
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Dr Lee said: “I look at the whites of the eyes of people every day with that. I stand in that place every day. And that is shameful that anyone in this day and age should die in that position. Jacky and I can agree on that. That is unacceptable. But it still doesn’t justify the response that we meet suffering with killing someone, rather than addressing the needs that are in front of us.”
Dr Davis responded by saying: “You say you’ve looked in the whites of patients’ eyes at the end, and I’d say looking into the whites of patients eyes and listening to what they’re asking for when they’ve been offered everything that you can offer them and they’re still saying, ‘I’ve had enough’, then we should follow the example of other countries and say, ‘we will help you’.”
These are the two very divided opinions of two NHS doctors, but these are the same arguments that will be taking place in hospitals, hospices, offices, factories and living rooms across the country.
In about a week’s time, it will be down to the politicians to decide.
