Doctors who back assisted dying ‘frightened to speak out’ ahead of major vote

Doctors and nurses have said colleagues feel “frightened to speak out” in support of because the voices of those  who don’t oppose it are “stifled”.

As the national debate ramped up ahead of Friday’s crucial vote in the House of Commons, experts spoke in support of the Bill at an event in Westminster.

Recounting harrowing cases of patients whose suffering could not be eased in their final days and weeks, they argued that assisted dying had its place in the spectrum of end-of-life options.

And they insisted that the Association for Palliative Medicine – among the organisations most strongly opposed to any change in the law – does not speak for all professionals in the field.

Surveys suggest that between 70-85% of palliative care clinicians oppose the legalisation of .

But Sam H Ahmedzai, a retired palliative medicine consultant and emeritus professor at the University of Sheffield, said the APM did not allow “the one in four doctors like me who dissent from that [opposition] view to have a voice. We are stifled. We are often afraid to even speak out.”

And palliative medicine consultant Dr Jane Neerkin said: “I think people are frightened to speak out and show support. The Association of Palliative Medicine doesn’t speak for everybody. It has always been against.

“But if you look at medics as a whole – the Royal College of Physicians, The Royal College of Surgeons and even Hospice UK, all have a neutral position. So I don’t think it’s necessarily representative of everybody.”

During a discussion hosted by Kim Leadbeater – the Labour MP sponsoring the Bill – the panel recalled cases which had shaped their views.

Prof Ahmedzai shared examples including that of a man with throat cancer who was told he would eventually die of what surgeons called a “blowout” of his carotid artery.

The medic said: “I used to sit with him at night, after visiting hours, and he would tell me that he was so fearful of dying in a pool of blood in front of his wife and children. He repeatedly asked me to increase his pain medicines to put him out peacefully. 

“He did die of a blowout eventually, not just in a pool of blood but with blood all over the bed, the walls, the ceiling, just as it was predicted.

“His carotid artery just burst open. And it still haunts me that there was nothing to save him from experiencing such a death.”

Prof Ahmedzai, who has 40 years’ experience in the field, said palliative care provided in the UK was “amongst the best in the world”.

But he noted that it falls short in some cases, either because patients are referred too late or their pain and existential suffering cannot be adequately relieved.

He added: “The reality is that palliative care in the UK, in any country in the world, has limitations. 

“Some patients have very special needs, such as pain which is no longer responsive to morphine or any other stronger painkiller, and they scream every time they’re touched.

“Or they may have extreme breathlessness, like suffocation, because cancer is blocking the windpipe. Or they may be vomiting faecal fluid because of an intestinal obstruction from bowel cancer.

“Here, even the best of specialist palliative care has little to offer in symptom control beyond sedation to the point of unconsciousness and, eventually, death.”

The panel challenged the portrayal of dying people as being unable to make measured choices. Dr Neerkin said: “Just because in that situation you may be less robust and a little bit more vulnerable, that doesn’t mean you do not have capacity to decide what is right and wrong for you.”

And they discussed the idea that some palliative care professionals may feel like their abilities are being criticised by those who support assisted dying.

Mark Jarman-Howe, chief executive of St Helena’s Hospice, said: “It does challenge people’s identity, that has been built up in a slightly unhelpful way over the years.

“The staff who work in hospices and palliative and end of life care are amazing people and they get told an awful lot that they’re angels.

“I think it’s unhelpful language because they are doing superb stuff and they are often heroic, but sometimes layering on that sort of language…doesn’t encourage reflection and people to think differently and take a step back.”

Mr Jarman-Howe raised a recent report by the independent Office of Health Economics, which estimated that 7,300 people die in unrelieved pain every year.

He added: “There are big issues with palliative care and demand for palliative care. We know actually between now and 2040 we’re talking about a 42% increase in demand for palliative care which is just enormous.

“We need to invest in palliative care to respond to that ageing population and that growing demand, but at the same time we’ve got to prepare for a future where the number of people who are suffering these horrible deaths is sadly going to increase as well.”

The panel also highlighted the recent Commons Health and Social Care Committee report on assisted dying, which found no evidence that palliative care had deteriorated in jurisdictions where the law had changed.

Gay Lee, a retired palliative care nurse of 20 years’ experience, said the lack of assisted dying legislation “actually blocks the improvement of palliative care” and stops patients having open conversations about their wishes.

She added: “The most misunderstood aspect of palliative care and assisted dying is that people think you can’t have assisted dying until you’ve perfected palliative care.

“Well we know that we need to improve palliative care, and as Kim says, hopefully that’s what will happen as a result of this Bill.

“But there are people who know the best hospice care in the world – and I think we have it – can’t help people.”

Dr Matthew Doré, honorary secretary of the APM of Great Britain and Ireland, said: “Over the past decade, recurrent surveys consistently show that, on average, 80% of palliative care doctors oppose the legalisation of assisted dying, 15% hold a neutral stance, and 5% support a change in the law.

“This is clearly reflected in the APM position statement. It would be highly unusual for an organisation with such a strong majority to deviate from the democratic consensus of its membership.

“It is incorrect to claim that 1 in 4 palliative medicine doctors support a change in the law, it is actually around 5%. The APM has never stifled open discussion, but has listened to diverse perspectives (as evidenced by the recurrent surveys), and has engaged with proponents of legal change, both within and outside its membership. To suggest otherwise misrepresents the APM’s approach.”