Assisted dying debate in the Journal of Medical Ethics and beyond…
On to 2011, and Professor Finlay and Professor George (both of whom campaign against the legalisation of assisted dying) published a ‘critique’ of the Battin article in the same journal. Their article claimed that both the methodology and concept of ‘vulnerability’ in the Battin article was flawed. Battin et al then wrote an evidence-based response to this article, arguing that Finlay and George’s comments were not about the data but about the limitations of the study. All research has limitations which are either acknowledged head-on by the authors, or they make sure that the conclusions are based purely on evidence and do not wander into conjecture.
Here is a summary of the response to Finlay:
- Finlay and George claimed that deaths between 65 and 84 years had been omitted (and that older adults were a risk group), however this data was clearly displayed and supports that there is no evidence of heightened risk of assistance in dying among older adults (defined as 65+).
- Finlay and George questioned whether the concepts of vulnerability used by Battin were appropriate. Battin’s response is that whilst they could not hope to cover all types of potentially vulnerable groups, they picked those groups thought to be the most ‘at risk’ as defined by public and medical debate around assisted dying, i.e.’ elderly, ethnic minorities and the sick’ etc. Battin does not dismiss that there may be other potentially vulnerable groups worth examining – but the evidence she presents is on particular pre-defined groups.
- Finlay and George refer to a ‘four-fold rise’ in assisted dying cases in Oregon between the initial years of the Death with Dignity Act (1997) and the present. Whilst assisted dying cases have steadily risen over the past 14 years the figures have remained at 0.19/0.2% of all deaths per year for the past three years and have never risen above this. It is a misrepresentation of the trend to call this a four-fold increase.
One of my own concerns is with the motivation behind Finlay and George’s critique – which appears to go against the grain of traditional evidence-based academic debate. Wouldn’t it have been more beneficial to the academic community, and have more meaningfully contributed to debate, had they made their concerns known in 2007? Living and Dying Well (the group lead by Baroness Finlay claiming to be a ‘public policy research organisation’ on assisted dying) states that ‘the debate needs to focus on rigorous analysis of the evidence rather than on campaigning spin’. This, of course, is an excellent approach. However, a recent eight page briefing that Living and Dying Well produced which was in response to a Dignity in Dying briefing on patient safety and assisted dying contains very few academic references – one of these being an article written by Finlay and George which is referenced but which neglects to state that they were the authors, thus giving the impression of other academics backing up their case.
Dignity in Dying prides itself on using evidence to shape a safeguarded model for assisted dying. Our ‘Matter of facts’ document details research from Oregon (which we use as a model of good practice), the Netherlands and Belgium which demonstrates that assistance to die practices are working safely in these places. Importantly, it also provides us with ‘lessons learnt’ to inform how we would want an assisted dying law to be developed and implemented in England and Wales.