As a result the debate on assisted dying has become increasingly focused on pragmatic concerns around patient safety rather than more theoretical considerations of right and wrong. Given that it is universally acknowledged that end-of-life care is not a panacea to all of the suffering the dying process can cause, the core issue at the heart of this debate is whether some dying people should forgo choice and suffer against their wishes in order to protect other ‘vulnerable’ people from potential harm.
It is the contention of those opposed to a change in the law that people will come under pressure, real or imagined, to die. Except there is absolutely no evidence of this from those countries that have legalised and regulated some form of assistance to die. In the US state of Oregon, where assisted dying was legalised in 1997, assisted dying works safely and effectively. Eligibility has never been extended beyond terminal illness, nor has there been pressure for such a change. Numbers are low – assisted deaths have never amounted to more than 0.25% of all deaths per year – and there is no evidence that potentially vulnerable groups (such as people with disabilities, or people who are over 85) are negatively affected.
The argument on patient safety put forward by opponents is an assertion about the impact of legalising assisted dying. It masquerades as an empirical claim. But a look at the evidence tells us is has no basis in reality – it is the current law that does not sufficiently protect people. As is well documented, dying Britons are travelling abroad to die or taking matters into their own hands at home – sometimes with the assistance of loved ones. At present the law attempts to protect these people by examining the motives of those who helped them die. Surely people would be better protected if the law thoroughly examined the motives of a person who wishes to die when they are still alive.
Our society is built on the premise of trusting competent adults to make decisions for themselves – such as the right to refuse treatment. To safeguard against undue influence we advocate informed decision making via access to relevant information. When it comes to assisted dying this is not achieved by turning a blind eye, but rather by allowing dying patients who wish to control the time and manner of their death the option of discussing their wish and their alternative choices with healthcare professionals. A process that would also allow healthcare professionals to assess diagnosis, prognosis, competence and whether there has been any undue influence.
So why do some people continue to oppose assisted dying on the grounds of patient safety? I believe some opponents are dressing up immutable opposition as pragmatic concern. We will never change their minds, regardless of the strength of the evidence we present. But they will never admit as much. However, some people currently opposed to change will simply not yet be aware of the evidence and assume assisted dying will harm potentially vulnerable patients. It’s our job to change that by publicising the evidence to the contrary and so dissolving their opposition to assisted dying.