Doctor makes case for offering an assisted death

Could we be at risk of the ‘normalisation’ of assisted dying? What is known about the drugs that are used in some countries to help people end their lives. James Tytko put those points to Dr Aneez Esmail who is emeritus professor of general practice at the University of Manchester and a board member of the Dignity in Dying campaign group, who believe that assisted dying for terminally ill, mentally competent adults should be legal in the UK...

Aneez - I'm a bit concerned that she (Ilora Finlay) puts it like that. I think there's a lot of fear mongering going on here, and I think that's wrong. I think we have a lot of experience when we talk to doctors in the US and Australia who provide assisted dying. They give a totally different perspective on this. We have a lot of information about how assisted dying works. If you compare it to a lot of other areas of medicine, and I look after dying patients, it is a bit of trial and error. You do things and it doesn't work as well, you try out other things, that is how medicine works in real life. I'm not denying that there might be individual cases where things haven't gone as smoothly as we'd expect, but in the vast, overwhelming number of cases, from what we have understood and what I've understood by looking at this, is that this isn't the case. I think it's a bit wrong to make out that this is untrialled practice, that we don't know what we're doing, because I think it's based on many years experience from around the world actually.

James - And the argument that some people make that this is a slippery slope, the change in the law Dignity in Dying are proposing, towards normalising euthanasia. Is that a risk? Is there a chance that when we start going down this path, palliative care becomes less accessible or less of a priority?

I don't accept that at all. I was an opponent of assisted dying and my own experience of looking after patients of mine who were dying, that then brought me to the position where I realised that, in a way, assisted dying is part of what palliative care should be about. It's not one or the other, and all the evidence that we have shows that palliative care improves, actually. I think that's the other thing to think about: you might decide when you are given a terminal diagnosis that I want to have that option of assisted dying but, in the end, about 1% I think actually go through with it. But it's sometimes having that peace of mind that, look, if things get unbearable, if my symptoms and my pain can no longer be alleviated, I do have that option as well. So I think that is more often the situation that we are faced with rather than the examples that baroness Finlay gave.

You know, someone who has a catastrophic accident and then decides they want to end their life, I don't think that we have ever talked about in those ways. I'm talking about people who are coming to the end of their life they're going to be dying, typically in my experience, within a few weeks and they are having unbearable suffering. I just don't accept this premise that we'll just flick a switch and say, yes, it's alright. No, I think it's going to be difficult. You've got to have two doctors get involved in it, there's got to be a legal process that you have to go through, which will be quite stringent I think. I think that we can judge, when you have a cancer with metastases which have gone to your brain, to your liver... you're going to hide. This idea that we don't know prognosis, well, I would say that the majority of doctors looking at people like that will tell you that you will probably die in the next two or three weeks. We need to sit down and work on, how are we going to do this? Let's call your family, let's talk to everyone, let's explain what's going to happen. But, in this situation, there would have already been a discussion that, when you get to the point and you can no longer cope, you have to let us know and we can then do the next and final stage.