Responding with compassion - A GP’s Guide to Assisted Dying Requests

There are numerous strongly held positions on physician- assisted dying. Many feel passionately on one side or other of the debate, with compelling and often highly personal reasons to support their views. A summary of key arguments used by those who support or oppose physician-assisted dying can be found here, and relevant UK Law here.

It is also a topic that is regularly hitting the news, with bids to introduce new legislation in Scotland, Jersey and the Isle of Man, and high profile campaigners such as Esther Rantzen and Liz Carr making impassioned cases for either side of the debate. 

As is always the way, whatever is high on the news agenda often finds its way into our consulting rooms. But when it comes to a patient's request help to hasten their death, it can be difficult to know how best to respond. 

Whatever our personal views, it is important we remember the law, and of course respond professionally and compassionately. To help us with this, the BMA has provided useful guidance to guide us through what can be a legal, ethical and emotional quagmire. 

First and foremostly, all forms of assisted dying are illegal in the UK. We must avoid any action that might be considered assisting, facilitating or encouraging suicide (and seek legal advice whenever we are unsure.) That doesn’t mean we should ignore a patients request for assisted dying, and listening and acknowledgement is a crucial part of our response, but we must always be clear with our patients (and ourselves) about what we can and cannot do.  Lawful clinical options, including pain relief, symptom control and capacitous refusal of treatment, can and should be discussed. The law is also clear that where a patient makes a subject access request (SAR), we are obliged to provide this under the General Data Protection Regulation (GDPR), regardless of whether we know or suspect that the medical records may be used abroad for assisted dying. 

Secondly, if a patient expresses a desire to die, it’s helpful to view this as we would any other symptom, something that warrants further exploration. It may indicate underlying physical, practical or emotional issues, or specific concerns about the end of life. This is an opportunity to consider what might help improve the patient’s quality of life, review advanced care planning and explore those feelings, thoughts and emotions. 

Thirdly, we must not abandon our patients. As is so often the way in real life, there may not be an easy solution, perhaps no underlying problem that can be easily addressed or a hidden concern that can be uncovered, explored and allayed. If this is the case, it is still vital we continue to be there to care for and support our patient, acknowledging their wishes and provide assurances about the care we can provide. It is also important we don’t let our own views influence the care we provide; our patients need us to remain non-judgemental so they know they can continue to speak openly to use, even if we ultimately cannot grant their request. 

Finally, as with so much of palliative and end of life care, these conversations can be challenging and emotional. Remember to take care of yourself, consider involving a colleague or other members of the team around the patient. You are never alone in this work, so seek out those people to turn to for advice and support and try not to get so personally attached that you burn out emotionally. 

Shiv and I have been busying designing the Hot Topics Palliative and End of Life Care course to equip you with the skills, knowledge and confidence to navigate challenging situations just like this. We will also be covering important topics such as symptom management, communication and prescribing so you can really make a difference to your patients. Do join us for this brand-new course on Thursday 27^th June from 9.30-1pm, or catch up on demand.