The debate over assisted dying highlights the challenges of making clinically reliable six-month prognoses, as illness trajectories can vary widely.
Social inequities significantly influence requests for assisted dying, emphasizing the need to reevaluate criteria and improve palliative care services.
Deep dives
The Assisted Dying Bill in the UK
The ongoing discussions concerning the Assisted Dying Bill in the UK highlight significant complexities regarding patient eligibility and prognosis. The bill proposes that doctors will determine if patients qualify for assisted dying based on a six-month prognosis, a notion that many experts find challenging due to the unpredictable nature of illnesses. Medical professionals, such as family doctors, are questioning the feasibility of accurately predicting when someone has six months left to live, as illness trajectories can vary widely. As a result, concerns are rising about the implications of such legislation on the dying process and the responsibilities placed on healthcare providers.
The Challenges of Prognostication
Prognostication in clinical practice is fraught with uncertainty, particularly regarding predicting end-of-life timelines for patients. Experts note that physicians tend to err on the side of optimism, often overestimating how much time patients have, which could complicate the assisted dying process. It has been suggested that more reliable methods, such as focusing on a shorter prognosis of six weeks, may provide a more feasible approach to evaluating candidates for assisted dying. This raises a critical question about the accuracy of prognoses and their impact on patient decisions regarding assisted dying.
The Role of Social Factors in Assisted Dying
The motivations underlying a person's request for assisted dying extend beyond mere medical factors, with social inequities playing a significant role. In certain instances, individuals may seek assisted death not solely due to terminal conditions but rather as a means to escape unbearable social circumstances, such as financial hardship. This broader understanding of what constitutes unbearable suffering challenges the notion of purely medical justification for such requests, prompting a reevaluation of the criteria used in assisted dying legislation. The conversation emphasizes the need to address the root causes of suffering to provide a more comprehensive support system for those at the end of life.
The Importance of Palliative Care
Though the assisted dying debate intensifies, many experts argue for the essential need to improve palliative care services as a complementary approach to end-of-life options. Access to quality palliative care can significantly influence a patient's experience, providing comfort and control during the dying process. However, disparities exist in palliative care availability, with many patients lacking adequate support, which may contribute to the desire for assisted dying. The consensus among healthcare professionals is that both robust palliative care and responsible assisted dying legislation should coexist to ensure patients have choices while receiving optimal care and support.
The UK government is debating legislation to allow assisted dying in England and Wales, which puts doctors at the forefront of deciding if their patient will be eligible for a medically assisted death - the key criteria being a 6 month prognosis. But is making a 6 month prognosis actually clinically reliable?
To discuss we're joined by a panel of experts on end of life;
Scott Murray, emeritus professor of primary palliative care at the University of Edinburgh
Simon Etkind, assistant professor of palliative care at the University of Cambridge
Nancy Preston, professor of supportive and palliative care, Lancaster University
Suzanne Ost, professor of law, Lancaster University
Also in this episode, we dim the lights and raise the curtains - there is a public fascination with doctors who kill and the stage show turned podcast, ‘An Appointment with Murder’, takes a deep dive into the crimes of GPs John Bodkin-Adams and Harold Shipman.
Kamran is joined by Harry Brunjes and Andrew Johns to talk medical murder.
