Hostname: page-component-7c8c6479df-24hb2 Total loading time: 0 Render date: 2024-03-28T02:05:06.395Z Has data issue: false hasContentIssue false

Assisted suicide: two sides to the debate

Published online by Cambridge University Press:  02 January 2018

Philip Graham*
Affiliation:
Institute of Child Health, London. Email: grapjgraham1@aol.com
Rights & Permissions [Opens in a new window]

Abstract

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists, 2011 

Editorials are surely meant to provide balanced, dispassionately presented information. The editorial by Hotopf et al, Reference Hotopf, Lee and Price1 while implying by its title that it is impartial on the issue of assisted suicide, is, in fact, highly tendentious in its approach and selective in the information it provides.

The authors first fail to draw an important distinction between ‘assisted dying’ and ‘assisted suicide’. The former term is now widely used to describe the situation that pertains in Oregon, where terminally ill, mentally competent patients who are suffering intolerably despite the best available palliative care, have the right to ask their physicians to provide them with the wherewithal to end their lives. The term ‘assisted suicide’ tends to be used where patients are given the means to end their lives, although they are not terminally ill. They might, for example, be paraplegic or in the early or intermediate stages of a chronic degenerative neurological disorder. Dignity in Dying, of which I am a Board member, supports assisted dying but not assisted suicide.

The authors present a number of arguments that have been used by opponents of any legislative change in this area. They quote the ‘slippery slope’ view that suggests that if legislation allowing assisted dying were passed, it would not be long before assistance would be permitted with less stringent criteria in place. They do not present any contrary views or data. For example, in Oregon, where legislation has been in place to allow assisted dying since 1997, no attempt has been made to broaden the criteria. Nor have the numbers of patients asking to be given assistance to die increased to any significant degree. Deaths as a result of assisted dying have remained at or under 0.2% of all deaths per year in Oregon since 1997. 2 The editorial makes the wild suggestion that legislation might even be broadened to include the chronic mentally ill, a proposal not, I think, put forward since the infamous Nazi policies implemented in the 1930s and 1940s.

The editorial further suggests that, if psychiatrists were involved in assessing mental capacity, as they inevitably would in a limited number of cases, this task would present intolerable difficulty. Unless the clinical skills involved in distinguishing between the normal lowering of mood shown by people with life-threatening illness and those with clinically significant depression have been lost since I was in practice, this clinical task seems to me in no way insuperable though, of course, I agree that in a small number of cases it is indeed highly problematic.

Finally, the authors object to legislation on the grounds that physically fit people with depressive disorders who make suicidal attempts often change their minds about whether they want to die. They compare such patients with people in the terminal stages of physical illness who are suffering intolerably and reckon their quality of life does not make continued survival anything but horrendous. This comparison is surely quite inappropriate.

Although this is not stated in the editorial, the first author was a member of a working group of the Royal College of Psychiatrists that, in 2006, produced a most unsatisfactory document strongly arguing against any legislation in this area. 3 I very much hope that the College will withdraw this statement and take the only position that is appropriate in circumstances when, as is the case here, opinion is sharply divided, namely one of neutrality.

Footnotes

Declaration of interest

P.G. is a member of Healthcare Professionals for Assisted Dying, www.hpad.org.uk

References

1 Hotopf, M, Lee, W, Price, A. Assisted suicide: why psychiatrists should engage in the debate. Br J Psychiatry 2011: 198: 83–4.Google Scholar
2 Oregon Public Health Division. Oregon's Death with Dignity Act: Annual Report 2010. Oregon Public Health Division.Google Scholar
3 Royal College of Psychiatrists. Assisted Dying for the Terminally Ill Bill. Statement from the Royal College of Psychiatrists on Physician Assisted Suicide, 24 April 2006. Royal College of Psychiatrists, 2006.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.