Death is not a “treatment option”

Dean discusses conscientious objection to assisted dying.1 It is important to recognise the consequences of construing assisted dying as a “treatment option” in the conventional sense. In Canada, doctors “must take reasonable steps to ensure persons are informed of the full range of treatment options available to relieve suffering”2 including the option of medical assistance in dying (MAID). Doctors have an obligation to tell patients if they are eligible, except where this would not be “consistent with the person’s values and goals of care.”2 In practice, patients are often unhappy when a doctor raises this option before it has been raised by the patient.3

The Canadian Practice Standards do not follow the logic of this position consistently. They state that “advising persons of potential eligibility for MAID is distinct from counselling persons to consider MAID.”2 But if MAID is a treatment option for the relief of suffering, then in some cases a doctor should counsel a person to consider it, just as a doctor should sometimes counsel a patient to consider other effective forms of pain relief.

Furthermore, if giving lethal drugs was a treatment option for intractable suffering, then doctors would have an ethical obligation to administer such drugs without consent, when this was “of overall benefit” to a patient who lacked capacity.4 This might include lethal injection of a patient with dementia under restraint.5 The BMA is right to insist that providing a lethal drug with the intention to cause death must not be regarded as a treatment option in a conventional sense in the UK.6