Voluntary assisted death: how to ensure access and safety

Some people would choose a voluntary assisted death. It’s their right to do so. The right is reflected in the fact that few UK medical organisations oppose assisted dying, and surveys suggest that most of the British public is supportive. While some members of the public and health professionals do, of course, oppose the principle of voluntary physician assisted dying, the debate has advanced to consider how assisted dying can be implemented safely.

On this point, even some supporters of the principle express doubts. Notably, the UK health secretary has stated that, although he’s in favour of the principle, he fears that the country’s standard of palliative care is insufficient for voluntary assisted dying to be a legal option at this time. Wes Streeting isn’t alone in questioning whether it’s possible to implement voluntary assisted dying. A parliamentary vote is planned in November with the support of the prime minister, Keir Starmer, although full details of the proposed new law are yet to be made public.

Whether considered personally, professionally, or politically, the matter is one of individual conscience. It’s clear from testimonies of health professionals around the world with experience of voluntary assisted dying that their work is complex and makes them think deeply. It confronts their doubts, personal morals, and professional ethics. It’s not work that they take lightly. And yet, at the core of this internal reflection is an empathetic desire to do what’s best for patients (doi:10.1136/bmj.q2355).1 This test of conscience is not only confined to health professionals. What should a carer do when their spouse is determined to end their life on their own terms (doi:10.1136/bmj.q2355).1

Doctors, our Hippocratic oath guides, must do no harm. One dimension is the growing field of patient safety, which has just acquired seven worthy principles (doi:10.1136/bmj.q2334).2 But, in the context of assisted dying, what is harm? On his deathbed Socrates said that he owed “a cock to Asclepius.” Socrates was about to drink hemlock—his death sentence for “corrupting the youth” of Athens with his ideas. According to one interpretation, he viewed life as a disease that would be healed by death. Asclepius was the Greek god of healing to whom he wished to make an offering.

The first step for doctors is to be open to the debate—to be open to the idea that someone’s individual choice goes against a personal belief system, be open to death being the path of least harm (doi:10.1136/bmj.q2352),3 and consider the limits of medicine in alleviating suffering. A group of palliative care consultants, angered by what they saw as their professional association’s attempts to close off this debate, acknowledge that “even the best quality palliative care has its limits, and access to assisted dying could be complementary to it, for those who wish it” (doi:10.1136/bmj.q2351).4

Yet, as David Oliver asks about Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill that will be debated in parliament, how can misuse be prevented if assisted dying is legalised (doi:10.1136/bmj.q2348)5? Here, we might turn to international experience. Our editorialists consider eligibility, safeguards, conscientious objection, oversight, and reporting. The message is that implementation is feasible provided that lawmaking is informed by international experience and evidence, to “maximise both safety and access” (doi:10.1136/bmj.q2382).6

The duty of politicians voting on legalising assisted dying is not to oppose it on personal principle, or to object to it on the basis of fears about implementation, but to ensure that the law does maximise safety and access for patients who seek voluntary assisted dying, while supporting doctors in navigating a new and difficult future in aiming to do what’s best for people in their care.