Assisted dying: principles, possibilities, and practicalities. An English physician's perspective

Area of Science:

• Medical Ethics
• Public Health Policy
• Legal Studies

Background:

• Medically-assisted dying legislation is increasingly probable in England and Wales, with similar bills progressing in other jurisdictions.
• Current discourse often prioritizes individual autonomy ('my life, my death') with generally uncritical media support.
• Devising effective legislation requires balancing patient autonomy and compassion with respect for human life and medical professionals' autonomy.

Purpose of the Study:

• To critically analyze the challenges and potential harms of medically-assisted dying legislation.
• To compare existing physician-assisted suicide models in Switzerland, Oregon (USA), and Victoria (Australia).
• To propose a framework for a 'least worse' legislative approach to assisted dying.

Main Methods:

• Comparative analysis of three international physician-assisted suicide legal frameworks.
• Discussion of ethical considerations, including patient vulnerability, autonomy, and societal impact.
• Review of advocacy for assisted dying, noting potential disinformation and hidden risks.

Main Results:

• Existing models present complex challenges in balancing competing ethical principles.
• A significant concern is the potential negative impact on vulnerable populations, including the disabled and elderly with dementia.
• Advocacy for assisted dying may be biased, and a 'hidden danger' includes patients avoiding palliative care due to fear of hastened death.

Conclusions:

• Implementing medically-assisted dying requires careful consideration to protect vulnerable individuals and avoid negative societal impacts.
• A proposed model suggests a stand-alone Department for Assisted Dying, separate from palliative care, with clear roles for legal and medical professionals.
• Healthcare professionals must retain the right to opt out, and there is an urgent need to improve overall palliative and hospice care provision.