Taking the Decision to Die

By None, The Guardian, May 12, 2006

Letters

The Royal College of Psychiatrists shares the concerns of colleagues in other branches of medicine, in particular the possible unintended effects of the assisted dying for the terminally ill bill (Doctors reject assisted death bill, May 10). There has, however, been no public debate about the mental health issues relevant to the bill, and no reference to these issues in the bill itself. Two weeks ago we published a discussion document (www.rcpsych.ac.uk/pressparliament/ parliament/responses/physicianassistedsuicide.aspx) which explores the role of the psychiatrist in deciding whether someone is competent to make a decision about their death, and the importance of diagnosing and offering to treat the depression and suicidal feelings which so often accompany pain and terminal illness. If the treatment is effective, people are more likely to want to go on living and accept physical care.

We have concerns that many doctors will not recognise that a person lacks the capacity to make a rational decision, due to depression or confusion. People must be properly assessed, not only to establish whether they have capacity, but also to understand the motivation behind their decision to die. A vital part of a psychiatrist's role is to understand the motivation behind a wish to die, and to help the person to recover hope.

We also have concerns that it would become impossible to restrict physician-assisted suicide to people with a limited life expectancy, but could lead to patients with severe disabling illnesses, including mental illness, seeking PAS, as currently happens in the Netherlands and Belgium.

Prof Sheila Hollins
President, Royal College of Psychiatrists

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As a GP I believe that with improvements in palliative care, good clinical care can be provided within existing legislation and that patients can die with dignity. A change in legislation is not necessary for the small number of terminally ill patients for whom palliative care does not meet their needs.

More than 70% respondents to the survey of fellows and collegiate members of the Royal College of Physicians agreed with the two statements above (www. rcplondon.ac.uk/news/news.asp?PR_id=310); this shows that the college cannot support legal change on assisted dying.

Dr Stephen Willott
Nottingham

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Today the lords will debate the assisted dying for the terminally ill bill. Organisations that are against this bill are misleading about the bill's terms. One argument is that it will encourage people to kill themselves simply because they feel they are a burden to their carers. The bill's terms make this impossible, since it requires that the person must have an incurable illness and be in intolerable pain. Perhaps the motives of such campaigners are honourable, but they are, in effect, demanding that the state continue to impose torture on helpless sufferers.

Amorey Gethin
Cambridge

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Jane Campbell (Stop trying to kill us off, G2, May 9) tries to give the impression that she speaks for disabled people as a whole. Available survey evidence contradicts this. For example, in an online poll in 2005 by Radar (an umbrella organisation for disability rights groups ) 91% of respondents thought terminally ill people should be allowed to ask for assistance to die. There are few dying people who are not disabled in the very final stages of life but they are most unlikely to have access to the support facilities she presently enjoys.

Don Aston
Solihull, W Midlands

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Jane Campbell should not include all of us in her intolerant views. I am terminally ill with slowly progressive cancer. I would enjoy the remainder of my life far better if I knew that a doctor could give me a quick lethal injection when I found the pain intolerable.

Palliative care has its limits. And a prolonged, agonising death does not only affect those who suffer it, but also those who watch it. Under present law, suicide is the only option for those of us who do not relish the idea of 24-hour assistance with our most personal needs.

Elizabeth Seager
Witney, Oxon

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