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As a GP, I felt the lure of assisted dying. That’s why I oppose it

Doctors are not tireless saints. And the ability to deliver both life and death is intoxicating

12 September 2015

9:00 AM

12 September 2015

9:00 AM

‘I want to die. Please help me.’

It was 2 a.m. in the good old days when patients had 24-hour cover by their own GPs. I knew Martin well. His bladder cancer had been diagnosed the year before, but more recently it had spread to the lymph nodes in his pelvis and he had run out of effective treatments. Martin had borne his illness with stoicism so far but on this night he was in terrible pain — both physical and existential.

He asked to die more than once, and each time his request scared me, but not for any obvious reason. What alarmed me about Martin’s death wish, both at the time and now, looking back on it, is that had it been legal to kill him, I might well have done it. I would have helped him die, not through compassion but because it would have been easier: a way out for me as well as him.

The Marris Assisted Dying (No. 2) Bill wants to legalise physician-assisted suicide and, though I have witnessed enough suffering in death to understand why, I am totally convinced that we should not. Marris insists that assisted dying will only be for the terminally ill, but I have my doubts. Every state that has introduced assisted suicide for the terminally ill has ended up using it for the mentally ill or just those tired of life.


Once you accept that doctors should help patients take their own lives, it becomes impossible to deny death from those who say they’re suffering unbearably. This is not mere ‘slippery slope’ speculation, but cliff-edge reality in those countries where doctors are already allowed to give patients the ability to jump.

Marris insists, ‘The Bill would not allow euthanasia, because it does not allow anyone other than the patient to administer life-ending medication.’ But what about the patients who are physically unable to take the dose, or those who do but find that it fails to kill them? Doctors will end up dealing with patients in comas, not quite dead.

Supporters of assisted dying assume that doctors are saints, with endless reserves of compassion. They assume a doctor always acts in a patient’s best interests. But even the most dedicated doctors become tired and numb to suffering. Death itself and certainly the desire for it doesn’t keep regular hours, and I was dog-tired when I arrived at Martin’s bedside. I couldn’t honestly tell you that I wouldn’t have taken the line of least resistance in order to get back to sleep as quickly as possible. Martin lived alone and was diagnosed as terminally ill. No one would have turned a hair if the law had allowed it.

Recently I attended a small gathering of doctors in favour of assisted dying and, as I listened to them talk, I realised they all seemed scarily eager to ‘do their first one’. It’s not that they were a callous bunch so much that the idea of being able to deliver both life and death was intoxicating. It’s the ultimate power trip, in a way. The evidence from the Netherlands and from Belgium is that doctors do get mesmerised by it. One Belgian GP described helping a patient to die as ‘magical’ and admitted ‘I might lead a patient one way or the other’ when discussing assisted dying. Others just become inured to it, which is equally dangerous. An inured physician stops asking questions. He becomes more inclined to just get on with the job.

Marris supporters get very agitated when I mention Harold Shipman in the context of assisted dying. They say: ‘He has nothing to do with it. He was a murderer.’ But he was also a much loved and trusted doctor — which is why he could kill undetected for so long. If there is another Shipman out there, assisted dying will be a gift to him.

I am glad the law did not allow me to grant Martin his request in the early hours. His pain turned out to be mainly from loneliness and precipitated by a bladder infection which was successfully treated. His anguish subsequently abated. Martin had a good few months after that with no recurrence of the infection, and several months later he died peacefully in the local hospice.

Got something to add? Join the discussion and comment below.

Trevor Stammers FRCGP was a family doctor for 27 years and is now a bioethicist at St Mary’s University, Twickenham.

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Show comments
  • Peter

    I agree. Having been in and out of hospital throughout my life, having known medical students at university, doctors and nurses are the last people I’d trust with this decision. Seriously.

    • DennisHorne

      Sounds like acupuncture for you, then.

    • andyrwebman

      But that just means to me that doctors and nurses should be separate from the people who provide the assisted dying.

      I want medical professionals to continue to do exactly what they do now – always be an advocate for saving you, always try to keep you alive.

      If you ask for assisted dying, they should try to gently persuade you out of it. BUT – if the patient continues to ask for it, they should then contact someone whose job is solely to provide assisted dying.

  • cartimandua

    So you left him in agony? You are a monster. Your job is to relieve suffering.

    • James H, London

      RTFA. He did relieve it, by treating the bladder infection. If human life means so little to you that you could put someone down like a dog, that’s monstrous.

      • Jaria1

        Dont underestimate the distress caused by people putting down their dog. They do it so their faithful friend no longer has to suffer.
        It is and should be a personal decision. I can see the pitfalls of getting rid of grandpa to get your hands on the money but this is where a doctor does come into the situation

        • cartimandua

          Teams of doctors must be free to make courageous decisions.
          They do make such decisions now and then flinch in case some idiotic family member complains.
          I recall one case in the papers of a woman with terminal lung cancer who also had a broken neck after a car accident.
          The family complained about a DNR.
          One good chest compression and her spine…….

          • it’s not courageous to take the life of an innocent person. You don’t own your own life, You didn’t even create yourself so what makes you think the final authority of your own life lies in your hands. You will give account for your life.

    • Stephen Burrows

      It was a bladder infection…

      • cartimandua

        The patient was terminal with cancer. The pain of endstage cancers cannot be relieved for all but a small minority of people.
        That’s the big fat lie the anti euthanasia brigade are peddling.
        There is no “palliative care” which truly works for some patients and some conditions other than full sedation.
        Its expensive and it needs hospital care so no one likes it.

        • Tom M

          A fair few years ago now my father was dying of pancreatic cancer at home. The GP came regularly at all hours to administer pain relief. After a long time of this he handed my mother a box of morphine vials and a syringe. He put his arm round my mother’s shoulder and said “you can do this yourself when he needs it”.
          She said “but what if I give him too much?”
          “It won’t matter will it” he said.

          • cartimandua

            Well quite but the problem is that morphine gives some people scary hallucinations. It only “ends things” for people who have difficulties with breathing.

        • Jaria1

          We are getting the proverbial fudge as unless you are extremely unlucky the Doctor will fill you up with morphine but until he does you are obliged to experience the pain.
          A sensible solution would of course be to avoid the pain

          • cartimandua

            Morphine is not the magic answer as it has so many side effects.

          • Jaria1

            Why worry about side effects if its sending you off before side effects can take place.

    • Ivan Ewan

      No it isn’t. His job is to make people better, not to make alive people dead.

      • Jaria1

        He should be sufficiently skilled to be able to tell the patient that his chances of recovery are good enough not to take this final step.
        The alternative is the patient takes matters literally into their own hands which is something to be avoided.
        Another law which those who wish to can ignore.

        • cartimandua

          Its not about recovery. Its about being honest in the face of intractable symptoms at the end of life.
          All this “right to die” goes away with guarantees that people will not be left in terrible suffering which no one can help.

          • Jaria1

            That was my concession to the doctor who is prepared to allow people who have no chance of recovery to be released from terrible pain.
            I seems many that are prepared to expect people to face intolerable pain have yet to experience it.

          • cartimandua

            We don’t want to spend money on the dying which allows symptom management in a decent environment.
            People are choosing to “die at home” when only 18% of those are adequately palliated.
            They end up going to hospital and could like one woman in agony end up being given paracetomol in A and E as she was
            dying of pancreatic cancer.

          • Jaria1

            Speak for yourself . I cant imagine a money better spent on relieving pain on the dying with dignity.

          • andyrwebman

            I want to die at home. I want to have the pill to do so. And if society doesn’t give me it, I might very well concoct my own.

            In the word of 3D printers this might very well become a reality.

          • ed t

            However, if you had read it properly, you would have seen that his symptoms weren’t ‘intractable’, but in fact temporary ones arising from an infection. As the man says, he died ‘peacefully’ months later in a hospice.

      • andyrwebman

        No cure exists for many of these diseases. He cannot make people better.

        But I agree that someone other than the doctor should do it.

  • stephen

    this article is hardly compelling in fact it reads like something out of the readers digest people should have the right to seek assisted death

    • Jaria1

      Demonstrates just how out of touch our MPs are either that or they are not addressing the problem for their own political ends.
      Dont wish pain on them but wonder if it would change the way they vote.
      Lets face it if you are in real pain everything else is secondary certainly whomyou leave money to and of course there are those thatvare qualified to make that decision for you if there is a dispute.
      I know when in hospital my five year old came to see me and asked if I could croak . So I did my best to sound like a frog. I asked why she wanted me to do that and she said Mummy said when grandpa croaks we can go to Disney land

  • Ivan Ewan

    In a Dilbert comic strip, Dogbert is running a careers advice service. After a few questions with a client, his recommendations are narrowed down to serial killer, or else a doctor. “What do you think of other people?” Dogbert asks.

    “Other people are worthless insects,” was the reply.

    “We’ll have to go to a tie-breaker,” Dogbert decided.

    • Feminister

      No, doctors like rescuing attractive women. Serial killers like murdering them.

      • Ivan Ewan

        To be honest, feminister, considering your worldview, I would have thought you to consider both those acts equally despicable.

        • andyrwebman

          You can’t expect to disagree with someone on everything.

  • Jaria1

    As a GP you can make your own decisions but should not make mine for me.
    Your job is to tell me of the state of my health and prospects of a recovery after that and assuming im compus mentis or considered able to make a valid will The decision is mine!

  • cartimandua

    I do wish doctors would be honest about the limits of controlling end of life symptoms.
    They just lie about it to dodge the issue.

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  • cartimandua

    http://www.uptodate.com/contents/ethical-considerations-in-effective-pain-management-at-the-end-of-life

    “Studies of patients in their last week of life reveal that up to 35 percent describe pain as severe or intolerable [1]. Quill and Brody define the escalation of pain that is uncontrolled at the end of life as a “medical emergency” [2]. Untreated pain can be devastating to the patient and family not only because of the suffering it produces, but also because it interferes with the ability to complete many important tasks at the end of life. These tasks include, for example, getting legal affairs in order, grieving the loss of his/her life, making amends in strained relationships, and saying goodbye to loved ones.

    Pain management at the end of life is the right of the patient and the duty of the clinician. The World Health Organization states that patients have a right to have their pain treated [3]. This is supported by the Supreme Court ruling in Vacco versus Quill, which addressed the use of aggressive palliative care in the last days of life. Justice O’Connor stated in her concurring opinion that “…suffering patients have a constitutionally cognizable interest in obtaining relief from the suffering that they may experience in the last days of their lives” [4]. (See “Legal aspects in palliative and end of life care”.)”
    And that 35% of people suffering horribly is about medical cowardice and medical ignorance.

    • andyrwebman

      I reckon if nothing else we should get to dose our own morphine. If it kills us at least it’s going out with a smile, not a scream.

  • DennisHorne

    So you don’t want to do it. Okay, don’t. Let others. They might find it easier.

    Yes, there may be a slippery slope. Does it matter?

    We’re so tame we’re going to be slaves anyway.

  • Blindsideflanker

    We already have evidence of the scope for whom the Assisted dying campaigners would offer this ‘service’ . Everybody.

    They make the case on the back of people who might be incapable of ending their lives from a painful death , but their intentions would be to have everybody included, for they allowed the debate to now include people with terminal cancer, people with severe injuries , like spinal injuries, and people who don’t want to get old.

    It seems they want to clinically cleanse society of all its ills.

  • Steed

    I side with Hume on this matter when he said:

    “I believe that no man ever threw away life, while it was worth keeping. For such is our natural horror of death, that small motives will never be able to reconcile us to it”

    If I was in dire pain, terminally ill, no quality of life and no hope of it getting better I would seek a way out. For the state to stop me from doing so is immoral.

    • you didn’t give yourself life mate…you will have to give account for how you lived it. You know why because your life is something you are given custody of. That means you are not the ultimate owner of your life. God is. And it is to him we shall all answer. To handle what is not your irresponsibly is immoral.

      • Steed

        “That means you are not the ultimate owner of your life. God is”

        No it doesn’t, it means you happen to believe things for which there is no fact. If you take the time to read Hume, you’ll see that he shows that if God created man, then he also created man with the ability to take his own life.

      • andyrwebman

        Come off it, you can’t go surrendering your judgement so absolutely to someone else unless they have proven beyond all doubt that they exist.

        Given the many scientific and historical errors in the Christian bible – in particular its utterly inadequate description of our planets 4.5 billion year history – you have absolutely no right to claim divine provenance for the Bible.

        Otherwise I can reasonably claim that if I die with a sword in my hand then I will go to Valhalla – should I demand that someone stick a sword in my hand and fight me to the death, because of a desire to end up in Odin’s hall?

  • cartimandua

    Only 64% of people in hospices have adequate symptom relief as they near death.
    At home it is only 18%.
    And people want doctors to do less????
    The problem is there is nowhere one can choose to die where one can have symptoms adequately managed AND be treated like a human being surrounded by ones loved ones.
    In the end hospitals want people to “get on with it”.

  • Jonathan

    “Marris supporters get very agitated when I mention Harold Shipman in the
    context of assisted dying. They say: ‘He has nothing to do with it. He
    was a murderer.’ But he was also a much loved and trusted doctor — which
    is why he could kill undetected for so long. If there is another
    Shipman out there, assisted dying will be a gift to him”

    The thing with shipman was that he operated in secret whilst his actions were highly illegal (and will continue to be after yesterdays vote) and still managed to do away with approx 300+ victims. I am sure that in the current anti-God morally relative culture we have developed for ourselves, that it is highly likely there will be many more gp’s and others in the health care industry who have secret eugenicist tendencies, and have urges to act on those tendencies to socially cleanse society of the weak, the insane, the handicapped etc, and who would have seen their opportunities to come out and act on their urges be greatly strengthened if the law had been changed.
    Ironically it was only when someone looked at cold hard facts and stats about shipman, and STOPPED seeing him as the pillar of the community jolly decent chap, that the awful reality of what he was finally came out into the open.

    • andyrwebman

      Just means that the people administering it shouldn’t be doctors.

      • Jonathan

        What do you mean, be more specific..! The health/death industry already has too many chiefs and not enough indians.

  • cartimandua

    Johnathan
    So the fact that only 64% of those in hospice care have adequate symptom relief as they die doesn’t bother you?
    At home its only 18% because people like you have told doctors they must do less or be accused.
    They leave a lot of people in agony.

    • Jonathan

      You will just have to suck it up, your views have been decisively
      rejected after due parliamentary debate and vote-twice now in 18
      years-and now by a GREATER % of mp’s than in 1997.

      “So the fact that only 64% of those in hospice care have adequate symptom relief as they die doesn’t bother you?
      At home its only 18% because people like you have told doctors they must do less or be accused.
      They leave a lot of people in agony”

      That is not the main issue at stake-although all the death wish people have attempted to make it so.

      What DID bother me on this issue was that potentially dangerous closet eugenicists would have been given a very significant green light of encouragement to come out into the open, with legal protection, to eventually be able to culturally cleanse society of the old/sick/weak/handicapped, motivated by their perverse aryan ideas.
      No matter what the do gooders and hand wringers say, the proposed change in the law was always about trying to open the door to state backed killing of vulnerable people, by exploiting emotive cases of terminally ill people as a pretext to try to popularise it.
      You only need look at evidence from other countries to see how the practise of eugenic suicide has been seriously abused already in such a relatively short length of time. I mean a doctor admits openly its “magical” to do someone in. I expect shipman was addicted to that, being dr death.

      BTW My personal view is that serious criminals should be hung. Most people tend to agree with that, but parliament DOESNT….

  • whatever name

    The vote was a disgraceful and cowardly capitulation to religious fanatics. 86% of the British people support the choice to die. What part of that don’t the politicos understand?
    It is also high time that we disestablished the Church of England and kicked the bishops out of government.

    • Mrs. Bennett

      I actually am a believer in God, but I still don’t want the bishops in government. My greatest problem with the Churches is their insistence that people should be forced to live, no matter how much pain there is and no matter how little or no hope there is to get well.

      • Jonathan

        My greatest problem with interventionist murder, would be the rise of malevolent state agencies insisting that people should be forced to die.

        • Mrs. Bennett

          murder = unlawful killing

          assisted suicide = lawful killing

          That is exactly what the change in law would be about.

        • andyrwebman

          The key measure should be to look at life expectancy for the countries which have assisted suicide.

          If it continues to rise even though some people choose to die, you’re still better off than people 20 years ago. If healthy life span also rises, there should be less reason to worry.

      • andyrwebman

        George Carey and Desmond Tutu are other Christians who share your views.

    • Jonathan

      Do you want England to be catholic again, or put under shitdrier law?

      LOL, you sound desperate. You mean to say that the 74% of mp’s who voted are all religious fanatics, or are somehow in the pocket of such people? If that was even vaguely the case, why did the same lot of mp’s under the thumb of their mystery religious fanatic backers not vote against non hetero sexual marriage then? Give them credit for voting according to their individual conscience, it was a free vote…..All you need do is suck it up and accept that your view, despite having some degree of popularity at present, after a barrage of highly emotive propaganda efforts, has been rejected in parliament after due debate and a vote, actually MORE decisively so than back in 1997.

      Capital punishment is also extremely popular among the general public, it always has been. I support the practise. But parliament and the mp’s DIDNT. You win some you lose some…..chin up!

  • Margot5000

    If doctors get a kick out of helping someone to die then maybe the whole thing should be taken out of their hands. Presumably most people would be able to administer a lethal dose and years of medical training would not be necessary. The medical profession seems to have deteriorated into a bunch of pontificating posers with a belief that they should have control over what should be an individual’s decision. What on earth gives them the right to deny an individual that choice! Who on earth are they to claim to hold life and death in their hands. They are merely individuals who have studied more chemistry than the rest of us!

    • Mrs. Bennett

      I agree, Magot, Travor Stammers statement that (doctors’)
      ability to deliver both life and death is intoxicating is worrying. It is not ABOUT the doctor. It is about the patient, for goodness sake.
      As a patient I want to make that decision, and if I can’t do that any more I have a living will that states what is to be done in the event of a terminal illness that brings great pain. That decision is too previous to be left to doctors. It should be taken by the patient.

      • cartimandua

        People don’t want to die. they want their symptoms dealt with. Sedation is an option where nothing else controls those symptoms.
        So why is it not being mentioned?
        Its expensive that’s why.
        No one is being honest about how many people are beyond any palliation apart from full sedation.

        • andyrwebman

          Not exactly true. People want a cure.

          If there’s no cure, are you happy lying in a bed with symptoms dealt with? I’m not. I consider it worthless compared to life in all its true joy. Therefore I don’t want it.

        • Mrs. Bennett

          Not really, cartimandua. Some people DO want to die, when their symptoms can no longer be alleviated. What is the point of a never ending sedation? It is only useful in a medically induced coma, to deal with the pain, where there is a chance the body will heal. Medicine can keep people alive in perpetuity, on a heart-lung machine, with artificial “feeding” and artificial everything and anything. Surely something not to be wished on even your worst enemy.

          • cartimandua

            Medicine cannot keep people alive forever although I agree that it now prolongs dying.
            Tubes are an entry for infection whatever is done.
            Its something which should be offered people whose symptoms are beyond help.
            Neither side like it as one side calls it euthanasia and the other side thinks it is expensive.
            1 in 3 of us die with uncontrolled symptoms. We have to make a fuss about that.

  • Patrick Roy

    When my mother was dying, I hoped it would end fast. It was the worst dying, the worst death. She wanted to die. Thank God the hospice people were with me and helped end it fast(er).

    • cartimandua

      Could the hospice not sedate as well as offer pain relief?

      • andyrwebman

        Here’s a thing. I believe we can ask for deep palliative sedation and refuse all food and water. So that amounts to asking for 2-3 days of (hopefully) insensate nothingness whilst the body dies on its own.

  • Feminister

    This is an argument against assisted dying with poor safeguards, not assisted dying per se.

    Evidently it would be a bad idea for the law to allow one doctor at 2am to make the decision. It might be a better idea for the law to allow two doctors and a judge to make it at 9am.

    • cartimandua

      So the patient screams all night or chokes or vomits blood or faeces?

  • Margot5000

    Did anyone else find Tanni Grey-Thompson’s comments amazing? – and absolutely nothing to do with the discussion. She is disabled but is no more likely to end up wanting to die than anyone without a disability – yet she sees fit to vote against letting an end-stage motor neurone patient or a cancer patient in great pain being helped to die. Presumably she in claiming that in the future, given her disability, she might be seen as a burden – but that is very unlikely given the life she has and is in any case no more likely than for all of us when we get older and increasingly infirm. The ‘burden’ argument is a social one and nothing to do with this argument. If her disability meant that she was unable to move or breathe easily then her views might have more weight – as it is, they have no more than everyone else’s.

    • andyrwebman

      I think Stephen Hawking is one person who has a perspective on this we should all respect.

      Clearly he is not a burden to society – indeed he is a treasure. He has found value in a situation which would have destroyed many people.

      And yet, despite how well he is adapted to his life, he has said that he might like assistance to end his life someday.

      Given all that he has been through, all that he has achieved, who are we to tell him he’s wrong?

      What annoys me is when a sub category of the disabled community see another person’s choice as a comment on their own worthiness to exist. It seems they think that all of society has to agree that life can be worth living despite the hardships – and that any dissent means that others will decide they should die.

      This is patently the wrong attitude – of paramount importance is the concept of autonomy. If I find my life unbearable and wish to die, it says nothing about whether anyone else should feel the same. We must each make our own decisions and not follow others like sheep – or, worse still, not make another’s decision for them because you’re afraid others will follow them like sheep.

      In contrast, I’ve never met anyone in favour of assisted dying who feels they need the approval of others (beyond the mare minimal legal tolerance) to make their decision. If I wanted to end my life, I wouldn’t give a monkeys if everyone else in my position had declined assisted dying – I’d want it for myself and damn the world.

      What we need to promote is not one decision or another, but the utmost respect for the wishes of the individual, together with a complete absence of pressure in either direction.

      • Margot5000

        Exactly – you’ve put it much better than I could have hoped to – and what I was trying to say.

  • cartimandua

    20% of people in hospital where the best symptom relief can be achieved still suffer severe pain or intractable pain or other symptoms.
    Its much worse in other settings much much worse.

  • cartimandua

    Johnathan that’s EXACTLY whats at stake. right now doctors are not doing enough for the dying “in case they are accused of doing too much”.
    Assisted dying would just have protected doctors when they “do enough” to relieve people in mortal agony.
    Now people in terrible pain will be given paracetomol like that woman dying of pancreatic cancer.
    The NHS has already withdrawn drugs which extend life and ameliorate symptoms.
    1 in 3 of us will have terrible deaths.
    Slow hand clap there buddy.
    It would be nice if they could be honest with people so they could “make their own arrangements” before they are helpless and screaming.
    One woman watched no one come to relieve her dying 27 year old son in his last hours.
    That was on a palliative care ward. He was in agony.
    The most complaints the NHS gets is about the care of the dying.

  • andyrwebman

    “Once you accept that doctors should help patients take their own lives,”

    This is why if AD is ever allowed, the people doing it should be completely separate from the medical profession.

  • jay brads

    I believe everyone has the right to die when they want, but, they themselves should do the administration, ie suicide. No doctor or medical practitioner should knowingly refuse fluids or food to a terminally ill person UNLESS it is that persons wish. Pain relief should be given but not overdoses of morphine, adequate pain relief only, to keep their son comfortable. As medical practitioners and not sitting as God, we have no right to take life from a human being. NO RIGHT. That human can take their own life and that is their choice!

  • Darryl Harb

    Don’t overlook the financial/political incentives behind much of the advocacy for “assisted” dying. It is the Final Solution for the impending debt apocalypse. If the State “assists” people to shuffle off this mortal coil in a timely fashion, it won’t have to pay them the benefits delivered to the previous generation in exchange for the votes that put the politicians in power, and which they knew the State could never sustain indefinitely.

  • Garbanzo Bean

    Trevor, thanks for sharing this.

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