Medical Matters with Dr Tom: Will assisted dying be on offer in Northern Ireland?

The proposals being debated at Westminster are for adults who are expected to die within six months, have full mental capacity and will need to declare twice in writing that they want help to die. The person must be able to administer the medication themselves. Doctors will not be obliged to take part in the assisted dying process but two independent doctors must be satisfied that the person is eligible and there must be seven days between the two doctors’ assessments. A High Court judge must hear from at least one of the doctors and can question the dying person and others as appropriate. There will be a sentence of 14 years in prison for anyone found guilty of trying to coerce a person into dying.

Prominent supporters such as Esther Rantzen who has stage four lung cancer says “why at the end of life do we treat dogs better than people.”

Opposition to this legislation has come from some politicians, church leaders and palliative care doctors who feel that if health services, especially palliative care services were improved there would be less need for assisted dying. The doctors’ union the BMA has moved to a neutral position and feel that safeguards for patients need to be stringent and that doctors should not be obliged to take part in the process.

Most doctors that I speak to have no objection to assisted dying but don’t want to be involved in the process. A minority are supportive enough to be involved and another group of doctors are opposed, usually for ethical reasons as they feel that assisted dying runs contrary to the “do no harm principle” of medical care.

The State of Oregon in the USA has had an assisted dying scheme for 27 years with access only for those individuals with an incurable and irreversible disease that is likely to cause death within six months Their annual report for 2023 notes that 367 people died after taking the medication provided under their scheme which is 0.8% of the total deaths that year in Oregon.

The average age of death was 75 years and 66% had terminal cancer with 88% of these people able to die at home. It is notable that 87% had already been involved with hospice care prior to accessing assisted dying.

The reasons for opting for assisted dying were loss of autonomy, the loss of ability to participate in enjoyable activities and a loss of dignity due to pain and incontinence.

So what does this mean for Northern Ireland. It seems clear that England and Wales will soon move towards legalising assisted dying with Scotland and the Republic of Ireland likely to follow suit. Stormont will dither but will eventually catch up. It is the baby boomer generation now in their 60s and 70s who are driving this agenda and they usually get what they want.

*Dr. Tom Black is a Derry-based GP and is the former chair of the British Medical Association (BMA) NI.