Prof Allan House

Prof Allan House: Why I support Better Way

Allan House, emeritus professor of liaison psychiatry

I support Better Way because it opposes ‘assisted dying’, and it supports more positive ways of ensuring those in need receive the care they deserve.

‘Assisted dying’ is a re-branding of “physician-assisted suicide”, which involves a clinician prescribing drugs that patient and doctor both understand will be fatal when the patient takes them as prescribed. The counter to this process being called “assisted suicide” is that the patient is dying anyway and all they are doing is making a choice about the time and manner of death. But all suicide involves making that choice, and the rationale for the act of suicide has never been part of its definition. The Office for National Statistics publishes suicide statistics based upon coroners’ verdicts, including suicides of people who have what ONS calls a severe health condition. Are we to say that this is suicide because the patient finds their own means of ending their life, but it would not be suicide if a doctor had provided the means?

Assisted Dying is presented as a variant of patient-centred care. It is promoted using case studies that typically involve articulate and educated people with caring support, and indeed data show that (for example) those with graduate or higher levels of education are over-represented among prescription recipients. Framing the practice instead as a variant of assisted suicide introduces a different picture – because suicide is often associated with isolation and a lack of social support, previous problems with mental health, and a sense of burdensomeness. Can we be confident that people with these characteristics, who are likely to find it harder than most to access good healthcare, won’t be offered Assisted Dying as a “dignified” alternative to their current condition?

We are reassured that such developments can be prevented by safeguards built into legislation. UK assisted suicide campaigners say that Oregon’s Death With Dignity Act is “a law proven to work” and US campaigners claim the Act “works exactly as intended and exactly for whom it’s intended, without fail”. This isn’t reassuring, it’s alarmingly dishonest. There is no human system that works without fail. Oregon’s own annual reports can’t reassure us because they don’t know what happens to more than 10% of those given a prescription and they don’t record key risks in those they do report. Even so it is clear from the reports that there are people whose end does not go “exactly as intended”.

My professional career was spent working to improve quality of life in people with severe physical illnesses and to prevent suicide when it’s a risk. Assisted dying legislation says that instead I should have been thinking of some suicides as a good idea. There is a better way to direct society’s responses to the ill and disabled – working for high quality care, including mental health care, for all patients with severe physical illness, for those near the end of life, and for the disabled.