Assisted dying – choice and recognition

I am writing in response to the editor's call for letters from psychologists who support the Assisted Dying Bill. I read with interest the news article on the subject which was published in September's Psychologist, including contributions from psychologists who work with people who are seriously ill and/or disabled through illness. All three people your journalist spoke to identified the specific psychological challenges which their clients confront as a result of their medical conditions and they presented proposals for improvements in the support offered to such clients.

All presented strong and convincing arguments in favour of such improvements and I found myself agreeing with these entirely. However, the next step in their argument seemed to be that the provision of improved psychological and social support for people with terminal illness removes the need for access to assisted dying. This is something that I do not agree with.

The purpose of the Assisted Dying Bill is to offer people the choice to access assistance to end their lives if they have less than six months to live. Whilst it may well be the case that the provision of improved psychological support would mean that fewer people may feel the need to use of this option, improved services are no alternative to freedom of choice. It is interesting that in a society that promotes freedom of choice as one of its principal values across a wide range of contexts, the choice about whether or not to continue suffering with a serious illness is not offered to its citizens. This is probably a legacy of Christianity, the notion of the 'sanctity of life' and the idea that suicide is a 'sin'. Whatever the cause, it seems to me that in a secular society the decision about how to die ought to be in the hands of the person who is dying.

Surely, if we believe that adults are capable of making decisions about how to live, we must accept that they should also be able to make choices about how they end their lives. Recent opinion polls have shown that the majority of people want to be able to make such choices when the time comes. I do not believe, as suggested for example by Professor Murray, that it is a lack of knowledge about what is involved in the process of dying that leads people to wish to end their lives prematurely. To the contrary, when asked for their reasons for their support for assisted dying, people often say that seeing a parent die slowly and painfully has informed their desire to be able to choose a better death for themselves than the one they have witnessed. Knowing that it is possible to ask for assistance to die should the situation become unbearable may remove some of the anxiety and the sense of loss of control that can cause so much distress during the final phase of life.

Professor Carla Willig
City University London

Whilst I am glad that the Assisted Dying Bill was mentioned in the September issue of The Psychologist, enabling debate on the thoughts of psychologists and students who read the monthly magazine, I am saddened to have read the letters in the October issue which are still missing one vital point. From what I have read there has been no mention of the fact that doctors and nurses today do administer high levels of morphine to patients who are dying in order to quicken their deaths. I and many other individuals are aware of this.

Whilst this is currently seen as assisting pain relief for the dying to leave this world relatively pain free, it also has a sedative effect on the patient as well as depressing the heart rate and lowering blood pressure, which causes an imminent death. The administering of a drug that both offers pain relief, sedation and eventually death, whether in an hour or a day, is in my opinion a form of assisted dying. Something that occurs daily throughout the UK and many other countries around the world. The fact that nobody has mentioned this vital piece of information in relation to the Assisted Dying Bill or the discussions that have continued in The Psychologist in the last two months begs the question as to whether anyone sees this as legal or dignified.

One other point I would like to make is that in none of the letters or the original article in the September issue have terminally ill patients or their carers given their opinions. I would like to hear from those on the front line either living with terminal illness or those health professionals working within palliative care services what their thoughts are. My professional opinion is that assisted dying to a certain degree is already legally occurring and so assisted dying legislation will only formally recognise this practice as a legal and acceptable way of an individual being allowed to die with dignity.

Louise Mullins 
Psychological therapist, hospice volunteer and trainee psychologist
Bristol