Opinion: Professional body continues to misinform on palliative medicine doctors’ stance on assisted dying

The Association for Palliative Care Medicine (APM) continues to misinform on palliative medicine doctors’ stance on assisted dying, warn a group of palliative medicine consultants in the BMJ today.

Five years after first raising their concerns in the journal, Sam Ahmedzai, Samuel Fingas, and three colleagues say the APM’s strong opposition to legalizing assisted dying, means it “continues to provide a one-sided and inaccurate perspective on assisted dying to the British public and to government.”

Its stance also “stifles our ability to [speak openly about supporting a change in the law] without fear of repercussion, meaning some of us must remain anonymous,” they add.

Clearly, public and political opinion are moving towards acceptance of some form of legalized assisted dying, they write, and say palliative medicine, which operates at the heart of death and dying, “should be open to a range of views on how to pursue our patients’ preferences.”

Yet they are concerned that the APM’s active campaigning on this issue “could give the country a skewed impression of palliative medicine.” Rather than reassure the public of palliative medicine’s motivations, this “risks damaging trust in the doctor-patient relationship because our specialty might be seen as the primary force trying to block a change in the law that most people want to happen.”

The APM has slightly shifted its position by moving the discourse from resistance to changing the law, to accepting the possibility of change but arguing that assisted dying be taken out of health care and given to new independent bodies, they explain. But they argue that allowing end of life decisions to be made without the central involvement of compassionate, trained health care professionals “would clearly increase the vulnerability of dying patients.”

The APM also insists that the alternative to assisted dying is increasing access to palliative care, they note. “As palliative medicine consultants, of course we support greater funding for this sector. But we know even the best quality palliative care has limits and that access to assisted dying could be complementary to it, for those who wish it.”

It was recently reported that Wes Streeting, the Secretary of State for Health and Social Care, was “not sure as a country we have the right end-of-life care available to enable a real choice on assisted dying.” But Ahmedzai and colleagues challenge this view, saying “it ignores a body of evidence that shows assisted dying has often been a catalyst for improving palliative care services.”

“We are aware from our conversations with colleagues that more doctors and nurses are moving to a position of openness to legal change, but they still feel they cannot speak out,” they write. “The debate around assisted dying is undermined if these important voices are stifled.”