In July this year, Debbie Purdy, a 46-year-old woman suffering from multiple sclerosis, won an important victory in the debate on assisted dying. Purdy was concerned that her partner would be deemed culpable should he accompany her to the Dignitas clinic in Switzerland in order to die. In response, the House of Lords asked Keir Starmer, the director of public prosecutions, to clarify the legal position. He is due to unveil an interim policy later this month; a wider public consultation will follow.

Objections so far to assisted dying seem to have been largely religious. My own unease is far more practical. The first concern I have relates to society’s ability to reliably and enduringly interpret the law. Take, for example, the issue of abortion. When the Abortion Act came into effect in 1968, it was not intended to sanction abortion on request. This is widely acknowledged, even by Sir David Steel himself, who introduced the original bill. That two doctors’ signatures were required before a termination could proceed was meant to safeguard against this outcome.

Instead, the law has come to be interpreted as meaning that women who want an abortion can – up to a certain gestation – have one. The doctors’ agreement serves as a rubber stamp, not an opinion. I am not sure that the medical profession has realised this discrepancy, never mind challenged it. This in turn makes me afraid that similar rubber stamps will eventually be applied to even a careful law on assisted suicide.

My second concern is for carers. Research shows that they are under immense stress and in worse physical health than their contemporaries. Although many would not give up their role, they will admit to the strain they are under. This strain is witnessed, of course, by the person being cared for. Until this situation improves, it will continue to be a factor in some people feeling it would be better for all if they were dead.

My last concern relates to another problem facing patients with terminal diagnoses. In the last stages of life, all parties wish to ease distressing symptoms as much as possible. But in administering drugs at this point, doctors are often treading a fine line between relieving discomfort and hastening death.

Morphine, for example, can decrease consciousness and even breathing when used in sufficiently large quantities. This “double effect” means relief of pain at the cost of shortening life. After the scandal of Harold Shipman, the GP who murdered patients by administering morphine, many doctors have expressed concern that their decision to use the drug in terminally ill patients may be misinterpreted. It would seem more important to get this sorted out before creating any new laws.

Margaret McCartney is a GP in Glasgow
margaret.mccartney@ft.com

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